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February 28, 2022: Guillermo Ramas, Founder and CEO of NotiSphere, a Cedars-Sinai Accelerator success story, joins Bill for the news today. NotiSphere makes it simple to manage recall alerts and tasks in one place to prevent recalled items from ever causing harm to a patient or provider. What it’s like to be a part of the Cedars-Sinai Accelerator program? What are the top issues confronting hospitals in 2021 according to the American College of Healthcare Executives? For doctors drowning in emails, one health system’s new strategy? Pay for replies. Billionaire Mark Cuban is ready to buck healthcare's status quo with his company Mark Cuban Cost Plus Drug Co. Their sole mission is to be a low cost drug provider for as many drugs as they can possibly provide. Sometimes industries get so set in their ways that it takes someone from the outside to implement real change. 

Key Points:

00:00:00 - Intro

00:01:50 - NotiSphere is changing the way the healthcare industry communicates recalls from suppliers to providers

0:17:45 - The US pays more for meds than anybody else in the world

00:22:45 - Changing an industry fundamentally, even in one tiny area, takes time.

00:23:00 - It's not uncommon for primary care doctors to spend hours every single day sifting through emails from patients seeking medical advice

Cedars-Sinai Accelerator




Today on This Week Health.

I think that the issue is in any industry when there's a problem that affects a lot of people and that problem starts being complicated to understand or difficult to understand. And it just keeps growing and growing. And folks frustration grows. Eventually enough is enough. There's gotta be a simpler solution to this. And a lot of times, if you think about it, the answers are not complicated. They're actually simple. What's difficult is to then change everything that's already in place that's been building up over decades.

📍 📍 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 news day and I'm excited to get us going. We have a special guests here today. Cedars-Sinai Accelerator is one of our sponsors for this year and one of the things I asked them about. Is it possible to bring the companies and their founders through, to be a part of the Newsday show to get a bunch of different perspectives and they were excited about it. And so today we are joined by Guillermo Ramas, the Founder and CEO of NotiSphere. Guillermo, welcome to the show.

Hi Bill. Nice to meet you.

Looking forward to the conversation. I was kind of disappointed looking at your background. I thought that was your actual background looking at the Pacific ocean. That's a common thing for me. I'm like, are you really in Vail looking at the ski slopes and people are like, no, I'm in Vail looking at

This is a visualization technique. Basically I'm hoping that eventually this turns into reality. That's just by repetition.

That's a beautiful scene. Tell us about NotiSphere.

NotiSphere is actually changing the way the healthcare industry communicates recalls from suppliers to providers. So today, I don't know, most people are not aware of this unless you work hands-on with recalls, but medical device recalls today are communicated to hospitals and other provider organizations via paper. Believe it or not.

There's a lot, I mean, I don't want to say there's a lot of them, but it felt to me like there's a lot of them.

The number has skyrocketed over the last five, seven years. It's just incredible. That there's a couple of obvious reasons for that bill. One of them is obvious. Devices have become more complex. A lot of them include software, right? So obviously software needs updates and there's glitches and whatnot. So there's a lot of that going on. But there's also an issue with devices that get approved just based on the prior device, on the prior device being similar enough.

Right. So, so you're going to get some of that. It's actually turned into thousands, right? What used to be maybe 15 years ago, two or 300 recalls a year has now turned into 3000 or more. Right. 4000.

Right. In a system like ours. I was at St. Joe's down in your neck of the woods in Orange County. A system like ours was 16 hospitals. You almost had to have, somebody was monitoring for that, looking for that. So on the provider side, it's a significant task to determine which one of these are actually relevant to us. But then on the device manufacturer side, wouldn't that be a tool they would use as well to communicate them out?

Yeah, so, and here's, here's a fascinating thing, right? So you you're hitting it on the nail. Today providers basically spend an enormous amount of time trying to figure out if a recall alert that they've gotten in affects them or not. And the reason for that is about 15 years ago or so several solutions cropped up when there were very few recalls in the market, right.

Saying, listen, I'll just give you a feed of all of the recalls in the country and you can decide which ones are affecting you or not by looking at your history or whatever. And it'll be. Well, that was okay. Maybe. And the intention was certainly good. As the number of recalls skyrockets, that becomes an absolute burden.

So today, if you think about it, I'll give you a couple of quick stats. Any given pediatric hospital say children's of LA here, right? 95% of all of the recall alerts they receive from one of these feeds from one of these broadcasters do not apply to them at all. And the reason for that is half a lot of the recalls are batch or lot specific or serial number specific, et cetera.

