This Week Health

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May 3, 2021: It’s Newsday with Bill and Ed Ricks, CEO, Director of Healthcare at Sirius. EHR giant Cerner will provide life insurers access to 54 million patient records via MIB. Is this reciprocated to the patients? Will they get access to their own information too? Teladoc Quarter 1 revenue more than doubles. How are health systems integrating telehealth today? Where are they plugging it in? How are they pushing it forward? Henry Ford Health System launches a competition to tackle health disparities. And the results are in … nurses are very unhappy with EHR usability. How can we ensure that nurses are being represented in the EHR build so that it serves them better as a group? To get to the 80% vaccination rate poses a huge marketing challenge for healthcare and is patient-matching still a problem or have we solved this?

Key Points:

  • Health systems own patient records. Should we have joint custody? [00:12:05]
  • Henry Ford Health System is seeking out new ways to address the digital divide [00:24:00
  • The overarching strategy in healthcare is that we're just trying to solve problems with solutions, not technology. It sometimes takes a lot of technology to make those things happen but the hospitals, the clinicians and the patients shouldn't have to think about that. [00:02:16
  • EHR usability is so important. Data is even more important. The EHR can lead to adverse events. That's a nice way of saying the EHR can kill people. [00:33:50]

Stories:

Transcript

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

 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.

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I. Today we look at patient matching tech to address health disparities, price transparency, the marketing challenge that healthcare faces to get to the 80% vaccine, uh, threshold that we're looking to get to. So a lot of good stories with Ed Rex, director of Healthcare at Sirius Healthcare. Since Ed is on the show, I, I should call out that Sirius is sponsoring the show as well.

And welcome to Newsday Ed. Hey, thanks Bill. Appreciate it. Well, I, you know, did I call that right? Do, do I call you guys Sirius Healthcare or should I call you serious, serious computer solutions? Well, I mean, so we're both, but we try to brand ourselves serious healthcare because our team, that's our entire focus is healthcare.

Well, yeah, I mean, you have a healthcare, I, a lot of the people I've talked to, Vic is a healthcare background, and Fred, as a back healthcare background, you have a significant healthcare team that is focused on. The, the challenges that healthcare faces and, and some of our CIO guests have talked to me about some of the things you guys have helped them with and you, you really do address a broad range of things.

For healthcare companies. Yeah. I think, you know, probably our overarching strategy is really that we're just trying to solve problems with solutions, not technology. It takes a lot of technology. Sometimes I make those things happen, right. But the, the hospitals, the clinicians, the patients shouldn't have to think about that.

Yeah. You know, I, I, I gave you that little segue because it's interesting. Sirius is one of the most amazing sponsors to me because they. They don't want any fanfare, , it's like, you know, just mention our name. We just want people to know that we support your mission and, and that's really enough. And it's, it's really kind of crazy to me.

I'm like, do you want me to read an ad? Do you want me to talk about the services you offer? Like, no, no, no. We just wanna support what you're doing. And so I, I have really appreciated that. I just want to give a shout out to, uh, all the things you guys are doing. So, no, wait a minute though. I'm looking out my office window.

I'm waiting to see the airplane go by with a banner or something. Um, I don't know. You guys, you guys are pretty low key, but you show up everywhere. Every time I'm, I'm talking to a client, they're like. I'm like, well, you know, what are you doing in this area? It's like, well, we brought, we brought Sirius in and those guys are helping us with our, you know, our, our build out of our, you know, patient room next and, and those kind of things.

So it, it's really interesting. This the stuff that you guys are doing. Yeah. Alright. We should get to the news. Otherwise people will think the whole show is about advertising and it's, it's really not. We actually only have, I think, eight advertisers on, uh, all the shows that we run on this weekend, health it.

So we're really kind of lean in that area, which is great. Let's start here. 'cause it, it, it got a lot of traction. Last week I did a post on LinkedIn and I haven't been checking LinkedIn recently, so I want to do that 'cause I want to keep pulling the community into the conversation. And it, it really was a lively conversation.

And if you wanna engage in the conversation, go ahead and follow me on LinkedIn. Bill j Russell, I throw a post out there every day. It's usually a news story. I usually follow that with a Today show and then. You can read the, the, just the posts I do on LinkedIn. You can read the article that's connected with it or you can listen to the Full Today Podcast and get more information.

But this one was, Cerner Corporation launched a, A program with MIB. If you're not familiar with MIB, it's not Men in Black. It's actually a clearinghouse, if you will, for information to insurance carriers. Really life insurance carriers. And Cerner announced that they will provide MIB access to 54 million patient records via MIB.

At least that's what the headline read, and it's a really poorly written headline 'cause it's not like MIB all of a sudden has access to 54 million patient records. I. It actually is that patients will have the ability, if they are getting a life insurance policy to do patient directed interoperability and say, send my record to MIB, or send it over to New York Life.

And that will expedite the process because regardless of if you do it electronically, you still have to do it. So if you don't do it that way, you have to go to the electronic medical records. Part of your healthcare organization, get the information and send it over. And the, the last time Cerner did this, which wasn't that long ago, it was probably about two months ago, they did it with New York Life and I did a little post on it.

And you would think that Cerner had betrayed the trust of patients everywhere. And people came out in earnest in, in that post against it and just said, you know, how could they do such a thing? , and it's interesting. In this article, they made it very clear that MIB had already done this with Meditech and had already done this with Epic a couple years ago, and I thought it really put things in a different light.

Did did you get a chance to look at, uh, I mean. Uh, I'm sure you saw that post. Did, did you get a chance to look at this and, and do you have any, I'm gonna read some of the comments we got on this, but what are your thoughts on this? Yeah, no, I did take a look at it and, you know, again, everybody's so worried about like big Brother having all this infiltration and their life and what they're doing and they, they miss what's really happening, right?

