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August 30, 2021: Dr. Eric Quiñones from World Wide Technology joins Bill for the news for some post HIMSS talk. Plus how can your IT team prepare for a COVID surge? Crisis teams have been sent to hard-hit COVID hospitals in Oregon. Tom Burton from Providence St. Joseph reveals how they are generating patient engagement ROI. NYU Langone experienced significant growth in digital engagement. The May cyberattack cost Scripps nearly $113M in lost revenue. And The National Emergency Tele-Critical Care Network (NETCCN) is here with their clinical care teams to help you.

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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Today, on this week, in health it, you have to be able to pivot and if you don't have that core infrastructure to be able to be agile, you don't know what's gonna be thrown at you.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT at channel dedicated to keeping health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our new state show sponsors for investing in our mission to develop the next generation of health IT leaders.

Uh, just a quick note before we get to our show. We launched a new podcast today in Health it, we look at one story every weekday morning, and we break it down from a health IT perspective. You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there.

You could also go to today in health it.com. And now onto today's show today on Newsday, Dr. Eric Quinonez. Dr. Q with Worldwide Technology is here to discuss a lot of different topics and we're looking forward to that. So Eric, welcome back to the show. Okay. Thank you Bill. Appreciate it. Yeah, I'm, I'm looking forward to this.

There's a lot going on in healthcare. You just got back from himss, so we can have a little conversation of, of what went on at HIMSS and those kind of things. We're gonna cover a bunch of stories straight outta himss. These are the presentations that went on. Uh, great one from NYU. That I we're gonna cover.

There's one providence, uh, St. Joe's talking about bundled payments. I think that's a good one. Tom Leary from HIMSS talked about patient identifier, so we'll hit those things. But you were actually on the, but you were on the safety committee. Is that what you were a part of? Yes. I was, uh, a part of the Health and Safety Committee for himss.

It was made up of myself, Dr. Collier at Worldwide Technology and a few others. We started way back in March to . Really address it. It was a different world in March, wasn't it? ? Very different world Bill, and it kept changing as we know and as things change, we had to change and pivot our strategies and how we were gonna handle this.

But I think from the get go, we unanimously believed that we had to have a. A mandate is, if that's a bad word or not, but we had to have a way to control the bubble, if you will, of himss. Right. And the easiest way to do it was to, you know, ask everybody to be vaccinated, um, appropriately and, uh, fully vaccinated prior to coming to himms.

But that's part of the challenge. You really can only control the bubble like the. The floor, the booths, the, I mean, that's the only part you can control. And when I heard people saying, Hey, the reason I decided not to go was 'cause it's Vegas. Right. Vegas is Vegas. I mean, it wasn't, it wasn't that they were concerned about the conference itself.

In fact, Drex last week said if the conference were anywhere else, we may have gone. Right, right. And, and, and you're absolutely right. So we knew that in the reality that we live in, we couldn't control anything outside of the. We were fortunate that the Nevada Gaming Commission and the State of Nevada actually mandated mask wearing as well within the casino.

And surprisingly, when walking through the venues and walking through the casino, what I noticed were non attendees were compliant. They were wearing their masks, some, and folks that I just thought maybe they just didn't. Or wouldn't care, they would walk in off the strip into the casino and put their masks on.

So people were pretty, pretty compliant with that, which made me feel comfortable. And I'm sure others, but you're right, you can't control things outside of the bubble. And we knew that from the get go. And, and I'll tell you, the people who went told me it was a really great conference, you, you cut the number from 40,000 to whatever the number ends up being.

They had announced that prior to the event, it was somewhere around 18,000 plus. And, and we don't really have a file number yet, but when you cut that event down, I could see it just being much more personal, much more intimate, a lot more access to the speakers, a lot more access to each other. And I mean, not that there isn't a place for a 40,000 person event, but you know, some of us just want to be with people again.

I mean, that was one of the reasons I really was sad that I wasn't able to go Right. A hundred percent. When we first started opening, opening up here in California, it was nice because, so my kids play, play sports and play soccer and, and to be able to get back out on the pitch and to see them, you know, doing what they do best and to see the smiles on their faces was really heartfelt and was very positive.

We haven't had meaning on the adult side, the professional side, we haven't had that opportunity. So Hims was kind of like going to the soccer pitch for me and uh, it was great. He was seeing a lot of great colleagues that I haven't seen in a long time. And being able to reconnect was very valuable. And I think the level of conversations that I know I had were very meaningful, and I can say that for sure.