And these feeds, obviously, because they're kind of broadcasting to the world, as opposed to individually telling everybody if they're affected or not means you look at everything now. Okay. So this was the reason to to make notice fear of reality, right? We basically said there's gotta be a different way to do this.

And a way to do away with the paper and do away with these feeds that are driving everybody crazy. Right. A large system like St. Joe's is probably receiving about 55% of their alerts are non-applicable. Is what we call non-applicable.

Amazing. So you went through the Accelerator. Yeah. How was that? For people who aren't familiar, the Cedars-Sinai Accelerator, essentially, they take companies that are already off the ground and they give them access to their staff and whatnot to be coaches and to help them and have meetings.

And there's a little bit of ownership and stuff that changes hands, but there's a lot of valuable information that comes in your direction. Talk about that process a little bit.

I'll tell you. I always say that I have an enormous space in my heart for Cedars-Sinai itself and for the Accelerator in particular for a couple of reasons. One of them is the companies that they select and in our year, that was 2019 out of 400 plus companies, they looked at, they picked 10 and we were one of the lucky ones.

We, at that point had a prototype. We weren't fully off the ground and operational and in production or anything like that. Right. But they had, they saw what we were trying to do. And they looked at the picture of the benefit we could provide to the end of the. And they said, okay, this is a good idea, and this is something that's needed.

And so once they, they bring you on board what's great is actually the interaction that you get with startups that are in the accelerator, plus obviously the excited readers folks experience. And more importantly, I would say is the access that they give you to the folks at Cedars-Sinai medical center.

So the fact that you could set up a meeting with Dr. Goertz, the head of surgery at Cedar Sinai and sit down and, and talk about what you're trying to do and get his perspective and his advice, or sit down with biomedical or pharmacy and just a slew of, of these meetings was phenomenal. And then on top of that that they bring you a ton load of advisors from that they curate that are folks that have gone through what you're going through that have maybe done it several times. So it's fascinating and incredibly valuable. I'm still in touch with them. In fact, we're going to Vive in Miami under their booth. So you know, nothing but absolute love for these folks.

Fantastic. Well, I will see you at the Vive conference. little known fact. I took this week in health. IT, the little company that is this This Week in Health IT through the accelerator. Darren Dworkin who isn't there any more, but he allowed me to take the company through, so I got to sit in on the meetings and the grilling and all that stuff.

It was really kind of fun. Now we didn't get accepted in this accelerator and I'm not sure that was the intention. The intention was to give us exposure to what it would look like and what it would feel like for a company. It was really fascinating from my perspective.

As we were talking about it, Darren's like, I want to give you the experience, but it makes no sense. It's like, you're going to talk to doctors about what, what you should do as a media company, but it was a great experience. All right. Let's hit the news. Well, first of all, we have ViVE and HIMSS coming up. Are you going to both or just one?

Just ViVE.

Just ViVE. Who are you hoping is going to be there? Have you seen the attendee list yet or anything like that?

I haven't gone through the whole list cause it's enormous. And I've, I've been we're pretty busy. But I'm planning on doing that over the weekend. There's a couple of different audiences that I'm hoping to, to interact with. Right? One is obviously you have other startups and technology companies that in some ways.

You're looking at the device companies, first of all, but then you're also looking at the providers. You're hoping to interact with on both sides.

Yes. Yeah. I mean, I think the key is understanding or figuring out there's actually three, if you will, three levels of it. So you have device manufacturers and other technology companies that obviously we want to talk with. Providers, for sure. We have a ton load of context with providers, but face-to-face interaction cannot be. As much as we do zoom all day long now, face-to-face, can't be beat. Right. And then there's an additional layer, which is solution providers that actually have providers as clients. And so we actually can enhance some of these solutions and we do that for free. And we do that we don't charge providers and we don't charge these solution providers because the idea is to allow for the right person to get the right alert and only that alert.

And without having to pay coz that's a matter of fairness, right. They shouldn't have to pay to be alerted. It just shouldn't happen.

Yep. Well, I'm looking forward to, I will swing by at the ViVE conference. I was talking with some people, the other. we just had a small conference down here with, with some CIO's and it was just good to see people. The people are still in 3D. The interaction is just so much more dynamic when you're face to face.

📍 📍 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. 📍 📍

We're going to head into the news. So we have Mark Cuban is ready to buck healthcare status quo. This comes to us from a Becker story. Let me give you some excerpts. So, so whether they take the form of pharmacy benefit manager PBM or spokespeople, mark Cuban cuts out middlemen.