In some of these cases, you're trying to make people's lives easier, and I think that's sort of the goal of technology if we use it right. So while the goal is the right thing to do, I think that what, what they're doing is the right thing to do. The public perception's always the wrong thing, you know?

And I did, I saw some of the comments on your LinkedIn post and just reminded me of, uh, like if you, if we do the same thing with the healthcare organizations and the payers, I. To improve prior authorization claims processing, that kind of thing. At first, I think people were hesitant, but when they realized, you know what, if we have this kind of connectivity, we can have prior auth and get paid maybe day one on some of these claims.

That's what some of the payers wanna do. And so that's a different way to look at it. And sort of easing what's going on from a technology perspective. We, you've been to some of our healthcare to healthcare conventionals, so they're all peer led events with CXO people in the room and from all different kinds of health systems.

And usually we've got one or two from a large payer that come to that also. And so you see this distrust, you know, one, one of one of our favorite. CIOs physician, you know, had this, this distrust for payers because of the experience as a provider over the years. And then they talked about, you know, sharing the data real time for these things.

And you could just see no, what, no, you're, you know, you shouldn't get a. Our data like that. And then when the payer says, but our goal is we maybe can pay you that same day for the claim, all of a sudden, like the light bulb goes off and say, all right, I, I get it. You know, if we can share that data to improve what we're doing, I think that's better for everyone.

Then I don't see any difference with the life insurance. Oh, same thing you're gonna submit. It used to just attest to that information before, and now you gotta submit meal data, so why not make it smooth? Yeah, my, my test on these things is always does value accrue to the patient and is the patient in control, right?

That's my lens for which I look at all of these things and it requires a patient initiated request for that record to move to MIB or two New York Life. So that clicks my one criteria. And then the second is what accrues.

I don't have to track down my, my medical record. I don't have to go over to all, Hey, look, I didn't go to one Health system. I've lived in six states, right? I, I literally have to go to six different states, six different health systems to, to get my medical record. I mean, that's literally probably taking 20 hours out of my life to collect that information.

It's, and send it over to. To my insurance carrier just to get a life insurance policy. Let's, let's hit some of the links to see if there's, so David Chow posted a link to the 2018 agreement between MIB and Epic Margarita Koff, and this is the hardest part of this reading. People's names ask, is this reciprocated to the patients?

Will they get access to their own information too? You know, that's an interesting question. We, you know, we. Created a way to share a significant portion of the medical record with MIB and New York Life. You would think that sharing it with the, the patient wouldn't require that much additional programming and at least as much additional programming as we were led to believe in the interoperability debate that would have been required to share it with the patient.

I mean, if we create this mechanism to share that information over there, in theory, I mean, am I thinking right or am I theory, wouldn't it be. Couldn't you just use that same code and tweak it a little bit, put a, some sort of security and identity framework around and share that information with. I mean, it's the patient's medical record, right?

So they, they should have access to probably all the elements that are gonna go over there, I would think already, one way or another. Uh, I'm sure the mechanics of what's being sent over through interoperability is different than a what a patient could ingest. But, you know, like you said, . Yeah, I, I don't wanna let common sense in logic to, to really cloud this.

A mechanism you can easily, if you, if you're using, if your programmers aren't good, you're using reusable code and blocks and, and those kinds of things. It should be easy to do. Lee Lee Milligan chimed in. Uh, we've had this in place for a long time and it's indefinite time saver for medical record staff, and that's pretty much the primary objective that everybody talks about.

So that's somebody on the front lines, who's medical record staff is using it. Jim St. Clair, chief Trust Officer at Lume Rights c Turner Corporation, will provide life insurance access to 54 million patient records. He, that's the title therein is the cultural problem. My credit union doesn't send press releases saying they're granting access to my bank account in other organizations, but we've accepted this as okay.

In healthcare. There's, as yet, in this country, no cultural impetus that ownership of this data is sovereign with the person, not the system. And you know, a couple things. One is he really goes off on the title and I think the title was Misleading, which is what led him in a interesting direction. And he and I went back and forth a little bit on this.

But I think the other thing is, and, and I just need to call almost every time I have this conversation, I just need to call it out in 49 states, the patient doesn't own the record. It's not your record. And the people always get, get frustrated with me. It's like, no, it's my record. It's about me. No, no, no.

The creator of the record owns the record and you didn't create the record even though it's about you. The record was created by the health system. The health system owns the record. The EHR provider doesn't own the record legally, and the patient doesn't own the record legally, except in the state of Vermont.

It is not the law that you own the medical record. It.

Should we have joint custody? And I think that's, that's the direction we should go. Sure. If the health system's gonna create the record, they should own the record. I, I'm all for that. That makes sense to me. But I want joint custody. I want the ability to get access to the record so that I can start to engage other organizations on behalf of my health if I wanna use big tech.

If I wanna start signing up for Apple Programs and something that Amazon does and maybe a, i, I don't know, a Livongo or a Teladoc and I, I'm gonna start going out the normal channels that I, I do, I want, I, I really want joint custody of my records so I can give it to the players that I choose to create as my.

Health ecosystem. Now, again, I just need to check here. Am am I smoking something or does that make sense? No, I mean, I like it. The, the thing that you have to be careful of is, well, patients can request to change their medical record. I don't think you want that car blanc, right? To have a patient be able to update a record because it's now it's theirs.

You know, it's both of ours. Only the health system can update it. Some people say, that's not right, you know, it's my record. I wanna update it. You know, I might've said I'd take eight drinks a day, but I really only wanna put in there three drinks a day, or one or zero or whatever it is, you know, whatever it might be.

