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We've got such a shortage of clinicians out there right now and so many really needing a break after COVID. How do we start to automate more things and really allow folks to use technology that's been used in other areas of the world for a long time. And bring that into healthcare to try to ease some of the things that are going on.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.

It is Newsday. And today we're joined by Patty Hayward with Talkdesk. Patty welcome back to the show.

Thanks for having me, bill always so much fun to be.

Gosh, I hope I have your name. Right. I'm coming down from my COVID cloud fog thing. And I'm looking at my notes that this, this could be a, this could be a fun one. We'll see. did you have a bout with COVID yet?

You know what? I had it really early on before we knew what it was. And it was bad. I hadn't been vaccinated. So it was a, it was definitely a tough go. I have not had a redo with it thankfully, but

Yeah. Well, my mine's pretty recent. I'm just now in fact, I think if I test right now, I'll show positive. but I'm on the, on the tail end of it. It's interesting. Obviously not nearly as bad as it would've been early on. And it did feel a little bit like the flu. I mean, it's respiratory. Tired.

I would start to feel like, okay, I'm, I'm through this, I'd walk out to the mailbox, walk back and I'd go back to sleep for like an hour. Yeah. So I could do so we're, we're going to try to, we're going to try to cover the news. There's a lot of really cool and interesting articles, some alarming things, some optimistic things.

So let's start with the story you just sent me, which I think is an interesting one. So Walmart air to build a new regional health systems in Arkansas. Alice Walton's foundation has partnered with Washington regional medical system in Fayetteville, Arkansas to build a new regional healthcare system.

The new healthcare system will serve Northwest Arkansas, the Walton foundation and Washington regional medical center plan to work with Cleveland clinic to support growth of healthcare services in the region, the three organizations will work together to help residents in Arkansas access specialty care.

This is really fascinating. Shattered with Matthew Cole last week at the Scottsdale Institute week and a half ago about that. So they're excited about that partnership and bringing this down here. why did you pull this article out?

So I know that we've talked a lot about all of the disruption and the different folks coming into healthcare, looking at retail, coming in. Looking at what happened with that Amazon partnership, that sort of dissolved. And now Amazon coming in with Amazon care and all of the different, big retailers that are looking at healthcare and feeling like they've got this ability to come in and disrupt and fix it. And a lot of the response to that has been okay, that's great.

You can come around the edges, but if you really want to come in and fix. The system, you need to do it from the inside. You need to look at the hospital, the acute care system, and how do you fix the whole thing? So the fact that she's now jumping in and saying, okay, challenge accepted. Let me come and work and partner directly with a health system to really transform how we're delivering care.

In an area. I find really, really fascinating and I hope we have some great success there because I think there's a lot to be learned and bringing in some interesting different types of players. I'm really excited to see where.

I love your perspective on this. I'm a huge fan of follow the money. here's the thing I will note. This is not Walmart. It's the Alice Walton foundation it's relate. It's like a cousin to the Walmart organization. Now, if it was the Walmart organization, there would be a profit motive having to be tacked onto it. It's a publicly traded company and those kinds of things, same thing with Google, Amazon, all these tech companies, they're not out to fix health.

They never were out to fix health care. They're out to profit from healthcare. Okay. And they're trying to figure out where they're going to profit from healthcare. It's interesting because we're what was the, it was. The TV show, Silicon valley, they, in the beginning, did you watch Silicon valley?

I got addicted after I watched the first one because I was working with so many startups and I'm like, oh my gosh, this is like so close to reality. But there was one early on where they did a competition where everybody got up and talked about how their goal was to world peace or world hunger or or magnify the world and stuff.

And Silicon valley. Prone to do that. But at the end of the day, it's run by venture capital. It's run by private equity. It's run by even self-funded and invest. It's funded by investors, correct? It's follow the money. They're thereafter. They were never out to change healthcare unless it changed the model and frees up that $3 trillion to start floating in different directions.

All right. The Alice Walton foundation, though, that's a different. Correct. I mean, that foundation is as a bunch of philanthropists sitting around going, Hey, healthcare, isn't working, we've got billions. Let's create a model that works in this market. Now it will be interesting to see what did we say? Northwest Arkansal? Yeah, so I assume that's been Ville. That's probably the headquarters, right? I would assume. So they're going to take care of their employees and this is another employee play here, which I think is another thing. But it will be interesting.

I think this is going to be worth keeping an eye on for two reasons, one is that bent toward, it's not towards profits. It is towards changing the healthcare model. The second is I think this is the model that changes healthcare. I think it's partnerships. I think it's interesting partnerships coming together in ways they never have done before to create new models for patients new models for employers to connect into and it could be, and this is an interesting one a regional player with a Cleveland clinic at a fantastic national brand specialty system. And and th the right reach in that market, the right support by the employers and players in that market.

