Today on This Week in Health IT.

We are seeing that there's less and less brand loyalty. And I know that that's a struggle with the health systems. They're trying to work on their patient portals that are now in the third iteration of post meaningful use. So they're trying to make sure that they're not clunky. That they do have the digital tools available to be able to really drive that customer experience. And so I will say that there is still some benefits to going into your healthcare organization.

It's Newsday. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in Health IT. 📍 A channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH and Cedars-Sinai Accelerator, 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 today we have Christine Parent Associate Vice president at Meditech with us. Christine, welcome to the show.

Hello, Bill. Excited to be here today. Thank you for having.

I'm excited to be talking to you today. The KLAS announcements came out. Meditech's doing really well with the KLAS announcements aren't you?

I was a happy Meditech customer for all those years. I wasn't happy when we started, because we had acquired all these hospitals and brought them together and they all had different versions of Meditech. But one of the first things we did is we put them all on the same build. And it really is an efficient platform to run a hospital on. And, and people say to me, they're like, really you ran a six and a half billion dollar health system on Meditech. And I'm like, absolutely. And it ran really well in fact.

Yeah. So I will say that I think that you're alluding to one of our more legacy platforms. So the new Meditech expanses is a recent new web based platform that just came out a few years back. And it really is a driving where we think the industry needs to be with EHR. So we have we've leapfrogged what we've done in the past through innovation and really advanced where we think that the industry needs to go.

We took, we took a pause and rewrote, a post meaningful use EHR platform, web based. So we do think that we are a game changer when it comes to usability efficiency and clinical satisfaction. And based on your comments with KLAS, I think that that's proven out in the industry with just only a few years to its backing.

And we're seeing that more and more people are, are interested in what we have and moving to more of what we consider a personalized approach and a user approach, similar to what you would do. Smartphone and getting a plane ticket or doing your banking online, similar EHR experience that it's really all about the user experience.

Let's, let's get to some of these news stories. We have to start with this feel good one. And that is nurses are the most trusted professionals in the US for the 20th year running. This isn't just like the most trusted professionals in healthcare. This is the most trusted professionals in everything. This doesn't surprise you at all does it?

It doesn't and this was of all the articles that I read. I think that this was the one that sang to me and saying to my, my soul a little bit. The Americans have gone out there 20 years in a row. Think about that. And this is based on honesty and in a country that's a bit cynical. It's amazing that they continue to be on top and not only on top their 81% approval rating. And the next one behind it is physicians, which I also agree that medical medical doctors should be up there and they're at 67%.

So they're leap frogs above. What I'll say to you is nurses were very passionate, at least in the EHR industry. I know Meditech we have nurses on our staff. We work very closely in the hospital in systems to install the EHR. If you think about it the people that are using our system, they are the largest share of any healthcare organization workforce out there is nursing.

And I will say that nurses need the benefits of an EHR more so, or as much as physicians. And they should have available to them innovation through either at bed devices, usability, automation incorporated into their, their daily workflow and what I've been impressed, just working with various different committees, different nurse advisory committees is, they truly are the natural problem solvers within a hospital. And so I do know through various institutions, they've actually created hackathons and included nurses to help solve very complex medical process issues. And so I do think it's, it's interesting and it's a, it's a group that sometimes goes a little bit unappreciated. So it's nice to see the recognition and it's nice to at least hear through that Gallup poll that they continue to, to shine around honesty and ethics in that profession.

It doesn't surprise me either. One of the things that came up in a couple of the stories that we've talked about over over the years is the EHR builds, right?

So there's this, there's this timeframe where you're trying to determine what the right workflow is and how things should function within the hospital. And one of the things they tied to failed implementations was the lack, and I can't, even as I'm saying, it's almost comical, the lack of nurses involved in the process. In the build process. And that's that's one of the things I think that most health systems have have rectified over the last last couple of years to make sure that the nurses are included and also in the optimization of the EHR and looking at innovation around the EHR and the workflow.

I mean, at this point, it's almost becoming a critical issue with the nurse shortage. That's not only projected, but happening as we speak every health system leader that got up and spoke at the JP Morgan conference talked about this, this labor shortage that is happening and specifically the nurse labor shortage that's happening.

