This Week Health

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March 22, 2021: Why is healthcare still about a decade behind? How can we start taking advantage of the cloud to get more flexibility and agility? How can we create faster, better and stronger consumer first workflows? Vik Nagjee, Director of Healthcare & Life Sciences for Sirius joins Bill for the news. Grand Rounds and Doctor on Demand have merged. Banner Health posted a 19% drop in net income last year. Michigan Medicine is moving forward with a billion dollar hospital. Amazon Care launched in 50 States for their employees. Plus the amazing platform Health Share, the impact of IRIS, robotic process automation pilots and the challenges of 5G.

Key Points:

  • The veto culture in healthcare is very challenging [00:06:53
  • What is the impact of IRIS to a health system? [00:10:25
  • Banner has an amazing M and A strategy. They’re super fast. They're super precise. Clinical precision. Surgical precision. [00:24:55
  • Amazon Care is essentially a concierge level service for employees for an employer program. [00:26:40
  • Silicon Valley still barely understand healthcare [00:29:55
  • Coopertition with big tech is what is going to win [00:31:05
  • Transcarent are applying the Livongo playbook to the employer-sponsored healthcare system [00:31:35
  • There’s a whole new art and science around the patient room of the future [00:37:35



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 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former Healthcare 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.

We set a goal for our show and one of those goals for this year is to grow our YouTube followers. Uh, we have about 600 plus. Followers today on our YouTube channel. Why You might ask because not only do we produce this show in video format, but we also produce four short video clips from each show that we do.

If you subscribe, you'll be notified when they go live. We produce, produce those clips just for you, the busy health IT professionals. So go ahead and check that out. Uh, we also launched today in Health It a weekday daily show that is on today in health We look at one story each day and try to keep it to about 10 minutes or less.

So it's really digestible. This is a great way for you to stay current. It's a great way for your team to stay current. In fact, if I were ACIO today, uh, I would have all my staff listening to today in health it so we could discuss it, you know, agree with the content, disagree with the content. It is still a great way to get the conversation started, so check that out as well.

I ran into someone and they were asking me about my show. They are a new masters in Health Administration student, and we started having a conversation and I said, you know, we've recorded about 350 of these shows, and he was shocked. He asked me who I'd spoken with and I said, oh, you know, just CEOs of Providence and of Jefferson Health and CIOs from Cedar-Sinai Mayo.

Clinic, Cleveland Clinic, and just all these phenomenal organizations, all this phenomenal content. And he was just dumbfounded. He is like, I don't know how I'm gonna find time to listen to all these, all these episodes that I have so much to learn. And that was such an exciting, uh, moment for me to have that conversation with somebody to realize we have built up such a great amount of content that you can learn from and your team can learn from.

And we did the Covid series. We did so many great things, talked to so many . The brilliant people who are actively working in healthcare, in health, it addressing the biggest challenges that we have to face. We have all of those out on our website, obviously, and we've, we've put a search in there. Makes it very easy to find things.

All the stuff is curated really well. You can go out onto YouTube as well. You can actually pick out some episodes, share it with your team, have a conversation around those things. So we hope you'll take advantage of our website. Take advantage of our YouTube channel as well. Now onto today's show. Today we're joined by Vic Naje, CTO, extraordinary for Sirius Healthcare.

I know that's not your title, but I just wanted to say good morning, Vic. Welcome to the show. Good morning, bill. Thank you. Well, the reason I say CTO extraordinaire is 'cause I, I love having these conversations with you 'cause we, we get to nerd out a little bit and, and you're at a different level with the technology than most.

So I, I love, I love these conversations. You know, we've run into each other a bunch, but this is the first time that it's just you and I on the line sitting down and having a conversation. What, what, what have you been up to these days? Cloud believe it or believe it or not. That's something that I've been spending most of my energies on these days is, you know, healthcare organizations are starting now, finally, to start getting into this, this rhythm of, Hey, we really want to do cloud, want to embrace it.

And so trying to get these organizations sort of on a, on a roadmap and path strategically to get there is really what I've been focusing on. Also been doing a few other things, but that's mostly . What have been focusing on. Well, that's fantastic. I'm not gonna shame anyone because, you know, it's, it's, it's, I'm just happy they're at the party at this point.

But my gosh, I mean, we, we were doing some of this in, in 2012, and when we started doing it. Other industries have been doing it for a decade. So , that, that would indicate that healthcare is still running at about a decade behind. Yeah. I mean that a decade behind is, uh, putting it nicely. Right. I usually say like somewhere in 25 and 30 years behind.

But is that, is that just because of the complexity of the operation, the workflow, the data, the, the, the systems you. To move all these moving parts. Is that, is that why we still maintain about a, a a, about a decade behind? I've, I have my theory, so I'm, I'm curious what yours are. Yeah, I think that there's a, a bunch of things.

I think it's very incestuous, you know, they, the applications are all foundational, AKA, you know, older generation applications. That were typically built fit for purpose, for specific things. They were not born in the cloud era. They are very, very, they are, they require very specific care and feeding and, and then you couple operations onto that.

