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Bill Russell: Today on Newsday.

Like three years ago, five years ago, it hasn't really changed.

Bill Russell: My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health. where we are dedicated to transforming healthcare, one connection at a time. Newstay discusses the breaking news in healthcare with industry experts

Now, let's jump right in.

(Main) Alright, it's Newsday, and today we are joined by Philipp von Gilsa, CEO Contact io. Philipp, welcome back to the show. Hi, bill.

Philipp: Thank you so much for having

Bill Russell: me. I love the fact that you're recording from your office and you have your whiteboard behind us. So if people are listening to this on the podcast itself, if you wanna see all the things that Philipp is working on, you're gonna have to tune into the video to see all the stuff behind him on the whiteboard.

Bill Russell: readable on that entire board.

Philipp: Yeah, except I think IPA, which is not standing for beer, but it's an internal acronym for an extremely important strategy we're working on that is going to cure a lot of things in healthcare.

But that's not the topic for today.

Bill Russell: we have three headwinds, let's call 'em headwinds that are facing. Healthcare leaders, health IT leaders across the board. I'm gonna start with the America's Hospital bed shortage.

This is from the Wall Street Journal Sandeep who's actually a physician from, I think one of the, one of the larger

Philipp: Northwell. He is from Northwell. And by the way, I think we're going to talk about his article, I've reached out to him after the article and we're gonna speak next week. And I think he wrote a couple of books and I encourage you to maybe invite him as well because this is one of the sort of articles that I didn't discover.

Bill Russell: Lemme give people. So, American Hospital's bed shortage is about to become a crisis and, lemme give you the synopsis here. Most compelling aspect is 85% occupancy threshold, warning that hospitals may cease to function properly once they hit this critical point, and the US could reach a dangerous level within 10 years, potentially causing tens

or hundreds of thousands of excess deaths annually. This transforms the hospital bed shortage from a current inconvenience into an imminent public health catastrophe. The article reveals we're already at 75% occupancy up 11 points. I think as people hear this, and then they talk about the policy contradiction.

I think everybody's seen this, right? Yeah. We've all been in a hospital where there's beds in the hallway. I've been in one of those beds in the hallway and it's because, and they will tell you, it's like we're waiting for a room to become available. And I think this is probably more acute where he's at in New York City than anywhere else.

because it's so difficult to build a new hospital or to retrofit an existing hospital. It's hard to put more beds in. But my gosh, I mean, what's the solution to this? The converse is there's a lot of people saying, Hey , we're gonna make beds out of people's homes and we're going to change the care dynamic where we're gonna be able to deliver higher acuity levels in people's personal beds as opposed to having them come to a hospital bed.

And I think if you think about it conceptually then there's only two ways to solve for that. Either you need to have less people going into the hospital. Yeah.

Bill Russell: Or more beds.

Philipp: Well, you need more beds. Yeah.

Bill Russell: You need more clinicians for those beds as well.

I mean, the problem doesn't just end, it's, it just keeps going.

Philipp: Which has all sort of the drip effect sort of on the cost structure, which is an entire sort of separate conversation where everyone is currently in the boat of trying to say, how can we, do more with less and actually sort of overcome up some of these.

And I think what hasn't been mentioned in the article, but what is, I think one of the key themes that is happening in parallel, that you obviously have this massive shift sort of to ambulatory and sort of outpatient and different type of care setting that is all about sort of preventing people or not preventing, or making sure that not everybody sort of ends up in the ed because that's the most costly.

And then I think there's sort of the long term, capital deployment around how do we, increase the number of beds. And on the other hand side, move more patients to a different type of care setting.

Bill Russell: Have you seen any initiatives that are addressing this?

I mean, saw, Mayo has something in the Jacksonville area where they are doing higher level of acuity in people's homes and that kinda stuff. But it hasn't scaled. It's very limited in the amount of scale they've been able to do. because when you think about that, you still have to get clinicians to those locations.

Philipp: I haven't seen or heard anything that is extremely compelling from where I sit obviously we are getting more called in

When the problems are acute. Ed boarding, what can we do? How can we use technology to sort of address some of these challenges? And you go further and you look at, okay it's a discharge problem or it's an inpatient problem, so how can we improve inpatient flows so that we can actually, reduce boarding.

But to get to your point, putting a CIO hat on, I think the implication of these type of challenges sort of being brought into the room now, let's fix them as they are pure. I think is something that's going to grow and grow. Given sort of the trends of where the.

Overall environment is heading.

Bill Russell: By the way, this is very similar to other problems.

