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Today on This Week Health.

If you have a product that is deemed to be free, or you think it's free, the reality is you are the product, right? And the product is you and your data and institution in this case is Facebook's ability to go sell that data back onto the marketplace. And the more data they can collect about you, the more valuable you are to them as a customer.

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.

All right. It's Newsday. And today we're joined by Ryan Whit healthcare leader for Proofpoint. Ryan, welcome back to the show.

Great to be here, bill. Thanks for.

Lot of stuff going on. We're finally going to touch on the topic that I've avoided for the last couple of weeks, which is the Oracle what I'm calling the day after event that they did. We're gonna get to that. That'll be the second or third story we cover.

But I wanna start with you on the Facebook is receiving sensitive medical information from hospital websites. So this one's out there, I've actually talked to a handful of health systems that were mentioned in here, and they have since taken some action on this. let's just give the context real quick.

So this is a joint article between the markup and Stat news the markup tested the websites of. Newsweek's top 100 hospitals in America. On 33 of them, we found the key tracker called the Meta Pixel sending Facebook a packet of data. Whenever a person clicked a button to schedule a doctor's appointment, the data is, is connected to an IP address and identifier and the computers, which is the computer's mailing address.

That's an interesting way of saying that and can generally be linked to a specific individual or household creating a Receipt of the appointment. So some of the data that it's sending over can be things like the name of the button schedule, online name of the doctor. You have things going across like diagnosis or search terms, like pregnancy termination topic of the week.

You have like Alzheimer's dropdown, any dropdowns could be sent over as well is what they found. So let's start with, why do people use Facebook's meta pixel? I think people are shocked that you would use this tool, but this is a very effective tool in the marketing world to collect information.

Yeah. I mean, I think there's a couple things you gotta say here about, about that tool, and about Facebook's role in this. and the marketing or advertising sort of just world generally. The reality is really between Facebook and Google and Amazon is kind of one of those up and comers.

Like they dominate the world of online marketing. I mean if you have any sort of product or server that you're trying to promote. Collectively to the marketplace and you want to use online or use online your vehicle. You have to essentially use these sort of platforms. So they're very appealing to advertisers.

I, I think this is a really concerning development one that I don't find surprising at all to be candid with you. We've seen a lot of similar activity from Facebook in particular about this sort of data gathering. And it just brings back the old adage, which I think those of us in tech have realized for a while now, maybe, maybe more broadly in the marketplace, it's becoming also known that if, if there is no such thing as free right.

If you have a product that is deemed to be free, or you think it's free, the reality is you are the product, right? And the product is you and your data and the institution in this case is Facebook's ability to go sell that data back onto the marketplace. And the more data they can collect about you, the more valuable you are to them as a customer.

And the more they can monetize that data. Right across the marketplace. And so make dumb, and think about it. You might think you're getting this free experience, but there is a cost and the cost is being born out with articles like this, where data about you and your activity is being collected. It's being sold by Facebook and by other aggregators across the marketplace

It's interesting. I'm not gonna be an apologist for CIOs here, but some of this is gonna sound like being an apologist for CIOs. In my organization, the marketing team went to a third party outside the, the website didn't really fall under my purview, as odd as that sounds like I gave them a server to run.

And in some cases you don't even give 'em a server to run it. It's hosted somewhere else. And those kind of things we give them. Feeds, we give them integration points and that kind of stuff, but the marketing team feels like they're technical enough and they have their marching orders of, Hey, we need to personalize this.

We need to make the search more personal and find the right doctor at the right time. And so they're bringing all their marketing tools to bear on the problem. and the CIO, quite frankly I, I'm thinking a handful of systems I've done work with. The marketing team is off doing their own thing on this website.

Right. For the most part. And, and I wasn't even consulted on ours, like, Hey, you know what tools, privacy, that kind of stuff. Because the minute they would've said something like this, I would've said, Hey, if you're using a Facebook or Google, Anything, we've gotta have a conversation about privacy because that's their business model, right?

