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January 23, 2023: David Ting, Founder and CTO of Tausight joins Bill for the news. There’s lots of challenges financially within health systems. What did the J.P. Morgan Conference uncover? What is the financial state of healthcare today? Is healthcare out of the recession? What should health system CIO's be focused on right now? Ascension posted a big net income gain to $1.8 billion. CommonSpirit is limiting expansion in a bid for positive cash flow after recent struggles. Plus what are the classic blunders in the digitization of medical devices and how can we avoid them?

Key Points:

  • A lot of CIOs are talking about shrinking budgets
  • Have we hit rock bottom? Or is the economy on the upswing?
  • If you don't take care of your existing staff, you're going to have to get really good at finding people
  • Tausight - https://www.tausight.com/

Stories:

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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.

Today on This Week Health.

Everybody wants to know, have we hit bottom? Are we on the upswing? I think that there's a little, that reticence of let's not invest, while it's still going down and start thinking about what the new economy's gonna look like this year. As we hopefully come out. Will there be a really deep recession? Is the recession over? I think everybody's watching those numbers.

Welcome to Newsday a this week Health Newsroom Show. My name is Bill Russell. I'm a former C I O for a 16 hospital system and creator of this week health, A set of channels dedicated to keeping health IT staff current and engaged. For five years now, we've been making podcasts to amplify great thinking to propel Healthcare forward. Special thanks to our Newsday show partners for investing in our mission to develop the next generation of health leaders now onto today's 📍 show.

All right, it's News Day and today we are joined by David Ting who is the are you a co-founder or founder of Taite? I'm the founder of Taite. Founder. But you were the co-founder of Imprivata, is that right? Correct. Correct. Okay. I I, I need to get that right and and actually really the technology. A leader behind what is going on at Tao site and, and the stuff at Imprivata. You were part of that team as well. Welcome to the show. Appreciate it. Thank you.

Good morning, bill. It's a pleasure to talk to you this early in the

morning. Yeah. . Yeah. Not, not many people choose this time slot for the, for the interview, so I, I appreciate it. Between you and Frank Tao Site is a company that starts. Early in the morning. That's, that's one thing we can take from that.

Badly. We don't stop .

Exactly. So tell me this is your first time on the show, so give me a little rundown of, of Tao site and what you guys are doing. So,

TA site is focused on, Finding and helping providers understand where their e, their E P H I is in a, in this distributed healthcare environment, not only on their file servers, their cloud shares, their email servers, but where it moves to, where it moves around inside of your organization in, in this decentralized healthcare model that we have

today.

Yeah, and it's, it's, I I think one of the things that's interesting about that is the the environment keeps expanding. We have so many BAAs out there now, and that has been identified as a point of vulnerability for a lot of health systems. The BAAs ab

absolutely. When you, when you hand off that, Email when you hand off those files, can they, can they really secure?

Do you actually know I went out there? And can you account for all that that, that I think is the challenge in this new digital world

of ours. Yeah. Well, a lot of challenges. So we're gonna look at some news stories. It is the Tuesday after JP Morgan has finished. We're gonna talk about JP Morgan a little bit.

I usually go to the nonprofit track where the CFO and the CEO get up and talk about their financial results, give you sort of the lay of the land, and then talk strategically about what they're going to do. Moving forward. I'm gonna focus in on, on really. Three of those. But I'm also gonna talk about just overall.

Overall what I've read is essentially very few announcements. So usually JP Morgan is when the, the VCs come out and say, Hey, this is what we're doing. As well as the companies come out and say, Hey, we've raised more money and more rounds, and that kind of stuff. That did, it was really quiet on that front.

I mean, there was a little bit of activity. CVS was very active. But outside of that very little does that surprise you at all? That, that the vc, the, the, the deal making and the raises is down right

now?

Yeah. Just talking to our VCs that are on our board things are quiet in the healthcare. Side, they're all waiting. All these large organizations are trying to figure out what the financials look like.

So is is it a wait and see kind of thing before they, they allocate their money out? Or is it, is it more they're, they're waiting for opportunities at this point to emerge with this economy the way it is?

Everybody wants to know, have we hit bottom? Are we on the upswing? I think that there's a little, that reticence of let's not invest, while it's still going down and start thinking about what the new economy's gonna look like this year. As we hopefully come out. Will there be a really deep recession? Is the recession over? I think everybody's watching those numbers.