So a billionaire investor known for owning the Mavericks and being on shark tank launched generic drug company called the Mark Cuban cost plus drug company. Talk about having what you do in the name. He's like just didn't spend a lot of money on marketing. It's just mark Cuban's cost plus drug company.

The company has expanded since then launching an online pharmacy, building a manufacturing facility and working to create its own PBM. Mark Cuban said it's not disrupting the pharmacy space to make money. In fact, it's decidedly unfocused on growing profitability for his drug company, he told Beckers in a February 21st email, he sent just 24 minutes after our inquiry was sent.

And that's the interesting thing about Mark Cuban. He reads his own email. He responds to his own email. Our sole mission is to be a low cost drug provider for as many drugs as we can provide possibly offer Mark Cuban said. The counter to most business interests, particularly over the long period of time.

The company's rejection of bureaucracy is incongruous with healthcare, goes on to say some things there. Mr. Cuban pointed to hospital price transparency. As an example, even when the federal government requires transparency health systems fail to comply. And those that do post disclosure and list that looked like something straight out of the looking less, since price transparency regulations went into effect January 1st. CMS has said about 342 warning notices to hospitals that have been found noncompliant of the rule. So it goes on to talk about what they're going to do. The mark Cuban cost plus drug was first born from a cold email. Drugs at the pharmacy are sold with a 15% markup for price, a $3 pharmacy fee to pay the pharmacist that it works with and a fee for shipping.

And Mr. Cuban says that's it. That's the market. That's the business model they're going with one more quote here. So sometimes industries get so set in their ways. So acquisitive and incestuous, or the opportunities are so big that they become the focus of private equity and other similar investors.

He said, when that happens, it takes someone from the outside and a lot of years to result in change, just look at the auto and mainframe computer industries as prime examples. All right. So Mark Cuban has to be one of your heroes as an entrepreneur. yup. I saw him at the HLTH conference get up and talk about this.

He used some expletives and whatnot, so he's sitting on the HLTH stage being interviewed and he's like, I don't understand you people. I don't understand what's going on here. Why does it cost this much for this? And why can't we tell people what it's going to cost. And, he's just, I mean, the whole audience.

Life sciences, healthcare providers, payers, and whatever, and he's laying into all of them. He's an equal opportunity. Like you, people aren't serving the communities well, because they don't know what it's going to cost for healthcare. They're not getting a fair shake. They're paying too much for pharmaceuticals. And he's like, I'm coming for you.

He'll strike everybody

and come after you people. So

But if you think about it. That is, it's a logical thing to happen. That it comes from somebody like Mark. Right. You can see the same about Musk with Tesla, right? Doing something that I think a lot of folks way at the beginning were looking at going, there's no way. How can a guy with no experience in car manufacturing show up here, come up with an electric vehicle and actually make it right.

And here we are today. So I think that the issue is in any industry where, when there's a problem that affects a lot of people and that problem starts being complicated to understand or difficult to understand. And it just keeps growing and growing. And folks frustration grows.

Eventually one of these guys says enough is enough. And there's gotta be a simpler solution to this. And a lot of times, if you think about it, the answers are not complicated. They're actually simple. What's difficult is to then change everything that's already in place that's been building up over decades.

But what he's proposing is probably a pretty simple approach that says, listen, there is no hiding prices. There is no and by the way, he's starting with pharmacy, but I'm sure he's already noodling on other things, right? I mean, if you think about it back in 2007, 2006 if you went to sourcing folks in healthcare they couldn't compare pricing for medical devices between hospitals. Right. They had gag clauses in their contracts. Right. And so how can you take cost out of an industry when you can't even do shopping properly. Right. And you can't assess if you're actually being given a good price or not. Now, today that's changed, right? It took a few years, but today that's no longer a reality. Today people can do benchmarking and do all sorts of things. And in fact, everybody does it. I think what these guys do and I, and I like the fact that not only does it take somebody with a kind of mentality of Mark Cuban or Elon Musk or others, it also takes an enormous bankroll. Right. Because as that article says, Bill, it takes somebody from the outside, but also many years to then untangle the mess that's been built up over time. So the little startups have it, a little tougher, but the guys that come with a big bankroll and have the right infrastructure to do it with the right connections, et cetera, have the ability to them put muscle behind these things. I think it's great.