And then all the key things you need. and worst case, maybe Cleveland, Cleveland probably will build a facility down there, but for maybe some cases they're actually flying them to Cleveland or or one of their other facilities that they have in the country. So.

She's also pursuing a school of medicine in the area as well. Hasn't gotten accredited yet but think about adding that piece into it as well. So she's looking at the entire, entirety of this, which I find fascinating, and I think soup to nuts. That's like you said, that partnership and her bringing in all those different players. I love the model. I am very interested to see where it goes.

Yeah. So you, mentioned that whole health school of medicine in Bentonville, the medical schools currently working to share accreditation and authorization. It's interesting. Cause we had a conversation with Dr. Classical last week and he talks a lot about how medical school needs to be changed. And so maybe this is the you bring in a whole health thinking about not only the 20% of healthcare, but the a hundred percent of whole person care and you teach that throughout the entire medical school. And then you integrate that into the delivery system for Northwest Arkansas. And then you. See work. that's fascinating. Yeah. great story to start with. Thanks for sending that one over. Let's see, I was going to another partnership, blue cross blue shield of Michigan and honest medical group launched value based care, joint venture. Providers often need to make significant technologies. Technology investments and administrative upgrades to succeed in value-based care models. Executive said blue cross blue shield of Michigan and Nashville based honest medical group, which I have to admit I'm not familiar with or launching a joint venture that aims to make it easier for docs to transition to value-based care for medical patients. The goal the insurer said Monday is to ensure that providers can access conferences, clinical, operational, financial support. Medicare and Medicare advantage is what this is targeted at this kind of partnership again, why is this story is important?

I thought it was interesting because there's the automation and the technology piece that they're trying to bring into this whole area and really look at how can we combat clinician burnout as well as get education for the patients in there.

So what are the sort of ramifications of how do we start to offload some of the tasks that we typically use to invoice and have communications and conversations, and then start to try to offload some of those things with automation and with intelligent AI to try to really move forward with some of our technology to, to help ease the burden.

We've got such a shortage of clinicians out there right now, and so many really needing a break after COVID. How do we start to automate more things and really allow folks to use technology that's been used in other areas of the world for a long time. And bring that into healthcare to try to ease some of the things that are going on. So I think it's another thing to watch to see if it works. Obviously, if you're thinking of working on Medicare advantage and different things like that, and think it's a fascinating sort of test.

I would hope not. I mean, I know that my physician, quite a few, she actually takes her Fridays and does telehealth visits and that helps her choose to take the day off funny enough.

But now she sort of like uses the morning to just touch base with patients that don't need to actually have physical touch. But still need to maybe have discussions of their results. Updates. If they're a chronic care patient, just do her check-ins and really continue to, she's a very empathetic physician who takes probably longer than your normal physician that comes in.

So for her, it allows her to have this great connection with her patients and continue to have that. And still be able to work from home too, to reduce that burnout, but yet still continue to really invest in, in her patients. I know that on the mental health side, it's a huge piece to be able to see patients to to do that connection and have that discussions and really see more patients that way.

So. I liked the tele-health model. I love the fact that we can extend over borders based on some of the rules that we've changed during the COVID piece to extend, to allow more access, especially in areas near borders. You're just going across the state line to go see your physician. I think it's, I think it's important that we think about how do we continue to keep that going?

And not move backwards because I think you're seeing a lot of different folks really like the model. Like for me, when I'm doing these kinds of things all day, I don't to take an hour to go to an office, see someone then come back where it's really. In minute visit. I'm much happier to be able to do a check-in this way. And I think a lot of people are.

📍 📍 We'll get to our show in just a minute. As you've probably heard, we've launched a new show TownHall on our Community channel. This Week Health community. And it airs on Tuesdays and Thursdays. I'll be taking a back seat to some of these people who are on the front lines. TownHall is hosted by an array of talented healthcare leaders who are facing today's challenges head-on. We're going to hear from professionals and their networks on hot button issues, technical deep dives, and the tactical challenges that healthcare faces. We have some great hosts on this. We have Charles Boicey and Angelique Russell, Data Scientist, Craig richard v ille, Lee Milligan, Reid, Stephan, who are all CIOs. We have Jake Lancaster and Brett Oliver who are CMIOs and Matt Sickles, a Cybersecurity first responder. I'd love to have you listen to these episodes. You can subscribe on our Community channel. This Week Health Community, wherever you find and listen to podcasts. Now let's get to the show. 📍 📍

There's some more numbers in here I'd love to share of those using tele-health 93% used live interactive video with patients with 69% performing audio only visits. And that number actually kind of surprised me a little bit. I'm surprised there was, it was that high. that might lead me to believe that they pulled a lot of urban physicians as opposed to rural physicians.