Yeah. Hopefully they're not looking at healthcare providers cuz those. we're not good last year and we knew they weren't good. Going into the JP Morgan conference, we had a couple of stories come out of this one, the the ascension presentation, essentially 1.8 billion loss the prior years and, and a couple hundred million loss in their first quarter, cuz their quarter doesn't match up with annual or with the calendar year.

So they're, they announced a major re. Common Spirit also came into this and essentially said, look, we're limiting all expansion, except they were focusing in on two markets. I think, I think it was Arizona and Gosh, I don't remember what the other market was, but it's essentially, I think what they looked at is their profitable markets and said, Hey, we're gonna continue expanding there.

billion net loss across the:

And then I think the other one the other one I'll comment on was Jefferson Health launched a re reorg and reported layoffs. I don't know if this was at JPM that they announced this, but this is just a, an article I read this morning. And they're also, they're looking at a loss. But really what they're looking at is they've acquired so many hospitals over the last three to three to five years that they're restructuring in a way that Providence did in order to just make sense just makes sense of the, of the thing.

So a lot of challenges financially within health systems. I don't know if you want to comment on that or if you just wanna go at the technology side at, at this.

I think that's been an ongoing story. We, we talk to a lot of CIOs and they're all talking about the, the shrinking, the shrinking budget, the rev, the top line numbers coming down, the losses, labor shortage, like you say, labor inflation, difficulty acquiring staff.

Post pandemic, it's still

still suffering from it. I, I'll tell you, one of the I, I commented on William Walters his LinkedIn post this morning, and one of the things he, he put out this post and essentially what he was talking about was. As a CIO for a health system. He gets a lot of emails what keeps the CIO up at night and how can we help, right?

And he said, here are the ways you can help. And one of the things he made note of is he said, it used to be we could look at ROIs in the two to three year range. He said now it's essentially 12 to 18 months. 18 at the, out at the long end in 12 months is what they're looking at. And that was reaffirmed in our webinar like a week and a half ago.

With some CIOs, Intermountain Sanford and, and Baptist, Jacksonville, they all came back and said the same thing. They said, look, it's 12 months or less, the project gets a g green light, an roi, or a return of some kind. 12 to 24. You really have to make the case 24 and above. We're just not even considering it at this point.

So does that change the way, so your company , does that change the way you go to market and think about those kinds of things?

Oh, absolutely. I think, I think any project that involves having to roll out stuff to prove out the value over that length of period is, is d. Everybody wants almost instant gratification.

We, we, we like to see it move the way. We, we deal with mobile apps, roll it out. It's effective. You can measure it as a sas just offering you ch pick and choose, right? If you don't like it, if it doesn't pay out, it's gone. It, it's harsh

out there. It, it is harsh. What, what kind of, so you talk to CIOs and I've been talking to some CIOs. What kind of projects in an economic downturn, fighting the things that we're fighting, labor shortage, labor inflation, those kind of things. What kind of projects are you seeing or do you think that health systems should really look at right now?

Well, obviously Cybersecurity's always gonna be on the top of the,

of the staff.

No, but yeah, that's like table stakes, right? Table stakes,

but it's gotta prove it's worth labor inflation for it people with cyber skills incredibly difficult. Everybody we talk to will say, I'm looking for so and so to come in and take over work a new project. There aren't. enough skilled personnel to manage all the tools that we have.

So consolidation is a big one. How many tools do I need and how effective are they? And am I gonna be losing staff to somebody who's a better providing organization that will Just take away my skilled staff. Those are the things that we hear. We constantly hear that, oh, I'd love to get a project started, but I'm, I'm missing a person, or I'm missing somebody to head that.

Probably the most prevalent one.

Yeah. And that's, that's the one area I would be that's the one area I'm concerned about right now is, is yes, we, we do have to address the clinical labor shortage that's going on. And we do have have to address the, financial challenges. But people are on the move. People are moving jobs. and you have to take care of your existing staff. And if you don't take care of your existing staff you're gonna have to get really good at finding people. Cause there's, there's just gonna be gaps.

And they can, they can work anywhere. I mean, I, I see so many IT organizations that are virtual.

They haven't gone back into the, hospital for months. And so it's a, it's a very decentralized workforce that you're dealing with.

Yeah. Do you think that will continue?

I think as we move things and rely more on non on-premises technology, you're gonna end up with a health desk that will work on-prem.

You're gonna end up with people that will service the equipment on, but your infrastructure, IT infrastructure is just becoming more and more distributed and more being more managed remotely. I mean, I hear it all the time. CIOs here. CISO is in a different city. The workforce is distributed with the exception of a handful of folks that go into the hospital to service the endpoints, and so I think that's going to be the reality.