Yeah, it's important to note that they're not the only ones doing this. We have Civica RX is doing this as well. So the health care providers looks at generic drugs and they're doing it. So it's not like they're the first ones. Civica has a bunch of significant health systems. I think Mayo is on it. CommonSpirit. I think HCA is a part of it as well. Providence.

I'm not gonna name them all coz I'm not gonna remember them all, but it's a combination of players that came together and said, you know what? We've, we've got to have more generics and we've got to keep the chairs from, from rising and prices as well.

So health systems are heading down this path. It's not only the entrepreneurs who you know, that the Mark Cubans who are doing this, but it's welcomed. At least from the patient perspective. It's absolutely welcome entry into the market. So we'll see where that goes.

I do think Bill to that the fact that these things are happening and you're right, I mean, there's, there's several different players. I like folks that do come with a different background because I've seen that those folks tend to ask questions that others might not come up with . The guy that's been in the same industry for a long time. I don't mean this in a negative way. It's just kind of the way the brain works. The guy that comes from outside the industry tends to ask a lot of wise, some of them are just obvious, but some might not be. And then the other thing I think with all this is the fact that all these different players are trying to change that should tell us that probably as a nation maybe at the federal level or really are, not doing enough to change the entire structure of this right.

There's a lot of that going on. I mean, we know as a country that we pay more for meds than anybody else in the world. We know that. And that's why people end up driving to Canada and there's been all of these different stories over the years and the papers. Right. I think that there is maybe this also helps lawmakers understand that there's additional things that can or should be done.

Yeah. I think they're looking at that. The price of pharmaceuticals is a very complex thing. It's not, it's easy to look at it and say, Hey, drugs costs less than Canada. They're subsidized by people paying 50% tax rates. So yeah, naturally they do cost less in Canada and they cost less than Africa than they do in the United States. Well, not because Africa is producing these drugs, it's because the US is producing these drugs and selling them at a discount in those countries from a global humanity kind of standpoint. And so it's not as simple as just pointing the finger and plus we are the R and D for a majority of these drugs around the world.

It's not. I don't find it to be as simple when, when it gets simplified to me, I sort of step back and I go, I don't think it's as simple as that. It's like when people simplify the economy and they go well, if we just lower taxes or increase taxes. Wow. You simplify driving the car to just turning the key, but there's probably six other things you need to do to get that car moving.

Absolutely. I don't, I don't mean to, I don't mean to say that the problem is simple, right? All I mean to say is people's frustration keeps growing and growing, right? And eventually that means that entrepreneur's going to say somebody needs to fix this. Now, whether they fully succeed or they end up just improving it somewhat. That's a different story writer or whether they end up realizing, well, there's several factors as the whole product marketing story is pervasive, right? You have it in every solution that comes up.

I agree with you. The entrepreneur I'm always reminded of the movie, Tucker. Did you see the movie Tucker? He tries to go in and change the automotive industry and just gets just absolutely flattened as history would tell us. And then Elon Musk goes to do it a number of years later. Why is Elon Musk successful? And by the way, people who think this analogy doesn't make sense in healthcare. I can roll out entrepreneurs that got flattened in healthcare. By health care. With good solutions and whatever because it didn't align with whatever that was going on at the time. And so why was Elon Musk able to succeed? Is it the time? Is it the environment? Is it the change of technology? He didn't succeed by building a new car.

He built a very different car than had had been out there before. One that was electric powered, fast, sexy sports car. That was the first car out of the shoe. Again, very different thinking than, than what had gone on before,

I think are the things that impacts all that is timing. When Tucker tried to do his, things probably weren't moving as fast, right. And people weren't used to change happening so rapidly. So obviously you can see it in automotive and how the models change and evolve over time. But it was a steady progression with a few spikes but, but for the most part, it wasn't this the Tesla model was a huge jump. And if you think about it, he also didn't cater to everybody. He was catering to very specific people that were early adopters that were willing to pay a premium for something that was unique. And that probably wasn't going to go far because there weren't a lot of charges at the beginning.

But at that time, I think we were already used to things that were changing rapidly. Right. Think about how often you changed your phone 20 years ago, not often, right? It wasn't something that you every year, I mean, today, an iPhone holder is basically every year swapping it for the new model. Or every other year. We've grown accustomed now to accept the fact that things are going to change rapidly. And in fact, we get disappointed if the new iPhone is not coming up with great things that are different. So, so I think that has to do a lot with it.