So you, the organization has grown in maturity over the years by creating the best in class operations and day two operations that they can. Given the circumstances. So decoupling that and getting into a cloud operating model just for the day two operations pieces is like a huge lift, right? And then you start thinking about, yeah, how do I actually take and do some.

You can't just take an application and, you know, lift and shift it. I mean, you can, it would be a really bad idea to do that from a cost and, you know, scalability and performance standpoint. But just in general, like these applications were not created for the cloud and the operational models that . That healthcare organizations have weren't born in the cloud.

So there's two big things that stand in the way. So the idea is like, how do you actually start taking advantage of things in the cloud to get you flexibility and also demonstrate that if you do this in the correct way, you will actually come out ahead both financially. And from an agility standpoint.

So you'll be able to start doing things a lot better, faster, stronger, and start be, you know, get back into this whole consumer first thing that everybody's going after, rather than just focusing on keeping the lights on. So it's a, it's a journey. It's gonna take a long time to do that. Yeah. But we're on our way.

Yeah. It's, it's interesting.

there's a, there's a veto culture in, in healthcare, right? You could be running down a path and just have one or two people not be on board with something and months, if not over a year or so. Specific project. So that veto culture is, is very challenging. Very few health systems are top down. I mean, there's a handful of them that are, are pretty top down and, and you know, uh, Kaiser's one of those where it's, it's more top down than most.

And you know, so you, you have that veto culture. I think the, you know, the, I think the complexity is part of it. The amount of data, amount of systems.

Then you have, you always have the financials, you know, follow the money. Where's, you know, where, who is?

And there's very strong incumbents that are not moving very quickly. I'll leave it at that. I'm a little tired today. I, I feel like I gave birth last night or as close as I can come to giving birth. I, I pulled my first all-nighter, I think since college, for heaven's sake. And so I, I'm, I'm not gonna be as sharp as I usually am.

When's the last time you pulled an all nighter outta curiosity?

It's been a while. . I think that, I think I literally, well, for, for work purposes or personal purposes, , I guess those are two different things. How about, how about when we stick with work purposes? This is recorded, so this is gonna go down in posterity, I guess. Yeah, yeah. No, I, I think that both of those were related and combined.

I think it was actually March. 13th? No, let's see. March 15th, 2010. So that my, my son was born on the 16th and I just had to get there. I was working in InterSystems at the time, and we were just about to launch this new feature called Mirroring, which everybody uses these days for replication purposes.

You know, epic is built on the InterSystems cache platform, and we were about to launch that. We had our big users group meeting and of course I couldn't go 'cause my wife was due somewhere in that time, but I had to prepare all the materials and, and the presentations and the press release and everything else.

So that's the last time I believe I pulled subs, you know, several aligners in a row. So it's been a while. That's, that's brutal. I, we, we, we launched our new website last night and we were doing testing into the wee hours of the morning. So you're, you're looking at somebody who's going on about 30 minutes sleep.

So this is gonna be fun. We got a lot of interesting stories. Grand rounds and Dr. On Demand have merged. Banner Health posted at 19% drop in net income last year. Michigan Medicine's moving forward with a billion dollar hospital. Obviously the big story. Amazon Care launched in 50 states for their employees.

Bunch of stuff on testing and vaccine. $10 billion for schools for testing. Walmart's gonna launch digital records recipients. See anything else exciting in there? A vaccine credentials is gonna continue to be a hot topic. I, you know, I jokingly say to people that it's, we're getting to the point where it's gonna be, show me your papers to get on an airplane and go to events and those kind of things.

And healthcare has not disappointed. I'm seeing articles from.

We are gonna have to show our papers to do things, but none of that really sets up the conversation I'd like to have with you. You do have ACTO type background, and I, I'd like to, I'd like to hit on a few topics with you before we go into the stories. Uh, let's talk IRIS a little bit. What, what is, what's the impact of IRIS to a system at It's a significant change.

On the Epic platform, what, what whatcha seeing and what, what do you think it means? Yeah, so interestingly enough, I was actually at InterSystems when IRIS was in its, uh, dream infancy state. It was, there were, it was referred to as a code name at the time. IRIS wasn't really a, a name yet. Uh, so I was part of a lot of the initial discussions and, you know, the things that I will tell you is that

Yes, it's a different platform. It's built on top of the same engine that Cache is, was built on. It's. Better and it's faster, it's more scalable. There's a lot of features that have been added to it Operationally, InterSystems and Epic have both done a really good job, I think, in terms of helping customers be able to make.

That switch from cache to IRIS. So think about, you know, the, again, coming back to the day two operations, like there's scripts that folks have, like the database administrators have, the storage folks have, et cetera, that leverage features and functions exposed via APIs, uh, inside of cachet. Those all need to be updated to reflect now the new command set and the new API.