And they're, they're really struggling to keep nurses at their system for starters. And so there's a lot of creative things they're doing there, but there's also this push for making them more effective with the tools that they have. And I think a lot of our listeners on this week in health IT are being challenged with that. How do you make nurses more effective with the tools that they have in front of them? What are some of your thoughts on that? How do we help the nurses to be more effective with what

they have?

Well, I know for, for us, we've taken a step back with the nurses themselves and actually put different devices in their hands at the bedside. So we've been working with them to really redesign what they need to do instead of bringing in wows and cows these days, they're actually using tablets and smartphones with a very different user interface. So we are working with them to try to decrease a lot of their documentation burden. I will say, and I go to your how do you value the nurses?

I know we are seeing it within our own customer base that the nurses are looking for other opportunities. So I know that we're, we're seeing a lot of these folks not necessarily move out of nursing or healthcare, which is their passion and why they got into it. But some of them are actually seeking and we hope they continue to seek opportunities where they can really help a patient care.

So whether those are care managers, nurse navigators, patient advocates, we've brought on some nurses into Meditech as well to help really design from some of the process flows. So we can hear directly from them. User groups that we work on. Focus groups, and as we tend to shift more to this value based care, which we may be getting into today having these nurses that may be don't want to practice on the floor in other areas really will advance the EHR.

It'll advance some of what we need to do to get to more of a value-based care through some of these patient advocates, new nurse navigators. And I do think that we can shift their resources. And as I mentioned prior, I think it was one of the best problem solvers in, in the hospitals today. But it's, it's making sure that they have the right devices.

And I'll, I'll add one other thing to you. We actually just had a KLAS. You mentioned KLAS earlier with some of their awards, but we meet with them annually and they're doing a lot with the Arch Collaborative which is looking at how different EHR systems, regardless of the system, how the process in tools when you install the system are actually affecting the outcome.

And what I thought was interesting is they looked a lot on training and there is some statistics that back that, that nurses are sometimes the better trainers for physicians, which I think is very interesting because a lot of it is the communication, the process flow. And it's not necessarily physician to physician training.

In some cases, it's the nurses that are making the biggest impact on the physician satisfaction and usability, and really getting in there and helping to navigate some of these EHR system.

This is your first time on the show and you've interacted with some of these nurses and whatnot. What would you postulate or some of the biggest time-wasters for nurses? I remember we were doing a project at one of our flagship hospitals. And it's it's sometimes it's the silly stuff. Like we're talking to these nurses and we're like, what's, what's the biggest time waster. And they just, without batting an eye, they were like walking to that printer from here.

I was like really? It's like, yes, we, we make that trek and it wasn't, wasn't all that far relatively speaking. But when you multiply it times the number of things there, like if you put a printer right here, you're going to give me back maybe 15 to 20 minutes a day. I was like, oh, you're kidding me.

Yes. So I, I don't disagree with you. I think some of it though is still documentation. And so I know that there's a bunch of different initiatives. I know Dr. Englebright that was out of HCA, who is recently retired, but had a big push in tying to really relook at what the nurses are documenting. There's a challenge.

Is anyone really looking at all of that data or should they document by exception or is there a different methodology in which to do the documentation? I do think as we start to get into some of these virtual assistants and some of these AIs, we could see changes. I know we're, we're focused so much on the physicians these days, but I do see that this is also an area that we would be able to develop and bring in the nurses and really makes them some change.

But to your point with the printer, I think most of the organizations these days have really gone through that lean process because they identified and it was almost like you mentioned, it's almost by accident that they're identifying different areas in which to cut down some of, some of the waste and burden and get the nurses to not do as you mentioned, these, these silly, small things and move a printer here and there, but a lot of them have gone through that, that mean process to really understand it's almost putting a GoPro on the nurse, right? Finding out what they do on their daily shifts.

When we talk about documentation, that's such a heavy lift because so much of that is driven by the regulatory. And maybe even the litigation burden associated with practicing medicine. Do we, do we have initiatives that are starting to really look at the unnecessary documentation that's going on?

There are some national initiatives and I will have to actually send you who, what, who those are. And maybe we can add those in the comments bill afterwards, with some links, if people are interested in getting involved.

I know as I mentioned, we just did a recent podcast with Dr. Englebright and she was talking about really what her, her slant was. And she was working with number of organizations and it wasn't just an HCA initiative. It truly was a nationwide initiative to try to decrease that burden and relook at how, how nurses were doing their documentation.