Their business model, as you just said, is data. So if that's their business model, we've gotta be careful of what data we're going to be sharing, given our HIPAA status and those kinds of things.

And also to be good steward of data and being a pillar. these, these health systems are pillars of their community. So there's an onus on them and responsibility on them to be good stewards of that data.

Yeah. be interesting to see where this leads will the ONC look at this and say, Hey, we're gonna doll out fines, HIPAA fines, and that kinda stuff based on the information.

Or is it just gonna be. One of those things they found, they made people aware of if health systems don't remediate this in the next couple of months, I, I would assume most health systems are remediating this immediately. This is the kind of thing that people get pretty

The algebra on this was pretty clear. And I've seen this too frequently with particularly in Facebook, but others in big tech and the algebra is simple. The money they accrue, the revenue they accrue from doing activity like this greatly exceeds any sort of fines they receive from regulators. And they've been fined quite frequently from regulators. Let's be clear about this, but the algebra still works out in their favor.

Well, thing I wanna point out here is in this article alludes to there's no obvious examples of privacy violations. I'm not entirely sure about that, but okay let's think about face value. There's no, obviously privacy violations, but there have been other examples with other websites in particular. And I think one that comes to mind is patients like me.

Yes,

Who that used to be the website that was really for patients who had some sort of acute ailment, and they were able to go there and share their experiences with other patients that were like them.

And that website was also collecting data about, about their users and nothing they did was particularly untowards. They didn't violate any sort of privacy regulations, but what ended up happening is when they sold their data. To one of these aggregators who then collected data from Facebook and Google and whatever sort of feeds gave them.

Other gave them data. They found the aggregators were able to start putting the pieces of the puzzle together. So data that was all each individual sort of channel or sort of stuffed by de-identified actually got built up and they were able to. Identification. And so I don't know if the ONC has the right sort of framework and leak out legal sort of structure to understand how to find on that sort of basis.

Cause maybe they're failing close to the line, but they haven't crossed the line, but it doesn't mean that there's not a significant possibility that there's a privacy exposure coming forward.

It's interesting. about de-identified data and the use of de-identified data and I've had a data sign. I've had several data scientists on here who said that there's no such thing because you can with all the different data stacks that we have and bringing Tobe and those kinds of things on this eventually you can piece these things back together, but no, that's not right.

That's. That was a pretty broad statement, although they were pretty, pretty adamant on that physician of you gimme enough data. I'm gonna tell you exactly who this de-identified data is. And, but that's the reality. We're, there's this push and pull going on. When we talk about being more relevant to our consumers, being more relevant to our patients and really knowing who they, so it, it takes knowing who they are and then.

And then providing them information that is relevant to who they are, as opposed to just generic to who they are. And the, and so a lot of health systems are going down this path of saying, all right, we are going to start buying these data stacks. We want to be as relevant as Amazon is. When, when you go to Amazon, you're gonna get a different set of books recommended to you than I'm gonna get.

Now I understand health data is a lot more sensitive than the books I'm reading. But. With that being said, that's what we're trying to do is create that custom experience of coming in and having relevant data be delivered to me. So they're starting to buy, buy these, blocks of data that we have about our community, they're starting to piece them together.

And then they're starting to meld in the other information they have, which is the highly sensitive data, so that we can build these, these kinds of experiences. the question becomes outside of logging in and telling them. hey I'm bill Russell. Now go ahead and put all your activity to work and show me who what you want.

That almost has to be the front door. Doesn't it? Doesn't it have to be some permission based. I'm gonna tell you who I am so that you can start you can start customizing the information you're giving back to me.

I mean, I think that is that's the classic form of permission based marketing or permission based sort of customer experience.

which is yes, the moment you, allow that then you, can you have a completely different sort of construct? I think it's also worth, probably mentioning here is that when I think about those that I interact with and, the spectrum of sort of age ages of people, I interact with millennials and those are certainly are even under 30 care a lot less about privacy. They just it doesn't seem to matter them so much. So maybe the marketplace will move to a point where this sort of story becomes a non-factor to some degree or to some stage. I'm not entirely sure about that. Particularly if the broader sort of privacy implications with GDPR and, the push in this country to have something similar from a legislation sort of standpoint, whether we get there or not, it's a different story.