And so I think it's okay to request a change, and there is a format and a process for that, where that goes. Yeah, and, and we created some tools for patients to give us information and we always had metadata around that. That said, patient generated data, right? So, so that the clinician or administrative staff that was looking at it understood where it came from and they would determine whether it needed to be verified or whether it needed, you know, what level of credibility.

By the way, we had metadata around provider data. Provider created data because some of our doctors said, look. If data's coming from that doctor, I don't trust it. . I kid you not, I mean, right. Yeah. And if you've been in healthcare long enough, you've heard those statements and so they would say, look, we need to know if this is generated from within our health system or from a partner or from, and so we would, we create metadata around the, the actual data all the time that says, this is the source of this data.

Give it the credibility that, that you're.

Some actually called for a complete end to the electronic medical record altogether. ? Yeah. So you know, I love the discussion. I'll tell you one of the things that's apparent to me is that Epics clients defend Epic. They aren't seen as a corporation. They're seen as Judy. Right. They're seen as a person.

They, they care for them. Cerner is seen as a corporation. The two of them do the same exact thing thing, and, and one is seen as helpful and the other is seen as villainous. And that's just an observation on my point. I don't really want you to comment on it because I can get in trouble. I don't want you to get in trouble.

But I'll tell you what, if people wanna participate in the conversation, go ahead and follow me at Bill j Russell on LinkedIn. And, uh, love for you. So we have a bunch of different stories. Let me hit on one of the ones that I think is really fascinating to me and that is Teladoc. I don't, I'm not sure I shared this story with you.

I shoulda The, so Teladoc announced, and this is recent actually, this might even be this morning. It is this morning, Teladoc re-released their Q one revenue and it more than doubled to 454 million as telehealth visits continue to climb. Let me give you a couple of excerpts since I didn't share this with you.

Despite a historically weak flu season, the Telehealth giant delivered 3.2 million virtual visits in the first quarter of 2021, up 56% compared to the first quarter of 2020. Earlier this month, the company launched its first wave of members to access and register for the Livongo programs, which is their recent acquisition within the Teladoc app.

Marking the first step in creating a seamless member experience to engage their members more effectively across programs, said their CEO. The company also launched a medical group referrals into chronic care management program and a major new contract with a regional, regional Blue Cross blue Shield plan in on the East Coast.

The number of consumers enrolled. More than one chronic care program tripled year over year, which indicates users are choosing Teladoc Health to meet broader health needs beyond urgent or episodic issues. According to the company executives total US paid membership is expected to rise between 52,000,050 4 million members.

Teladoc expect to deliver more than 3.2 million visits in the second quarter, possibly up to as many as 3.4. Million visits, I'm sure you're following Telehealth and telehealth is, is the conversation with a lot of health systems these days that still those numbers are pretty st staggering to me. I mean that their, their numbers have doubled in Q one.

We knew that they doubled last year in Q two with the rise of the pandemic. Everybody went to telehealth, but this would indicate that Telehealth's trajectory is still on the rise. Well, I mean, guess what? Everybody figured out what you and I have known for 10 years that telehealth is really probably a better way to, to deliver medicine.

You know, in healthcare, I, I think the payers always knew it, although they didn't always reimburse for those visits, but they knew intuitively it was gonna be less expensive, probably, you know, get quality care physicians, get them on board a little bit. So I, I really personally hated all these discussions in the last year, probably since the pandemic started of look at all the innovation.

People have come up with to sort of respond to what's happening. Uh, most of it I didn't see is innovation, so that just like we're adopting the things that we already had available, we're just doing it really, really quickly and, and folks are getting on board. So, you know, those who were resistant before had no choice, right?

I mean, we had to evolve telehealth a little bit last year, and I think you're just gonna see a mushroom because it's easier. It's, it's better, I think. And for a lot of things, some things you gotta have hands on, but, so Ed, let's, let's go back and forth a little bit on this. Why is it. Better obviously it, it's, it's gotta be more efficient, right?

I can, I can see more people. I can have a larger panel. I think's one of the things, I could see more patients via telehealth than I would in person. Just the logistics of it would make sense. Are there, are there other areas where it's just better? Yeah. Well, I mean, I think the logistics for the patient too, right?

So you, in many cases, you're looking at, at minimum 30 minutes each direction. Plus wait time in a office or something. In some cases it's an hour depending on where you live or where you have to go for a specialist or something. So if you can eliminate that, improve that patient experience, that's a win.

Right? Yeah. It's clearly more affordable. If you look at big picture, what the cost to deliver care is, you know, you don't necessarily have to have all these bricks and mortar. Buildings anymore. We still have 'em. I've been amazed at how many new facilities that are still going up today, you know, which is incredible to me.

'cause if you're, I feel like if you're thinking 5, 10, 15 years down the road, you know, care is gonna be like super, super, super acute care and then home-based somehow, or you know, some different level of care to deliver the same thing we do today. So that's gotta happen. But it's and, and that might fall into the same category as we saw telehealth 10 years ago and it's now come to fruition.

It's like we, we see home-based care and we see a alternate ways of delivering care today, but it's still, it might take whatever pandemic 2030 to really, I don't know, catalyze our movement in that direction. I, it's gotta change. I think it is. I mean, a lot of people are working on. New programs that can help with that, I think.

But I just think that telehealth is gonna be more efficient. It's gotta be, it's definitely a better experience even for patients who were resistant before. And probably more importantly, physicians or clinicians who are resistant before. And you know, it can manage it and there's good, great vendors out there.

You talk about one, but there's. Plenty of others that do a great job in that field. It sounds like your dogs wanna be a part of the show. Is that what's going on? Yeah, I'm sorry. You know, , that's like our three wireless doorbells, you know, laying on there, charging mats and tell the UPS guy happens to be brave enough to come up the driveway or something.

