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Sarah Richardson joins me to discuss opioids and Apple. Both enjoy bi-partisan support and make meaningful progress over the course of this past week.


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 Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 36. Today we talk Apple and opioids, more specifically, legislation to fight their proliferation, opioids, not apple. Uh, this, uh, this podcast is brought to you by health lyrics.

Health systems are moving to the cloud to gain agility, efficiency, and new capabilities. Work with a trusted partner that's been moving health systems to the cloud since 2010. Visit health to schedule your free consultation. My name is Bill Russell. We're covering healthcare, c i o, writer advisor with the previously mentioned health lyrics.

Uh, before I get to our guest, I wanna make everyone aware of, uh, our great resource for your IT team. Since Weekend Health, it has a YouTube channel with great insights from industry influencers like our guest today. Short segments, complete episodes ALK curated for easy access. Every week we add another, uh, seven or eight videos, uh, to the collection.

Uh, and it's now up, uh, uh, well over 300 videos, uh, at this moment. So check it out today at this weekend, health and share it with your colleagues. Today's guest is a returning host from episode 12. Wow. It, it, it's really been, it's been a long time. And, and, and the host of the HIM SoCal podcast.

Today we are joined by Sarah Richardson of Healthcare Partners at DaVita Medical Group. Good morning, Sarah. Welcome to the show. Good morning, bill. Thanks for having me back. Wow, you're like a professional. You have such a great podcast with the, uh, SoCal himss, uh, podcast. And, and by great podcasts, I mean great guests, great topics.

Uh, you know, what, what do you think the best thing is about, about doing a podcast from your perspective? Oh gosh. You know, it's funny, it started out as a sort of pet project for us at SoCal himms to see how we could expand our educational footprint of topics that were relevant in the industry. What we found out was that there is a ton of content out there and so many people who are willing to share that information with others.

And so what we love about it is that it forces us to go and say, Hey, we need to be talking about these topics. And it may not be topics where we're. Subject matter expert clearly. So in order to thoughtfully do that interview, you have to a go call the talent to have come, come have conversation, and then you have to do your research, uh, before they show up.

And so what most people don't know is that we record those in bulk. So we'll sit set a Saturday aside and record like four or five hours of worth of shows. So those, like those days leading up to that day, I feel like I'm, I feel like I'm a college student cramming for an exam. 'cause every topic's pretty, pretty intense.

And then having to go and create all these different questions, et cetera. But I'm fortunate enough to have the contacts that I can reach out to colleagues, and I know that it's gonna be a great show because no one's gonna try to trump anybody up on a podcast. It's all about sharing of ideas and information.

So it's just been a great journey. Yeah, absolutely. Sometimes people are nervous about coming on this podcast and I'm like, look, my job is to. It's to bring out the best in you. It's not to like stump you with, with the questions. Yeah. Yeah. I give 'em the questions ahead of time. I let them send me their questions, et cetera.

The whole point is to like, have a great conversation about a cool topic that all of us need to know about in today's, uh, h I T world. Yeah. So you guys have covered a lot of great, uh, cybersecurity, innovation, uh, cloud computing. Uh, what are, what are some, who are some of your guests and, and what are some of the things you've talked about?

Oh, absolutely. So we've had Saji Ed talk about artificial intelligence. We just did this month's, the September episode that. It comes out actually today. Um, is Dr. Anthony Chang, uh, another level of AI being interviewed by Alan Young. So it's great. Alan's been our first guest podcaster from a host perspective, and he's on our SoCal board as well, um, which is very cool.

And we've had everything from people talking about leadership traits. So in the next, like in the next four months, you're gonna hear from Drex to Ford about relentless prioritization and governance. You're gonna hear from, uh, Tom Stafford, about 10 leadership principles. They're gonna, we had a conversation with Finland really about how they host medicine and their thoughts around r and d.

And we chose Finland because that's where HIMSS Europe is gonna be over the next three years. And so we've created that partnership with Finland as well. So, um, those are the types of topics that are coming up. And then I've got a whole slew of people that I'm reaching out to. And if I'm, one of my favorites is that we're gonna have Senator Ed Hernandez on the show, uh, recording with us in October to talk about his state h i t agenda and really how we can be, continue to be huge advocates because.

Uh, on the side. I took on this year the VP of Advocacy for SoCal hims. And, uh, just the importance of how we can affect legislation and you see that, you know, in the opioid epidemic with what Chime is doing and other, uh, leaders in the industry. Yeah. So you're, you're heading off to Washington soon for that, uh, for that get together.

Is that, is that right? It is, it's the first, uh, annual chime, uh, policy summit. It's October 3rd through the fifth. It's on Capitol Hill, it's in dc. What's really good about that bill is that a few years ago, the HIMSS chapters used to go to DC and do like the national h i t week, which is October 8th through the 12th this year, and now we do.

About two years ago it switched over to state levels. Now you do like state h i t days. We do ours in May in California. So there's really been that gap of how do you get your h i t advocates onto Capitol Hill? Well, chime is, is stepping in and doing that work and Chime has been so active with policy anyway, and Cletus Earl's been leading that for, for Chime for a bit this last year that, um, it's really cool that we're gonna be able to start to have a reciprocal way to get to Washington and be heard, uh, and really combine our state and our local efforts.

Wow, that's awesome. So the last time we checked in with you again, it's been 20 some odd weeks. Oh. Yeah. Optum, uh, uh, healthcare partners, uh, DaVita Medical Group all coming together. Uh, what's the update on that? How's that going? It's going well, and we are, we're still anticipated to close in 2018, so it's still in process and we're hopeful that it happens this year.