And, and I actually had more time now to actually attend. Some really, I felt important sessions so that that was also nice too. Yeah, I'm cheating. What I did is I went through, I looked at all the sessions and then invited the people on the show that I wanted more information on the sessions, and they sent me their slide decks, and I'm gonna do one of those interviews this afternoon.

I'm looking forward to it on data supply chain, so it'll be fun. And we're gonna hit five stories here real quick with just, you know, your, your kids are into soccer. And a friend of mine just said, Hey, you, you have to watch Ted Lasso. Have you happened to see Ted Lasso? Yeah. Not, not the, not the kind of thing you watch with your kids, but it is exceptional.

It was, it's so good. I can't believe how good it is. They did. The writers did a great job at that. It's not overly. You don't have to be a soccer fan, a football fan, to really love it. Right? It is just more about the characters and his particular character is so positive put in this situation that he has no business being in, but yet he's just got this attitude that just radiates.

I'd put it this way, he'd be a coach that I think most people would like to. Oh, yeah. Well, it's not that he's naive. This is what I like. He's positive, but it's not that he is naive. He sees it all, he just chooses to respond in the positive. So it's really right. Anyway, it's, it's, it's really exciting. So my wife and I, uh, just finished watching all the episodes up till the one that gets released tomorrow.

So we're, we're all cut up and ready to go in season two. All right. Let's, let's hit a couple of these biggest story right now. Iss obviously that's going on and we'll touch on this briefly and, and here's the story that I, I pulled on this and it happens to be a. Was in contact with this week and had texted with earlier who's affected.

So Oregon has hit pretty hard. Crisis teams are being sent to hard hit covid hospitals in Oregon. Essentially what happened is the state governor went out and contracted with a firm, a staff, a medical staffing company. They have 500 some odd care. Medical professionals going around. Uh, they have some breakdown of the numbers here.

61 certified nurses, 20 paramedics, 34 respiratory therapists, so forth. But they're gonna be sending them to places like. Let's see. St. Charles Health System in Bend in Redmond, Oregon. These are mostly the rural areas. Portland's doing okay. Right now it's the remote areas, Southern Oregon to support Asante Hospital in Medford, Ashland, and Grants Pass, as well as Providence Medford Medical Center and Mercy Medical Center in Roseburg.

So. Uh, they're gonna be sending all those people out and I, I don't really wanna talk about the, the surge per se. What I wanna talk about is really getting ready for that as an IT organization because there's a lot of stuff to do. I texted with one of the CIOs at, at one of those health systems, and they were just talking about, Hey, we're right back into the thick of things, converting their or spaces and other spaces into ITU spaces or ICU spaces.

And they have all these people coming in. So there's a lot of IT related activities

you would think. We have experience with this over the last year and a half, but not every area surged. Some of these areas. This is potentially the first real surge that they had. Even with the initial bout with the pandemic, it sort of came in and, and really spurts early on and Southern Oregon is one of those where it never really.

Surged in the first half, but right now it's overflowing. Their hospitals are incredibly full. How can an IT team prepare from your perspective for the tasks and things that they need to put together to take on these new staff people that are gonna be showing up? Right, right. So there , that's a huge logistic issue as you, you can imagine.

You have new people coming into your environment to be a part of a A care team, if you will, to be able to triage patients, to be able to identify those that do need to be admitted and those that maybe just need to be surveyed maybe at home. So there's a lot of things that go into play there. We, early on in the pandemic, I was involved with.

So Mtech, which is the medical technology, uh, enterprise Consortium, which is made up of the military and academic and also industry as well. It's basically a way that the, the government fast tracks ideas to get implemented when situation, when they need these kinds of, uh, technologies. So Mtech actually sponsored what was called the

National Emergency TeleCritical Care Network in the early days of the pandemic and what this was put out as a think of as an art. Out in public and about 79 folks, uh, 79 teams, I would say actually responded. Of those nine were selected. Of those, it's down to four and we're part of one of those teams that my previous employers, which is awesome.

And what we had to do is come up with a platform to be able to quickly bring up popups, if you will, or . Situations where we would use either hospitals, brick and mortar hospitals or schools, auditoriums, concert facilities, whatever have you, but to bring up those, those mash units, if you will. And not just that, but also the infrastructure and the technology and the staff to be able to help triage patients and to to care for them appropriately.