This is the world that we live in. How are health systems do you think today really, uh, uh, you know, how are they integrating it? How are they pushing it forward? I mean, Teladoc sort of stands over here on its own, but how are health systems really looking at this? Where are they plugging it in? Where are they trying to expand it?

And, and as you said, it's not perfect everywhere. So where are some marriages they're pulling back and where are some marriages they're pushing forward? Yeah. You know, I think the traditional model was like. Either the real telehealth, you know, like stroke to a tertiary center to a community hospital or something sort.

Sort of that telemedicine with internal, but then people started, probably the biggest thing was urgent care visits, right? You could do a Teladoc and ml, some of those other vendors and just sort of relieve your ER, hopefully, of patients who probably didn't need to be going in there to begin with, but now you're seeing a more full adoption.

I think the challenge is gonna be like, as we all grow. What's, what data do we wanna collect out of that visit? You know, that virtual visit, where does that go? Is there home-based data that's gonna go in that? How do we use it? How do we store it? You know, as you mentioned before, put metadata around stuff because it may mean more to a clinician or mean, mean less to a clinician if it came from the patient in or the home or something too.

Yeah, I, I, I like, I like health systems doing this work as opposed to a third party because it, it, it integrates the, the, the medical record. And, you know, I, I, I worry about the silos and I've talked to some people on the show who worry about the silos as well that get created. In fact, when we were looking at telehealth systems, and this was a long time ago at St.

Joe's, Teladoc is one of the ones that we were looking at and essentially said, look, own ER in this thing. And data separate. Well, that, that doesn't work at, at all for us or the patient. I mean, the, the patient wants that longitudinal patient record. And so we were talking about sharing the data through the HIE and other things.

I'm like, look, I don't understand this. Our physicians were delivering it, and all we were really using Teladoc for was the, was the mechanism for establishing the video visit, the, the waiting room, and then, you know, just the whole workflow and the process of standing up. So if our doctor's doing it and they're in our EHR and we're just using your technology, couldn't they just document the whole thing in our EHR?

And the answer to that was no. So we didn't, we didn't go with Teladoc at that point. Yeah, I, I, I worry about those silos and I, I hope that, uh, we're, we're not creating more silos as we go. That whole medical record and all those visits together because that we know that that leads to better care. All that.

Yeah. You know, I think most of those applications that was their model before is we document within what's happening in the visit and then we'll send a PDF back to the R, but that's not really all that useful . That's what we need. More PDFs than the EHR for, for all doctors out there. That I was kidding with no more PS in in the eh r Let me hit on another story and then I'll.

This one I wanna make sure we get to. So Ford launches a, uh, a tech program to, uh, address health disparities. I like this. This comes from modern healthcare, is where I picked up this story. Henry Ford Health System launches competition to tackle disparities with tech. Henry Ford Health System is seeking out new ways to address health disparities.

On Tuesday unveiled the digital inclusion challenge at competition that it is hosting in partnership with Google Cloud and Novi, Michigan based information technology firm, miracle Software Systems entrepreneurs and engineers from across the globe are encouraged to propose ideas on how to use digital technologies to reduce racial, gender, and other health disparities that include, that could include projects.

Make more affordable, accessible, or make it easier for patients who don't have access to high speed internet access and learn about their health. The challenge supports Henry Forges broader initiatives, double down on diversity, equity, and inclusion and so forth, which I heard their their CEO talk about at the JP Morgan conference.

They're very committed kicks 19th. Submissions due June 24th, the winning team will receive 75,000 and will participate in a co-development program at the Henry Ford Innovation Center, where the team can collaborate with the systems, clinicians, it, and other staffers. So each issuing program, I, I wanted to give them a shout out.

I wanted to get that out there. There's a lot of other innovation programs out there. Are these kinds of, uh, challenges and those kind of things, I, I like the focus of this one. Have, have you seen others out there? Yeah. And I think that's part of the challenge, right? Because there's so many different people doing different competitions to drive some kind of innovation or plug some of the holes that we have and, you know, whether, whether it's, you know, like this through some of the disparities, I think in the way people receive their care.

Uh, it's exciting. What, what's interesting for me is, uh, we, we all end up with a technology solution somewhere, right? That's new or somebody's kind of put, stitched some things together, but I think it all sort of assumes that the patients, we, we keep saying there's a shift to consumerism that. They wanna be consumers somehow they wanna use the technology differently or more in their care.

And I don't know if that's always true. I, you know, I hate to be a downer on that, but it's just some people, a lot of people I think don't want to be in that position. So while I would over manage myself electronically, 'cause I do that with everything else in my life. I know folks who won't, they just won't interact that way.

Yeah. And that, and that, you know, doesn't help with outcomes downstream For sure. Population management. Well, that's what I, I love about these, these competitions. By the way, if I were doing a startup, I wouldn't participate in any of these competitions, , just, just for clarity. Uh, and I wouldn't coach people to participate in these competitions unless you're doing it outta the kindness of your heart and the, uh, goodness of your heart.

It's not a good way to start a business. It's not a good way to, uh, really get to the next level. If you, if you have a good idea, go get the funding and, and go launch it. , but you know, these challenges are a great way to get a lot of energy and focus. This is how you know SpaceX got launched. This is how you get, you know, 20 organizations, 20 smart groups of people working to get a, a rocket into low orbit.

And once they're successful, they're able to go on and commercialize that at least, uh, a lot of 'em are able to, if, if they're thinking right, they're able to commercialize what they've done and, and those kind of things. And that's the concept here. If nothing else, you'll get a lot of energy around this.

I, I think there are ways I, you know, I, I, I agree with you. We end up with a lot of technology solutions in silos that don't really integrate real well, and we don't take the community that we're trying to serve into account enough. And I think that's where the generic competition things don't, don't serve well.