I think anybody that's been through it knows that, uh, an acquisition of this magnitude takes time and we're just in that final, you know, checks and balances of making sure everything's the way that it's supposed to be. And of course, F T C makes the file decision and so, We're hopeful that it happens this year.

Um, that's where all of our time and energy's been spent is what we call day one readiness. And when you spend probably the last two and a half to three years combining all of your h I t and your IT resources into a shared service like we did with the DaVita umbrella, which was phenomenal. We were just about done creating a singular IT organization for all of DaVita inclusive of kidney care.

And they go, Hey, by the way, uh, you're being sold and now you need to undo all the work that you did over the last two and a half years. So, That's really been the last few months of my life is making sure that we are an independent medical group. Again, ready for day one once the transaction finally closes.

Yeah, it's, it, it's amazing. So one of the things we like to do with our guests is just, um, we just talked about a bunch of things that you're doing, um, but you know, what are some of the things that you're working on that you're excited about? Uh, right now? I would say for work, it's, it's continues to be to build that independent team.

So, you know, what's wonderful about the whole healthcare partners footprint in Southern California is that it's always been a series of acquisitions and really select acquisitions to become, you know, the leading independent medical group in SoCal. And being able to do that again, just basically able to say, Hey, we're now, we're gonna go back to being, uh, a medical group owned by a medical group organization, essentially.

But when you really bring your teams through that journey, it's watching them be able to say, okay, we did all this work. Then we need to essentially undo the work. We're not really undoing something, we're building something a little bit different and stronger than before. And so I've been excited about the fact that our teams have just

I mean, heads down, getting the work done, looking forward to the continued future like they've always done. Uh, probably most pressing was in a, um, in a recent town hall with the team. And there's just, you know, anytime there's change, there's strife. And one of our managers said, Hey guys, I've been with the organization 25 years, and that means I've been acquired seven times throughout the journey of healthcare partners.

So this is just one more step in that journey. And she's such a pillar on our team, and everybody was like, oh, right, we can do this again. And so I feel like it's the ability for the team to focus. On being able to become part of something even bigger than what they were and realize that their future is, is very much in front of them and, uh, that they have control over that.

Yeah. Sue Shade and I did a show on, uh, m and a and she, she took the role of the acquiring, uh, entity and I took the role of the c i o of the being acquired entity. And we just talked about the different things and one of the things. I made it a point is that, you know, in, in being the acquired entity, a lot of times that opens up a whole set of new opportunities, uh, for the organization.

And so people sometimes get skittish and want to jump ship, but in reality it could be the best thing to happen to your career to be acquired by another entity, especially one that's like, I mean, at the end of the day, it's, it's a Fortune six company. And I'm like, guys, . , there's gonna be more, more opportunities than you've ever even considered in, in your life before.

And, and it helps too. I think that if people like me and others have are, are totally set, we're, we're like, we're looking forward to it. We're ready to go. We're not even, even ex exhibiting any kind of concern, only because ai, I've done this before, but more importantly, we're, we're on the right trajectory.

And so when your, when your leaders are comfortable and they're excited about what's coming, then I think it helps the team assimilate a little better too. Fantastic. All right. So on the, on the show, we do two things. We do in the news and soundbites. Um, in the news. We each pick a story and discuss, and we've got a lot to talk about this week.

And in the soundbite sections, I just ask you a series of questions that I have shared with you earlier, not too much earlier, I, I assume you did yesterday. Uh, I'm gonna give you the first story. So, uh, go ahead and, and share your story and, and give us a little background. Yeah, absolutely. So, you know, as, as you get more and more involved in the advocacy realm of things, there are, there are four key things that really the chime advocacy teams are focusing on at a national level.

It's cybersecurity, interoperability, uh, opioid epidemic, and telemedicine. Um, all very relevant and, and what's probably the most pressing in some cases is the opioid epidemic because, In our, you know, we don't necessarily hear about it as much. We hear about the things that we can do to do like E P C S and, and help our physicians get in front of that.

But, you know, I personally haven't been affected by anybody with opioids, but I know it's rel it's very prevalent. I mean, 70,000 people a year are dying from opioid overdose overdoses, and it's not like, The people you would expect it, it, I'm surprised. I don't know anybody and I'm grateful that I haven't.

And so if you think about things that you can advocate for, uh, the Senate was actually voting this week on a bill that you can get fentanyl, which is 50 times stronger than heroin, uh, mail order through China, through the US Postal Service. And, uh, the Senate's voting on a bill to ask the U S P S to have to register these packages that are coming in.

It's something that FedEx and D h L and u p s already do, so you can least get in front of the fact that. You can mail order some of the strongest opioids out there in the world and to, and to figure out a way to get in front of that more than just, you know, through the h i t efforts. And so, uh, I'm grateful that, uh, we have such, uh, visibility into it at a national.

Level, I feel like it's something that's not partisan. You know, whether, it doesn't matter what your politics are, it's a problem. And you see people coming together at a time when they've been more divided than ever on helping, uh, people overcome an addiction and creating policy that allows for that to potentially be a true statement.

Yeah, I I also noticed that in the bill it has, uh, it accelerates the research. Uh, to develop non-addictive painkillers and alternatives to opioids, uh, which is, you know, I, I guess they call it really the silver bullet. If you can get a non-addictive, uh, painkiller. Uh, and, and so that's a great step as well.

Alright, so that's a regulatory step that's being taken and we appreciate that. Um, It's interesting when I had, uh, uh, Anne weer on the show, uh, the c e o from Well Pepper, which is a digital startup, she discussed how hcaps is a potential driver for overprescribing. So hcaps has a score, as you know, of, you know, how was your pain managed and.