I think it is too, and I, I, I have spoken out of both sides of my mouth on this saying, I think we're, I think we're gonna see a pool back into the office that is naturally gonna happen. And, and I still believe that's gonna happen in some markets with some health systems. But the problem with that is people might just go, you know what?

I need to work from home now and I'm going to work from home and I'm gonna find a different job.

Increasingly we hear. From a lot of organizations that we deal with, technology firms that will say, well, I'm having a really hard time getting our engineers, our develop, our testing folks to come back in.

Even though we offer them all kinds of perks. You can't mandate one place. I know that mandated went from five days, they're back to four days. Four days are kind of struggling with that. A lot of folks are threatening to resign. This, this is. We're dealing with a new workforce that I think have gotten used to working remotely even.

So, I think , it's much more difficult for somebody like from our generation that are used to having designs in, in meetings, in person to, to this one at a time kind of. Communication channel.

You guys are in product development, life cycles and that kind of stuff. Are, are you doing that remote or are you trying to get the team together?

Because there's an awful lot of, of magic that happens when the team is in a room, isn't there?

Yes, there's definitely that magic and we've, we are fortunate that the majority of our folks are in this northeast area. We, we have a handful on the west coast. But even getting the folks that are in this area together on a regular basis with offerings of free lunch all the things that you can imagine to, to get people in.

It's still challenge.

Well, you know what they taught us? The first week in economics, I, I was an economics major in college. You know what the first thing they taught us? There's no such thing as a free lunch .

They know that. . Yeah. I, I, they, why are they giving us lunch? I don't

even remember what the point was that the professor was making, but that he was everything has a cost, there's an opportunity, cost.

There's all that stuff. I, I think that is the point he was making.

📍 📍 In:

📍 📍

You've now initiated and created two successful products. I, I want to talk about let's see. Lisa Sunan, who we've had on the show before, talks about the classic blunders in digitization of medical devices in, and I will skip here to this cuz I, I wanna get your thoughts on this.

She says here are the pertinent blunders that people make building. The digital program to support the sale of the product for the benefit of the company rather than the support the practice for the benefit of the physician and patient. Again, she's talking about medical devices, digitizing the information and medical devices.

And then the second is thinking that digitization is a valuable thing in and of itself when the real value is improving, that having data. Makes a difference in cost and outcome. I, I'm curious, first of all, your thoughts on, on those two what she calls blunders that people make, so, oh,

that's, those are great

comments.

it's interesting to me she goes on to talk about the reason that that it will have to be medical device manufacturers and not wearables. And she said some of the problems with wearables are it's not always with you for starters. Mm-hmm. . And the second is that a wearable has a battery and the battery runs out and those kind of things, whereas medical device manufacturers can implant things that have long-running life cycles and they're constantly reporting.

I, and I loved her analogy. She said it would be like having all those devices in your car, but it requires you to bring your phone or your laptop in, in order to see 'em to see what's going on. Right. I I, I'd love to, I'd love to hear your comments as, as they're developing, as these, these medical devices are emerging, and as the wearables are emerging how do they position themselves to add value to health and healthcare?

That's a great point. Just because you can do something in a wearable or in a, in a miniature device because of the technology curve that we're on, the cost of connecting. Things to other things. The, the ability to capture data is considerably easier than it used to be even 10 years ago. But that doesn't mean necessarily that is a good thing that every patient carries with them their entire.

Telemetry in, on an ongoing basis using a wearable, it may be useful for you to find out your heart rate. It may be useful to find out your sugar glu glucose level, but does, does your doctor really want all that data? Is it really meaningful? I've talked to. Lots of specialists in this area who, who will say if I, if I get that data from the patient, then I'm responsible for doing something with it.

And sometimes it's not that useful. I'd rather tr have a trusted device that I know is calibrated, is put on and used properly, and I can see a window of, of data when it's meaningful as opposed to just this ongoing. 24 by seven monitoring of your sleep, how deep is sleep how much activity is it really helping to improve the health of that patient or to diagnose something?

I think for the patient certainly is useful. To say, gee while I'm exercising my, my exercise rate, is that the level I want for the rest of the day? Do I is there a real, real benefit? I, I'm not the doctor so I can't say, but just because you can have all this monitoring on the, on, on everything that goes on in your body does not necessarily mean it's gonna improve your physician's ability to, to help you.