Who's looking at it. What is, what is really necessary as part of the documentation process. And then if you can get that identified then you look to more of the EHR system. How do we, what devices do we use to input that. Is their voice that could be done? Is there some AI that could be instituted et cetera.

So I do think that there is, there is those initiatives that are trying to break down those barriers that you mentioned.

The first one's around consumerism and healthcare disrupters. Okay. So healthcare disruptors are moving quickly to capitalize on growing demands for a better healthcare experience by consumers. And then we have all these other players who are coming in and we have people who are literally designing from the ground up and experience for patients and consumers and they are thinking about it. I still remember the CMO for CVS. And this was a number of years ago. It may have been four or five years ago. It was presenting at HIMSS. And he was presenting how they're, they're going to do all this stuff around primary care and whatnot.

And he's presenting to a bunch of providers. And so one of the providers got, went up to the microphone and said, what makes you think you could do this better than us? And his answer was priceless. He said parking. Right. But I love telling that story. And I've told it a couple of times because it encapsulates consumerism in healthcare. It's like our expectations are, we can find a parking spot. We can see a doctor when we want to see a doctor and we can not only see the doctor, but also get our prescriptions filled at the same place. I mean, that whole experience that you have, these you have the CVS, the Walgreens and the Walmarts of the world, trying to build not only then village MD and others.

And then you have telehealth providers also there, there, I mean, they're billion dollar companies now, but they're around the edges and they're really trying to change how we experience healthcare. How are you seeing it?

No. So so I thought this was fascinating and I think you're right that CVS, by the way, as a, as I mentioned, it's, it's really doubling down.

It's really closing some of their CVS offices or what you'd know as the regular retail opposites in space and opening up these primary care centers. I find it fascinating that you now have, as you mentioned, you were talking about the telemedicine, so you have Teladoc that now is having a first virtual first insurance plan, which I find that very interesting, especially in the past two years, as we're seeing that virtual care is, is really there's a stickiness to it.

I think that you're going to start to see consumers expect either follow up visits or some of their more basic visits to be done via telemedicine or virtual care. Best Buy. You mentioned current health acquisition, which is remote monitoring. I think that's interesting that who you would typically think of buying a TV from is now going into patient remote monitoring.

But we are seeing that there's less and less brand loyalty. And I know that that's a struggle with the health systems. They're trying to work on their patient portals that are now in the third iteration of post meaningful use. So they're, they're trying to make sure that there's, it's they're not clunky that they do have the digital tools available to be able to really drive in that customer and that customer experience.

And so I will say one of the things that we are seeing is that there is still some benefits to going into your healthcare organization. This is not necessarily for your flu shot or your COVID test, but there is some kind of benefit to seeing your own care provider that knows maybe you have a chronic disease which we know that about 50% of all Americans have at least one chronic disease.

But now you're pushing one of my hot buttons, which is why wouldn't that provider know that?

So the interoperability, yes. That is also something that will be changed. And I think that was one of the ones that were on here as well, that we are making strides with interoperability and we do foresee in the future that regardless of where you go, whether you're on vacation whether you need to be reminded there is an accessibility with being able to actually get to that data. I'm actually doing a discussion later with Commonwell, which is one of the Commonwealth care quality, really trying to bridge those gaps. They're working on data governance. So there is going to be a time in the near future where we're not going to talk about these, these walls.

So you will have in many of these organizations that we're talking about by the way, have also entered and are now members of some of these Commonwealth organizations to make sure that they can get at that data. But I don't disagree with you. There is going to be less and less barriers to that, but the question is, is do you want to see someone new or do you want to see like for some cases we actually have the ability for a physician that can see his patients.

So if you want to see, I'll say Dr. Smith, who's my physician. I would have the ability to go in and say, I want to see Dr over the next week, I want to just talk about blank. You'd be able to do that without being introduced to a new physician. It's not to say that I still don't go to the parking lot and get my COVID test.

When you need to get on an airplane for, for certain restrictions that's still is, as the CVS CEO said, There's parking. It's easy. It's convenient. So I do think that the healthcare organizations do need to step up a little bit with this engagement and creating the user experience, looking at some of the tools that they have from a digital forward perspective, which also includes their portal making things more accessible.