I.

We are, we're, we're trying to serve this population in these communities in and around Detroit, and it's the people that are disconnected digitally. Alright? So how do we help them? And to be honest with you, we know that 80% of healthcare is not health related. It is social determinants and other classifications of activities that we do.

I just don't know how people function anymore without technology. How do you apply for a job without technology? How do you even know that a job exists without technology? I, you know, as an employer, I, I never put an ad in a local newspaper anymore to hire people. I mean, I, I go out, I, I get people through, through Upwork and some of those Fiverr and other things.

For things that we need to do short term and the other hiring, I do, you know, it, it'll go out through, through technology platforms. How, how do these people find out about jobs? How do they apply for jobs? How do they, you know, you know, how do they read a lot of these journals these days, a lot of these journals have gone to digital.

Only if you are disconnected from the internet.

If we want people to be healthy, it's almost like we have to figure out how to plug them in. Now, we also know that there's a lot of unhealthy things on the internet as well, like all of Twitter, but at the end of the day, it's, it's hard to function without access to. Yeah, I mean, I totally agree. I like who really reads the local paper anymore that that's almost a thing of the past.

And even our local paper here, which we do still have a subscription to, they've actually stopped printing on Saturdays. They just no longer print a paper. I. You know, they're happy to tell you that you still can have the digital edition, so you know, you can get into that. So it is crazy. And I guess word of mouth, right?

I mean, some of those communities, and I'm from Michigan originally, so I'm pretty familiar with Detroit. In fact, I'll be up in Michigan next door and go and visit some family. And I understand some of the communities that they're working with. It's not unlike actually where I live now, pretty rural area.

It's, you know, a grouping of islands essentially, and this huge disparity between. The kind of income levels and, and neighborhoods and things like that, uh, which is incredible. So that was always our challenge. The, the health system I worked at here for 10 years is, you know, how do we deliver care equally to all the folks who are here, you know, from a population health perspective.

And it was complex and we had to go through, you couldn't rely on technology. We had to go through some of the other networks, working with local churches, things like that. because people would, it was, it was meaningful to them, I think. And we had a way to contact and get in touch with people. Yeah. It's, it's, it's interesting.

I think we need to be connected to technology and then we need places like that where we can get away from technology. Right, right. So, all right. What story do you have? Well, which one do we wanna jump to first? So let me see if I can grab one of them. Got, uh, two. To me are sort of, sort of tied to each other, right?

So one is, uh, good lord we got too many things going so. EHR usability and, and this is something, you know, when I was ACIO also for 25 years in different places, you know, as we were implementing the technology for what we all thought were the right reasons, doing as good as we could do and things like that.

Always, and I'm sure you got this pushback from clinicians you hear, you know. You're, you're gonna kill somebody. You're, you're ruining my day. You're, I'm burned out. I'm blaming the technology. And, you know, and I know that that's certainly a piece of it, right? I mean, there's a number of things that. Drive to clinician burnout.

So technology is a piece of it, but you know, obviously the reimbursement changes over the years. The expectations. Organizations trying to be more lean because they almost have to, to survive from a nursing perspective and things make a huge impact. And my wife's a nurse so I know, you know, the day-to-day of everything that happens from that perspective too.

And you can't always do more with less. It just technology doesn't plug that gap. HR don't necessarily plug that gap. This was, uh, an article recently in the last couple of days, I think, about poor EHR usability linked to nurse burnout and patient mortality in the study. You know, so nurses are blaming the usability of EHRs and, you know, they had a ranking of, or scoring system of EHRs.

And so for those, they, they say didn't do a good job of developing the HR and good implementation of it. That leads to nurse burnout. Well, I guess it makes sense. I think a good implementation can lead to nurse burnout, to an hr. You know, the problem with all these studies, I think, is that you never really hear the flip side of what you do.

Like you're delivering data that's necessary at the point of care when it's needed, things like that that can help drive decisions. So we all get that, and I think long term, hopefully quality improves and everything. But the interesting thing about this was it was a 12,000 nurse study. Um, EHR, usability and outcomes, and then they were able to go back and look up mortality data for those organizations who ranked it low and saw that the mortality was higher, uh, in those, and to me that's, that's compelling, scary, and compelling at the same Yeah, it's, yeah.

So I, I, I always come about this in two ways. So we covered, nurses gave the EHR usability an F grade. Last week on the show, so if anyone's interested in that, but there's almost a follow on to that. Mm-Hmm. , the usability is, is so important. The data is even more important. Well, I mean, the EHR can lead to adverse events.

That's a nice way of saying the EHR can kill people, right? I mean, if there's incorrect information in there and people are acting on that incorrect information, there's a checks and.

It can lead to an adverse event. Doesn't have to be a death, but it can lead to a lot of adverse events. So it's like a paper chart, . Yeah. I, yeah, exactly. In, in incorrect information is incorrect information. The, the challenge with an electronic versus a paper is, you know, paper doesn't propagate across as many locations.

You know, if you put this.

Have the same kind of practices that you have to catch errors. So electronic health systems, , electronic mechanisms tend to create larger problems just 'cause they can propagate it so quickly. It's just moving once and zeros all over. But yeah, so, so there there is that aspect of it, it absolutely needs to be looked at and needs to be, it needs to be done well.

But then I, I hear the other people who are. The earlier comment, you know, we should go back to paper charts from the, uh, post that I did this morning or, or last week. And the, the challenge with that is, and I've had people say to me, there's no studies that show the ER has led to any health benefits or any reduction and not true.

And, and you know, we can go back to early, early on, we found all the information. We, we stopped using Vioxx as a result of the electronic health record. The electronic health record was able to bring all that information together. People started looking at it and saying, look, we're administering Vioxx and people are getting sicker and.