Yeah. It's a, it's interesting. So when this airs, I will have done the webinar, but I'm doing a webinar tomorrow to health systems that have taken Epic to Azure. So Epic, not running on prem. Production actually running an Azure. And this isn't Epic hosted. This is Epic in the cloud on Azure. And it's interesting as I was talking to them prior to the webinar, the question was how long did it take? And they said, you know our instance probably will take twice as long as what the next one will take, because we had to get everyone comfortable with it.

We were moving the EHR to the cloud. We had to get epic, comfortable with it. We had to work through a bunch of stuff and they said, so it did take us good, better part of two to three years. And people who think Tesla was an overnight success. They have to remember that Tesla took whatever that car was. I forgot what

The first one. The Roadster that they did.

Yeah the Roadster. They took that car and they had like five or six years of research that they were doing before they were ready to do what felt like an overnight success. It was anything but an overnight success. Fundamentally changing an industry, even in one little area, it takes time.

It takes a lot of communication. It takes some luck. And so there's a lot of stuff that goes into it. All right. Let's hit another story. Talking about changing things. Doctors drowning in emails. One health systems new strategy is to pay for replies. Let me give you a little context on this. It's not uncommon for primary care doctors, Maria Byron, to spend hours every single day or every single week sifting through emails from patients seeking their medical advice.

These messages might contain medication questions or completely new concerns patients didn't mention during face-to-face visits. And while the university of California, San Francisco UCF where Byron practices has seen volume surge from a few hundred thousand such emails in 2016 to about 2 million in 2021.

She and other clinicians typically haven't been paid for answering them. It's become sort of a, an extra thing that physicians are expected to do I guess. That's why she's leading a novel experience at UCF to let clinicians bill insurers for certain medical correspondence. It's partly to assuage the burnout caused by all the unpaid tasks on a clinician's plate, but it's also intended to give clinicians an incentive to spend chunks of their workday on email. A modality patients are increasingly comfortable with. Imagine being sent 50 emails a day, all asking for your advice, but having a packed schedule without any time to answer them. Tim, Justin a UCSF hospital medicine and urgent care physician who studied patient's response to electronic communication said in an email, that's how most doctors feel every day.

And so since November doctors, nurses, practitioners, physician assistants, and a handful of other UCF clinicians have been able to bill payers for patient emails that require medical evaluation, or more than a few minutes to respond. Which is interesting. The move follows pandemic era policy from CMS, which did something similar.

Part of the comments here is if it's not valued and recognized via any payment, it's very difficult for healthcare organizations to move email into this sort of daytime activity Byron said. It's interesting when we look at the modalities, the way people want to communicate. It doesn't have to be sophisticated. It doesn't have to be a portal. A lot of people just want to text back or they want an email back from their healthcare provider or the system. Information on an appointment, information on stuff. A text will work and an email will work as well because that's how most of us communicate all day, right. It's pretty ubiquitous. What are your thoughts as you hear this?

I think I mean, I have to say that I actually am a user of messaging through MyChart with my PCP and I love it. Right. Because if I have a quick question, the thought of not being able to send that message where I can get a response by the end of the day versus having to schedule an appointment, wait a week or two show up, ask one question and then having lost an hour and a half then go on about my life. Doesn't make much sense. On the other hand, obviously. I thin what you're getting is caregivers are getting, their schedules are busy, right? I mean, it's not easy to get seen even by your PCP today. Certainly not on the same day, unless you're having something

Same day, that's a phenomenal health system.

It's almost, I mean but honestly, I, so I think you do have the issue of confidentiality and keeping the information safe and that's where things like texting and email get a little bit tricky. Portals help now. So for me, the portals worked fine. I always tend to think about what happens when the patient's older and doesn't manage the electronic means all that great. So a text or an email might work for them. But maybe managing portals now becomes a little bit harder, right? A little bit more challenging. So we have to keep that in mind. But I do think that this kind of communication might allow the same physician to, to take care of many more patients. Right. Then having a line of people waiting in the office. They should be rewarded somehow. Right? Maybe there's a, there's a way to quantify how much time these emails are taking, or I don't know. But it's certainly something that will improve the quality received by the patient at the end of the day.

But, we have to be cognizant of workflow, right. At all times. So whenever we're talking about clinicians, because the next story we're going to talk about is the clinician shortage. When you think about it, they're not going to have 16 windows open on their thing and go, all right, I'm in the EHR. And then go over here and check their text messages, then go over here. Even if a HIPAA compliant texting solution and then go to email and check that for what it needs to be checked for.