That same thing's gonna happen here because it has happened every, the baby boom generation just demographically ends up being a significant number that ends up shrinking. So, you also don't wanna make that over capacity mistake. But let's put on the technology hat. Because the executive team calls the CIO in and says, what are we gonna do about this?

If I were the CIOI think I'd break this down and say, alright you tell me how you were thinking about solving this. And I'll tell you how technology can be applied. Because if you're thinking we need to build more hospital beds, then we need to free up capital in order to do that. So it becomes more of an efficiency play than necessarily a care play where I go, all right, we can do this project, and this project,

that will increase our efficiency. And if we do these things across the board, we're gonna make our clinicians more effective. And if we do those things, we're gonna create more capacity. Rather than saying, Hey, here's a technology solution to this problem.

Philipp: Bill, can I ask you a question? Because I think the problem of capacity and the problem of at the end, call it patient flow or like moving, you know, a patient from admission to discharge, I think is probably the most complex operational problem

begin with and I think calling it a problem in itself is misjudging it because it's multiple problems and it's one of those domains where there's not just one counterpart, right? Like it's not a security problem. So me as the CIO, I have my security counterpart you're going to touch essentially all different aspects from sort of the physician to nursing, to operations.

Bill Russell: So when I look at those problems I start with you know, cotters Method where essentially I have to build the burning platform. In order for me to build the burning platform, I have to create transparency into the problem. because people won't acknowledge that the problem actually exists or the severity of the problem, or they will say that problem's over there, it's not here.

And so what I would look to do is to surface information about the flow of patients through our system. And I would try to measure time and where the sticking points are and what's going on and that kinda stuff, so you can elevate that to the conversation. When you create that transparency. Now you can have.

So you almost need to come up with a methodology to first of all, turn those anecdotes into real data, surface that real data, create a sense in which, hey, if we need more capacity, the capacity's right here in front of us. I've interviewed people and I remember one of the stories that a patient had to wait nine hours to be discharged because they were waiting for the specialist to see them.

And I don't know that's still happening today, but if it is still happening today, that's an easy fix. That specialist did not have to physically walk in that room. They could have come into that room the same way you and I are talking from New York City to Florida.

I mean, they could have from anywhere in the city gone into that room, had the conversation with the patient and the nurse and that patient could have been just discharged within an hour. No, no,

And my last sort of hospitalization experience with my son. Which, you know all went well, but we were in the emergency department, waited six hours to get into an inpatient room. And the interesting thing, what happens is if you're in this ed boarding situation and I was there with my wife as well, so she probably every 20 minutes is asking

like pressing the nurse call button, asking. And so the amount of communication that gets created through the system, when are we here? Where are we here? Right. Like it's extremely inefficient. And then we are finally the pediatric ward, and every single bed was free.

I mean, there were like three beds occupied. It was much transport issue than it was a capacity availability issue while the ED was sort of, overcrowded because it was not just, for pediatric

So I text somebody from the help desk who, who's in charge of the help desk. I'm like, Hey, there's a couple things going on, blah, blah, blah. All of a sudden it, people start showing up all over the place. I was like, man if only everybody had the ability to, like, with their phones, Hey, this is what's happening and mobilize resources.

But I'll be honest with you, I mean, for me if it's not uniformly understood and there's not a especially for these big operational changes that need to happen, I'm not gonna be able to do that as the CIO. All I can do is I can shine a big spotlight on it and say right there, this is what we're seeing.

They know how to do the technology, take out their checkbook and buy a new thing, but they don't know how to mobilize the entire organization to an operational project.

Philipp: I think a lot of conversations we've been having, it's always we discuss it, what are problems, what is the technology aspect?

At one point there is a question of, so what's the ROI? are we doing this? And like, what are the hard cost savings? And I think the interesting thing is, solving for this type of problem in light of the broader crisis, but also for the existing unit of analysis, which is the total beds that you have available today, which we're not going to change immediately.

It is such a valuable problem to fix. And I think, ahead of the call, can get one additional admission. For every 50 beds you have, on a weekly basis, I think it's roughly half a million. Yeah. So you, you have like, 10K per bed. And so if you look at all your different initiatives and you put in the ROI there's really a lot there.

Bill Russell: you're saying I'm a, I'm a slacker as a CIO I'm not helping, I get it. No. I'm in you camp. Yeah. I do want you to take you to the next article because it's indicative of a CIO's world, right?

So, connected Health needs more provider collaboration for better data integration. This is a healthcare IT news story. Deloitte researchers say IoT technologies could make more agile health systems and better patient outcomes if challenges to more widespread adoption can be resolved. And the problem they're saying is essentially that device makers think lack of EHR interoperability is the main issue.