And so. Part of that was to be able to monitor patients remotely in the event that they did not need to do, seen in a more higher acuity environment. So, so anyway, fast forward at himss. As a matter of fact, on the DOD side and the DHA side of himss, they were promoting the national emerging Tele Critical Care Network nets.

They were basically letting folks know that, hey, this is available to you. You just need to sign up. and, and you'll be connected to the right team and they can come out and help you actually with the logistics and a lot of the technology platforms that you really need. So the, it, it's not like it hasn't been done.

So I, I guess instead of reinventing the wheel, my advice would be to reach out to nets and, yeah. So those teams coming in, I just jotted down a couple things as I, as I was thinking about this, but you want them to practice medicine, right? So. You want them to come in and get, get practice medicine as quickly as possible so they, if they're coming inside your four walls of, of, of your hospital, they're gonna need access to your systems while standing up groups of, you know, 30 or 40.

That is a logis logistics challenge. Hopefully you have the tools to provision and deprovision user pretty rapidly and pretty effectively grant the right access to tools and permissions that they need. If you're gonna give anyone access to your network, you obviously have to do some training. They have to understand your documentation procedures within a certain parameter to be able to, to do things.

Obviously, you don't wanna hinder them delivering care, so however you do that, maybe you're using scribes, maybe you're using something to sort of create a, a barrier. I, I'm not sure what you would do there. It really depends on your budget and depends on what you're trying to accomplish there. The other is anytime somebody accesses your network concerned about the cybersecurity risks.

I wouldn't be giving these people access to email. I wouldn't be giving them email accounts or those kind of things unless it was required to provide care within your health system, in which case you have to. And if you do, then there's just different levels of training that they have to go through if they're going to be accessing your thing.

And then obviously, I think the last thing for me is information. They, they're gonna need access to information, if that's your EHR, just for the basic medical record, but also probably some analytics. Somebody needs to be looking at the, the bigger picture. I, I thought of some questions that I had as I was, I've seen these numbers and these numbers are too generic for me.

I, I have too many questions. So they say this many unvaccinated and this many vaccinated are coming in and it's like roughly 85, 15 percentage wise. And I say the 15% I want to know, I, I wanna know which vaccine. So if it's 15% and they're all Pfizer, I, I want that information aggregated as quickly as possible so that we can escalate that.

And someone's looking at it going, Hey, you know, this Pfizer vaccine needs a boost a lot quicker than we thought. Or if it's Moderna, or whatever it is. So there's, there's analytics around that that I'd want to know. I'd wanna know how many people that have had covid are coming back in with Covid a second time.

If that's even a thing. I would assume it is a thing. I, I'd want to know those percentage. I, I, I'd want, I, I'd want to know so much more detail. I'm seeing these charts and they're great charts, but I'd want so much more detail, so. I, I think the information and the analytics teams need to be agile and really going overdrive, and it's really almost a demand driven analytics effort that's going on right now.

It's just, what do you need? This is what I need. Look at the data supply chain and build those things as quickly as possible. I think when the surge is going on, those teams need to be incredibly. Dynamic. Let me ask you this. From an education standpoint, I've seen some good posts and I saw you, you highlighted one of the posts where health systems, we, we went through this shaming phase of I can't believe you're not getting vaccinated.

And as you sort of like looking at your kids saying, I can't believe you didn't do your homework. They just sort of look at you like, okay. But once a kid understands, Hey, I want to go to a certain college 'cause I'd like to, you know, see Ohio State football games and whatever, and the GPA required is X.

Once you educate them, they sit there and go, Hey, you know what? I think I'm gonna do better in school. 'cause I, I, I wanna go to Ohio State and watch the football games, whatever, whatever it happens to be. And I've started to see some better posts. Lee Milligan at Asante put out a post, just has the, the statistics.

Hey, 85% unvaccinated, 15%. It's a nice graphical chart. You just look at it. Uh, number of people who are vaccinated in ICU is only two, and the number of people unvaccinated is I. Like 30 some odd. So percentage wise, that tells a story and I think it tells a good, it's an education story. It's not a guilt story, it's not a shame story.