And this is across this whole patient population. So they were able to capture that quicker, stop doing that, and then move forward with, you know, a different, a different direction. So the, the EHR has saved people can save people, but it needs to be built. Right. And this is the thing I don't think, I know that the average American doesn't understand, and I think most people in healthcare understand.

The build is highly dependent on the health system that's implementing it, and this may not be as true in an Epic case. This is why Epic is so popular, because Epic has become very prescriptive. This is the build we recommend. The, the standard build that we recommend. This is the, the foundation that we, we suggest you go on.

If you're not a large health system, we suggest you go on foundation, and if not, we expect you. We, we suggest you find a community connect partner who can do the build correctly and go in this direction. They, they were very prescriptive, but before that, a lot of EHR providers would come in and say, we've got this technology.

Bring your people together. Tell us what you want, build it how you want. And to be honest with you, we weren't good builders. No, I don't think we understood what the end point was and you know, and so I completely agree almost, don't you wonder like, shouldn't we even have less variation in the hr? I mean, a lot of those studies you're talking about that show the quality outcomes, why?

'cause we reduce variation in the way we deliver care. And you know, I know there's the argument from the clinicians about. Patients are individuals and all these unique, you know, so the art and the science piece of it together. But every study that looks at all the right data, if you reduce variation in the care, you're gonna have better outcomes overall and probably reduce expense to the organization, which we need from a healthcare perspective overall and all those things.

So I almost wonder, like you can't say, all right, I'm gonna call Microsoft and order my version of Outlook to be like this. Whatever this is. I what if we didn't have any ability to have the workflows so different from organization to organization and an EHR and like, and some have more flexibility than others, but they all do.

I mean, even in Epic, you can, you can go down the wrong path if you want to. For sure. Don't you think it'd be better? I mean, I, that would scare people, I suppose, and there's almost no way to get to that point. You know? It's, it, it, yeah. Reducing vari clinical variability is important. But you, I mean, it, you've done a build, I've done builds and it's so challenging.

My gosh. I mean, you sit in that room with five oncologists and you say. Let's get to the way we're gonna practice. And they, they come back to you and say, alright, these are the three ways we wanna put into the system. And you're like, you couldn't agree on one. And they just look at you and say, no. And they might be partners, you know,

Yeah. Serious, seriously. You know, or orthopedics. Hey, we want you to, we want you to narrow it down. Right now we have five different manufacturers we have to deal with for hips. We want you to get down to one or two. Yeah. We couldn't do it. You couldn't do it. It's like, yeah, we don't. It's like, well, wait a minute.

That variability is costing everyone a lot more money. So, uh, are you telling me that this hip is that much better than this hip? Well, these pe these two think this hip is better, and these two think this hip is better. And these four think this hip is better and they're not gonna change. Okay, so we , you know, and at the end of the day that it's really, I think it's a lot harder than what people think to, to do Bill.

For sure. I mean, all of those implementations to be good. It's not a technology problem, it's a culture problem I think that you're trying to overcome. And I. You know, that's where you have to spend most of your effort and the education of what you're doing. Um, communication around what you're doing, why, but even at that, it's impossible.

And the larger the organization, you probably the more complex it is and the more people you've got with voices in it, even though you would think they'd have more ability to say, here's how we're gonna, you know, deliver care here. It doesn't work that way. And it is crazy. And the competing priorities, those providers might also have a clinical director.

Relationship with a different vendor, you know, which, which means that they're getting some sort of compensation and, and doesn't mean they don't like that it's, they can't validate that that's a better solution for them. But definitely changes the way people look at things. How can, so I mean, this study and the nurses, I mean, this really focuses a little bit on the, on the nurses.

How can we ensure that the nurses are being represented in the build so that it does serve them better as a, as, as a group. I don't know if there's any silver bullet. I mean, clearly most organizations now have a lot of nursing staff people, uh, in the IT staff, and then through the governance of the organization.

When everyone's got like A-C-N-I-O kind of a position, I. That's peer to some of the others in the organization from a IT perspective and organizational, I think that's helpful. CMIO now is pretty common. 10 years ago was it, you know, a few places did, some people had part-time or people that might help, but they weren't really an executive level role and, and I understand.

You're probably ruling out real small organizations, but medium and larger, you know, that's just a common thing. I think the CIO is a great place, you know, certainly having CNOs engaged in the, the entire process. 'cause you have to, and you can't just do things in a vacuum. And I remember the good old days when you'd say, here's how the system worked.

And the reality was, here's how we work. You know, that, that can't, you can't tell us because that's what you programmers built that, you know, that's the way we deliver care. Hey, let's, let's hit on a topic that I know is near and dear to, to all of our hearts, and that's patient matching. So interesting article and, and granted, this is written by, I think this is written by somebody who runs an HIE Sean, all Freds executive director and CEO of Health, infonet and independent nonprofit information organization that manage statewide.

The, the reason I do that is I now read articles and I look for, is this a sponsored article? Who wrote this article? What is their lens that they're looking at this? So it, it is a, it's an IE lens, but I, I think it's interesting and I think it's a topic that, you know, we don't, we don't talk about enough and it's, it's a challenge.

So the title is, it Comes From Healthcare Innovation Group. Is your organization making avoidable patient matching errors? And then it goes on to say, imagine there's three people named Sean, Sean, Sean, Sean. Three different spellings walk into a hospital. While this may sound like the start of a joke, it's no laughing matter.

It's seemingly harmless, clerical error, which takes place. This could jeopardize the accuracy of the downstream patient matching. When an electronic health record receives a misspelled name or a duplicate record gets created, there be a misunderstanding about medications. Follow up instructions or delays in care.