And, uh, she shared this story, you know, so when someone subscribed opioids after total joint replacement, uh, surgery, uh, they're, they're typically prescribed a large number, uh, because you can only prescribe them in person. And so if they're having joint replacement, they can't get back into the, to, they struggle to get back in to, to get the prescription refilled.

So, So they overprescribe and then, so two things happen. Either they take 'em all or it ends up in a medicine cabinet for, you know, a high school kid or, or, or younger to, to take. And, um, and you know, and she actually shared a, a patient story. They were doing some, some research. And one of the patient stories, you know, a good patient said, well, I took all the O opioids.

And they said, well, you know it because of your pain. And the answer was no, it. My doctor prescribed it to me. I assumed I was supposed to take it. Um, so, you know, the, the legislation is one aspect of it. Uh, but there's still, uh, you know, there's still a policy challenge, uh, in, in the unintended consequences of, of the H cap measure, uh, and, and some other things.

But one of the things I wanted to talk to you about is, uh, so we're gonna be the ones in the room, uh, and we're gonna be asked the role of technology can play in addressing, uh, this crisis. What do you think are some of the things that you're seeing out there from a technology perspective or from technology partners, uh, that may help in addressing this challenge, do you think?

No, it's, it's an excellent question, bill, because you think about the fact that, um, that first . I mean, you got the, you got the medi med adherence, but med adherence isn't about taking your opioids. Med adherence is about making sure you're taking your statins and other things that were being measured on.

So you think about the reconciliation process when a patient leaves the hospital or even leaves a post-acute setting, what that follow-up looks like and what kind of education materials we can give to them. Whether it's the patient portal or another s m s push technology or messenger service, that allows us to be able to say, here's the education behind your opioids, and here's what you should do if you don't need all of them.

Like, here's how you can get rid of them, or if you do need them, here's how we can call you. And P, you really in the care management plan that helps to manage your pain or manage the issue that's at hand. Um, but there's a few things that are in flight. There's the Overdose protection and Patient Safety Act that allows us to manage opioid records, but they don't necessarily get shared because of hipaa.

And so how do you create opportunity for, um, drug treatment or diagnoses that are out there in the EHRs to be interoperable, to share? Specific details because you get this blob of data in a C C D A, you're not gonna go look to see, Hey, bill got fentanyl for this at one point. Um, so there's the interoperability, there's the ability to share the drug history records.

Telehealth to me continues to be a space where if you can, so like you think that federally qualified health centers aren't allowed to bill for telemedicine right now, and a lot of the, um, people in the US that have an addiction to opioid may go to those locations for care. And if there's not a way for that, uh, provider or for that patient to be able to have access to either maybe a behavioral health, Uh, advocate or someone who can help them manage that care more effectively in a setting of where they are.

Then we're gonna continue to put ourselves at risk at some of our, uh, most vulnerable populations. So using the tools we already have, um, just making them very specific to something that's been identified as a very worthy cause. Yeah, and I like, uh, the aspect of education here I think is really key.

Sometimes recording those . Uh, conversations that the physicians have at the end where they're, uh, giving the, uh, care plan and the care instructions, recording those and, and, and putting those into a portal so that they can be a watched later. I know that with my, my family, I'd like to see what the doctor actually said.

'cause I'm not in the room and they're like, well, I. I, I don't know what she said. She said this and this, and I'm like, oh man. Uh, you know, so how do we know what's right? So recording those things is interesting. Uh, I think the, one of the more interesting things I've seen in, in my career was I saw a design agency that worked with a hospital in Chicago and they took their discharge documents and they did, uh, I think like a 90 day, uh, program with them and design thinking and really redid.

The discharge and they, they gave, I wish I had a copy, but they gave me a copy of it. Uh, in fact, I know who to reach out to. I'm gonna reach out and get it. 'cause it's phenomenal. Um, that they took this really complex, you know, five page thing that they handed somebody and they made it into, uh, front and back color coordinated, uh, really interesting pictures.

And I just looked at it and I'm like, And they said, you know, fifth grade reading level. And I looked at it, I'm like, yeah, it's pictures. It's, and it was very clear what I was supposed to do and I think it was for asthma and, and I was like, it's very clear, you know, when I'm supposed to just, you know, take my inhaler.

It's very clear when I'm supposed to go to an emergency room. And, and that kind of, that kind of thing. Maybe not falling within technology, but the whole idea of bringing design thinking into the organization is something that it really can, uh, facilitate and help with, I think. Oh, absolutely. And you think about when your patient, if you know a patient has a prescription for an opioid, It's, it's some of those like in your face numbers, like, and we don't want you to become a statistic.

72,000 people a year are dying from this as an addiction, and here's what we're gonna do to make sure that you only take this as long as you absolutely need it, kind of thing. Yeah. Yeah. Well, that's great. I, I'll let you have the last word. Is there anything else you want to say on that story before we get to, you know, the flashiest story of the, of the week?

What I would just share with those of, uh, that are listening and our peers is that if you're not aware of what's going on both in, in Congress and across the board with opioid epidemic, become familiar with it. Because if it hasn't happened to you, uh, and so in your world that you know about it very well may and you wanna know what resources are available to help someone who may be suffering from something like this.

Yeah. And it's great to see Chime taking a lead and, and it's great to just plug right into that, uh, for, uh, For those of us who are, uh, connected with Chime and looking forward to, looking forward to having you on the show. Let's see, it's been 24 episodes, so the next time we'll have you on is sometime in the spring.