It's a really good way of doing that. Have you seen some others that they're starting to really go after this? Educating people through social media or other platforms? Yeah, I mean, I think that's been a big thing when we see the, I saw something just the other day. It, it was kind of sad to see, but because the clinician was so overwhelmed, the headline was basically, I, I just don't have empathy anymore for folks that are not getting vaccinated because he's taking on so many VA unvaccinated patients in the ICU for covid.

That's kind of hard. I, I get that because there's a, a ton of reasons why they may not have gotten vaccinated and I don't wanna get into all those, but I think your point is really well taken and I think that we live by the numbers, at least most of us, we try to live by the numbers and numbers can really tell a great story and what you're saying is really important.

So yeah, I am seeing that more and more and I am seeing folks that may have . A platform, if you will, a voice that folks follow, whether they're celebrities, whether they're of some sort of celebrity, but you know, they're actually touting those numbers and saying, look, it's, this is why it's important. Every, every bed that's taken up in the ICU from a patient that was covid positive, you know, that didn't have to be there because if they're vaccinated, is taking away a bed that, you know, somebody that doesn't have covid but has another maybe medical or traumatic, uh, injury.

I happen to be sitting in a chair yesterday getting my hair cut and the, the person . Happened to gimme a a, I mean, clearly not vaccinated, doesn't wanna get vaccinated, has listened to all the myths, and she said, well, my sister got covid from getting the vaccine. I'm like, really? Which vaccine did she get?

She said, oh, she got the Pfizer vaccine. I'm like, you realize that's impossible. And she goes, oh no, it's not. There's a lot of cases. I'm like, no, it's impossible. There's no virus in the Pfizer vaccine. It's not a traditional vaccine. Right? When you get that information out, I can have a conversation with someone like the hairdresser to say, what you are saying is a myth, and they have five myths on down, down the left side.

It changes your DNA. The vaccines were rushed and are not safe. They're new and much is unknown about them. It makes women infertile. It makes you test positive for covid 19 on a viral test. And these are questions people really have. The vaccines are rushed and not safe, and I've heard this over and over again from people and it says, mRNA vaccines have been held to the same rigorous safety and effectiveness standards as all vaccines in the us.

And mRNA is not new either. We've been working with mRNA for. For decades. And look, I got the vaccine. There are people in my family, my direct family that have not gotten the vaccine, and that's their choice. I don't have a problem with them not getting the vaccine, but I want them to know the facts. Right.

And I think that's, that's the kind of stuff I like when we're doing as health systems, when we're educating people. Because if you wanna get the message out, it's not your post that's gonna do it. It's someone who reads your post that's gonna do it and goes and gets their hair cut and talks to a family member or that kinda stuff.

So I think the education stuff goes far more, far better. And the empathy for, for healthcare workers, we have it because we've worked in healthcare, but the average. Hairdresser doesn't really . No, unfortunately, and I think you're right. A lot of folks are speaking from a place where they haven't been in the situation where they've cared for patients at bedside.

And my colleagues have, I have, and it, it's when you're in there doing it, and then you're doing, you're focused on the patient, you're focused on their outcomes, right? And then you stop and you think like, why did they come here? Why did they get here? How'd that happen? What was the story behind that? So, in the ed, right, there's a lot of reasons why people come into the ED, and especially prior to covid.

There's a lot of different reasons that people are coming to the ed. And then when you look at when that patient ends up in the ICU, that that patient journey has been a downward spiral, but maybe didn't have to be, and again, goes back to your point. Because of the information they may have been listening to.

It wasn't factual. It was, um, again, maybe coming from their hairdresser in this example. Right? And they act on it. And again, that's, I don't think people necessarily ask the questions that they should ask. Dig deeper, really looked at where the facts are coming from. Investigate for yourself. And I get that.

I get that. That's just not maybe general human nature. But to question, right? To hear some of these, some of these reasons why a vaccine is bad, is bad for you, is actually, you can't write that stuff in Hollywood, quite frankly. So it's, I trust the science, I'm a scientist and I'm gonna continue to trust the science and look at that.

But I also question the science too. So, but again, consider the source where you're getting your information. Yeah. Absolutely. Alright, I wanna hit some of these stories. Covid 19 accelerates ongoing digital transformation efforts at NYU Langone. So, NYU is one of the first hit downtown New York City. And let me just give you some of the, uh, some of the story.

So because of this. Because of its investments in its foundational technology. NYU Langone in New York City was able to quickly scale its digital solutions, not only to meet clinical demands, but also to develop ways for patients to access care. Despite the physical restrictions inherent in various pandemic protocols.