We were always tasked with how do you bring it into their inbox and their inbox that they're in most of the day is the EHR. So if they're getting emails, they want that email to be identified. And then routed into their inbox on the EHR so they can stay in their EHR just about all day. We can customize that EHR experience to what, how they practice or maybe their, their specialty in those kinds of things.

And so they can, they can stay in there all day. And see things as they're coming across, maybe respond to your requests about some sort of medication during the middle of the day, because they're there in that same thing that they don't have to do context switching. Context switching is a killer for productivity. If they have to go from one tool to a different tool, to a different tools. So it's interesting to me. I mean, clearly there's some challenges with this. You could end up with some fraud and those kinds of things, but I'd like it because healthcare is trying to meet me where I'm at. Right. It's trying to, it's trying to meet the consumer where we're at.

There's also a couple of things that will probably happen over time. Right. So today I know for example, that my care team. It's not my PCP reading, every email that comes in, right. He's got some folks in his team that are reading and filtering them and deciding which ones that doc really needs to read versus the ones that can be answered by a nurse or somebody else. I think that'll evolve with a little bit of AI so that the machine and the algorithms tell you when something is urgent or, or a little bit more urgent. And what can wait. So today they're actually relying on the patient to qualify those initially, right? You get from a dropdown you're selecting is this a non-urgent medical question or is this a refill, a prescription refill type thing, et cetera? I think those things will flow a little easier over time where at the end the routing will happen. you know Will be done by algorithms. And the four or five that are truly serious will be put in front of the doctor right away. And the other ones will just be taken care of by a team, a triage team of some sort.

I'm getting more and more excited about what AI can do and the combination of NLP AI determine what messages are really about. Direct them into the right location. So I think there's, there's some neat technologies coming down the pike.

Let's talk about the top issues. So Guillermo, this is probably not going to come as a surprise to you being in this space, but I think some people might come as a surprise. If they're listening to this show, it's not a surprise cause we've talked about it several times. So top issues confronting hospitals in 2021.

So ACHE American college of health executives did their annual survey send it out to a couple thousand, maybe 1300 hospital CEOs. And they got 310 responses. About 23% response rate. And they asked them what are the top issues confronting healthcare?

And for the first time, since 2004, we have a new leader. The leader has always been financial challenges. Since 2004 has been the number one issue. And so the new leader is personnel shortages of all types, including physicians. So the clinician shortage is a significant, but that's not it. I mean, it's across the board.

I mean, there's shortages in IT. In certain areas and technicians and other things across sports. So that was number one. Two financial challenges. Three, patients safety and quality. Four, behavioral health addiction issues. Number five government mandates. And it goes on from there. And I think it's all the usual things from there.

So personnel shortages, let me give you a lot more detail. So personnel shortages, they're most worried about RNs. 94% of those who responded, said a shortage in registered nurses, technicians, medical technicians, with some majority therapists, primary care physicians, physician specialists. So these are some of the areas that we're running a little short on people.

And they're just feeling a significant burden on staff in general. That doesn't come as a surprise to you does it?

No, no. I think given what we've been through over the last two years, there's, there's certainly probably a correlation now. So if you look at nurses, I guess the one thing that jumps to mind.

There's always been this discussion about nurse pay and these kinds of things. And now you've got a lot more traveling nurses, right? So nurses have this decided, well, I'll travel, I'll be a traveling nurse. I'll make more. But that has a consequence, right. Which has now the hospital basically is paying more for traveling nurses because they can't find local ones.

Yeah. So the local nurses, I love that point. I mean the local nurses leave and they were making standard wage and then they sent them to be a traveling nurse and they go over here and by the way, where they just went those nurses left and became traveling nurses went over here. That's it? So now there's wage inflation in both places.

So in essence and as these things take a little bit of time to settle, right? So for a while in the short term, what you have is a difficulty finding because you're not just automatically pulling a switch and saying, let's just switch to traveling nurses. That happens when you realize that you have an inability to find local ones.

That's probably part of the issue with that concern today. I think the other one that we obviously all can relate to is the burnout of folks in healthcare after the last two years. And if you tie that to the, what they're calling, the great resignation, where we have millions of people retiring that in the short term will also create pressure, right? Because in the short term, folks that you assumed were going to be in their seat for awhile still aredeciding I'm done with this and I'm going fishing. So all of that is definitely going to create pressure on a hospital, considering personnel is the number one expense in a healthcare organization.

