July 18, 2022: Charles Boicey from Clearsense joins Bill for the news today, and wow, do they cover a lot. The Metaverse and virtual reality are gaining a foothold in healthcare and Charles shares his personal experience with investing in the Metavers universe. 86% Of Medical Alert System Users Say The Devices Have Helped Save Them From An Incident. CMS Issues Proposed Rule for Rural Emergency Hospitals. Synaptic Health Alliance provider data blockchain initiative expands. Hospitals see challenges around price transparency, technology and resources. How can RTLS security protect healthcare workers and reduce burnout?
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I would challenge that we already do have that crisis. If you think about it's digital disparity. The rural small safety net, those that serve underserved communities. Why are they always technologically disadvantaged? Why do they have to wait and wait and wait for the attack? And then from a resource perspective, it's not right that family member has to drive 20 miles to meet an ambulance halfway if they have a family member that needs immediate care.
It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.
All right. It's Newsday. And today we are joined by Charles Boicey. My favorite chief technology officer, chief innovation officer. data officer, what title haven't you held at this point?
C so CXO. Yeah, that's probably the best way to describe you. It's like people come in and they say, I need a technologist to solve X, Y, or Z. And that's where you. That's where you thrive.
As long as they pay me, I, I don't care about the title.
Yep. Well, and I'm really the same way. And it's kind of interesting with this week health we've hired a couple people and It's interesting. We've trained people that the titles matter and all that stuff. And I'm sort of the opinion that titles don't matter. But what does matter is a description of what work you're going to be doing and who you're gonna be doing. Absolutely. And that kinda stuff, but I maybe I'm, maybe I'm old school on that. We'll see. We've got a lot of, here's what I think, I mean, I've got 20 stories in front of me.
So I'm gonna hit headlines and we're gonna talk conceptually about some of these things. We won't go into the articles too deeply. First one metaverse and virtual reality are gaining a foothold in healthcare. This is from an Accenture. Digital health technology, vision report. This is their strategy deck for 2022 Accenture every year will do a set of strategies and say, these are the four things you should be looking at over the next three years. So does Deloitte, so does McKinsey. They all sort of do the, Hey, this is something to keep your eye on.
When you hear metaverse and those kind of things does that, metaverse in healthcare? What are your thoughts?
it's interesting bill, because I dunno if you realize it or not, that you can actually buy property in the metaverse there's actually real estate brokers. I think from a, from a healthcare perspective, if it helps healthcare. Great. I'm more curious in the demographic that's gonna make itself available to this technology and whether that demographic, even you. Cares about healthcare. And it's usually a younger demographic that's,
invincibles I think is the category that we call them.
Yep. Now, however, there's a potential there from a mental health perspective that I think is warranted in an investigation. It's been my experience that from a mental health perspective working. With non-humans has been a benefit. Mental health patients do very well with bots and text back and forth. And if there's an escalation point human gets involved. So there might be something there from a mental health perspective where they can interact with a virtual therapist.
So the metaverse for people who are wondering it's I, I just did a show with the Accenture folks on this one. And the metaverse is really about creating a place like when we go to the internet, now we sit in front of our computer, but we don't really go to a place. The metaverse is virtual reality. You actually go into the, for lack of a better term, you go into the internet and it has a place. It has buildings, it has substance to it. It's digital, it's all virtual, but essentially you could, as a health system, Acquire some real estate in the metaverse that people go to visit and have conversations with doctors and those kind of things.
But as you say, it's not like my parents are picking up virtual reality tomorrow or even me at my age, picking up virtual reality and going to the metaverse. But the younger generation might look at these kinds of things and it, and I like the fact that Accenture's saying, Hey, Keep this in your mind, because the internet web three, whatnot, the internet is going to change and how we interact with the internet, how transactions are done are going to change.
And therefore there's probably an implication to healthcare. So keep that as a technology in the back of your mind, as you're redesigning for digital visits and those kinds of things.
And bill, I have a beautiful 7,000 square foot beach home in the metaverse that I will show you at some time, but from a healthcare perspective, you could build the most pal experience. So the experience could be second to none. Absolutely.
Do you mind me asking how much you paid for your palatial? Ocean front
a little bit under two grand.
Wow. So you actually, did you forked over some money for a place in the metaverse?
Oh, you better believe it.
so you spent some time there.
Oh, absolutely. it's very, very interesting. I think that everybody should, give it a shot.
what does it take for me to get into the metaverse
Yeah. A few hundred bucks. You've got some equipment that you've gotta buy and I'm not gonna specify brands or anything like that. And then you need to do a little bit of studying and. Get in there, take a look around.
from a gaming perspective and I'll leave it alone at this. It's a very, very cool environment to do gaming and whatnot. You and I can go fishing in Northern Manitoba together without ever leaving our living rooms.