The result of miscommunication between caregiver during patient transitions can include readmissions, patient harm, or inadequate informed consent. And this, uh, research from Circ C-I-R-C-O Circo strategies indicates that such communication failures have led to nearly 2000 preventable deaths. 1.7 billion malpractice costs.

Wow, that's a lot. To improve healthcare outcomes, the patient for patients, and reduce costs for providers and payers, we need to improve patient matching. Amen. Okay, so now they say, here are some lessons learned and key opportunities for organizations to consider in order to achieve more seamless clinical data exchange.

So be ready for this because I'm gonna come back to you and say, you know what, what can we do around patient matching? So the first they give is involve patients in their data validation and registration. In other words, take down the information, turn it around and say, is this right? Is this accurate? Or at better yet, have the patient actually input the information, figure out a way to use the patient as a data steward.

Number two, establish cohesive data governance. All right, so what they're saying is all health systems and their IT vendors need to use the same terms, definitions and processes while compiling patient records and, and interoperability and more efficient care. It leads to is possible, but when need, but we need effective structures in place to make this.

Technology investments. And the third, fourth one is establish strong partnerships. Build an expert team that can tackle these daunting matching challenges. Lemme start with the obvious question. Is patient matching still a problem or have we solved this? I mean, it is 2021. Patient matching is solved, right?

Seems pretty simple, right? About like voter ID man. Like it somehow became a political problem a long time ago, and not just a technology and a people process problem, you know? And so I'm a great example. So my name is Edward Ricks for my entire life. I get called Rick Edwards. Ricky Edwards. You know, it's just one of those things.

And then you, you probably know there is a Rick Edwards that's been in healthcare it for the last 25 years, bouncing around, uh, like me. And we used to get each other's email from vendors all the time. 'cause you start the AutoFi and it goes and just like that's gone. So, you know, clearly there are some technology solutions that the, it, it is process though.

It's people in process. The, the read back, all that stuff makes sense. I don't know if you guys . It played around with any biometric authentication at registration points of entry that can help. Some people are worried about that and scared of it. Uh uh, we need, we do, I don't understand the pushback of a patient idea.

Universal patient Id. that would help, right? But there are so many like points of egress to make the mistake. So registration's one point, you know? So you could make an argument that that's maybe the one of the most important roles in an organization. And I will also counter argue that's probably the lowest, one of the lowest paid roles in an organization.

Getting that information correct from a clinical perspective is one thing. From a financial perspective, you know, from a billing, medical records, claims process, all that stuff, it's just a critical job and it's complex all the time. So you've also got the families with multiple people with very similar names.

You've got people who will lie because. You know, my brother has health insurance and I don't, you know, so no, I don't have any id, but my name is whatever, you know, so there's a host of reasons I think that it's a problem. I, I like the biometric that can help. I. That's not the only answer. And again, some people won't use that or don't like it.

I, I don't know why it's still a problem. It is still a problem, but it's also a problem after registration. Yeah. I mean, when you are taking care of a patient, you still got a clinician at some point selecting a patient. Now, a lot of the workflows sort of make that almost fail proof, but it's not, and it happens all the time.

Select the wrong patient, do orders, and it's done. And I, I'm sorry, I'm giggling over here. I'm giggling because it's still a problem because we, we just, it's interesting to me. We did, we did a lot of things. One is, uh, yes, it is one of the lowest paid people doing the process, but anytime you have the lowest paid people doing the process, you, you put in systems that have checks.

And so we had, we used, I think it was called Initiate I, BM had a thing called Initiate, and we had, I did patient matching on the fly and so persons tried to, in Edwards. It would look at, look at the information and go, we have a person that looks an awful lot like this person named Ed Ricks. Are you sure you want to create another record?

And then they would go, yeah, yeah. You know, they're flying, they're trying to do it as fast as they can, and it goes a little further. And there was another one that would pop up and say, no, we're pretty sure this is Ed Ricks. This is not Rick Edwards. Are you sure you wanna do this? And they would go, yeah, go ahead.

You know what? If they said, yeah, go ahead. That created a log file that went to their manager that said, Hey, they created a new record and we told them twice that we thought this was this person. Now it was that manager's job to validate is Rick Edwards Ricks? And if they said yes, then there was a training initiative that had to happen for that person.

Hey, you're working too fast. You're trying to move too fast, or do we have too many people lined up in the er? Do you not understand the job correctly? And all those other things. I mean, that's the, it's process. It's not that hard to do, and technology, technology works with.

Implement. Did we have duplicates? Yes, we had duplicates. We, we did. We had people moving too fast. We had people that you, you just wouldn't expect, right? So somebody from Cal, we were in Texas, California, Northern Cal, Southern Cal. Somebody from Texas went to Disneyland, showed up in one of our hospitals in, in Southern California, and, and people would just say, no, that can't possibly be that record.

Well, at the time, what we had, we had eight different EHRs. So that's one of the reasons.

Uh, you know, that that went way down because the, you know, the, the Texas patients would show up in the Southern California EHR and, and vice versa. You know, I am a, I just wanna go on the record here, and if saying, I am for a longitudinal patient record, I want all my information to be able to be aggregated, except I want the patient to be the locust of that.

And I don't think that requires a national patient Id now, national patient Id, might be required for research and other things. Somebody can convince me of that. I'm more than happy to listen to it. But I, I don't want the health system to be able to aggregate my, my data. I want to aggregate it all myself.

And when I show up, you say, do you have your health record? And I go, yeah. Here it's care for me. 'cause you know what? I'm the constant at the point of care. I know if I'm seeing Teladoc and you don't know about it, I know if I'm seeing some Homeotherapy and you don't know about it, I'm the constant at the point of care, I want to be the aggregator.

And you know what, if you wanna aggregate it, aggregate it to my phone number, people are like, oh, they could, they could hack that. I'm like, I have more confidence that they're not gonna hack this iPhone. Right. And they're not gonna hack my health system. So I wanna be the aggregator of my patient record.