They're missing the broader integration complexity that IT leaders actually face. The research suggests device companies misunderstand the severity of the challenges of moving the data back and forth. They're almost creating these little islands, and then the IT leadership has to deal with them.

It's not just about talking to EHR, it's about fitting into the entire existing workflow. I say that we go to this story next and it's interesting because this could be the excuse that IT leaders. Could give you and say, look, Philipp, man, I've got a lot of problems. I'm not just dealing with this one.

I'm dealing with many. And this is one of those. And I guess my question to you is this a device maker problem? Is this a EHR problem? Is this a government regulation problem? I mean, we keep creating these little islands of information.

Philipp: I have a very strong opinion on this subject. Yes. So I'm going to call that out to begin with.

Bill Russell: Okay.

I also think it's a Deloitte problem because the article No I'm like, look at the headline. Yeah. IoT and connected care can transform outcomes. It's not speaking to value. It's speaking about this concept of technology and IoT as the whole, and that goes beyond. Healthcare has suffered from being a technology looking for a problem.

And if you. go into the article It says you as a technologist, right? Like, yeah, you get excited. It's like AI, and the first ChatGPT version three years ago. Yeah, it's going to change everything. But now the question is where and what, and I think the article then says demonstrating end user value. Yeah. Is the number one reason adoption is slow.

In other words, like if you look at a mature market, like the system integration job and figuring exactly out what the value proposition is, is up to me. I feel and again I'm exaggerating, but to make the point, like you cannot be in healthcare approaching things from, here's the technology looking for a problem, and it's kind of 85% there and we let you figure out the 15%.

I need to be able to walk into, the doors and say, look, we are in the business of solving, I don't know, ED body. We have done that for the following health system, in those three ways we produce sporting by like 30% here, 40% here. How did we do it? This, this, this, this, This, let me take care of it.

Bill Russell: Would you put cloud in the same sort of category?

We kind of understand we wanted a lot of data, now what?

Bill Russell: Here's what's interesting to me about, by the way, I agree with you. It would be more interesting if I didn't agree with you because then we could argue. But the, There was this whole thing of blockchain's gonna change healthcare, change the EHR, and that's the one that we all sort of laugh at because nothing materialized there really was nothing.

There per-se around it and it really was a technology play. But then we move up and we say IoT and we're, and everyone sort of shakes their head and goes, yeah, I agree with you. We don't just bring technology. Then we move up and we say cloud and people go, well wait a minute. I mean, cloud really is changing things, blah, blah, blah.

Philipp: the exact same thing. And I think, to some of your like, excellent sort of LinkedIn, articles you're publishing, like you can replace the word and just change the date back two years ago, three years ago, five years ago,

it's the same thing. Like I think there's a lot of AI governance conversations right now, right? Like at the round tables, et cetera. And if you delete the word AI. You put in, a different word, cloud IoT. I think with one of the last round tables, somebody said, yeah it's kind of the exact same conversation we've been having, right?

Like three years ago, five years ago, it hasn't really changed. And look again, like why am I making these statements sort of around the IoT, if you were to ask, Goldman, like one of our investors about Kontakt.io

and you have these like polished banker presentations. They would probably put us into the IoT category.

Bill Russell: Deloitte is part of the problem. I love that. By the way? They're

Philipp: great yeah? I'm just like,

Bill Russell: They are great. Let's go to the last story. We're already over time, but we will do it anyway I think it's an important story. You'll cut it short at the end. Oh, no. I won't. This is fun. So, a HA reports fines, workplace and community violence cost hospitals more than $18 billion annually.

Bill Russell: I

Philipp: was gonna actually

Bill Russell: have. Of the other studies that

Philipp: exactly, it went up significantly.

And that's like 20 million for, a thousand better hospital.

I think they're pulling in like everything related to gun violence and that kind of stuff. It's like, so they're saying, Hey, any gun violence victims in these cities that come in, their thesis is if there wasn't a gun, those people wouldn't get hurt. They wouldn't be coming to the hospital.

I think. I, again I'd have to read it more closely, but the, the lower number, the billion to 3 billion number, I think is actual violence against doctors and nurses in the ED and other things, which is also a serious issue. And one I think we have a role from a technology standpoint of helping to support and helping to

avoid if possible either with cameras in the room badges screening all sorts of things to potentially protect our workforce. You're like reading the article now to find out, aren't you?