And hopefully we'll hear more about what you're doing, uh, in that role with, uh, with advocacy. It should, should be interesting. Um, so I feel kind of, I, I feel kind of wimpy here. I took the, I took the easy story, but I think it's something we should talk about. It's, it's already getting. Uh, play, uh, in the physician community and, and some other things.

So Apple unveils, it's, uh, watch series four with F D A approved E C G. So, uh, you can find the story anywhere. I'm actually looking at the healthcare IT news story and you know, the, the big thing is right there in the title F D A approved E C G on the Apple Watch, uh, was one of the big reveals and. You know, and that's pretty exciting to have that on your, on your, um, wrist.

And you can just touch the digital crown. You can get the E c G done. Uh, but I thought the more interesting one to me was the fall prevention, uh, work that they had done. I. And so the fall, fall prevention is when it detects a fall. They, uh, you know, they can tell if you slipped, if you fell forward because the actions, uh, are pretty standard.

And, and the watch would sort of track that. And, uh, so if you, if you fall it, uh, Initiate, uh, an s o s call and you can, or it'll pull it up. So all you have to do is hit a button and you can actually call somebody. So the, the famous I've, I've fallen and I can't get up it, the Apple Watch will, will function as that.

Uh, the second thing is if you fall and are immobile and don't move for 60 seconds, it will actually make that emer, uh, call that emergency contact for you. And, uh, I, I would assume give your g p s and those kinds of, uh, those kinds of settings. So the Apple Watch is really becoming. A, uh, a, a a medical device.

I mean, clearly, I mean, it's f d a approved and they are continuing to push in this direction. Uh, so I guess let's start here. So, where does this fit in the strategy? Are we, uh, let's see. Are we issuing an Apple watch to all patients of a certain acuity in the hospital so that they fall in the hospital?

We find, you know, we. We know if they, or, or home care is probably a better case. Mm-hmm. , uh, should I buy one for my, my parents and, and my father-in-law who are in their eighties so I can have peace of mind and set me up as the emergency contact. So if they fall, I. Yeah. You know, and they, they live, uh, my, my father-in-law lives on his own, so if he falls, that would be, that would be great for my, my wife to get a, a phone call and, and be able to help him in that time.

So where does it fit? Where does it fit in the overall IT strategy and, and, and really health system strategy, do you think? Yeah, it's a great question and I, I, it is interesting when I saw, when I saw that they'd unveiled the ability to do, you know, the E K G or the, um, elevated heart rate. What I love about it is I think it, we, we sometimes discount that our, our baby boomers and our seniors and there's a thousand people every day in the state of California aging into Medicare eligibility.

And so that, I mean that whole population is very tech savvy. I literally, so I share a plan with my mom. She's almost 76, a data plan. I had to go unlimited data. This is a woman who didn't want a smartphone and now she's like, I mean, literally I like, I feel like I have a teenager for all the right reasons.

I had to go on an unlimited data plan because my mom is online so much on her smartphone. She's like, wow, these apps really use a lot of data. I'm like, yes, they do. Um, So part of that, what I think is great about what Apple's doing is that they have slowly integrated themselves into a population that was historically seen as being maybe, uh, scared of technology or not as much of an adopter.

And now it's not a big deal. I could give my mother a. An Apple watch, and I probably thank goodness I already have unlimited data. It's one of those things that it would be one more thing in her technical ecosystem and she has Alexa and she helps her out with all kinds of different things that she's looking to do.

So I remember last year at, uh, himss, the day before himss, we always had the big CHIME conference, and one of our first speakers talked about the fact that hospital systems that are early adopters of taking high risk patients like somebody who has C H F and or C O P D a pretty, uh, common combo of being a.

High likelihood for readmission. . Sending that patient home with an eye watch to look for elevated heart rate and to look for just different anomalies that may be occurring to provide that intervention ahead of time and call them and potentially prevent them from having to go to the ER and be able to get in front of those types of things.

We are at the precipice of this, and it'll be some of the larger health systems that maybe take this on initially, but it's the beginning of being able to say, if I'm wearing an iWatch and it starts to track my body temperature, And for two or three days, I've had a fluctuation in body temperature and a fluctuation in my heart rate that I wasn't anticipating or I wasn't even paying attention to.

It's actually the sign of like a pending infection. Then my watch is gonna tell me ahead of time that even I may have something going on. Um, so it's, right now it's maybe high risk patients and, and that are at risk of being readmitted, but at the end of the day, it's gonna be people that are in their forties like me, who maybe have something going on that we weren't even aware of because it's not happening at a, at a very acute level.

Yeah. John Halamka and I last week talked about, uh, the role of incentives and how 80% of their patients now at Beth Israel deepness are at risk. So they're not at risk health, but the, the health system has taken risk, uh, in terms of the contract to manage that patient. So they're only getting a fixed amount of money to manage those.

Uh, those patients and that really changes the paradigm. So, you know, giving somebody a $300 watch to go home with, uh, might make sense if you, if you have a risk-based contract and you need to, to monitor those things. If we're still in a, a fee for service model, you're maybe not looking at, uh, these kinds of alternative models.

But if . If matters to you, what's happening at the home? Not I, I understand it matters to everybody from an altruistic standpoint, but if it matters from a financial standpoint, then you're saying, Hey, this $203 investment. Make sense to manage, uh, to make sure that we're monitoring this person on a, you know, 7 24 basis so that, uh, they don't become, uh, you know, to, to a higher acuity and higher, uh, level of need.