I saw the pictures from your fishing trip to Northern Manitoba. Congratulations. I mean, that, that fish was bigger than anything I've ever seen.
There you go. And it was real.
It was real. So you didn't, you didn't doctor the image or anything to that effect. Let's save a couple more of these headlines.
So 86% of medical alert system users say the devices have helped save them from an incident. That's probably not surprising to you, right? That's the medical alert. Devices, if you fall, if you have issues for those people who happen to be living alone one of the stats that's interesting in this most people, 53% feel medical alert systems invade their privacy.
That's interesting. I mean, at the most it's a passive device, right? It doesn't do anything until I sort of activated. is that accurate?
Bill, I'd be more worried about the applications that you have on your cell phone that haven't been locked down that are letting everybody know everything that you do during the day than I would be from one of these alerting technologies and whatnot, but you've basically signed up for it. Are they using everything they. For research and other purposes most likely, but you know, the benefits to most outweigh potential harm and whatnot. And again, if they're using that data in a responsible and ethical manner, then we're good.
But think about those numbers you would love as a data scientist, you gotta love 86% of medical alert system users say the devices have helped to save them from an incident 86%. That's exceptional.
That's high. And that may not just be the individuals that may be the family members and so forth that actually got those alerts to men and or caregivers that then rendered care. And they're very specific. they're very tuned in if you will.
And Not to be equated with the alarming and off of instruments and whatnot in a healthcare environment where there's a lot of legal implementation. So you get over alarmed over fatigue. These are very well tuned to only alarm alert when it's absolutely required. And that's why you're seeing those kinds of numbers. Otherwise they've just, they would've just dropped the app and taken the device and tossed.
that's an interesting at home device for caring for that population. CMS issues proposed rule for rural emergency hospitals. Let's see. Since twenty ten, a hundred thirty eight rural hospitals have closed. With a record breaking 19 hospitals closing in 2020 alone. CMS recently released a new proposed rule seeking to protect access to emergency care and additional outpatient services for people in rural communities. It's interesting. This past week I did a news day episode with a gentleman who was in Northern.
It was called Northern country. Healthcare. And it was three critical access hospitals in Northern New Hampshire, north of the white mountains. So not quite Manitoba, but north of the white mountains. And I think that he said they served maybe 30 or 40,000 total patients. And there's some challenges up there cuz there's no scale.
So you have. Things like you have to figure out a way to get at and T or Verizon, even interested in putting up towers for trees, essentially, which is what you have up in Northern New Hampshire. It's really interesting. So we could end up with a. Rural healthcare crisis. And I think that's what this proposed rule is looking to avert at this point.
Yeah, I, bill I would, I would challenge that we already do have that, crisis. And if you think about it, it's digital disparity. The rural small safety net, those that serve underserved communities why are they always technologically disadvantaged why do they have to wait and wait and wait for the attack? And then from a resource perspective, it's not right that family member has to drive 20 miles to meet an ambulance halfway. If they have a family member that needs immediate care. So yeah, definitely in the right direction, but you know, we've got a long way to pull back from where we were
in these cases do we wait for 5g cell towers and that kind of stuff? Or do we look to things like satellite satellite tends to have better coverage in these kinds of rural and remote areas, or does that limit us too much in terms of our application of hospital at home and those kind of.
Yeah, well I've been involved in that in Alaska and especially without naming any organizations setting up the dish network to transmit from the hospital to a station that then can transmit up from a satellite perspective. It's workable. It's not ideal. The preference would be 5g, but unless it's mandated that's not economically advantageous to the provider, so it's just not happening.
it's the latency. So we can't do the real time stuff is really hard, but the stuff that's asynchronous or the stuff that's maybe not as real time like this video call is real time. Right. We would have to sure. Maybe do this with voice and some other way, depending on the latency, are we getting better with satellite communication with regard to latency?
not really. it's a long way to travel, isn't it?
Yeah. You'll have some vendors that probably stayed otherwise, but not really.
Yeah, this is an interesting challenge. Rural healthcare is a real interesting challenge. And one of the things you could see I believe is you could see First of all, if we don't take care of this problem, one of the things you're gonna see is you're gonna see the urban centers get overrun, right? You're just gonna have these peop these people coming down from wherever, every time there's an issue and overrunning the urban hospitals.