NYU Langone experienced significant growth in digital engagement as a result. Nader mbi, who has been on this week in health, it. Is there. EVP, vice Dean and Chief Digital and in Information officer, my gosh, he has four titles, right? That's a, that's, that's a lot to do. I spoke on this issue at HIMSS 21 in Vegas.

It was titled Riding the Wave of Digital Transformation. I. How technology can enhance the patient experience. And he said, in the past eight years, we've focused on building the found, uh, fundamental platform of digital infrastructure from EHRs to connecting in the cloud in the right way to AI and machine learning.

All of these fundamental building blocks you need said, Ravi, you need to build your digital experience. On top of that, a sound digital strategy, he said is about synergy from the operations team. To the technologists and even marketing, all constituents need to work together towards common goal. Alright, so let's stop there.

There's a lot in this. Uh, and I do wanna read a little bit more later on what NYU did, but if we stop there, what is it? I mean there's two key points here. One is they were able to scale because they had put in the the right fundamental platform. And so what does that mean? And we talk about synergy of operations and we actually talk about it a lot on the show 'cause people will tell me.

That's an operational project or that's a clinical project. And what we used to do is everything was an IT project that had clinical involvement. And now we're starting to recognize that a lot of these are operations projects or clinical projects that have an IT involvement, which is a completely different way of approaching these things.

So Right, you pick this story. What struck you about this story? So I think, um, like you said, a couple things jumped out at me was one that. NYU Langone had the, the foresight to pay down their technical debt early on, and they were really bringing in an infrastructure, a core IT infrastructure that can support not just cloud, but AI and, and other initiatives that they were looking at to do.

They knew that they had to do that to be able to grow and be competitive and, and all that stuff. One of the things I heard at HIMSS at in the, the future of healthcare, uh, presentation was, uh, new technology plus an old organization is a costly old organization. Okay. Right. So I think they, they saw the crystal ball.

They knew that this had to not be the case. And, and so that was one thing I think they did, you know, exceptionally. The other thing is their thinking when it comes down to collaboration. So whatever the objectives are and the projects they are, they're, they're bringing in the right stakeholders, the end users, and so they call it, I think, design thinking, which is really human-centered process of problem solving.

And so they do that and bringing in the, all the right stakeholders to, so it supports, right? A lot of these initiatives. Whether it's clinical, where it's on the, on the business side, but it supports that looking at the current infrastructure and, and what, what tools do we have to actually do the, solve the problem?

And then on the end user side, is it gonna cause more friction? Does it reduce the friction for all those people that are, that are involved? So I think that's, that's really the two points that jumped out at me on this and, and kudos to them for really driving and being ahead of the game here. Yeah. This is where we, where when I talk to people, I, I talk about the importance of architecture.

You gain agility and you talked about retiring debt, which is also part of good architecture, right? So it's knowing what parts of the building are sound and what parts of the building. Need to move on as, but in our world it's not 'cause they're dilapidated and falling down, it's because they can't keep pace with the agility that's required moving forward.

Right. And we have all sorts of new internet based technologies, APIs. We have new tools like AI and machine learning. We have telehealth, which has just, uh, grown. And Telehealth is just a combination of technologies. It's, it's a video technology, it's an audio technology, screen capture technology. There's a bunch of technologies that come together and it, and actually it's a good example of you take those technologies and you deploy them at scale, and you can take your telehealth from a hundred visits one month to 25,000 the next.

'cause it's architected correctly. And a lot of people were able to do that 'cause it was architected correctly because they chose a cloud provider. A lot of times we do things, build your own, and I'm a fan of build your own in a, in a lot of cases. And in other cases we're not ready to build our own because we haven't, we haven't mastered the internet architectures yet that we need so that we can scale these things up.

Here's some examples of some of the things they did. The academic medical center's, digital efforts have been consistent and progressive throughout the pandemic. In particular, it created an AI risk scoring system for covid 19 Patients phenomenal. Created a comprehensive coronavirus dashboard for clinicians and executives.

Again, fantastic. Supported the peak of more than 7,000 virtual patient visits in one day. Received an FCC grant to deploy telehealth in converted ICU rooms, and began messaging patients to schedule vaccine appointments. These changes all occurred very rapidly because they had that infrastructure where they said, okay, we, we need to start doing, and, and we don't know what the use case is, right?