I agree. We're hearing that everywhere that hospitals are under pressure especially through wage inflation. And again, it is what it is. We just had a significant upheaval within the industry. And I agree with you. It will take some time to settle. I noted two things technology can do with regard to the on my Today show last week. And that was, first computer vision is creating some really interesting clinical automation opportunities for us. And I did a show with Artisight as well, and that's just really interesting technology and the stuff that they're doing, I've just placing run to the middle of cameras location, and then filtering that that image through AI to identify things that are going on.

Again, great great technology to take some of the mundane burden off of the clinicians. And then the second is we have these process automation tools, UI path, and Olive AI and others that are doing some really interesting things in that space. So. If people are wondering are we just going to chat about whatever?

There are things that I think IT is going to be asked to do, not the least of which is stop putting projects and technology out there that isn't really well thought out for the burden it's putting on the clinician. It needs to, if anything takes burden off, instead of traditionally, we've put it out there and said, well, just adopt the technology and yeah, we'll optimize it as we go. I think we need to really consider how to optimize before we even send it out.

Those that you're mentioning are very interesting, right? Because you do see these cases now where algorithms can detect cancer and images, for example, much more accurately than, than a physician or oncologist. And obviously that that's not a negative thing towards the oncologist. It's just the robot is the robot.. It can process so many points of information simultaneously, right. And in a split seconds that it can go over an image and just dissect it so greatly that it'll look at stuff that any of us would just wouldn't even notice.

So in those cases, I think the key then is how do you use that technology or how do you work it into the workflow in such a way that it frees up time from clinicians? Right? I think that's kind of the, in a point what you're making. Just throwing in the technology because it's cool.

If that's going to turn into a headache for a physician, cause that now needs to change his entire workflow and do more in a way. It won't help. That won't help. So there's a lot of that. And I think that also goes with patient safety as well. When you think about it.

I think when people hear about patients safety they're thinking about the more traditional way of thinking about it, which is making sure that every caregiver washes his or her hands and those kind of things. We follow protocol, but in reality, what happens is when you change workflows maybe the care that the patient receives starts being different.

Or it takes longer, or so there's other things that I know are there's many efforts being done.I I would point out Bill that there's also an additional aspect of all this, which is what I call the non-sexy part of healthcare. So there's a lot of underpinnings that make a hospital work that should be technology-based. And that have direct impact on patient care. And yet those haven't traditionally necessarily always gotten the attention from the C-suite . Or even from the doctors, believe it or not, like they just assume things work. Somebody is taking care of. But those tend to be the ones that then don't get the funding and the budget. They get pushed back.

And so things keep kind of inching along. People kick the can down the road. And then one day you are sitting there wondering why something hasn't been changed in decades. Right. And there's always something sexy and shinier that gets people's attention.

It's interesting you bring that up because one of the findings as I look at this study, which I find interesting, it talks about the financial issues. And it goes through a handful of them. Reducing operating costs, increased costs of staff, Medicaid, reimbursement.

But if you scroll all the way down to the bottom of the list, moving away from fee for service, it's the bottom one. And where's fee for value, the transition from volume to value. It's not far from that bottom one either. It's not that they are priorities for health systems. Right. It's just that there are every year, it always seems like something else gets above it.

And so that's the kind of thing that's this is why we feel like, Hey, we're always talking about this being a priority, but it never gets done. It's because you know for two years, it was the pandemic. And now it's a staffing thing. And you know what, it's going to be soemthing else next year, it's something else the year after that. We just don't make progress on the things that are number seven, eight, and nine on our list.

They just stay there. I mean, I'll tell you, especially like related to what we do at NotiSphere, that's one of the things, right. When I started getting the idea to tackle this problem at first, I didn't even, I couldn't believe what I was seeing. Right. I started asking questions and I was going well, when did this process start? When was the last time it changed and the answer was it hasn't since 1976.

Did you come in from outside of healthcare?

Interestingly I have a degree in business. Business administration. I came to the US from Spain in 1996 and I was working in accounting. I was an accountant. And eventually I picked up a job as a consultant, implementing ERP systems in healthcare. In hospitals. Right. In health systems. So I don't have a healthcare background. What I did and just by chance is the module that I started installing one day was purchasing for this ERP system. And then I just started, I like the deconstructing problems and just finding solutions and then just digging into it. And so I've now spent 26 years in supply chain, healthcare and technology. Right.

And that's, that's what I find people who come in from outside. You said it earlier, you said it before, but when you come in from the outside, do you just ask questions?

You just look at it and go, wow, really? We haven't changed this process since then. I'll bet you, there's an opportunity to make this process better if we haven't changed it in 40 or 50 years.