So InterSystems has created sort of a translation tool to allow folks to be able to port those scripts over, et cetera. You know, those sorts of things. And then, you know, we layer on automation orchestration on top of that. And things become a lot easier to migrate, but here's where it gets a little bit interesting, right?

The operational model aside, I think it's about the financial model and what it actually helps you decide to do, which can actually be a good thing or not a good thing, right? So previously, prior to IRAs. Healthcare organizations that were running on Epic were, you know, had multiple choices in terms of the platforms to pick.

And I'm talking about several years ago now. There's not that many choices. So it could be h hp ux, it could be Solaris right from Sun. It could be I-B-M-A-I-X. It could be, you know, there were, there were, uh, uh, a bunch of other platforms and systems out there and, and you know, it's whittled, it's been whittled down now, so it's AIX.

Red Hat on X 86 virtualized on top of VMware are their two choices, uh, on premises that, that that customers can run. But essentially it was more economical for a client to pick a particular platform and get a platform specific license. So it was like, okay, I'm gonna run on IX. That's great. To change from one platform to another was a huge financial lift for the organization.

So they would have to pay a relicensing fee, et cetera, et cetera. So there was a lot of financial implications and we're talking big, big dollars here. We're not talking some small, you know. 5%, et cetera. It was a big one-time fee that you would have to incur to change platforms. When IRIS came along, one of the things that InterSystems did, and then they subsequently did this with that big, was they gave their clients the ability to be able to switch platforms for a much lower barrier of entry.

So you still had to pay a little bit of a an an uptick, but that was an uptick. For the feature set from Cache to IRIS. So it's not really a re-platforming fee. It's a new platform fee, if you will. But what that actually allows you to do is it allows you to go down the route of being able to switch platforms if you decide, so what we're seeing in the industry now is that folks that have been running on IBM Power on AIX.

Now for the first time, have the opportunity to consider moving to X 86 Red Hat virtualized on VMware. And there's a lot of buzz about that. So there's a lot of people talking about it, et cetera. I don't have statistics in terms of, you know, how many folks are looking to re-platform, but I do have statistics around

When Epic first introduced X 86, red Hat virtualized and VMware, the number of configurations that were being requested. Net new by net new customers coming on board, starting probably about, so let's call it seven, eight years ago. I think 95% plus. We're on that configuration rather than on AIX. So the number of clients that are running on X 86 virtualized on VMware, leveraging Red Hat and VMware for virtualization is significant.

So people are looking and considering the options to move. So when they do that. The biggest challenge that they then have is to figure out how to take the operational pieces that they have built and all the resiliency that they've built on the power HA platform, on the power platform and my, and port that over.

And so that's where folks are starting to run into, Hmm, what does this really mean? How do I build the resiliency? What does my total cost of ownership look like? How do I actually go and build out the operational capabilities, et cetera. That's where we're getting into conversations with clients. So it's not just about a re-platforming from one to the other.

'cause there's technical stuff too, right? You're going from a big Indian system to a little Indian system. So you have to do a conversion of the actual database. And again, InterSystems and Epic makes that very easy to be able to do that. But there's, you know, those considerations as well. So I think in SumTotal it's a good thing that's happening and it gives folks choices, but you have to go about it in a methodical fashion.

Let me, let me ask you this. 'cause it's, it's, it's interesting. So I, while we, while we're hanging out here, I decided to get on their, their website and look at some of the marketing stuff that they have around IRIS. And it, it's, it's, it looks like a truly cloud-based architecture. And if. Epic has been able to replatform on top of IRIS, which is gonna give them the ability to do all sorts of things like plug into some of these, some of these advanced technologies like, like AI in the cloud and, and machine learning and, and whatnot.

It, it, it takes their game up in terms of. Data ingestion and automation around those kinds of things. It, it, and again, from an architecture standpoint, it looks like it gives you a ton of flexibility in, in terms of how you would architect your environment for, you know, high availability, disaster recovery, and.

And, you know, I'm not asking, I mean, you obviously worked pretty closely with some of this stuff. I'm not asking you to speak outta school, but I'm, I, I, I'm sort of curious is, am, am I reading this right? Is that the intention? And, and I realize that the intention and what actually happens in the real world have sort of a, a distance between them.

But is that the intention that we're gonna replatform by getting on top of, and.

New architecture. So I, the short answer is no. Let me, , let me, let me now give you the longer answer. Are you telling me I'm wrong? But, no, that's great. I wanna know why I, I'm just, I'm just telling you that, that there's a different way to look at it. That's all the, so let's back up to cache in cache version five.

Which was like 2003, 2000, 2002, 2003, right in our system. Somewhere around that, around that time, introduced a whole bunch of features into cachet, which was sort of now starting to deviate away from ANSI and turn into true InterSystems cachet and. Since that time, there have been multiple features that have been added to cachet.

And again, I'm talking about cachet, IRIS, and I'll build on this in a second, that Epic has determined that they do not want to take advantage of. And so they, they continue down the very sort of antsy moms approach for, you know, multiple reasons. So they've not taken advantage of a lot of these different features.