And I think one of the things on the list that we're going to talk a little bit about is some of the smart hospitals tend to be trending as well. And I think that those are the digital forward consumer experience areas that, that might be able to help some of these organizations retain. But I do think you're going to, you're going to see the CVS, the Walgreens the Walmart, the Best Buys trying to go after that $3.8 trillion industry.

No, I, think that's true. And then I think on the acute care side, it's going to come down to quality and brand. And the reason I say that is if I get cancer, I can name the five hospitals I want to go to. And none of them are near me. If my family and but a plane ticket doesn't cost that much and then Airbnb there so that they can go to multiple visits. There's just so many options that are available to us today. So that's why I say brand does matter in quality does matter.

We now have a lot of initiatives. That are going to be looking at and providing some transparency into the effectiveness of certain providers. And you have like transparent is doing that now for for some of the self-insured employers where they're saying, look, we'll, we will step in the middle and we'll make sure your peopleare seeing the best position.

So I think we have to shore up that side of it with transparency and with interoperability, we no longer have this this false barrier of, well, I'm going to go there because my medical records are. My medical records, there should be, that's the worst case scenario for that's why I'm going to that place.

It's you know, so hopefully, hopefully we'll get beyond that. So virtual care. It's interesting cause they say virtual care 3.0. Let me give you a little bit of this. At the beginning of the pandemic health systems move very quickly to implement solutions like video visits, asynchronous apps, symptom, checkers, to provide remote care to patients.

We view these as telehealth building blocks for organizations who plan to mature their virtual care strategy and deliver more care closer to home. And then. Go on to talk about remote patient monitoring and some of those solutions, you talked about current health earlier and best buy now sees themselves as someone who deploys remote patient monitoring into the home.

And so virtual care really is about designing care, where you ask a health system leader, how many beds do you have in this community? And they're not just counting the beds in the building and they're counting the bed. In the community that they are monitoring. So first of all, care really changes based on our experience through the pandemic doesn't it?

It does. And I think by the way, I think virtual care it's, it's funny that we're talking 3.0. I'm glad it says 3.0. We've been talking about virtual care and tele health for over a decade plus. And so I think that this is the pandemic. If you were looking for a silver lining, I think they, they called it the mother of necessity.

Right. Which moving in accelerating the adoption I think that there is a stickiness associated with it. I will say that we, we had a number of customers. We've had this technology for a while, at least within the medical umbrella of our solution areas. But many had always put it on the back burner for something else.

And only a few that were, forward-thinking and more digital type companies were, or hospitals that were moving forward and putting the investment in this area. And so I will say that the pandemic really accelerated and we saw overnight. These hospitals wanting to install as a needed effort especially on the physician offices to try to get some of these elective areas constantly moving.

So we, we saw them within, instead of a three month installation or two month installation with process redesign and training. We saw them doing it over night. With physicians within their hospitals, going on a zoom call for half an hour with their CMIOs and learning how to do an office visit via virtual care.

And what's interesting is is that the majority of them now that they've gotten used to it and they have gone through now almost two years, unfortunately of this type of environment are now not wanting to give it up. And I think that you're seeing the percentages of them saying that this is going to be part of my practice in the future.

And so what I'll say to you is the 3.0 aspect that's mentioned here is now taking it to the next level. So not just, okay. Now we have the fundamentals. It's almost like we need to do the virtual care first, but now we can look at him and pop our head up and we definitely need to go back into our customers and work with them on optimizing, making sure that they're cause they, they, they tried to do a wide spread of specialties.

We know that high talk are better than high touch specialties with when it comes to virtual care. So we're working with them to really, to optimize what they have, do some workflow changes, go in and do some retraining, but then start to do some of that remote patient monitoring. And that's what they're talking about when they say 3.0.

Is that remote patient monitoring component and bringing in driving that into the EHR, into the ambulatory environment creating some automated triggers to certain numbers so that if, if someone's trending poorly there's an alert or whatnot. That's either sent to the care navigator or to a physicians screen or nurses screen so that they can be followed up on.

But we are seeing a need for this. We look at where virtual care has gone and I will tell you, I spoke with a physician at the PAC, he did a virtual care. With someone on a tractor he's in a rural area think of Midwest. And so he said that it was a first for him, and it was kind of one of those pauses that makes you think, where has healthcare gone?