And it's crazy because you then start asking why hasn't it changed. What's the issue? And in our case, it was actually fascinating to dig into it and find out because I'm looking at suppliers and providers and going, okay, you guys deal with stuff all the time.

You communicate. You can buy stuff from each other, right. So clearly you're in contact yet why isn't this communication solved? And what you find is it's actually all about people. And I don't mean that as in people not doing what they need to do by any means, what I'm saying is there are different audiences and in some cases they're siloed based on obvious, logical reasons, but that impedes other things from happening and other communications enabling transparency. What's fascinating to me though, is that as you're saying, we know that this has been an issue for quite a few years. Maybe it wasn't an issue 20 years ago when there were a handful of recalls a year today, we, we definitely know there's thousands.

And so the noise of frustration and anger has been great. But it's still something that you sit there looking and you go, okay, so we're all screaming, but where's the solution. And that's why I decided to do this. I think that that same model can be applied to a lot of areas. Right. So I deal with it in supply chain, but I think there's other areas as well, where you look and you go these things have been here for a long time and people complained, but you're right.

They don't ever, by the time they go to a budget discussion at a hospital or elsewhere they tend to go, well, maybe next year. Cause right now we're going to do these five. There's always the top 5.

There's always something in front of it. Just out of curiosity, do you have a 5G phone?

I do. I do. Yep.

Are we seeing more 5G devices in healthcare, do you think or are we still a little ways off for that?

I think interestingly, I get the impression, this is now just depending more on the individual person and their willingness to go and buy themselves a phone. So what you get is a lot of companies and a lot of organizations that are saying, bring your own device as long as you can conform to let us provision it and do all other things. I haven't seen this widespread move around organizations saying we're going to push this to the staff.

I agree. One of the things I'm saying about, there's an article here on 5G. I'll cover it on the Today show. But one of the things I've been saying about 5G is just like 4G, it takes a couple of years to sort of take off. Then we have some killer apps that serve to start to pop up there. And we say we need this kind of bandwidth. And 5G becomes prevalent across the board.

But you have Eric Schmidt, former CEO of Google and a Harvard professor wrote an article about how the US is being left behind on the 5G race. And part of me as I look at healthcare, very few health systems are saying, look, I'm all in on 5G because I'm not even sure what that means yet.

And I'm not sure the technology's there yet. I mean, you have to have so many repeaters and so many things. I'm glad I have it on my phone. I'm not sure I use it ever on my phone. Like I don't look down and say, oh, darn. I'm not, I'm not on 5G. It's not going to be a good phone call.

I do think that part of the reason probably there hasn't been this enormous push is also, if you remember when 5G started being talked about by the carriers here in the US, there was a lot of talk as well about, well, they're saying 5G, but it's not really 5G. And it's a different flavor of 5G. That's not as powerful as the European 5G and yada yada yada. Right. And so what ends up happening is people start getting doubtful as to do I go and make any kind of huge investment on this right now, or do I wait until the dust settles?

And I know exactly what I'm getting. I do agree we need it, right. I mean, how many households have a landline now?

Yeah, no, that's that, that is absolutely. In fact, I mean, that's probably one of the words that's going to go by the wayside. Landline. People are going to be like, what are you talking about?

I'll tell you what. I suffered this. I was at a volleyball tournament in Vegas this week and from one of my daughters and my iPhone, I guess tried doing an update while I was sleeping and it failed. And it got bricked for I was able to recoup it after an hour of trying, but for an hour, I was thinking I'm kind of dead in the water now because I don't have a rental car. I'm using Uber to move over where obviously I call Uber from my phone and I started realizing all of the things I do with my phone that required me. My boarding passes my this, my that, and I thought there's an enormous amount of information that's flowing through our phones today, more than we even realize it I think. We always tend to think about bandwidth when we're watching Netflix but that's not it right. We're doing a lot of other things too.

Yeah, you got to get to those things. And by the way, to your point China's median download speed over 5G is essentially 300 megabits per second. In the third quarter of 2021, the US median download speed on 5G was 93 megabits per second.

So you're talking about a third the bandwidth that they're seeing in China, and that's part of what they're pointing out. They're saying, look, other countries are going to get to this level of bandwidth that's pervasive across the spectrum and in the US we're going to be well behind on that.

That may or may not be true, to be honest with you. There's leapfrogging that can occur and whatnot, but we're out of time. Guillermo. This has been fantastic. I appreciate the time. And I look forward to catching up with you at ViVE.

Bill. I really enjoyed it. And it's a pleasure to be here with you 📍 today.

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