But it's, there is kind of the ying and yang here in terms of what is what are people's attitude towards privacy with these sort of services,

📍 📍 All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. 📍 📍

Why don't we have a GDPR at this point? I mean, when I look at this thing, I'm like, all right, the the consumer has rights has control of their data should be notified on these. It surprises me that we don't have something like this.

Do you think there's legislative appetite to do these kind of things?

Well, no, actually what I think is happening is I, think we have large lobbying groups on behalf of the organizations with money who need the data who are making sure that making sure does not happen. It does not happen. And I don't know. I'm I'd like patients to have a complete set of data rights. For sure. I'd like patients to have that. Consumers, I think should have it as well. But patients, I think should have the ability to say here's how I want my data used. Here's how I want it used for research. Here's how I want it used for sharing. I want be able to use it we should be able to do this.

It's interesting. This whole, who truly owns the data who owns the patient data is a a very interesting philosophical hotly debated topic and does actually lead us to the next story.

Right. Which is the, the Cerner Oracle story and the evolution there, and Oracle's desire to create this sort of like national patient registry again, who would own that data right. Who has the gateway to that data, different story. But anyway, I think it a very interesting sort of discussion, and I know many health systems feel, they own that data. I know some EHR feel they own that data and patients of course feel, wait a minute. , I'm a stakeholder in this discussion as.

Yeah. So the article we chose is from chili, mark research, and it's more Eucharist than humility. And it says Oracle aims too high with Cerner acquisition announcements.

By last Thursday, Oracle had closed its much anticipated acquisition of Cerner the next day, Oracle hosted a webinar to discuss third vision and intentions for Cerner and more broadly Oracle in healthcare. The big visionary picture. Was provided by none other than Larry Ellison himself, while other Oracle reps chimed in on more mundane aspects of the acquisition.

And as you said, I mean, essentially what I took from it is they, it's a data play for Oracle. Oracle sees it as a data play and they're gonna try to find different ways to, to create value out of that data. But what I've hearing from healthcare organizations and Cerner clients is, you know what, we've got a lot to fix over here on the transactional side, before you start having these aspirations over here of what we're gonna do with voice and all these really cool things that they talked about.

I think they're, they're hoping that Oracle has a, a firm grasp on. The challenges that Cerner clients are currently facing and listen to those and put some resources behind.

Yeah, I kind of see the same thing. I think broadly it's a good thing for healthcare for a couple reasons. One is epic definitely has a lead, right? When it comes into EHR sort of implementation and adoption this will, I think, strengthen Cerner and that will bring competition to the marketplace. That can't be a bad thing. Right. Now, back to this sort of hubris and humility can, Oracle solve all the ills of healthcare, probably not. And we've been here many, many times when those in big tech had these sort of grandiose visions and idea ideas about how to go solve healthcare problems and kind of quickly decided that it wasn't doable, wasn't possible and exited sort of stage left.

This probably won't happen as the N exit age left. I mean, when you buy Cerner, I mean you're firmly planting your flag in the healthcare industry sort of landscape Now can they put together a, a solution that will truly compete against epic and be a really, really viable competitor perhaps.

And that would be interesting to kind of see, I think the other part that's interesting as well is that. I mean revenue cycle management has always been a little bit of a challenge for the healthcare industry. They haven't really solved that problem. And I think Oracle's got deep expertise in that area.

So maybe the combination of sort of Oracle Oracle applications and, and cynical Cerner sort of clinical expertise can. Offer an interesting alternative there. So we'll see how that, how that plays out, but the whole grander vision about building out this sort of national patient registry and this place where. Any sort of provider or any sort of institution could tap into this one sort of database to, to access your patient record. I mean, I think that's, we're a long, long, long way from that.