This is, this is something that I don't think he's ever dreamed that he would be doing something with someone on a tractor, on a smartphone and providing them medical care. But as he's thinking of it, this would have been a person that would have had to probably take a half day off. Louis some wages because they're agricultural get in a car drive whatever distance and have that same that same visit.

But he he thinks that it was just as, as a good quality. And what we're seeing with patient satisfaction scores is that they really haven't dropped. And that was a concern I know early on hearing from our customers, that they were really monitoring to make sure that if there was something that they could be doing different they wanted to make sure that they were getting the same experience as an office visit.

So I think that that's something also to take away that I think that there was a trust in that that office visit and people in patients felt safe. We were also seeing you would talk about what's going on with the pandemic. And I think that it's exasperated our access issues to mental and behavioral health.

And what we also saw on the rise during this time was the virtual care really helping with that specialty and making sure that patients were able to connect with their either specialist. And to your point, it could be anywhere in the country, potentially. It does could be. Someone that's within your city, but it also could be someone that's two hours away, but you're still getting that same similar service.

And I think that that is something that we've been hearing from our customers that they are planning on continuing to grow especially as they start to do that zero suicide prevention and really a lot of that triage. At that ambulatory level and not every physician office has someone that can do a psych eval or can do a consult. So we are seeing more and more of those drivers really increasing the need to expand.

I think one of the things I'd like to see, and I think this is going to be extreme, but cause I was gonna say blow up the workflows, but I would like people to look at the workflows with a different lens.

One that says, okay, all these tools are available. Let's rethink this workflow. Instead of, oh, we're a telehealth company. Everything's a telehealth solution. If I have a screwdriver, everything can be fixed with a screwdriver or a hammer with a nail kind of thing.

Or I may, I am a facility heavy care provider and we want to encourage physical. I'd like to see somebody step back and really think through and go, all right, how do we do this? Is it hospital at home? Is it is it virtual care? Is it remote patient monitoring? And just look at almost every workflow and build it out appropriately.

Now, the challenge with that obviously is, is funding and reimbursement. But the nice thing is you're seeing CMS start to acknowledge the value of some of these things and whatever CMS, CMS is the leader here. Right? So whenever they acknowledge that value, I think you see the other things come along. But I'd like to see that. I'd like to see, see us to really rethink the workflows.

So I, I will say and I agree with you talking even with some of our customers, they were using a variety of virtual care solutions during this pandemic time. We have we decided not to necessarily partner with a telehealth vendor in more built the workflows within our EHR.

But we certainly have our customers that are still using some of these standalone telehealth in, in certain areas. Maybe that makes sense. As you mentioned, it's almost like a different use case, different workflow. But we have it, so it's a more embedded in the physician. So that it's easy, they're not going into a different screen.

And that's when you talk about some of this kind of the, the patient data that you're trying to monitor remotely, having that also come into that same screen and be part of that full patient story as you're talking to the patient. We've built out a couple of different scenarios where it's it's a schedule so you're seeing your, your own provider. An example I'll give you is I know Avera Health does some followup appointments, so they might see someone, they might see Bill Russell, and then you would need a follow up appointment in a couple of weeks and they'll offer do you want to do this virtual visit or do you want to come back in depending on the scenario?

And so they can certainly go in and go in and schedule that with your own provider and that the convenience of your office or at home be able to do that follow-up appointment. So I don't disagree with you that there there is different flavors out there and it's almost like you have to have different use cases and make sure you have the process that's developed around each one of those.

All right. Let's keep moving through this predictions. Cybersecurity. I just read the first sentence of each paragraph. There's four paragraphs. Healthcare organizations experience a uniquely different set of security challenges compared to other industries because of what's at stake, which is the private and sensitive information.

About us healthcare is, has become vulnerable target for cyber attacks for several reasons, stemming from the pandemic. Another driver for increased cyber threats is the increase in remote work and traditional brick and mortar in a traditional brick and mortar industry. And the final paragraph starts with cybersecurity will be a top priority for healthcare leaders in 20, 22, as they work to secure their organizations. Now, you know how I got through college, by the way, I just read the first sentence when people gave me like 400 pages to read it the next week. I'm like, there's no way I'm reading 400 pages in the next week.