However, what they have taken advantage of and have been really, really good at taking advantage of and pushing the envelope on are the performance, the scalability. The reliability and the availability. So the Raz features that Cachet InterSystems has introduced over the years, this has allowed, you know, when I first started at InterSystems in 2008, epic could scale to probably about on a single server, probably about 12 or 14 cores on a single server.

When I left. To go back to, they were able to scale up to 256 cores. Wow, that Yeah, that's, that's a lot. Right? And that was all on the basis of in intense changes that were made to the kernel, to, to the core database, et cetera. And, and then Epic had to make changes to their application too. So it was kind of like a, a, a partnership, right?

So we worked very, very closely together. So those features, epic has taken great advantage of. Let's fast forward to IRIS. So the same platform. Continues on in IS and IS has a whole bunch of additional features, like it just rattled off from the website, which reminds me I need to go and check in on, on what the features are in IRIS , because it's been a while since I've looked at it.

But essentially the, there's one additional performance and scalability related feature, which will allow Epic to scale even further. In fact, be able to support larger clients in a more single system architecture than a distributed architecture that they have right now. So it's gonna add simplicity for the clients.

But beyond that, I think that because a significant portion of Epic's application runs on the client side. It's about, it's about, you know, 50 50, 60 40, something like that, server client split, if you will. There's not that many features that you just described that would be applicable to the Epic application, despite the fact that IRIS makes this available.

So, short answer was no long answer. Hopefully kind of made sense. That's interesting. We were on their, I think the platform.

To pull in all these disparate data sources. It was ensemble and then it got renamed into health share there. It's ensemble. That's right. And so we, we were pulling all that data in. I would imagine that platform can really take advantage of IRIS, I would say. Absolutely. Absolutely. That's all on IRIS. That was all built on cachet and now is built on IRIS.

That platform is incredible. So if you actually look at any of the Rios or any of the HIEs that exist out there. Vast majority of them around the world, not just in the us, around the world. They, they're powered by health share, so incredible platform and does some really amazing things. Well, and and I think those, I mean, for us, we were looking at it going, all right, we, in Southern California, we couldn't employ all the doctors, so we had to create a clinically integrated network across a, essentially we, our.

The data, and we had to build quality metrics and performance metrics across a lot of disparate EHRs. I would think any organization that's looking at an m and a type strategy, th that makes sense. But I see a lot of health systems taking the other approach, which is to essentially say, all right, we're gonna merge.

We're gonna get everybody on Epic, or we're gonna get everybody on Cerner, or we're gonna get everybody on, fill in the blank. Whatever the system is. Not that that's a bad strategy. I just think the, it, it's, it's interesting 'cause you can get to the same level of integration without doing the migration.

And you really have two camps here. You have the, we're all gonna be on the same ER and if you can afford it and you do, you should do it. But then you have this camp like the thec. Essentially said, look, we, we have a hundred, a hundred hospitals. They're all on different EHRs and even if they're not on different EHRs, they're on different builds and different data and whatnot.

And so they went the Google route, which is give all of our data to Google, and that was highly publicized. I can't believe they did a kind of stuff, but I understand.

Which, which overlays onto all these disparity EHRs and gives them a common clinical record across all 100 hospitals. And so that's a, that's a different path that some, some people might take. What's the, what's the benefits or downsides of, of either of those paths as you, as you see? Or, or, or is there another path that people are taking?

No, I, I think those are the, the, the ascension path that you mentioned is, is the least prevalent. The more the most prevalent is, you know, we're gonna, we're gonna bring everybody onto our systems, financial, clinical, administrative, et cetera. The timing of which depends on what the most pressing needs are, right?

And just remember, right, like healthcare organizations on average have about 500 applications, four 50 to 500 applications. You know, some have a lot more, some have a lot less, but. Give or take, that's kind of where you end up. So it's, it's not just about the r of course the R is the one that gets the most attention, but it's all a lot of these other, uh, applications as well.

But yeah, I mean, those are the two approaches and the vast majority of them are trying to figure out how to get everybody onto a single system. There's financial benefits to doing that, of course, so that you don't have, you know, you're not paying for multiple systems, et cetera, but it's all about strategy, right?

Like banner, you mentioned Banner earlier. Banner has a really interesting m and a strategy. So they go out there and they're super fast, they're super precise, they're like clearly clinical precision. Surgical precision. They'll go out there, they'll acquire somebody, they will have a team of folks descend on that new organization.

And within somewhere between 60 and 90 days, everybody's converted over and everybody's using banner systems, right? And it's, it's amazing. Now they, they don't do that in every single case where the EHR to bring it on this common platform simply because. They do different types of acquisitions, right? So some are just top line based acquisitions where the patient population isn't sort of shared across those organizations.