I don't want it to be, to be honest with you, when I leave my hospital, I wanna say, take it outta Cerner. Take it out of Epic. I don't want you to hold it because you know what you're gonna do. You're gonna sell it. And they're like, oh, we don't sell it. I'm like, I have story after story of health systems that are selling data, and they, and a lot of 'em don't even know it.

I'm not, I'm not pointing a finger and saying, you're doing this on purpose. Some of 'em don't even know it. It's like embedded in older contracts. My favorite is, is Explorers. Explorers had huge amounts of contracts and they sold to IBM for, I don't know, half a billion dollars or whatever. And at one point, you know, we were looking at their, their revenue stream.

'cause we were an investor. I'm sitting there going, what's this revenue line over here? And it was almost half their revenue. Like, oh, we, yeah, we sell patient data to blah, blah, blah. I. What patient data, right. Essentially the patient data they were getting from their health systems, they were selling to pharmaceuticals and others like, oh, don't worry, it's de-identifying.

Right? I'm like, okay, I didn't know it as the health system. I know the patient doesn't know it. Right. And I, you know, it's like, oh, well don't worry. It's de-identifying. Well, let's let everybody else decide whether it's okay. Yeah. It's like, well, it's in your contract. Okay, well we need to read the contract again.

And I guarantee you people are still, I think IBM probably is still making a significant amount of money that way and as are others that are making money that way. And I don't want you to comment on it. I don't want you to get in trouble. I'm just saying at my experience, I, I really do want, I, I don't think I need a national patient Id, I think I need, what I want is a shift in how people think instead of, Hey, we need to be able to aggregate all these at the health system.

No, no. I read it all at the patient and then let the patient decide, do I wanna participate in a research study? Do I wanna share this with the National Cancer Foundation? Do I wanna share this with the Biden Cancer Initiative? Do I wanna share this with the American Heart Association? Uh, do I wanna share this with the local hospital?

Who do I wanna share my medical record with? I think that would be a significant. And you know, I, I, I led you in a couple directions that could get you in trouble, so I, I, I apologize for that. Oh, I'm getting myself in trouble without your help. Don't worry about that . No. You know, and I actually, I like that.

But do you really think most patients are ready to take that kind of ownership? Like you, you're sophisticated, right? And you worked in IT and healthcare for a long time, so you wanna manage that. I think a lot of people don't. That's a comment I made earlier. I, I'm not sure every patient wants to be a consumer in healthcare.

I think they just wanna go get care when they need it. We were talking golf yesterday, so you, next time you and I, if we go golfing, you know, first of all, I'll warn you, stay, stay way behind me. 'cause anything could happen, right? But say something funny happens and I hit the tree and it comes back and knocks you out and we, EMS hauls you in.

You are not gonna be capable of managing what information they're 'cause you're on vacation and you know, it's one of those things. Don't you want like all of your record to be available? I would love anyone to be making an informed decision at any point, which I think most people do. And I've been having this conversation, I've been in healthcare for a decade.

I've been having this conversation for eight years. We do break the glass all the time. It's not that hard. So, you know, in case of emergency, here's how you get access to my medical record. We solved that problem probably two decades ago. So it's not, again, that's, that's not the argument against it. And in terms of anytime people say, Hey.

You know the cons. Anytime they belittle the consumer and they say, Hey, the consumer's not ready for this, they don't want it, and that kind of stuff, I say, okay, you know what's gonna happen in that case? Somebody's gonna step in. And it can be the health systems. The health systems can say, look, do you want us to house your record on your behalf?

And those who don't wanna be consumers can say, yep, by all means you house it. I don't want it. But for the, you know, you could. I mean, it could be.

It could be big tech that steps in and says, look, we'll be the ones who house your medical records for you. And because we know how to create APIs, we know how to share this with the people you're trying to share it with. We'll create a better user experience than you would ever get from a health system or some other player.

So go with us, and then you create competition for who is going to be the trusted broker of the information in the healthcare ecosystem and not be dependent on, there's only one today. We told there's only one person you can trust with your health record today, and that's the health system. And problem with that, my health record is all over the place, including on the dark.

Don't think. You know, we are, you know, we should be the only purveyor of the health record. So, yeah, no, I mean, I'm buying what you're saying. I just, how, how far out do you see that shift? 'cause that's a big cultural shift too. It's not, again, it's not just technology that's pretty solvable. I would think.

You know, the, the difference between where I'm at today and where I was as ACIO, we were developing. A lot of the tools we were developing was around these concepts, and we had some really cool startups doing things around that. So that's what I would've done in the CIO role from the concept of how do we empower the patient?

That's what I would've done what I'm doing in this role. I can look 10 years out, right? I'm trying to influence, I, I just want one person to hear this conversation and go. That's interesting. I wonder how that would impact the next project we do. I wonder if I introduce this and, and so as I've finally embraced the fact that I'm media, I say I'm a former CIO, but I am media and as media, how do I get more people to, you know, to not, not even embrace, I don't want people to all agree with me.

I want people to engage in the dialogue. Right. Maybe he, maybe he, right. He let.

Change the world or anything. Actually, I'm trying to change the world, but that's, yeah. No, I love the concept . Hey Ed. Thanks. Thanks for coming on the show. We went a little long, but I, I always like getting together and we will have to do this on a golf course the next time around. Yeah, no, that'll be more fun probably.

But I appreciate it. Sorry about my dogs at least. So we have a cockatoo. At least he didn't start going off on the phone stairs, , because you would really know that one. You make it sound like you live in a zoo of some kind. No, it's close . That's great. Hey, that's all for this week. If you know someone that might benefit from our channel, please forward them a note.

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