Uh, so, uh, you, you guys have a fair amount of a at risk population that, that you manage. Um, do you see this. I know you said the, we're at the precipice, but do you see like an Apple Watch strategy or um, or a device strategy, uh, in the home that CIOs should be thinking about? And I, you know, that patient-centered medical home has, has been a topic for a while, but where do you, how do you see that playing out?

No, it's already there. So we have, uh, a lot of disease management and high risk program management with our care managers. 'cause we are, we're risk, we do take almost full delegation from 14 health plans for all of our patient populations. And so, We're already in that boat, and we do for things like C O P D and diabetes and C H F, we have programs where we have the disease managers.

And if we know that you're discharged into a high risk program, we have, um, your, we have the I V R, we have a phone call you, you know, every two or three days. And based on your responses, we know to have someone do an intervention, et cetera. So, And we started adding technology for, we send people home with a home monitoring kit for 30 days for C O P D and make sure that they're doing well.

And if they show improvement, then obviously we discharge it from the, from the, the kit, but we still monitor them, et cetera. Um, it continue, you just continue to add the things that make sense from your population. And so most places are already doing things like that. Home home monitoring is not new.

It's a matter of . To your point, are we altruistic about it or are we just delegated for it? I think I'm lucky in that we are delegated for it, but we've been delegated for so long that that is part of who we are. Uh, it may be an altruistic mission, but it's also the right thing to do. I'm grateful to work for a healthcare organization.

That does the right thing, uh, perhaps based on some of our modeling, but it's, it's wonderful to know that we are a hundred percent responsible for the care coordination of that patient. And so adding technology to help them be healthier, um, is really one of the funnest parts of my job. Yeah. And I think we're seeing more and more systems, uh, go at risk.

And I, I think the more interesting story, uh, for, for me from this year was, uh, from the JP Morgan conference was Intermountain saying we've, we've selected a, a zip code of, uh, you know, a, a population that has very poor health outcomes, and we're going at risk with Medicaid. For that population. So Intermountain's doing a, a whole lot of work to try to figure out how to, to bring the level of that whole population up.

And, and literally, and we had Mark probes on the, on the show and he was saying, you know, literally, you know, from this side of the street to this side of the street, you know, someone could live an extra five years. And that's just doesn't make any sense. And so they're wading into social determinants.

They're wa into technology. They're waiting into, uh, you know, making sure that, uh, I mean not in, not in Salt Lake, but making sure that they have air conditioning, making sure they have mm-hmm. Uh, you know, access to people. And so that's, uh, I, I think we all agree that that's the future, the future of medicine is, um, More continuous, more, uh, where the, the healthcare provider acts as the, uh, the, the expert that, uh, is, is calling through that information and, uh, proactively reaching out and, and managing the, the population in that community.

So this, I think the Apple Watch is, is interesting. I think it's just, like you said, it's on the precipice. So I'm looking forward to. A fair number of pilots and integrations with this, uh, in the health system. But what do you say to, you know, so one of the tweets from this morning was, uh, what about all the false, false positives?

What, you know, who's gonna pay for the false positives on the, on the falls and that kind of stuff. And that was from a physician. And, um, you know, that's, that's gonna be kind of the, the pushback I think we get on this kind of, I, I'll, I'll give you the last word on this as well, if you'd like. One thing I love about Apple is it creates conversation and the conversation that it drives allows them to think about what to put into their next release or their next thing that they're gonna be doing.

I. To, uh, connect people and take better care, help take better care of patients. And what I love about, you know, and everyone knows I'm a big Apple fan, so it's like, fine, I'm always this evangelist of Apple. What I love is that they are taking the very best of what, uh, technology has to offer and incorporating it into things that we are already comfortable with.

So you see them introduce the product and then all the benefits that it can have. So it becomes ubiquitous with of how we do every day. So, It's not a surprise. The next thing is going to, you know, be, um, the ability to connect directly with your physician and do your, you know, video visit from your watch, et cetera.

So, you know, kudos to Apple for creating, uh, both solutions and controversy around doing the right thing. Yeah. That's awesome. Uh, yeah, and I am, I'm really excited about this. So let's, we'll transition to, uh, soundbites now. So during this, uh, section, I asked toss out about five questions, uh, one to three minute answers.

Uh, you know, if you go longer, I don't stop you. It's more of a guideline than a rule. Uh, and, and if you want, you can throw questions back at me. I can't guarantee answers because prepared. But we can, uh, we can see what happens. So, first question, you, you're, uh, your system's a leader in coordinated care, value-based care.

What foundational technologies enable healthcare partners to excel in this area? We are amazingly talented at Population health. We built our own platform, you know, 20 years ago, before it was even a, before Popul Health Population Health was even a thing. Healthcare Partners was doing it. Um, that's heavy though.

That's about utilization management, care management, disease management. An incredibly robust warehouse with very deep analytics and reporting capabilities on top of it. And I think one of our favorite things is that we grow, we've grown up running our own gap list and creating our own metrics. The blessing and the curse is all of that, is that now that most of this stuff is mainstream, these, these tools and technologies, it's us adapting all of our processes.

Into what's off the shelf. So we are at the phase where we can now retire our homegrown stuff, go mainstream, and then use all of that talent that we have in house to build tools that don't exist in the marketplace today that we need. Uh, so we've always been at the front end of a lot of the things that you're seeing be off the shelf today.

Um, but we've always done it with just really deep analytics and, and probably a. An incredible understanding of what it takes to maintain a healthy population. That's awesome. So that, that segues into our, the second question, which is, uh, you know, analytics is, is so foundational to everything we do, uh, in care, and especially value-based care.