Yeah, cause I think you're also looking at access to some of these technology and access to bandwidth that allow folks to have video and in a lot of rural areas, like you said that's where I think the voice component comes in pretty heavily. and into areas that just don't have access to the technology. Maybe they don't have a computer with video. They don't maybe have a smartphone that they can utilize. With, or again, you just don't have the ability to get the the Verizon, can you hear me now? And they have to use voice.

All right. So telephone and zoom are still the primary platforms used to deliver care and less than half the respondents are able to access their telehealth platform via the electronic health record. I think that's one of the things that is slowing this down a little bit is we may not have knitted this all together in a cohesive workflow yet. There's a, do you think that's part of the issue?

I do. I think that one of the things that's happened during the pandemic and the reason why people have jumped into different digital technologies, they've, they've gotten in and they've gotten a lot of points. And they've done that because that was what they needed to do.

That was what was available. I feel like what we need to do is kind of pull back and look at what are the platforms for communication that we need to utilize in order to really integrate, keep the system of record there, allow access to all of the data and not create additional silos of, information.

I think you saw a lot of this when we first adopted EHRs And today we're seeing that with a digital place. There's a lot of point solutions out there and there's more coming. There's more people jumping in and they have very specific slices. I think it's important to sort of pick, pull back and say, how do we put a platform together that allows us to really keep that integration as well as not create additional silos?

How do we put the platform together? Cause we have another story here of chatbots. Engagement could start with a chat bot. It could start with a call center could start with a phone call. It could start with a referral. I mean, it could start in so many different ways, but the chat bot being one of those things, the call center being another, then I'm going to see the physician and I need to schedule, we get that appointment.

The physicians like to sit in that EHR all day. Click a button and go into the visit, but then also have a screen here where they're documenting at the same time, they're doing things. And then you have the, obviously e-prescribing has gotten very integrated at this point and whatnot, but you have all the other posts visit activities that need to go on and the followup that needs to go on as well. does it start with a platform or what does it take to knit all those things together?

So I think what it takes is understanding that the EHR is the system of record. There are a lot of different point solutions out there. Solutions that are trying to recreate a, an area where they can have information and that's not necessarily viewable by the dock.

It's not necessarily then counter viewed. So you're having to have people be in multiple applications in order to understand the complete. So I think it's important that you decide that the system of record is your EHR and everything flows back into there so that you can understand what's happened.

And the patient doesn't have to continue to tell their story over and over again, depending on who they're talking to. And when they've got, I mean, we've all experienced that having to fill out the same thing over and over again, having to repeat ourselves every time we change into a different room to talk to someone different.

When you start with a chat bot on the website and you ask questions and then you decide that, okay, you can't get the answer you need from the automated chatbot. And then maybe you want to escalate to a live. Great. You want to be able to have that information follow and then maybe you need to actually speak to a human.

You want all that information to flow and then you want it to flow into the EHR. So that there's an understanding of that communication and what happened. And then be able to just have highlights. Obviously the physician's not going to read the entirety of a, of a chat discussion, but anything that's important, I think needs to flow.

And I think that. That, especially that whole interaction needs to flow. So if you've got one vendor for a chat bot and you've got one vendor for your text messaging, and you've got one vendor for your voice, you're going to have a very large amount of friction in that entire journey there. And I think that's what people need to sort of now reevaluate now that we've gotten through I think we we've now said we're post-pandemic Yay. How do we then take a step back and start to really evaluate all of the technologies that we've either put in or are evaluating and figure out how do we make this much more of a unified platform that then feeds into your EHR?

It's interesting. The other story we're going to talk about chatbots and related automation can ease staffing shortages. And help triage patients. it's interesting to me, I think the organizations that thought platforms maybe three and a half years ago, four years ago are way ahead of the curve. Because if you have to rally your physicians around a new solution right now, they're going to be very tired. They're very tired.

It's like, no, we're going to make your life easier. It's like, we heard that before. it is going to be an uphill battle. So I think that's one of the reasons you see point solutions as opposed to, Hey, we're going to build this nicely integrated end to end solution. And this might be where partnerships really come together.

If I'm a CIO, I'm looking at it going like. I may not have the relational capital or the political capital internally to make something happen. And so what I'm looking for is partners that have made something happen outside of my system and can come around my system of record.

Right. So I'm going to say, all right, can you work with this? Can you work with this? Can you work with this? And can you present an integrated solution? Because not all data has a home in the EHR. there's just stuff you can't shove in there.

No. And you don't really want in there, but there's also the ability to I think there's also this necessity to make sure you're not creating and generating more silos of data. Yeah, I just, I you see it a lot. It's unintended consequences of automation happens all the time because you go in with one idea of here's, what we're going to solve and the new problems kind of crop up.