What is what's wrong with you? People. And, I have since learned what was wrong with. Everyone and, now have become part of that. So they're, they're recommending a national EHR database eliminates EHR data, fragmentation doctors in an emergency can instantly access all your EHRs and public health officials can see anonymized national health data.

The challenge with this data and I, I believe we've made progress, but the challenge with this data is we have millions of data entry clerks. They are nurses. They are doctors, they are whatever, and they're, they're not great data entry clerks. We haven't done the governance around the data itself.

So you see some data means one thing, and that same data means something else to somebody else. And so the complexity of the data itself and the governance model around the data. Makes it, so it's not just a straight up tech problem, right? We're just going to take this data, do this and share it in this way.

Now we've, we've now got U S C D I we've got a lot of different initiatives coming down the pike, which are trying to normalize that data with with standards, which is going to make it a lot easier. And I think the pandemic drove some of this because when the pandemic first hit, I think we saw.

We saw how much of a problem we really had on, on not only the health system side of getting the data to the CDC and the government, but how much of a problem they had as well as the states had in receiving the data. They're like their, their systems almost failed under that. Well, they, they did for the most part fail under that pressure and had to be redesigned in the midst of the pandemic.

And so I think we've made a lot of progress there and Oracle can definitely help us to make more progress there. But I, I think the thing that rubbed a lot of health systems and health health healthcare providers, the wrong way was. My gosh, it was just a rerun of every other movie we saw where big tech came into healthcare and said, we're here to solve your problems. You guys have screwed this up for 25, 30 years. Yeah. We've got the answer. Here you go. Like, like. Like smart tech people don't exist in healthcare. We needed them to come save the day. And so that's that just rubs us the wrong way, I think.

Buffet, Amazon and maybe JPMC or a big bank.

Oh, yeah. Was chase Amazon and Berkshire sure. Pathway, which again, really smart companies. And they got into it. And. Yeah, this is, this is a problem. Not that their statements were wrong. I mean, you have Warren buffet saying that healthcare costs are a leech on the us economy and he's not wrong as it keeps going up. And we need to address that.

Not wrong and alison wasn't wrong with how he was trying to go pitch on that webinar and, and what they referenced in that article. Alison's not wrong in terms of his vision, what he thinks that the us healthcare system ought to look like. I'm just not sure he solved it.

I'm not sure he solves it way. That health system would want him to solve it. But in terms of selling or. Are presenting to us the vision of where we need to go. There's a lot of really good there.

yeah, I've analyzed a lot of the tech players and how they're thinking about and going after healthcare Because I want patient-centric interoperability. I like Apple's model the best. Although apple doesn't really have a model, they're just sort of tacking things into the apple health record over time, but it has my medical record and it has a bunch of other things associated with it as well.

But I like that. because it's patient centric. Everything else is health system centric. At the end of the day, because if you're trying to monetize the data, giving it back to the patient is not the best way to monetize the data. Because you lose control of, of the data when it goes to the patient, cuz now the patient can sell that data to whoever they want to sell it to. So

not trying to be the apple fan boy part of this Newsday segment. But I agree with you. Apple's the only vendor that has kind of compelled me to wanna store some of my health data in a kind of central repository. And I think the more, the more that happens, the more we see these sort of initiatives starting to take hold, you have to wonder how long for health, the health industry start to say we have need to find a way to incorporate that into the broader EHR.

And I love the number of health systems that have partnered with apple to get that data over there. I mean, it's it really has been a a strong move. We'll see where that goes. We're gonna close out on this. We're gonna close out on staffing and people. We have two stories here. Maybe we'll just talk about 'em in high level instead of doing the story.