So give us an idea of . How a new measure or metric goes from idea to operational dashboard in your organization. How does the idea get off the ground, get approved, assigned resources built and then operationalized? That's a good question. So I'll start with, we're not unique in that we use steering committees and uh, To help drive what needs to go into the tool sets that we utilize.

So obviously you're gonna get the regulatory and compliance things you handed down, Hey, there's new HEDIS measures. Hey, there's new P for P. Hey, there's new stars. Hey, there's new things we need to be thinking about. Um, that all goes into basically our think tank of this one steering committee. We figure out what pieces need to go into what we call the the pa, the physician intervention.

The physician information portal, which creates our, um, patient intervention reports. Like, these are the things you need to be talking to your patients about, et cetera. Um, it's always this think tank of ideas and sharing what's coming. So we're fortunate. We've got people who sit on a p g. We've got people that, uh, are connected with all of our health plans.

We've just, we're kind of all over. State and we bring that information back into our organization and be like, Hey, this is the requirement, but then how are we going to do more than just meet that? So we are not in the business of checking a box and meeting a requirement. We're like, here's what, here's why it exists, or here's what we need to be doing and here's what that looks like in our organization.

So our goal is always to create. What we think are the exceeding, uh, metrics that go along with that. And there's a lot of creativity that goes into that. So that's why so many of the things that we've built, anybody who's been a part of a healthcare organization for a long time knows that what I call the, um, the sort of organizational architecture of how your systems are built.

It looks like we call it spaghetti diagram, and it literally looks like that. It's very, it's a beautiful diagram, but I'll tell you, it's like a board gamer. So many pieces and connections and parts and things that have to work well. Um, that now we've also learned that not only is it important to bring an idea in how we're gonna build, design, test, implement, maintain, et cetera, do we buy versus build?

Who's gonna manage it? What does the reporting functionality look like? How are we gonna to use the data? How do we refine it? It's also how are we documenting this so that we aren't creating a monster for ourselves? We almost have to think about that internal interoperability as we build for the future.

Yeah, it, it's interesting to me, uh, you're now the second person I've asked that question to and I'm, I'm gonna keep asking it because each organization has a different flavor for how analytics. Uh, it gets operationalized within their organization. Um, and some have a very distri distributed governance model.

Obviously, the, the, the regulatory ones are easy and the business ones. Some of the business ones are pretty easy. You know, you have to do certain things for. Uh, the, the payment models that you, that impact your physicians and you have to do certain things from a regulatory standpoint. But then there's a whole host of ways that analytics bubbles up that I, I find fascinating to look at the differences of how organizations function.

It's everywhere. So it's, it, for us, it's, we're always getting better at it because we have so many spaces that can do analytics. So you give people access to your warehouse with reporting and . Just know what that means. Yeah. And that's, and that's the golden ticket, right? We've, we've often talked about when you can get analytics for your health system to be Google, ask or ask, you know, ask Siri or ask

Um, you know, Alexa, you know how many, how many of this, or how many of that, and you just get the response back. In fact, that's what, uh, my C C E O asked me for is I want it to be like Google. I want to ask about our health system or our population, and I want, I want it to give me answers back, like Google.

I'm like, I don't, I'm, I understand what you're asking for. You, you want the ease, ease of finding the information. But Google doesn't come back with, generally doesn't come back with a specific answer. They come back with, Hey, here's a hundred. And then you as a person have to go through and go, I think it's this link or this link.

Um, so, uh, the most cost effective, uh, care obviously is preventative home base. And we just talked about this with the Apple announcement, but I wanted to walk through some other technologies with you, uh, to get your thoughts on how they, um, how that will be applied to build healthy communities. Let's start with, uh, with the easiest and most prevalent today at least, and that's telehealth.

So, uh, how is that going to be utilized in home-based care? Are we at the beginning or are we starting to see this mature. And well to it's both. We're at, we're at the beginning and you're trying to see it mature where people have a level of comfort with the technology. So again, how many people have, you know, Alexa or, or the Google device in their home and they're already using it to do interaction?

Well, now you, did you have the video component that's available on that and be able to just go and, and speak with your doctor or, or connect to a healthcare provider if you need it. Um, and. So it just becomes, again, that ubiquity of healthcare is as easy for me as making a reservation or ordering flowers or, or doing anything else.

And so it just becomes part of the whole ecosystem. So it's, it's out there and it's available. It becomes more prevalent once you know that you can easily connect to your healthcare provider, your healthcare agency, um, through that technology. Yeah, so access is gonna be a lot easier with telehealth. What about IoT and sensors If you wanna wear 'em.

So here's the other piece, like the Apple Watch is great if you wear an Apple watch. So if you're gonna have sensors or wearables be part of how we manage, uh, healthcare, I. I personally don't wear an Apple watch, and mine's more about fashion than anything else, and I'm totally honest about that. I mean, I'm the first one to tell you I don't wanna wear the same watch as everybody else.

I already carry the same phone as everybody else and I changing, my band doesn't do it for me kind of thing. So, um, it's a matter of how pervasively people want to be, uh, in that space. People make think I'm crazy. I'd rather have a chip in my neck. Then have to wear a watch because I don't have to remember the chip in my neck.

And someone's like, oh, that's too, that's too invasive. I'm like, you're already carrying, you're already carrying your chip every day. Everywhere you go, it's a matter of where you put it. Right. Well, I mean, you, you, there's also passive sensors as well, right? So you can put 'em in a pillow, you can put 'em in a bed, uh, you can put 'em in a pill.

Um, so do you think, uh, do you think we're just gonna see more and more sensors start to surround the patient community, community? You will. And again, I'm hopeful that it's still the patient's choice as far as of the, the value that the, um, invasive feeling that it may have with it. So there's a bit of that big brother feeling when you have too many sensors or too many things around you.