Do startups struggle with trying to identify where the EHR is going next so that they don't somehow get, I don't know, steamrolled

I mean, look at what's going on with, with epic right now and announcing cheers. I think they're, they're really, they've really got a lot of these digital only vendors in their cross hairs. If you think about where they're going with what they would like to accomplish. And thinking about patient relationships. Obviously that's something that's really big on their mind right now as well. And that's tough if you were just came out got a lot of funding and now you're doing something that epic just announced. That's that's never a comfortable place to live.

So give us a little background on cheers.

So cheers is the epic CRM that was announced at well, let's see. It was right before hymns. And then, so at hymns, they launched it. if you look at what their platform is it's a lot of texting and some of the digital communication and things like that, but really relationship platform. So I think that. Being able to integrate into that and to work through is going to be important. But I think a lot of the vendors that sort of have just the, like a text reminder piece, that's going to be kind of difficult right now.

Yeah. If you're one of those players, you're just sort of looking over your shoulder at all times. When is Epic going to make the move to do that?

According to a new CB insights report, while all tech sectors receive smaller funding totals than the previous quarter of digital health plunge. Much farther than at much farther than others, FinTech and retail tech saw 18% and 11% decline. Part of that could be it was a steeper mountain. So it just fell steeper. So is this a bubble bursting or is this just a mild retreat here?

I think we'll, we'll have to see. I would think that again, if you think about where some of the major players are going with what they want to do, I think you're going to see more of a retraction, at least on the digital health side for more pointed solutions, right. Something that has a broader offering. I think you're still going to see that. Cause you're, you're still seeing the issue with telehealth, right? You only have zoom and not very many others that are not integrated to the EHR. So I think we're seeing probably more. But I think you'll see more push towards the tele-health and less towards some of these digital adoption type of solutions.

And I think you're going to look at players that have a broader portfolio and not just health, but that see work across the whole aspect of things. So I think it'll be really interesting to see where it goes because there are so many different players. If you walked around the floor at HIMS, if you walked around the floor at vibe, you saw a ton of different things. Vendors out there digital only. So I think that you always see that proliferation, then you see sort of who wins and then you see a retreat or purchase of the technologies. I think we're sort of in that inflection point right now. That's my guess.

I think the other thing we're not talking about is it's an election year. I mean, it's an off year, but it's an election year, nonetheless. the market is 300. It's not going to 4 trillion. If it goes to 4 trillion, we've got serious, serious issues in this country. so it's not like it's a growing market. You have to define what part of the market you are going to be able to grasp onto as a digital player.

I think we're going to see people get more discerning. We're going to see a lot of dumb money just fall by the wayside. I just saw the Teladoc earnings report and they had to do a. Was it 6 billion, $6 billion right down, essentially on their Lavango acquisition because of the valuation was potentially higher than our, their acquisition price was higher than the value of the company is which they knew going into it.

That they overpaid for it because it filled a specific need. Now you read that, you read this downturn plus the inflation people. Aren't sure how inflation is going to hit those kinds of things. I think you're going to see things. People just naturally take a step back from the market. We've seen that across all markets, but I think in the healthcare space, there's a realization that, Hey, these things may have, gotten a little too high.

We're not in a speculative phase anymore. We're going to be looking at people who have a very strong play. The funding for mental health continues to go up as a category. It's just the digital health is coming down. You're starting to see partnerships in the mental health as well space. So I think people are going to become more discerning. I think you're going to see less speculation in this space.

It's going to feel like, I don't think it's a bubble popping, but I think it is. I don't know. what can we call it? Sanity, sanity correctly. I think it's more like sanity. I mean, there were some of these valuations that you just sort of scratch your head and you go, all right. To get that valuation.

They're going to have to do this over the next couple of years. I don't see where that's coming from. But the Lavango Teladoc, I thought at the time, I thought that's, that's the model everybody's going to be following right now, which is to look at it, look at a major player, look at a space that they're, they have a gap and then figure out a way to plug yourself into that space and say, look.

With this and you, you're going to be able to do this. Therefore it's worth umpteen billion to you as an organization. It's not worth the market to that, but it's worth that to you because the combination of YouTube does X, Y, or Z. So it'll be, interesting to see how this, how this plays out.

At some point I want to do a show and really focus in on the investments that health systems have made in companies. I think it's a very, I think it's a very interesting. Chart to be made of which health systems have invested in which companies are they using that technology?

Which of let's just call them cousins. There are organizations around the country that are related. But they're not parked there, they partner, but they're not related. And you see their technologies start to sift around that community. I think that's worth looking at some point, cause yeah, it's, it's interesting to look at.

I want to thank you for putting up with my coughing today. And I really appreciate your insights on this stuff it's been, yeah, yeah.

This one's always a fun as is always a fun time to come on and chat with you about these things. So thank you for having me, bill.

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