This was a, the pandemic was a great example of, we don't know what the use case is tomorrow. Therefore, the infrastructure need at its core needs to provide, the one thing it needs to provide is agility. Now obviously it needs to provide security. It needs to provide performance and all those things, but it needs to be agile.

Um, as well, so that you can go, all right, where are we going tomorrow? Oh, we have to get all these people vaccinated. Do we have a way of getting information out to them? Oh yeah. We thought about that when we put our digital tool together. 'cause you know, if you just have it in your digital tool, they may not open that digital tool 'cause they're not going to the hospital.

What we found is people only go when they're going to a doctor's appointment or going to the hospital. Right. So you need, I mean, just basic texting actually is a very effective tool for getting the word out. It's, yeah. No, I think those are great. You nailed it. I was thinking, again, you have to be able to pivot.

If you don't have that core infrastructure to be able to be agile, as you said, you don't know what's gonna be thrown at you. And because they did that, they were able to do a lot of things, a lot of things in less than one year, and you think about it, if they wouldn't have done those, those things in terms of creating that, you know, core IT environment.

How long would it, would it really have taken them to do all those things? So, yeah. I, I wanna hit this story with you 'cause I think it's really interesting and I think we'll have interesting perspectives on it, which is Providence St. Joe's had a Tom Burton, director of Operations in of Orthopedics and neuroscience at Providence Health.

And he was talking about the, the bundled payments, right? Total hip and knee replacement bundles from CMS for risk-bearing organizations to seek new ways to maximize savings. That's the title of the presentation. I don't know if that's the title, but that's the title of the article. And so Burton talked about it and he said, we tried this way of measuring the pH physicians and clinicians and doing all these things to try to make sure, 'cause here's what happens, right?

So CMS goes out, they look at. Knee and hip replacements in a certain geographic region, and then they get an average and then they say, that's what we're paying. Right? So Providence is automatically signed up for whatever reason. I'm not sure why, but he says it in this article that we were automatically signed up.

Alright, so now they're on the hook for all. Let's just this for argument's sake, let's just say knee replacements. All knee replacements for a certain amount of money, and that's from diagnosis to complete rehab, right? In a lot of cases, this is going to sniffs, this is going to outside care, and so it's not even all managed within the the four walls of your acute care facility.

And they looked at it and said, we're a risk bearing organization now. This is the number we get. Our cost is higher than this. How do we get there? And their first approach was to look at the, to try to knit that whole thing together and put metrics around it and put things around the physicians to get there and it didn't get them there.

And so they changed the approach and went the the patient route and said, we're gonna educate the patients and have the patients really drive this thing. That was successful. Right, right. It's really interesting you picked this article, and I love this article. I mean, I can read more of it if you want me to read it.

I just sort of gave a synopsis, but is that a model that we should be really looking closely at for other health systems? What I liked about it was it kind of, it flipped the script in terms of instead of putting this on just alone on the clinicians, but also putting some. Responsibility in a way, if you wanna think of it that way, on the patients, right?

That's more scalable, number one. But you have to engage them in a positive way that they're gonna want to take ownership and they're gonna be educated. And why, what's, why am I doing this doctor? So they need to know why they're doing it, and obviously to have a good outcome so they can get back and ambulate and do the things that they love doing.

To be able to spend time with their family, go on walks, whatever they do, right? But it has to be shared with them that's really meaningful in a way that this is why you're doing it. So I think they did a really good job here at kind of flipping the script. And they use technology to help do that. So if you wanna read on, yeah, I think it, it kind of explains a little more, and, and I think you, you, one, before you do that, they had to take a snapshot of the current state.

So looking again, how much are they at risk? So looking at the SSNs again with patients who been, what they're going to a, you know, skilled nursing facility, they saw a 30%. Patients that about 30% of the patients who actually went back to the hospital were readmitted. That's a big number. Yeah. So that's that alone, you have to find a solution for that.

So. There was a lot of reasons, and I think putting the responsibility, the physicians to educate and, and do that, it, it's not scalable. They're doing everything they can, but to have technology help in that respect, I think was, uh, the right way to go. And that's essentially what they did. They found ways to engage the patients from the diagnosis all the way through the entire process.

Right. So they were able to communicate with them and help them through the process. It says Providence was able to save $365 per joint replacement, resulting in roughly quarter of a million dollars in savings annually. But the readmissions was 831,000 per year, which is, uh, significant savings. And really it was, it was just that transition of saying, we're putting it on the physicians.