Uh, so I'm hopeful that we still allow it to be the choice of the patient. I. Uh, before we assume that's what they're gonna want. Absolutely. So, you know, this is an interesting one. I'm getting more and more conversations with, um, with people that, because people like to talk to me about emerging technologies, and this is one of those that's.

On, on the edge right now, but that's chatbots and natural, uh, conversation with technology. Um, uh, you know, do you, do you see this, are, are, are you starting to experiment with it? Are you starting to see, uh, other, uh, uh, technology partners come in and talk to you about chatbots and, and natural language, uh, interaction?

I, I have been, what I love is there's the, um, . Uh, innovation Lab at Cedar-Sinai and some of the recent, uh, groups that have come through with them are those really, uh, playing in this space and, and taking, again, the Lexi type technology and utilizing it for inpatient settings so that you can use that device to say, You know, let's just say it's Alexa.

Hey Alexa, I'm cold. Or I need to use the restroom, or I'm hungry. And then that, that command is able to go and direct that request, the appropriate level of individual in the hospital. So a patient technician can bring you the blanket, whereas the nurse practitioner maybe needs to come and give you a dosage of your medication.

Um, so there's just really cool technologies that we're already integrating into that, uh, into that space. But you can have the, you know, there's the chat bots that run on rules and the ones that only are smart, do the things that you tell it to do. I think where we're headed is the ones that are really based on machine learning and use artificial intelligence to truly learn the language.

And so you can have a conversation, uh, with that, with that chat bot. Um, you can even, uh, it was so cool. We were at a chime event, uh, last week in Chicago and rest Friends i's like, here's the chat bot dog. He's like, I want this dog. And I couldn't get one. They're sold out for like all this period of time, but it literally, like if you're gone for like three or four days, This chatbot dog already knows to be mad at you for two days 'cause you left it alone.

Until it learns, you know, how to be happy to see you in these different things. So we are absolutely on our way there. Um, while today chatbots aren't used as prevalently for medicine, um, I think of the number one use case going forward is that because we, we do a lot with seniors is that seniors get depressed because they get lonely.

Yeah. And we think about the chat bot that can be conversational and really becomes that senior's friend and is managing their care and everything else about them. We're gonna see longevity in seniors due to the ability for a chat bot to, to become its friend. Yeah. And chatbot, uh, because of the nature of machine learning and because of the nature of te, of healthcare, because you cannot make a mistake and machine learning learns through iteration, just over time it gets smarter and smarter and smarter.

But the problem is we can't have like, hey, it's 95% accurate. In making any kind of medical, uh, you know, deduction. So I, I think this is gonna be slower adoption. I think you will see it in call centers for hospitals and scheduling and, and those kinds of things. And, and I'm looking forward to just seeing that slowly move from the business side over into the, uh, into the clinical side.

Last thing, gamification of health has always fascinated me. You know, when we could get kids interested in health earlier when we can get . Um, you know, people competing with each other to be healthier. Uh, what, how do, how do you see this playing out and are, are you seeing this, are you having a lot, some conversations around gamification?

Gamification, school? You know, a few years ago, Jim McConnell was one of the keynotes at Chime talking about using it to, um, help patients learn about how to combat like cancer. And they give them, like if they're beating, if they're winning the video game, they know that they can beat that disease as well.

And you're starting to see it come into back office operations too, because processing claims isn't the most exciting job every day. But if you can make it a game, uh, and win, you know, that daily, total, et cetera, then it helps to engage your teammates. So the gamification piece to me, I think about, and I don't have kids, but I hear about kids like being obsessed with this game called Fortnite.

Imagine if you can take that, the things that kids are learning in Fortnite. Teach 'em how to eat healthy. Hey, by the way, time to get up and go exercise or go run around and play outside for 30 minutes, et cetera. So the fact that we have this current generation, um, so I mean, their whole life revolves around just the technology.

Um, making healthcare a a game is just the natural progression of something that you'd wanna do. And I'm hopeful that that's where, you know, parents and and providers are starting to spend more time Is. How do you make healthy choices? Smart, because I spent all my time outside growing, uh, grow outside, growing up as a kid.

I know today kids stay in front of their devices and I'm thinking, oh my gosh, let's make part of that, you know, a game as far as getting your steps in at whatever age you need to get into. So yeah, gamification for healthcare, it's just a matter of how we integrate that into kids today, more than anybody.

Yeah. Uh, so you have a, a distributed staff, and we've talked about talent shortage and, and challenges in, in that perspective. Mm-hmm. . So, uh, you, you mentioned that, you know, you hire people really for the right skill wherever they're at. So what are some of the ways to effect that you effectively manage a distributed or remote IT staff?

What we're doing right now. So you and I are doing a video chat. Um, you know, obviously in person's best, but video is second phone I say is always third. So using that video connection and being able to actually see somebody and half the fun is the fact that they may be at home and you have a beautiful backdrop.

And I have a wall today 'cause I'm in one of our remote offices, but on Fri, especially on Fridays, about once, one Friday a month, I'll get to work from home and I tell people, beware. You're gonna see me in, in with no makeup. My hair's in a ponytail and I've got my cup of coffee, and my cat might do a drive by.

But you know what's really cool about those types of, uh, interactions with people is that they get to see you for who you are. And the most important, whether it's video conference or not, the most important aspect to any relationship with any teammate is a personal connection. I start every single meeting with an icebreaker.

Some of, and they're, some of 'em are profound. Like, Hey, if you could meet one person from the past, who would it be? And some of them are like, Hey, what's in the trunk of your car? Uh, and then we create these like fun stories around all of those. So getting to know them personally is the most important thing that you can ever do.