Well, your mortality morbidity rates are gonna go through the roof as well because of the delayed treatment and bill, we saw this in COVID. We saw this from a rural perspective versus metropolitan, especially in underserved communities, the rates, the latency for treatment, and then the long-term outcomes were, were poor in many rural locations. As a result of not having these services available.
this is clearly clearly an issue needs. Some creativity probably needs some partnerships. I would think this can't just be a government and critical access hospitals in these locations kind of thing. There probably needs to be some thought given to partnerships with some of the halves, right. That. The Mayos in rural the Clevelands clinics and rurals it's I think one of the ones I saw that was pretty interesting was UC Davis was really reaching out to their surrounding community, cuz it's really on the edge of Sacramento San Francisco area.
And they have a significant rural population just on the other side of that. And I think they were, building out. Partnerships to improve the care across that that rural area in Northern California. And I think those kinds of partnerships are gonna be required. So it's not just gonna be a government kind of mandate, but more along the lines of how can we provide, how can we expand our thought process of what our area is that we provide care?
Yeah. And if you look at if we take a look at India or even the EU, especially in India cell service service 5g is available even in these rural areas and whatnot. So it is doable. There just has to. A willing to do it and geographically in the us, if there was a if there's a will, we can do it. Absolutely.
📍 📍 All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. 📍 📍
All right. So this is an interesting one. We haven't talked blockchain in a while. We'll throw it out there. synaptic health Alliance provider data, blockchain initiative expands. Okay. So the Alliance founded by Aetna Humana, multi plan quest diagnostics and United health group has added a new member ProRes, P R O C R E D ex a blockchain health credentialing company.
There are now 11 members, including Sentine cognizant. Corvell. Prime health services and Providence blockchain function as a secure traceable and nearly instant way to synchronize information across multiple sources through the provider data exchange pilot project, its members were able to find an update, certain demographic inaccuracies in health plan provider directories faster than they would've on their own.
Blockchain in healthcare. I'm hearing it more and more. So it's probably over that hype cycle where it was gonna solve everything that we needed it to solve in healthcare. And now it's getting very specific applications, credentialing being one of those things, a I mean the immutable record, the contracts, all those things do have a potential application in healthcare. What are you seeing or hearing.
Sure. So I always say from a a clinical perspective, it's almost like autonomous vehicles. It's kind of gotta happen at once. Right. Everyone is not using it. Then there are exclusions to the benefit of it because if my healthcare organization's not using it, they still can't connect to those that are.
So there's still some issues there where I am seeing it take hold is outside the us where things are a little less regulatory and there's not an EMR using blockchain for purposes of personal health record. And then being able to distribute your record to who you need to using using your blockchain and build it, go something as simple as this you're taking care of in a physician's office and, or a clinic or hospital they have no, they do not have an EMR, but they do have your paper record. They'll give it to you in a PDF form or. Worst case scenario, you just take a picture of, of every single page. Now you have your health record and you can now distribute it to those providers and or healthcare organizations that you're, you're seeing, or you're you participate with now that's working the others that we discuss and whatnot.
Yes, regionally, but. It's kind of like one of those things everybody has to participate or it doesn't provide total value to to everyone.
One of the areas I, I hear this being used as credentialing and the credentialing process was. Interesting to say the least it, it used to take us a while and then we'd have to true up the credentialing process on an ongoing basis.
The systems were not technically the systems were not under my purview as CIO and some of them were pretty old. And so where this sort of comes up is we go to do. A we go to do online scheduling, or we go to do something on the website or whatnot, and then we have to get a provider directory and you would think it's like, oh, we know who all of our doctors and all of our providers are. And that process takes you a long freaking time to clean up.
We've actually built out provider data hub. So if you have 160 plus systems that have provider information, they they're they're visualized if you will, in that environment and then the stewards and whatnot, make those decisions. What's right. What's not. And then it all goes back out to those systems, but keeping all that stuff coordinated is a pretty tough, a pretty tough proposition. But if the source of. Was in a blockchain environment and the requisite technology was in place in each and every one of those systems. Yeah.
They can be maintained and kept true. And it's not just from a credentialing perspective, it's everything starting with the letters after the name, to where they went to school. There, there areas of practice, there is of specialty, all of that, and you can look at the same provider and a hundred plus systems and they can all be have some variance to. And that feeds back to claims and everything else, denied claims and all the rest of the the mess that goes along with it.
I'm trying to think which one of these headlines I wanna go to next with you hospital C challenge around price, transparency, technology and resources, essentially experience says that most provider organizations are expecting to spend more money on technology as regulations expand.
This is by the way I came into healthcare. I didn't understand this. And I'm now I'm now a seasoned healthcare person. I've been in it for a decade. And I don't understand this. I don't understand why we can't generate a bill. I don't understand why there is so much why it's so convoluted. Why we can't just say for this DRG.