So the greatest wealth transfer in history what's happening and what are the implications? Now that's an old story. I pulled that out from a long time ago. And then the other is I wanna talk about staffing in healthcare it, and specifically what people can do to get jobs in healthcare. It, so let's start with the greatest transfer of wealth in history, baby, boom generation. I said I'm. Summarize this very quickly, baby boom generation is moving on. That generation has accumulated a lot of wealth over the years. and to be honest with you, they didn't even have to do that well financially to accumulate wealth. That is that changes somebody's lifestyle if they receive it.

So, for example, if my parents who are part of the baby boom generation die and they leave me. $200,000, which is not a ton of money, but still at that given point in time, that's a lifestyle changing amount of money I could take off for the year. my spouse could take off for the year and those kind of things.

And so that's the kind of money that's a low threshold. This article talks about like 20% of people aren't handing anything to their children, but 80% are. And it's in that range to far greater than that. The other thing I will tack onto this is that during the pandemic more people died from the baby boom generation than any other generation.

We had a million deaths in the us and of that probably better than 85% were from the baby boom generation, which means that wealth transfer accelerated. during the pandemic and as a result we're hearing all this, Hey, we can't find people it's getting harder and harder to find people and those kind of things nurse shortage those, and I'm starting to sit back and go, is all this related?

Have people gotten sort of a life changing amount of money and said, you know what, we're gonna live somewhere else. And both of us don't need to work anymore. Why don't one of us stay home with the kids? And I, it, it appears to me like that wealth transfer is, is contributing to the challenge we have in getting workers. Cause I think some workers are, are changing their lifestyle, at least for the short.

Yeah, I, a hundred percent agree with that. Now it looks like we had some economic headwinds coming. Yes. And maybe pretty, pretty aggressive economic headwinds that are coming. I don't know if we can use the R word just yet, but we're probably not far away from talking about recession and those sorts of things.

And so this could all pivot really, really quickly in terms of People's desire to say, Hey, you know what? I had this life changing event. I'd inherited this great sum of money. I opted out of the workforce. I could see that changing pretty quickly. And unfortunately right now there's a critical, massive jobs available.

But that number is going down as employers either lay off or pull back some of those sort of job wrecks. So we'll see what the equilibrium is on this a quarter or two from now. I think from a healthcare standpoint, yes, staff storage is a significant problem. It's a significant problem in health.

It it's a significant of an L I T. It's a certificate problem in clinical organizations. The clinical side of the organization. We've never, my company has almost constant conversations that about some sort of service based model. And we were not having that dialogue a year ago, or certainly before that they want to provide a service now.

So that, that's definitely changing. I also think with a wealth transfer it's it might put more demands on the type of services healthcare need to provide. Right. So I think more and more patient wants to go live where they want to live, but they still wanna have access to top tier sort of healthcare.

So they're gonna want to have better, better sort of remote or telehealth sort of experiences. They might want more of the elective sort of surgeries that, you know, That comes with people who have high wealth and, and can do some of those interesting sort of things. So we'll, we'll see how this all works out, but I think there are definitely implications going forward for healthcare in the type of services they need to provide.

And if they don't provide those services, who's kind of waiting on the sidelines to go pick up that slack. Is it kind of the retailers who are dabbling in healthcare more and more. So yes, that healthcare pie might grow a little bit.

But I think there's others that are waiting there to go provide that slack if the traditional providers don't. Don't win.

Let's talk about the next generation right now. So it's June, we just had a generation of people graduate and they're saying, Hey, I wanna do something that matters. I wanna do something with my life that matters. And they're, they're looking at healthcare and they're going, Hey, I think I can, I can contribute there.

They're technically minded. In fact, this generation is digital natives, right? So they're, they're coming in. They've been on computers, their entire life. Some of 'em are, are gonna be trained. Some of 'em are not gonna be trained. When we look at healthcare, it jobs one of the things I'm hearing more and more is with some of the challenges we've had, getting people, we have health systems that are standing up the ability to train people on certain things, right?

So you can bring in a college graduate and train them to be an administrator on a lot of D a lot of different types of things within the cybersecurity world that they don't necessarily have to be cybersecurity trained. To start off in that role and they can get trained as they sort of move along. Cuz that's, that's really what college is all about.