So it doesn't really make sense 'cause you're never gonna have a provider in one organization, . Visit with a patient from the other organization in the prior world. Now it's like the lines are blurred, right? Everything's virtual. But in those cases, it makes more sense for the ERP system, for the CRM system, for some of the other administrative type systems to, to combine them, but maybe keep the HR separate, right?

So there's a few different strategies, but you're right, like the . The, the health share platform is, is one that has been used very well, you know, for, it's used for integration purposes internally inside of a healthcare organization to, you know, it's a, it's a message bus, right? Is what it is, an interface engine, but is way more than that.

And, and, and similarly now it's used for a lot of out outside organizations to sort of share data and bring it in. So, yeah. You know, I, I, I bring that up 'cause the, the big story obviously of the week is Amazon Care launching in 50 states for their employees. People not familiar with Amazon Care. It's essentially concierge level service for employees, for an employer program.

They, uh, will come to you in your office. They'll come to you in your home. They will see you virtually first, and they wills. It's really a concierge program for employers. They're gonna launch the telehealth portion of that in 50 states. But I wanna stay on the, uh, the provider side because I, I think those two camps sort of fall, come into play here.

I think there's a, a group of people that are saying, yeah, we see it, we get it. That's what the competition's gonna look like in the future, not the competition for high.

It's, it's Optum and others that are getting in between the health systems and the patient and starting to dis remediate and, and change the decision-making matrix of, of the, of the public at large is what, what it's looking like. There's two camps, right? So if I'm ACIO or a Chief Digital officer at this point, there's the, the one camp is, you know what?

My EHR provider is gonna gimme enough ammunition to combat this. They're gonna give me the digital tools and, and Epic's made some strides. They're, you know, they're MyChart platform is now extensible and you can break it down into core pieces and build it back up. Go with what aspect? A Care Anywhere strategy, a remote patient monitoring strategy, an IoT strategy A there, there's just a whole host of things that you have to put together and there's health systems that are saying, look, my EHR provider's gonna do that for me.

And then there's others. And we see these announcements, uh, come out from time to time where essentially they're saying, nah, you know.

Aren't, let's just say core competency for the EHR providers. Therefore, we're gonna go to people who, it is more core competency. We're gonna go in the in the cloud provider direction. We're gonna go with Microsoft Azure. We're gonna go in the Google direction. We're gonna go in the Salesforce direction, really bringing CRM into this equation.

And I know, get to a question. Well actually.

I see these two paths and you know, I, I, I've always been one who recognizes the limitations of both strategies, of all my strategies so that I can, uh, determine what, what direction I should go in. And the, the, the limitation of going with the EHR is they may not be able to innovate fast enough. They have a lot of clients, a lot of demand.

And, uh, they have regulatory, uh, you know, burdens that they have to adhere to, and they're gonna have to throw a lot of programmers just at those things, let alone the really advancing the patient experience and, and helping us to build a care anywhere kind of strategy. So that's the downside of that. The downside of going with the, with the Silicon Valley approach.

And for those who are on the Silicon Valley side, they're, they're, they're gonna feel like I'm blaspheming here, but they still don't understand healthcare. They barely understand healthcare. So you, you, you end up with, uh, solutions that are, uh, maybe not as integrated as they should be, maybe not as, uh, coordinated as they should be.

Uh, you end up with claims that are a little bit beyond what they should be claiming at this point. And so you end up with a lot of unknowns when you go down that path of are we gonna be able to connect this and this? Are we gonna be able to connect this and this, you know, if I put you in ACTO role right now, what direction would you take?

How would you build out your digital strategy for a, a Care anywhere kind of a solution to, to maybe compete against these, the Amazon care, the cvs, and the the Optums as they move into your market? Yeah, man, that's, uh, that's a good question and it's a tricky one, right? Like there's, there's a lot of, there's a lot of different ways that this can go, but you asked me very specifically about what I would do and how I would compete.

Well, I think it's co-Opetition is what is going to win, honestly, in this case. So. Just today there was an article, and I was actually looking it up while, while you were talking, you know, our, our, our good friends over at General Catalyst, the VC firm. So him Andia, who I know, uh, fairly well, I've talked to him several times.

Met him when I was out living out in the valley. He's a great guy. I mean, he's, he did the Livongo thing, right? And it's just, it's just, it's just crazy what he's done in, in healthcare. So he and, uh, his, his buddy Glen Tolman got back together and just formed a new company that was just, just came out of stealth.

Today, it's transparent, is what it's called, T-R-A-N-S-C-A-R-E-N-T. And essentially what it is, is they're using the Livongo playbook and they're applying it to the employer sponsored healthcare system. So they're going after this whole market where the employer, you know, a vast majority, some, I don't know what percentage of of insurance out there is employer sponsored, but it's big.

And so they're going in and they're trying to say, okay, but you know what, even, even if it's not big, it's profitable. It is. It absolutely, exactly. It's big in one way or the other. Right. So. So what they're doing is that they're going in and they're using this whole Silicon Valley mentality of creating a consumer first application with the consumer at the center, and they're actually building a platform.