Yeah. So cybersecurity is interesting. Right? So there is a lot of data that's actually stored in the healthcare environment. So I know that there is some vulnerability, cause some of it's financial data, some of it is also patient data.

Let me, let me focus you in here cause we talk about cybersecurity a lot on this show. The cloud. So the Kronos breach. There was a Kronos breach and it brought Kronos down, which was a problem in and of itself. We couldn't do timecards and a lot of health systems. I talked to at least five CEOs that were affected by this. They had to build makeshift solutions to do timecards, to get people paid and whatnot.

Now this morning, Puma who's also on the Kronos system has actually come out and said, look, ss a result of that we've been breached. Our information has been breached and Drex DeFord who also is co-host of the Newsday segment posted. He goes, this is the first of, many of these breach notices. The cloud creates an interesting which by the way, is one of the next predictions, but it creates an interesting security dynamic doesn't it? Because now all of a sudden it's not one health system that's potentially breached, it's five health systems that are potentially breached. How should we be protecting against that?

So first I would argue I'll kind of be the, the counter of that, for us anyways, we deal with a big spectrum of sizes of health systems within Meditech. So we have the small, critical access hospital to some of the larger ITNS. And what I would say to you is for us anyways, we're seeing, by the way, this is number one of boardrooms conversation. This is number one of CEOs trying to put their head on their pillow at night and not wanting the call that tells them that there's some sort of breach happening at one of their facilities. So when we get together with the CEO's this is top of line for them.

But we're seeing a lot of our base really interested in moving to the cloud. Sure that when you have a breach, it does seem like it is by volume. But we're working with some, some top notch vendors that they hire right out of college or the university or the military these experts to, to help detect from a cyber attack as well as then build the tools around it so that not only can they detect, but they can hopefully respond to and mitigate how many breaches that they have or be able to shut it down, so to speak. So what we're seeing and we've, we've been working with Google right now in the public sector.

They'd have the expertise that someone in a critical access hospital in the mid. Is not going to be able to bring in that staffing to make sure that their servers are up to par making sure that they're doing and they have the tools necessary.

I couldn't agree with you more, by the way. And we were six and a half billion dollar health system, and, I felt more secure with my stuff on a Google or well maybe AWS, you actually have to design your own security models, but on certain cloud platforms, I felt more comfortable as a CIO because they did have better experts who are monitoring the traffic and knew how to, to protect against the denial of service attack and a bunch of other things that my staff, first of all, I didn't have enough.

And the training is one of the harder things. Because you hire them and they almost become dumber by the day. It's because you just can't afford to train them. I mean, there's, there's, there's so much happening in cybersecurity and it's happening by the minute. So how do you keep them current by the minute you almost, you almost have to aggregate the intelligence somehow.

Yeah, no and I think like, to your point about cost. Even moving to the cloud allows you to have those experts available 24 7. And you're not, you're not having to bring in those folks. You're not having to buy your own. I think that they were talking about HIMSS research came out in the same article talking a little bit about within the next 24 months health systems about one third are going to start to implement biometrics, digital forensics, penetration testing. You're talking, you're talking a big footprint of your it budget right there. So I do think. Even though you do hear in the news, some of these larger breaches I think that you would be surprised how many breaches happen that we don't hear about that are done more at the local levels.

And I think that if I was someone that was betting on it I think that there was a article that I was reading recently that. Many of the health systems are all in with cloud. And I think we saw it with, I think there was a Mayo clinic article coming out about choosing Oracle fusion, really for some of their cloud applications for their business apps.

I do think that you're going to see some larger institutions saying I'm all in with cloud. And one of the reasons not only about the scalability is, is around the security aspect.

Yeah, this is the third party risk assessment I think is going to become it already is it's being escalated by cyber insurance companies and those kinds of things.

And we're going to have to get really, as providers, we're gonna have to get really good at it. I think we're also gonna have to get good at analyzing architecture. And say, is that good architecture to secure the environment and those kinds of things? I had a conversation with John Halamka earlier this year and when I heard how they do the architecture of storing their data in the cloud and how they third parties access it and I'll just tell people just go over and listen to it. It's, it's really interesting because they didn't just throw their data over there and say, Hey here's some tools go, go have at it. They really thought through the architecture and the security model and and the data never leaves. It's just the result of the the algorithms leave there, but the actual data can not be dumped or pulled out or, or whatever in any way.