Who are already pretty well burdened with stuff we've given them to do to, but we can do this through technology. They use tle, I believe. Yeah. But you know, there's a lot of different ways to do this actually. To create a good engagement strategy. And they were able to decrease, decrease length of stay, increase discharges straight to the home, bypassing, sniffs all together.

And it was all education, but people thought, well, this process is baked, so I have to go from here to here, to here to here. And instead they got educated and they go. Hey, you know what? I don't fit that category. I, I probably don't need to go here. I can probably just go straight to my house. So they're the ones having a more informed dialogue with their physicians and that's, that's always great to have that level of enga.

It's good to have an engaged, informed patient. I guess well, and I think an engage, informed patient. Again, getting back to our earlier discussion regarding the informed part, getting good evidence-based . Information. Right? Not some . Hairdresser stuff, but really evidence-based information. Are you kidding?

On my case, because I talked to my hairdresser about, and actually, to be honest with you, I didn't even bring it up. I made the mistake of wearing my hat, which said this week in health it, and she saw the hat and she goes, healthcare, huh? And then she . She gave me her, all of her theories and everything on the vaccine.

I was like, okay, . Uh, yeah, no, it's good. And good for them for doing this. This is, this is great. You picked out, we talked about this story. I talked about this story last week with direct. You picked out this story. I'm curious, uh, what your take is on it. Um, may, may, cyber attack cost for Scripps. So Scripps, they had to report their financials and in their financials they talked about 113 million in lost revenue as a result of the ransomware attack.

About 15 of that, they'll get back in insurance, but the overall revenue hit was about 113 million. What jumps out at you on that? What aspect of that story do you think is important? I, I think what's important there is that one, as an organization, Scripps, what is a medium size healthcare facility, about five hospitals or so, and under 20, I think.

Outpatient facilities. So they're responsible for a pretty, you know, tight-knit population and one. It's very bad that any organization should be hit this way, held to ransom, if you will, or, or cyber attacked and breached. But another is when that information is actually stolen. So there was also financial and healthcare information that was taken from about 147,000.

Records, so, or patients. And so there, there's that component of it too. It, it hurts them from a credibility standpoint. There's the direct cost that we can, we can look at, but there's that indirect cost as well. Do patients trust them now and things of that nature. And I think with some of the lawsuits that, that I think are facing them, we'll see as the time goes on, but.

Could these things have been avoided if they've taken a, a stronger stance on zero trust. So I again, remains to be in, to be seen, but you know, this is significant. Yeah. Here here's my take in a sentence. It was, Scripps is 3 billion, uh, $3 billion health system, clinics, hospitals, you name it, across San Diego.

It's pretty much in that market. They lost over a hundred million as we talked about 30 day ransomware event. They were essentially down for about 30 days. EHR was offline for, I dunno, we don't have the specifics yet, but for at least 20 days, EHR was really offline. I. What I said is if I were ACIO today, I'd be using that information to estimate what my health system's event exposure would be.

So for instance, St. Joe's was six and a half billion, so roughly double that size. If we had an event, it would be probably 200 plus million in lost revenue. And I said I'd get that number in my head, 250. Ransomware events, roughly 250 million in lost revenue for our health system. And then what I'd do is I'd go in and start talking to the executives and eventually to the board about getting about 10% of that number over the next 18 months to spend on cybersecurity to make sure that we can avoid that $250 million outage, which as you noted, comes with a lot more baggage.

I mean, you end up with reputational loss, you end up with lawsuits, you end up with a lot of other challenges and. And I, I, quite frankly, I would want that money cash up front. I wanna start investing in ransomware, a lot of times comes through the front door, which is your email system, right? I'd make sure that that was locked up pretty good.

I would look at, um. You know, your processes and your procedures, a lot of stuff is human error, which causes the the gaps. I'd look at smart tools that are going to be able to know what's going on on our network. It turns out that these people are on our network for close to, you know, three months before they actually launch these events.

So as the. The CTO for Proofpoint was on my show and he said, how would you feel if I told you, Hey, I'm gonna go ahead and put someone in your closet in your home for the next three months to observe how you're . And I'm like, that's kind of creepy. He goes, that's what they're doing in our health systems right now.