They built and launched a platform that allows employers to provide this to their employees so that the employees can very quickly based on the insurance that they have and the coverage that they have, very quickly get, uh, connected to a doctor within, within seconds. Get, get information on the closest, uh, place to get rehabilitation, those sorts of things.

And it's essentially the, their business model, which is really interesting here is like, and I was just reading it this morning, actually, the business model is that they're not charging employers on the front end. They're, they're charging employers a percentage of. What's they save by facilitating this sort of access to their employees on the backend.

So the, the reason why I mentioned this is like, you know, there's a lot of different folks coming at this healthcare, quote unquote problem from different, from different angles. So if you, if you actually look at what . Are doing that sort of saying, okay, we, we, we want to improve consumer experience. The existing capabilities and circumstances that that consumers have to have to go through.

They're spot, you know, they're, they're insured by their employer. The employer has certain agreements with, with healthcare providers. Let's just consolidate that information so you don't have to spend a lot of time figuring it out. Doesn't that sound a lot similar to what Amazon is doing in terms of sort of saying, Hey, I'm gonna give you very quick access.

right? So now if you go from the employer side and you go to the Amazon side, it sounds very, very similar as to what they're doing. Then there's this whole other class of folks that are, uh, focusing on some very specific things, which I think is really admirable, and I think that optimization is key. So they're focused on the problem of eliminating waste in healthcare, and there's statistics out there which I don't have in front of me that I actually have done a whole bunch of research on, but it's.

It's amazing as to how much waste there is in healthcare, and the waste is broken down into different categories. So JAMA had a bunch of articles that, that they released, that I studied, and I, I sort of pulled this information out a little while ago, but one of the categories that is about 20 to 25% of the overall waste is administrative.

So if you solve the administrative issues that exist in healthcare, the claims, the claims rejection, the number of times you have to submit them, all the work you have to do, the number of people you have to have to. Leveraging technology, I think you're moving the needle forward. Right? So you're asking me how I would do it.

You know, I think the short answer is, I don't know. 'cause if I knew I would already be doing it , but, but I think the longer answer is it's a blend of these things that are, I think, going to come together, and especially as the regulation changes, et cetera, et cetera. Reimbursement models change and so on.

I think that it, it's, it's gonna be sort of a, a, a mesh or a blend of these things that have to come together to really make it. Yeah. And, and I, I agree with you that it's a mesh of the two strategies. I also agree that there's gonna be a lot of really interesting partnerships as we move down this, this path.

Here's what we're, yeah, and I, I hope, I hope that there are partnerships, right? I mean, you and I were talking about this a little while ago where there's a lot of folks in healthcare that are exceptionally blinders based, right? They're super insular. They just want to do their own thing, which. Whatever.

Right. No judgment there. But in terms of actually moving the needle, I think there's gonna have to be a lot of partnerships. If you just look at what even the HSS is doing, right, the public private partnerships that they are actually starting to push is significant. Because if you actually bring in folks from the private side, the Googles of the world, the Amazons of the world, the Microsofts of the world, heck, whoever, right?

The seriousness of the world, right? , you bring, you bring folks in and, and we collaborate and we can actually do something really interesting. But if you kind of go it alone. You know, you're gonna get the same stuff that you have been. All right. Let's, let's touch on some of these stories and, and, and, I mean, we, we got about 10 minutes to go here, but I wanted to hit on some of them.

So, Michigan Medicine and Banner are both moving forward with building projects and, you know, building projects is as common in healthcare as you can get. I mean, they're just, they're,

you know, how. How are health systems? If you and I were starting a building project today for a health system, how would we be looking at, at the room, at the er, at other things post covid from a.

Yeah, that's really interesting. So there's this whole new art and science around the patient room of the future, patient room next, whatever you want to call it. And it's not just the room, it's like everything else in the hospital, right? Or in the actual physical building. Right. I, I mean, so let's just go base.

I mean, how am I. Am I going all wireless? No, you're not going all wireless. You're, you're still putting cable in there. What kind of cable are you putting in there and how extensive is the cabling that you're putting in there? What kind of density are we gonna be looking at for, you know, for the wireless in these rooms as well?

I mean, how many, how many monitors should we be considering? And if we're building this out for the hospital, should we be considering how we're gonna build this out for a high acuity situation out of the home? Uh, the answer to all of all of the above is yes in that, you know, you're still, you're still, you're still gonna be limited substantially by what the, what the physical systems and the applications can pump out or pump in.

So to speak, but just in terms of connectivity, you have to be wireless first, right? You have to have so much capability that not only do your, your, your clinical applications have the ability to leverage these wireless protocols, but don't forget about the patients themselves and their visitors. The visitors always get like completely shafted, right?

They get stuck on this guest network that's like, you know. Broad modem speed at this point. And they're like, you know, I can't even, I can't even surf on, you know, Facebook or Twitter or whatever it is without getting dropped 16 times. And that's a really crappy experience, right? So I think a lot of those experience based things have to be built up.