Right? You don't come out as a cybersecurity expert. Usually you come out as a I don't know, 80% of the people come out with a degree that proves they can do the work and then we have to take them along if somebody's looking for roles within healthcare. It, but you know, what kind of roles do you think make the most sense? And you, you can focus in on cyber since that's where you're spending a lot of your.

I mean, I went to a, a VC. I live in Silicon valley, so I went to a VC discussion not long ago and very prominent VC, a very interesting state high school students, parents of high school students and maybe early college students, and basically said if you want your child to have a job post post graduation when they graduate from college, you should focus on it. Cuz there's gonna be plethora of it. Jobs. If you want your child to have a career.

They should focus on cybersecurity because we are a long way from solving that problem and there'll be a need for that, those sort of skill sets for a long way. For many, many years to come I think we need to see a gap from our EDU from our education institutions develop that, that need to plug this gap of, skill shortages in this area.

But maybe you can provide that sort of skill shortages in more technical courses that are much shorter in duration. So I don't know, you, you can get an accreditation in a course, it maybe last a year and go solves a particular challenge within cyber or, or just generally in it makes you more.

Employable in the work workplace immediately. And then you. Work with that employee to go kind of expand and develop those skill sets to take on greater responsibilities over time. I, I think there's a significant opportunity now for the enterprising educator academic institution to provide that level of curriculum and that sort of qualification program.

Interesting. So if I get my business administration degree, are, are you saying I can go I could go find some industry certifications and that kind of stuff. And then when I go to a health system, I can say, look, I have a business administration degree. I know it's business related and whatnot, but I've got these I I've got these certifications from accredited institutions. I have, I have an aptitude for cybersecurity and that'll be a good, good way to get an entry into an organization,

or yes. Or you don't go for your, your BA at all. And you seek out these sort of certifications and these kind of year long, two yearlong courses. give that cert, I said, I'm proficient in this sort of skill set for a cyber security sort of role.

Interesting. I think those, I think those sort of jobs and those sort of skill sets are greatly needed. I can't tell you how many people I talk with who have the desire to go roll out some security infrastructure within their organization. And they just can't do it from a staffing standpoint. They have the budget, they have the ability to go procure technology, but they can't do it from a staffing standpoint.

Yeah, that's, that's kinda wild and I am hearing more and more organizations drop the college required for a bunch of their entry level jobs. Because I think they're finding that college is not required.

So I don't wanna get the hate mail from, from our academic medical center saying I'm talking down on college degrees, but one of the things I talked to sushi about last week, you take away that college degree required and you actually do increase your diversity.

Because there's a whole bunch of people that just can't afford to go to college. They have to choose the two year route or something else. And so you don't wanna put up those artificial roadblocks. If the job doesn't actually require that progression at some point will require additional learning, but that's true of all of us.

That's true of all. And I think college clear is a good thing, right? But I, you, you hit the nail in the head. It's like, what does college really do for an employer? It says that this individual has the drive, the determination, the intellect, et cetera, to go master this subject. And therefore. Probably has the attributes, that'll make that individual a good employee. And hopefully what they studied will be somewhat related to the job that they're going to. And so there is some skill that can be and knowledge that can be transferred, but really you're betting on that person and their drive and determination to go see through.

This significant sort of initiative. But that's not the only way to validate that. It's a good way to validate that. It's the only, the only way to validate whether somebody's a, is a good fit for your organization. I think we probably pivoted understandably to the, well you gotta have that is just like table stakes.

Maybe not, right?

Yeah, absolutely. Ryan, I want to thank you for your time. Again, always a great conversation and appreciate you touching base With the bridge behind you telling us that you are from the beautiful state of California. I'm I'm in Florida in the summer I do miss the the cool breeze coming off the coming off the ocean there. We don't have a cool breeze down here.

So great to see you, Kim.

Good seeing you take care.

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