This is the cost for this DRG. This is the cost for this. And then have every health system put those DRGs out there with this is the cost and be able to do a comparison. I don't understand why that is so hard, but it is evidently and and the regulation from the federal government. Didn't spell it out that clearly.
And so if you go out and look how a lot of the organizations have complied with this, they've put together spreadsheets, they've put stuff out there. They're all in different formats. And so it's, it's really hard to navigate. But if we do this right, there should be a, new set of players out there that aggregate this data and give us cost information on different procedures at different health systems. So we can actually become more consumers of healthcare.
So I will take it from the consumer perspective because I'm not even gonna try to to describe how the pricing is derived, but. I totally agree with you. There's no we have, we have uniformity of sorts and documents that we pass around 8 30, 7 S CDAs and things of that sort.
there's no uniformity, like you said, no regulation. So as a consumer I'll first I'll answer the question and I'll ask another one from perspective of a consumer. It's really difficult to decipher from one organization versus another definitely secondary to that how many people really care.
How many people really care. Yeah. Many people are really gonna look up and say, oh if, if you tell me that this hospital has five stars and it's gonna cost a little more, guess what I'm going there. In from a behavioral and cognitive perspective I'll get a perspective of you know, those that charge the most must be the best. Right. So I'm not so sure on the consumer side that. It's gonna make much of a difference. That's just me though.
Yeah. I think it can, and I think it can, for a couple of reasons, one is, we could create different kinds of plans. So say I'm an employer that is self-funded. Really all we're talking about is commercial payers at this point.
So if I'm an employer, who's, self-funded, I could partner with somebody who essentially can identify the best outcomes for the best price for me, for my employees in those markets. And I don't even have to make, I don't have to make the consumer even worry about it. Sure. I could just, I could have somebody who knows healthcare who's looking at it going, Hey, look, this MRI here is the same as this MRI here. It's the same as this MRI here. We think you should go here,
but yeah, there's all kinds of deals that are being made in those types of transactions as well. Irrespective of what the data that's published represents.
All right. In our last couple of minutes here, three more stories. So I'll let you pick one is creating a foundation for digital healthcare. That's one another is about RTLS. And we could bat around how RTLS gets used in healthcare and whatnot. And the other is integrating genetic data into the EHR. Which topic would you like to go after?
let's do door number two, RTLS for
RTLS for a hundred. Yeah. is a realtime location system and the story talks about how it can protect healthcare workers and reduce burnout. The presence of RTLS. Also can help hire new talent and improve the workplace for nursing during the nursing shortage, when expert says violent incidents at healthcare provider organizations are not unusual, but it's very important that workplace violence does not simply become part of the job for healthcare workers. This is, this is one application of it. RTLS has, oh yeah. A ton of applications.
And we. And we can get into those real quick from a security perspective. Yeah. If you're being accosted and or if you're being moved around in a organization, you can be tracked and found absolutely. Some of the other use cases that I've, I have experience that I've had experience with understanding how. The like say infusion pumps, ventilators and others are being used. So utilization when it comes to purchasing, how many do we really need to buy? That is very, very helpful hoarding of equipment which is standard
practice, finding the day equip.
Yeah. Finding it for preventative maintenance. Our TLS on caregivers, how much actual time is spent with the patients I even developed out a an application. What I called sync time are the patient, are the providers hit the sync before they go out the room. Are they washing their hands? All kinds of regulatory type of stuff is you you can do with RTLS. It's it's an excellent technology for uses other than was intended for. And security is a really good one.
Yeah, we also put it on beds so we could track movement of patients when we were trying to improve the workflow and that kinda stuff require some very specific technology in your, on your campus, in your building, in order to track those devices and whatnot.
One of the things we looked at, and I don't know where, where it's gone, but we had BLE Bluetooth, low energy was another one that worked. Essentially across the network we already had in place within the health system, have you looked at the, a comparison of RTLS versus some of the other technologies?
Yeah. And it all depends on whether you're gonna do like organizationally wide or specific to a an individual unit and, or smaller area and whatnot, which works best one takes a little bit more time and energy and, work and other, like a, almost like a plug and play right. Yeah. And just make sure you plug it, make sure you plug it in somewhere where it's not gonna disappear the next day.
yeah, so RTLS ends up being a bunch of, I don't wanna say proprietary technology, but it's not technology. That's just already there. You're gonna have to invest.
No. Yeah, you can't, you can't go out and buy the units and you can't go out and buy the sensors and whatnot. You've gotta, you've gotta rely on a vendor. Some proprietary software and whatnot, but they're usually all open and you can take those, take the output and do what you need to do with it
and create some really interesting solutions. Charles has always fun to go through the world of technology with you and great to have you back in the United States.
Cool. Thanks bill. Good to 📍 be here.
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