And then in terms of, I. The technology. I think it's really about this whole notion of bringing together ambient listening, bringing together sort of automation and, you know, like home automation type things where you actually have, you know, control of blinds, control of temperature, et cetera, et cetera.

So I think the technology needs are substantial, and that's why I say that there's this new art and science. I, I, I love pushing on some of these preconceived notions and one of 'em is, you know, that we have to offer a guest network. So I mean, we're getting to the point of five G. And if I'm in a major city, I'm going to those five G players and saying, look.

Build out at our hospital, use us for towers, all that kind of stuff. Right. So now I have, uh, and there's fewer people I have to do this with too. I mean, it's, it's essentially three carriers now that I have to do it with and, and let's assume I make my hospital, I. The hub in each one of the markets that I'm in for a five G network.

You know, quite frankly, all my systems are meant to be accessed anywhere from, from the home and whatnot. I don't need them to be on my internal network to do that. It's really a customer, uh, experience, uh, customer satisfaction kind of thing. Are we getting closer to the point where we don't have to offer an internal network that we could just have an external provider and, and make sure that we have coverage?

Uh, maybe a five G coverage across. 'cause everybody, look, everybody has a, uh, not everybody, but a, a significant number of people have a phone, have something. And could we just, you know, for those who don't hand them a device while they're in the, in the hospital, that's connecting up to the five G network, I.

A lot of challenges with that. So five G is amazing, but the infrastructure associated with it and the ubiquity associated with it is still so low that it's going to be years before it gets mainstream to the point where you can just be like, okay, I. You know, this is an alternative and we don't really need to pump out wifi.

Oh man, Vic, you're crushing my dreams. Oh, man, come on. You know, and then you're talking about sort of handing people phones, you know, there's the whole logistical issue associated with that. How does a phone ? Yeah, I wouldn't hand 'em phone, I'd, I'd, I'd hand them my, uh, tablet, I think is what I'd hand them

So, you know, so that's the, that's the point. It's like, there's so many of these things, but, and then you have to think about rural places. You have to think about places that have a high density of. Buildings in a short span. So, you know, again, it's like, it, it's, it's all a density based situation as to how well you can actually get, you know, service.

And then if you have one carrier that you're, that you're subscribed to, but there's another carrier that's providing the five G capabilities around you, that does you no good. Right, so, so there's a lot of, and you could go with a universal DASS instead of sort of a very specific carrier das to really make your life and experience a lot better, but then you're sort of shackled to this one particular provider.

It costs a lot of money. Like they're not willing to do it for free anymore, for good reason. 'cause they found people will actually pay for it. But, you know, I, yeah, there's a lot of challenges, man. I think that this whole notion of five G is, is a really good one. , but I think till till we get a little bit further along, it's gonna, it's gonna be a while.

Wow. Man, you, you just crushed my dreams. Although I've been, I've been saying for a while that keep an eye on five G. You don't have to be doing your plans today for it. It's something that's down the road. The challenge is that these building projects, Hey, we're building a new tower. Those kind of things.

They're point in time kind of things, and you have to make these decisions. I, you know, I remember, you know, do you go with, you know, cat three cabling, cat five cabling, now it's cat five, cat six, whatever. But you have to, you have to sort of put a, a line in the sand because that, that building, they're gonna start building that building and you, you have to put all the infrastructure in and it, it is kind of painful 'cause sometimes you're putting it in knowing full well that a year from now.

You're, you're gonna have to upgrade. Yeah. Yeah. And I, the good news is that a lot of the low and high voltage pieces have gotten pretty standard. So, you know, CAT six, for example, for ethernet, it's all about the thing that you hang on the wall that then provides to you the capabilities that are, you know, looking forward.

So then there's a new standard for BLE, low energy Bluetooth, for example. You take, replace your wireless access point or put, you know, a hub around it that the manufacturer sells, and now all of a sudden you have BLE where you didn't, without making any changes to the plumbing inside the walls, for example.

Are, are, are those projects, are the, are the way finding projects and the tracking of device projects, are they, are they finally starting to pick up? They are. And again, I think it's fits. It's, it fits and starts again. It's because of the cost associated with it. So if you go to the RFID route, for example, that's expensive 'cause you're now talking about asset tagging across all of your assets.

And, and then you have to actually upgrade your entire infrastructure to be able to read these, these tags, right? So as folks go through lifecycle for buildings and environmentals for, let's say, the low and high voltage is fine, but if I have a network refreshed coming up. That's the time to actually budget for any of those sorts of things.

So a lot of the net new buildings that are going in already have the capabilities built in, and all they have to add in now are the tagging pieces for the assets. So it's a lot, you know, the lift is a lot lower than, than used to be. So, so BBLE is, is now the, the direction that we see things going. Is that accurate?