Uh, and the reason I do things like icebreakers and fun facts is that teammates who have worked together for 20 years, bill, find out things about each other that they never knew before. Like, I dunno that about you. And those are those personal connections, like you care last night that the Bengals won.

For a teammate who likes the Bengals, whether you care or not, but you know that that happened and you say, Hey, great game last night, et cetera. Um, you extend the length of your one-on-ones and you, and you have an agenda to talk through. I'm a big agenda person. People give me grief, like, oh, I always have to have an agenda when they come to one-on-one with you.

Well, of course you do, because what happened since last time we met? What are your roadblocks? All the basic things that you want, but they're, they're owning and driving that conversation and it, and it's very, uh, realistic and it's important in person. Personal. Um, and I always say that the culture trumps everything in an organization.

So what culture are you creating for teammates, whether they're remote or otherwise, is creating a place that they wanna come to every day, even if what they come to is a video screen. So I would say that always the biggest tenets. Create an amazing culture. Get to know them personally, um, and be transparent and focused.

So right now I'm not, look, the phone's not ringing. I'm not looking at other things. You have to be dedicated to that time you spend with them and not be distracted by anything else that's going on. Fantastic answer. I I really love the, uh, the icebreaker questions. That becomes one of those things that, you know, it might, people might gloss over in the answer, but I, I agree with you knowing that somebody's a Bengals fan, somebody's, um, you know, into skiing, somebody's into whatever, somebody loves the Olympics.

That's, that's all great stuff. And even as simple as you come to. You know, hey, we're, we're buying each other gifts for Christmas or whatever. Those gifts become more personal 'cause you, you know, the person. Yep. And I think people, that's one of the things that people miss when you walk into somebody's office.

You can tell a lot about 'em. Like, for instance, your office and your Star Wars gear, which people don't see right now because you're not in that office. But you know, the first time I walked in I'm like, oh, that's, you know, that's that and you got a 49 ERs. Uh uh, you just, when you walk into somebody's office, you can just tell a lot about them.

Yeah. And that doesn't happen remotely. And so you have to, you have to generate it. You have to figure out a way to get it out. That's awesome. Uh, so we've talked about people need to own their own career and uh, this is another one of those questions I like to revisit often with different people from different perspectives.

What are a couple of ways, uh, you have seen that done effectively? People really owning their own career over the years? The number one thing is to you, you have to own it. And you have to be able to, even if you don't know, like, Hey, I'm gonna be this when I grow up. I call it curiosity and continuous learning.

I remember one time when uh, someone said to me, college was always gonna gonna happen, and my mom always used to say, the reason you're going to college is because no one can ever take that away from you. Once you have a degree, it's yours. And then it was like, Hey, you probably should get your master's degree because you're gonna need it to get promoted in the future.

And that was a good choice, and I'm glad I did it, but it wasn't like it was a one on done. You have to constantly be curious about what's around you. Join himss, join Chime. Uh, I recently just joined the Southern California Society, uh, for information management. It's a bunch of CIOs that aren't in healthcare because I need to know what's happening outside of my world too, because otherwise, You get so myopic into like, Hey, I've been in an organization for X amount of years and I know how to do this one thing.

Um, knowing how to do that one thing well is great, and you've gotta be able to know what's happening out in the world around you. And so there's a level of discomfort. I had a, a colleague once asked me, how do I know when it's time to move on? Or how do I know when I need to be doing something different?

When it's easy, when you are almost terrified about the fact that you have all these deliverables that you actually maybe don't know how to do all of them, you should almost always have a level of discomfort in your role because it means you're challenging yourself. And as soon as it's not a little bit scary every morning when you wake up.

It is time to learn to do something new. It doesn't mean you go like, find a new job, but I mean, go learn about data science. Go get a certification. Go take a class at U C L A extension. Like constantly challenge yourself to do something that you don't know how to do. Yeah, that's, that's, uh, great advice.

Um, Sarah, as always, uh, I love having you on the show. Thank you for coming. Um, you know, what's the best people, best way for people to follow you? Follow me LinkedIn. I love LinkedIn. Uh, I'm just Sarah Richardson. It's, um, there's probably, I think there's a lot of Sarah Richardsons in the world, but mine's a big leadership banner behind it.

Um, at Concierge Leader for Twitter. Um, or I just tell people, you know, email me, um,, but also Um, and just for that final plug, I am looking for a subject matter expert to talk about chatbots on the Southern California. Podcast, podcast. And if it's, if it is a vendor, the rules of engagement are that you can't sell your product on the podcast.

You just have to be able to talk about what it means from an industry perspective. So anyone out there who's a part of our world, bill, who is really, uh, in the chat bot space, uh, give me a call. Uh, let me know. I would love to have them on as a guest. And, uh, you are gonna be coming up as a guest on the podcast too.

Need to give you the date and organize it. But, uh, it's gonna be fun to have you and you get to pick your topic because, uh, you pretty much have covered all of 'em. So, yeah, I, yeah. Um, yeah, I, and I'm looking forward to that. That'll be great. It'll be great to work on a Saturday with you in your, you have a really cool studio.

So I'm, I'm, yeah. Looking forward to, to getting a part of that. Um, You can follow me on Twitter, the at the patient CIO health Eric's website, uh, writing. And, uh, don't forget the, the shows on Twitter as well this week in h it. And check out the website this week in health and catch the videos on the YouTube channel that we talked about this week in health

And, uh, please come back every Friday for our news information and commentary from industry influencers. That's all for now.


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