And I think so I think architecture is also going to matter. So as we look at our vendors, there's going to be this. There's going to have to be a better awareness of what good architecture looks like, what good risk models look like and, and how to evaluate the vendors we're choosing based on their ability to protect the incredibly valuable assets that we have. Automation.

They talk about healthcare workers, shortages But at the end of the day, this, this automation piece has hit every other industry and healthcare is now really taking it seriously. I think two years ago, some of the forward leaning CEOs I heard Daniel Barchi give a presentation a couple of years ago.

They had automated some processes. And the efficiencies were just astounding. They were so astounding that there, their RPA process triggered stuff on the other side that essentially said, Hey, you're submitting this stuff too quickly. Like, you shouldn't be consuming this too quickly. We're going to, we're going to cut you off cause you're. And so he actually had to build in a delay on his robotic process automation on this side, because they saw it as a potential problem that that was coming across that way. And so he did, and it just going across at the, at this rate, but he he talked about the accuracy rates a lot higher through robotic process automation for this specific process.

It's always important at this point to talk about the difference between administrative automation and clinical automation and IT automation. IT automation and administrative automation. We're seeing significant strides, maybe getting to that next level clinical automation. We're still at that early stage because the risk is so high. I mean, the stakes are so high on that side. We have to move slower and we have to make sure we're a hundred percent accurate.

Yeah sure. No. And I would agree with you with that. I think that we're seeing some automation right now with supply chain and that was essentially what Mayo clinic in that article with Oracle fusion cloud was really working towards is, is some of those business back ends with the supply chain.

Supply chain right now I don't think you can get away of the last two years with the pandemic. I know that even around most wired, I think that there is a number of weighted scores right now with, with health systems around supply chain. On the clinical side one, one bright star, if you're looking for one is really around some of those virtual assistants that are, are starting to get out there in the field.

And I think that we're, we're loving the concept of virtual assistants and what that really potentially allows for physicians to how they interact with the EHR, whether it's grabbing out data, using different devices. There is something to be said that they're, they're able to get at the data much more quickly and in some cases through voice than ever before.

So we talk about automation. Some of that is also just trying to render the data from this large massive repository and making sure that you have the pieces in place. And you can do that potentially through other means through virtual assistance that may be able to help. I know when we recently had a position, a committee meeting that we bring in some of our customers, we were talking about use cases and one of them that came up was around surgeons and the surgeons not going to stop in and put information into a computer, but if they could be speaking to it may help with some of their their documentation that the virtual assistant concept. Ordering et cetera, finding information past labs, vitals, et cetera. So I do think there's, I'm with you. The backend with the business office, some of the supply chain we've seen it in certain pocketed areas on the clinical side, we've seen it, but it is ripe for us adding in innovation and really advancing more of that clinical automation. I know you've mentioned about schedulers. I think we've seen that there's numbers out there that we're seeing through one organization they saved about five to seven hours of schedulers through self-scheduling during the COVID-19 on a date per day basis.

So we're seeing some of this through those automations. But we have not seen some of that on the clinical side. And I think those, those virtual assistants could be kind of that that next step or that next foray into us, adding in some of more the AI components and seeing what things we can do to help.

I would love to talk about that. We've two more topics and we have five minutes. Short answers on the last two. So cloud 61% of healthcare IT executives have adopted hybrid cloud approach, 10% reporting they're all in on public cloud. It's interesting because Citrix just got bought by a private equity. And I had a back and forth with Dale Sanders on social media. And we were just talking about how Citrix has extended the life of software that should not have been extended well beyond its, its lifecycle. And so when people hear cloud, they think, oh, I moved to the cloud, I'm using Citrix to run my EHR in the background and whatever.

And that's like, Yeah, technically yes. You've adopted a form of cloud, but the next iteration of cloud really is cloud native applications. How far away from that are we in healthcare?

So, I mean, to be honest, I think that we're not that far away and in many cases we've already moved at least for the expanse platform into that environment, with our with our web first rewrite that we've done for the expanse platform.

But so we are right now we're running in a cloud environment and we're not needing VPN to dial in. We can access our EHR data, just like anything else, be an app or web browser. So there, and also to that point, we've actually just released our first iteration of what we call our high availability snapshot, which is essentially our disaster recovery are our unscheduled downtime solution where it's the same thing. It's not even running it's in the cloud. It's not running on Meditech quote-unquote servers or have really Meditech applications or software behind it and they're able to access and they can do it either through a web browser or even just on their, their phone itself.