Yeah, no, it's, it's, it's interesting. I, I love her point. The fact that just collecting that data doesn't help. I, I do like the fact that she, she points to, it's more like a card. It's an alert, right? Yeah. So you're monitoring something and you're giving somebody an alert to say, Hey, you should probably talk to your doctor or see your doctor check engine lights on again.

yeah. Your check checking your personal check engine light on, right? Which, I, I've talked about for, for years that it's amazing to me how much technology has gone into a car and how little technology has gone into humans walking around. I think the value of collecting the the, the telemetry over many, many years is we can then, Do things like put it into DA data science models and come back to 'em and say, look, the average person sleeps this.

You're sleeping this, or the or this is a healthy range and mm-hmm. or that kind of stuff. I, I think there's, there's value in that, but I agree with you. The p , the physicians do not want to see it unless it's relevant to them providing care. To that patient. And they also, they, they can't handle the workload.

I, I,

I think that's really the correct case. I, I was giving my doctor, he, he said just trap these parameters around your, your weight, your blood. Pressures your heart rate. Give 'em to me on a weekly basis, but don't give 'em to me every day. I said, I can send it to you every morning if you want.

He goes, no, no, no . But I think that's where the real value of AI is, and I think AI has to help that doctor to say, yes, the check engine light is going on. It's gone on. And, and if you, so I have to monitor my car. I plug it in when the, the check engine light goes on and I can see all the internal operations and, and how much data they keep.

You almost have to get it to that state. But a car is a very different thing than a person in the sense that car should roll out the assembly line fairly consistent in how much CO2 they're generating, what the spark timing looks like. We don't have the equivalent until you, like you say, you can aggregate enough.

Historical data to customize those check engine light alerts.

She said it's, it's really incumbent on the medical device manufacturers to do their own studies. Are we providing value? Are we improving care? Are we improving health? Not that the other studies won't go on, but. That, that that is what people are looking for and that's what we need to deliver in that space. I wonder if that's something that could be applied across the board where we essentially say, look every technology we look at, we know we're gonna need an ROI now.

I mean, it's just absolutely necessary. It used to be we got by without 'em on some projects and whatnot, but almost all of 'em are gonna need. And we should be doing our studies as we move along. Do you think that's going to change our approach to going into health systems?

Oh, I, I, I think that's been the case for a long time.

You have to demonstrate like any other business. Healthcare is like any other business. If you're gonna acquire some technology, you better tell me what the return on investment's going to be or what the real cost is going to be as I operationalize it. And we hear it all the time, how do you help me consolidate?

How do you help me simplify? How do you help me deal with the need to have fewer people? And, and as we talked about earlier, cybersecurity is really complex. So I don't, most organizations can't hire enough people. So you have to basically say, well, in a cloud delivered service, like, Or that we don't, you don't need to have the full ft, you don't need we're generating those check engine alerts for you.

So you don't have to be monitoring all the parameters all the time. I think that's the way it's gonna have to go if we are able to take that responsibility away from the cio so that they could really focus on efficient use of that data. .

Well, David, I'm looking forward to this. You're gonna be on the show every six or seven weeks.

I'm gonna store up some special stories for you cause I think we can go

we can go a lot of different dimensions. I mean, I, I think the, the whole ML AI technology is going to make a huge difference to me. We, we just look at the computing power that we have available to us in the cloud on our, on our phones, on our endpoints, on our wearable devices.

I think there's another generation of, just because you can get the data in digital forum, it's still data is not insight. Insight's gonna come from the ability to aggregate historical trends and, and find those gaps. I mean, that, that's where I think we're gonna find real value in digitization.

Here's the trendy question.

Have you played around with chat, G P T.

No, not yet. it's

scary. , it, it's a little scary. It can be tricked. I, I've, I've started seeing some people try to trick it, Uhhuh, it says what's, what's 4,000 plus 10? And it comes back with 4,010, and the person responds. I don't think that's correct.

And then it comes back with another answer. That's not 4,010. Perhaps it's this it's, it's, it's, that's the challenge with AI models. We have to teach it and

train it and have to teacher to handle all the intent. The intent is hard. Yeah. Well, understanding syntax, computers can underst syntax are starting to get better at understanding Symantec.

Understanding intent is even harder. Yeah, just cause you're dramatically correct. Just because you have the word spelling correct doesn't mean you have the right intent.

Yeah, clearly. Clearly there's some people with some interesting intent that are playing around with chat chief. Exactly.

Have too much time on their hands,

Exactly.

David, thank you for your time. Really appreciate it and look forward to catching up again. Stay here. Thank you, 📍 bill.

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