They're on the network. Watching what you're doing, he goes, it is creepy. And we need to know that they're on there so that we can limit what they're doing. It's usually a three month lag or lead time before they actually launch an attack. Yeah, that's a visual that I'm not gonna get out of my head now it's gonna haunt me.

Um, someone being in my closet, but , no, but I'll tell you, it's, I'll tell you that visual is in every CIO's head. Right now, and they're, uh, I, I know a lot of 'em, a couple of them I have talked to have gotten board approval to escalate some spending on cybersecurity. I think that's the right move. If you're a health system of a certain size, a billion or more, I.

I would talk to the board, make them aware of, uh, what's going on. Don't assume they know what's going on. We live in healthcare, so we're like, everybody must know that healthcare is under attack. Right? They may or may not know. Some of 'em are running businesses, some of 'em are very busy people. You might need to educate them on, Hey, did you hear about the Scripps event?

Let me tell you about the Scripps event. Let me tell you about Sky Lakes Medical Center. Let me tell you about, and you could just go through, I mean, all the incidents are there. I mean, some are in more detail than others, but you can share that information, make them aware of the risk and exposure. And I, I think you have to end that conversation with an ask for money and say, look, right, good.

Cybersecurity costs some money. And, and I, I don't like the throwing up your hands that I've heard from some where it's like, if someone targets us, they're getting in. I'm like, uh, that's not, that's not acceptable. That's not acceptable. I mean, if you think of the logic you just said, okay, that let's say, uh, $113 million, they actually were, and direct cost, right?

And direct cost. So that was the loss of revenue plus the cost of consultancies to help get them back on online. And that was for about a 25 day period, let's say. That's. Quick math. 4 million. Four and a half million dollars per day. Right. Okay. What they're getting hit on and then you think of, okay, you said 10%, take 10% of your budget or what year, what that cost was.

So 11, 11,000,002. So $13 million or $12 million, whatever it is. So say 12 million bucks over. What'd you say? . A year and a half period. Yeah. It's gonna take me 18 months to, to do the projects I need to do anyway. So no need to ask for more money than, than that. Right. So then you, let's just say that you were paying four, 4 million, four and a half million dollars a day.

You could break that down. That 13, 12, 12, 13 million to three days. Yeah. Well, not only that, but let's say if you compared it for an 18 month period, you're paying about $20,000 a day on, on the cost to bring in that infrastructure up to snuff. Right. Versus. Four and a half million dollars. So yeah, it just makes a lot of sense to ask for that money.

Get ahead of it. You don't wanna have this kind of headline, um, about your organization. Yeah, and for those who were saying, bill, you talked about this last week. You gonna talk about this every week? I'm like, this is important. I hope everybody gets that story and is putting a slide deck together. If they want slide deck, shoot me a note, I'll throw one together for you.

It just needs to be four or five slides. Put it in front of people. Said, here's what's going on in healthcare. Here's what our exposure is. Here's what I'm asking for. It's almost that simple. It's, it's not a 20 slide slide deck. It's a five slide slide deck to really set it up. Yeah. We're having these conversations today with our clients and this is, uh, it's really important 'cause this is some of the work that we do and helping 'em get ahead of it, it's really, uh, critical.

Yeah. And then the other thing is if you don't know what you're doing and you get the money, call somebody in . There's a lot of really good people to help you. And I'll be honest, if people are like, oh, bill, you probably didn't call anyone in. I had consultants all over the place where I was. I mean, we had, our auditor was there on an ongoing basis helping us.

We had, uh, well, ww t was there as well as other that I utilized. I. And so yeah, there's gonna be areas where your team is not as strong as a consultant's gonna be. Yeah, go ahead. Go ahead and bring 'em in. That's what they're there for, is that one-time expertise that you may or may not have or need on an ongoing basis.

That's perfect example of when you use those kinds of, uh, people. Dr. Q, thank you for your time. Always a pleasure to sit down with you. Great to talk with you, bill. I look forward to . Hopefully seeing you in three dimensions someday soon. Do you plan to be at Chime? I do plan to be a chime. Is that the next event?

Uh, no. The next event for me is the health conference, HLTH, whatever you wanna call it. And then the, uh, then the chime fall forum in San Diego. So I assume you'll, you'll be down there. I'll be down there. I'll hit you up and let's, uh, let's connect over a cup of coffee. Sounds good. Thank you again. What a great discussion.

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