They don't even have to have their system up and running. They can, they can access it via cellular. So I think that that is what you're going to see health systems go into, and that's what you've already started to see some of them make that progression. But it needs a reboot of technology. So you have to start looking at EHR vendors that have invested in that kind of rewrite in that web design end ask the tough questions like you're asking, is this really? Now, if you're using Citrix, are you really in the cloud and what is the next iteration? For some of these organizations and I think that you have some stories that are better than others, of people that have handled it and how they've invested their R and D.

What's interesting is this. A lot of people said, Hey, we're doing backup in the cloud. Right. So our DR was in the cloud. That was one of the first iterations. And then people are like, Hey, we moved to the cloud. I'm like, okay, great. What's your DR now? And a lot of them are like, well, no, it's these, these are highly reliable data centers and stuff.

And like, so your hospital didn't have a high, reliable data center. It's like, no, we had a high reliable station and I'm like, okay, so you still need a disaster recovery plan. And then I started it because we had to do this way back in the day, I started telling them, I'm like, you need the reverse. If you're going to operate in the cloud, you need DR on site. And they just looked at me like that makes sense.

Yeah. So, so I will say the high availability that I mentioned to you, the reason why I mentioned it is because it's more on premise and also our cloud solution. So we have the ability to do that. So if you're on premise and I'll, I'll use the example, that was one of our use cases in a back co splits the line, which happened at one of our customers.

Down from days. This is the ability for them just on a dime to give their clinicians access. And you have a snapshot, not of, it's not a full-blown EHR, but you have a snapshot of the most critical clinical data for you to be able to at least treat Christine parent or bill Russell without missing a beat.

So, and I don't disagree with you. I sat through those early cloud discussions and people were like, I use Microsoft. Not exactly what we're talking about or DR strategies, right? So, so this is the next evolution, but I think that those are those are tough questions that people should be asking their EHR and they should be getting the right answer if they're really all in on the cloud.

Yep. All right. Last. What is a smart hospital? Isn't every hospital smart. When I walk up the door actually opens, no one touched it. Is that a smart hospital? What's a smart hospital?

So I will tell you that we have at least for, for us, we have two hospitals that we're very close to. Humber river, which is out in Toronto, was the first all digital north American hospital. So they're a smart hospital and there one of the ones that we e running on meditech. It's really in the other one that I'm thinking of is valley that's in New Jersey valley health. They're actually building a new hospital and it's going to be all smart hospitals. So it's incorporating digital technology into everything that they do.

Am I going to see a fax machine anywhere? All digital. I'm trying to think of what that means for me. That means my medical records going to follow me everywhere I go. Yes. Right. That means it's a digital foundation. So I could probably do digital pathology. I could probably do start plugging in the various digital tools that exist. I should be able to walk out of there as a patient not with stacks of paper, but with know videos and things to that effect. Is that what we're looking at?

So a lot of what they do, so, yes. But it's even beyond that. It's beyond even just the EHR components. It's down to even the digitization to the building. So if you go into an example, I'll give you is Humber. And we did a walkthrough when they did their opening there. Cause they, they originally were two hospitals. They built a one campus and it was all digital. If you're a patient in there your lighting is done based on the sunlight coming in. So it's not adjusted, it's automatically adjusted. Your temperature is automatically adjusted. You have, in the example, they give here is personalized iPads. That's the ambient controls that I talked about. The Wayfinder food, or even prescription delivery is done by robots. So it's very interesting. Now I won't promise you that you won't find somewhere a fax machine at some point. But I do know that there just even with, with him,

I appreciate the progress. That's, that's impressive.

Yeah. Because as you were sort of rattling those off, I thought, yeah, we had a couple of hospitals with that. A couple of hospitals with RFID and a couple of hospitals with wayfinding hospitals. But you know, we had 16 hospitals. Not all of them looked like that. But the good news is there's, there's a fair amount of capital floating around right now. People are investing in updating the infrastructure of buildings. I just read an article on that. So that's pretty exciting stuff as well. Christine, thank you for your time. I really appreciate it. And it's great to have you on the show and we'll, we'll do it again.

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