So, like double, right? And then talking about, again, the emergency department, it says. 100 percent experience verbally abuse annually and 50% physical assault. And I don't know, have you watched the Pit? I have not. You should give it a I actually think it's a, it's a great show and it's about the, the ED in, the Pittsburgh based hospital and like workplace violence, is sort of omnipresent there.

And then there's a whole bunch of different things sort of around process and technologies. And you mentioned camera, but here's the thing I think that we need to get right. You need to think about process and technology through the lens of preventing a situation from escalating because the environment is going to be the environment. Yeah. There's going to be people, they're very vulnerable, stressed, et cetera. The waiting and the ED. So I think the concept around sort of deescalation and trying to intervene earlier is critical in getting these numbers down.

Predominantly has the ability to call for help when you know the other parties maybe not even acknowledging that this is currently happening. And because of that, you have the capabilities of deescalating and getting response in precise the patient before something happens. Yeah, right and there's a lot of thinking that I think needs to go into it, but I think it absolutely needs to change because otherwise the entire kind of workforce shortage.

The Gen Z, the Gen Y, they are getting out of the workforce. You have one of these events and then they will say, yeah, great, i'll do something else.

Bill Russell: Let me ask you this. When you're in an airport, do you think you're on a camera at all times?

Philipp: No, but I know I am.

Bill Russell: But I don't

care.

And I think our security measures will continue to. Get more sophisticated as we move along. Be able to potentially compare facial images to criminal databases and that kind of stuff. I don't know, maybe this is me watching too many Netflix shows and that kind of stuff, but they make it seem like that's really easy to do, like the image and then it goes against the database and says, Hey, this is a dangerous person, and that kind of stuff.

But I think we're gonna get to a point where everything that goes on in the hospital from the ED to the, OR to patient rooms and whatnot, is going to be on a camera. And you're right, it is reactive.

Philipp: those things are not mutually exclusive.

Bill Russell: Philipp, I just wanna point out that all three of these things we talked about are gonna require money.

They're gonna require effort and resources. They're gonna require operational support. This is why it is such a complex thing and we're only touching on three macro trends that are going on in the industry, and we know there's like a hundred macro trends that are going on in the industry.

Philipp: Yeah. So what's your advice?

Bill Russell: Keep doing what you're doing. I mean,

Philipp: no, not to me. I mean, to the audience, I mean, I have to run a company but not, you know, a health system

Bill Russell: again now is the time for health system leaders to be so focused, laser focused on a strategy that is gonna deliver

on these things. It is a constant barrage of requests for money, for resources for new technology. And it's gotta be laser focused on delivering outcomes. And I think we're getting there because we've been in this crisis mode now pretty much since pandemic.

Philipp: I agree.

And I think, I mean, at the end of the day, I think we have to now also observe sort of how is the funding environment going to sort of further evolve? But yeah we'll have to make cuts in some domains in order to continue invest in different domains. And it's almost like I sometimes call it the Microsoft problem, right?

Like they announced we're laying off 3% and we are creating 10,000 jobs here. Like these messages typically come in sort of at the same time Transforming and shifting where to focus.

And it's like, well, we're gonna continue to use these, so figure out a way to secure them. And the answer to that is, yeah we can ish, but at the end of the day, they shouldn't be in here. We should get rid of them. There's this whole concept in IT that gets lost, which is when you buy something, put a date, you need to maintain it.

Yeah. Well put a date on it when it goes out the door, like don't assume that a technology has a 20 year lifecycle when it only has a 10 year lifecycle or a five year lifecycle. Put a date on it. It's going out the door on this date. We will need to reallocate budget on this date for new stuff. And you know

Philipp: who has done an excellent job on this?

Bill Russell: Who's that?

Bill Russell: it's just a perpetual, it's maintenance in some cases, and then it's replacement in others.

It is just a perpetual and

Philipp: it's cost and it's another

Bill Russell: Well, and like, if we've decided that wifi is important to have in every one of our hospitals, then what we're saying is it's like plumbing. We've decided that this is as important as our plumbing. The difference is that in five years, there's gonna be much better wifi.

Whereas plumbing is plumbing it has a life cycle of forever in that building. Yeah. In some cases I've had plumbing problems. Anyway, Phil, we good? we'll end on that. Hey, I love these conversations. Thank you. And appreciate the time.

Philipp: Thank you Bill.

Bill Russell: Thanks for listening to Newstay. There's a lot happening in our industry and while Newstay covers interesting stuff, another way to stay informed is by subscribing to our daily insights email, which delivers Expertly curated health IT news straight to your inbox. Sign up at thisweekealth. com slash news.

Thanks for listening. That's all for now