BLE is, is really, really good for some really innovative things that are coming out from, from different countries. Like there was one, when I was at the Cleveland Clinic, there was a provider that was trying to pilot this, which was a, a small bandaid type strip that they could put on, you know, under the arm of pediatric patients and monitor vitals that way so that the nurses didn't have to come in and wake the pediatric patient up.

On a, on a regular basis, you know how, how they come in every couple of hours to check on you and check your vitals. You could just get this via BLE and you're fine. And, and, and you know, the, the outcomes, the patient outcomes were so much better because they weren't getting disturbed and woken up every two hours.

That it was a huge, huge satisfaction thing and a clinical outcome thing. But here's the challenge, right? The building that this person wanted a pilot in was had a pediatric ward, but that building didn't have the capabilities to, to do BLE. It didn't even have the capabilities to add the BLE sort of a hub on top of the existing wireless access points.

'cause it's Whitehouse access points for three years old. So it required a significant amount of retrofit to actually get there, which is where these new buildings that have the state of the art to start with. Can sort of continue forward. So a lot of these have BLE to start out with the wireless access points due and, and you know, it's just a matter of other things starting to take advantage of them.

We, we did a pilot back in the day. We, we used to have sort of the old thing where people could work on whatever project they wanted to for a certain amount of their time. And some of my staff set up A-A-B-L-E pilot, if you will, and they were able to show how you put these, you know, tracking things on these devices and whatnot.

They overlayed it or they put a map in the background overlay these devices and you could see these devices moving around our. It was kind of cool. And from a, from a, you know, the, the cost of losing those devices or, or nurses hoarding those devices and that kinda stuff, there's a serious cost to that.

And, and I, I was looking at the, at the pilot that they put together, and I thought there's, there's real value in that. And it, and actually the cost, because we were, we were talking at the time about RFI versus something like this, and the cost was significantly less for something like this, you know?

Gotcha. Let, let's talk RPA robotic process automation in three minutes or less. What are you hearing out there? I mean, I, it, it, I, I think from a Gartner Hype Cycle standpoint, it feels to me like, you know, we were talking about it, talking about the good thing about healthcare is it's already gone through the Gardner height cycle.

By the time it gets to us. Sophisticated RP tools that are available. Are you seeing conversations and RP. Yeah. Yeah, we are, and, and it's interesting. So the, the, the traditional path of least resistance for RPA and healthcare is around claims, claims processing, claims, adjudication, sort of automating any of those activities by reducing, you know, and again, this goes back to the waste reduction, right?

Right. And, and there's millions to be had there. It's, it's unbelievable. Absolutely. Many millions, maybe, maybe even billions, who knows? But, but essentially there's a lot of that that's happening and there's like two or three different players in the, in the space that are, you know, jockeying for a top position at any given point in time.

So there's, there's a lot that's happening there. The number of organizations that have adopted it is shockingly low, and I think that's because again, it's a relatively quote unquote new thing, like the cloud is quote unquote a new thing in healthcare, right? I think it's gonna take a little bit of time for them to, I mean, you know what I'm saying?

Right. I.

I, I remember when I came in and started talking about cloud and people were like, whoa, slow down there. Buck Rogers. Where are you going? And I'm like, buck Rogers. Are you kidding me? . I mean, I, in 2012, I knew whole companies that were running in the cloud. I knew significant Fortune 500 companies that had moved their operations into the cloud, and, and they were just like, oh, that's the.

It's not the future in 2021, it's now the past. I mean, moving to the cloud, getting that agility. Uh, I feel the same about RPA. If you can identify the millions in claims adjudication, and, and we have the case studies. I mean, Daniel Barce came on and talked about it on the show. We have the case studies.

Daniel's willing, Daniel, Daniel talked about it at Chime, and he's willing to share, uh, information with people who wanna implement it in their health systems. And he, he raves about, you know, how efficient the process had become. And so it's, it's there. The use cases are there. We, we know that they're there.

Why are we, why are we struggling to move this forward? Uh, I don't know, man, inertia, you know, like there's a lot of stuff. There's so many priorities. Yeah, there's, and you know, yeah. There was this, there's this pandemic going on. Right. Exactly. Right. So, so there's a lot and, but I think it'll happen. But I think the other part that's really interesting is the applicability of.

If you drop the R out of it, just process automation in general, the ability to apply that to a broad spectrum of things, even on the IT side. So this is not just on the clinical or claims side, but even on the IT side to help move the needle on some of these other things and initiatives that are very repetitive and time consuming that can be automated.

We're, we're able to learn. In fact, we've been doing quite a few case studies here where we're starting to learn from different industries that have improved their IT operations by leveraging process automation, how can we apply those to healthcare? So I think that there's a, a really good road ahead, I think is again, just like everything else, it's just gonna take time.

Yeah. Hey, disappoint.

On the show and, and talking through this stuff. So again, thanks, thanks for doing this. I look forward to catching up with you again, hopefully, hopefully sooner rather than later and, and just, uh, keep hitting some of these topics. Yeah, man, anytime. Thanks. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, please forward them a note.

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