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Sometimes the question is what unlocks a potential future. What questions are you asking? Have you asked and entertained the absurd in order to free your mind from its current constraints? Today we explore.

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today we're gonna take a look at four or five stories that I got in my email this week because you wanted me to comment on them. So there we go.

 My name is bill Russell. I'm a former CIO for a 16 hospital system and create, or this week health, a set of channels dedicated to keeping health it staff current. And engaged. We want to thank our show sponsors. We're investing in developing the next generation of health leaders, short test and artist site two great companies. Check them out at this week. health.com/today.

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 All right. Five stories. We're gonna move quick. Us Senator probes, Ascension. Alleging it operates like a private equity fund. Senator Tammy Baldwin, of Wisconsin is probing St. Louis based Ascension, which operates 33 facilities. All right, let's take a look at why. She sent a letter, said some things let's see.

the letter was inspired by recent local reporting that illuminated long wait time surgery, delays, and staff concerns about patient safety at Ascension Columbia St Mary's and the closure of labor and delivery unit at Ascension St. Francis, both in Milwaukee. Ascension and its physicians, nurses, and caregivers are proud of our mission to provide care for those most vulnerable, so forth and so on. That's their response.

As a nonprofit tax exempt health system Ascension is required to serve public interest And benefit the communities it serves. However, Ms. Baldwin. wrote, she is concerned that the opposite is occurring. By operating like a private equity fund Ascension is squeezing staff, closing facilities and extracting cash from its member hospitals for dubious management fees.

All to advance its investment activities. And provide compensation to its executives. Ascension capital the health system, strategic investment initiative, lost more than 750 million. In the most recent financial quarter, which is around 200 million more than Ascension put towards charity care.

In the same time span. So they lost money. So the argument is they lost money. Therefore they should put more money towards charity care. keep going at this. At this year's JP Morgan healthcare conference. CFO Elizabeth Fa. Highlighted, Ascension's $18 billion of cash. Investments Ms. Baldwin wrote the number raises questions about why Ascension, a mission-driven health system with nonprofit status is not prioritizing reinvestment.

Into serving vulnerable communities and its own operations, which should include increasing pay, improving. working conditions for its burned out and overextended healthcare workers. there's nothing here. There's nothing in this story. They're gonna look at 'em. compared to other entities of its size, that's a very small amount of cash to have on hand or in an investment portfolio, , and, Ascension and all the rest of these nonprofits do provide an awful lot of charity care. And when this comes in front of people, be able to highlight that.

So. At the end of the day, you can't continue to lose money from operations and be a viable entity. This is gonna happen more and more, more and more health systems are gonna close down. Certain aspects of their their delivery that is not making money. And, we're gonna see politicians. We're gonna see community leaders and whatnot.

uh, get upset about it, but at the end of the day, they're not making money and something has to be done about it. That a challenge needs to be addressed. All right. Number two, a leap towards universal interoperability. Epic gets approval to join TE fca. epic systems has approved, been approved for onboarding to join the trusted exchange framework and common agreement. If you want more information about that, we've done two episodes.

On that, Uh, we've done it with, Oh, gosh. Mickey And, I forget who the other, uh, we did another one. Anyway, you could just search for Teka On our website and it'll pull up the various episodes providers in the epic community have led the nation in health information exchange for more than 15 years. Matt Doyle interoperability software development lead at epic said February 13 released, shared with Becker's. our support of HHS on this historic milestone.

will expand. Information sharing and create a single on-ramp towards universal interoperability. EHR giant originally announced that it was planning to join the organization in June as an inaugural qualified health information network. Epic has also collaborated with the office with ONC for, the Sequoia project that's who we interviewed the head of the Sequoia project and others to build the principles and procedures of HHS sponsored.

Interoperability. Epic has a lot of records. This is a good leap forward in terms of having the, , the health record available at the point of care, wherever that point of care happens to be. we, I would still like to see more of that data in the hands of the consumer. That's my, so what on that?

Next story. Oracle says terminating VA Cerner. EHR rollout makes no sense. I did a poll earlier. This week, my Monday poll for this week, which was uh, kind of a fun poll, Got a lot of, uh, a lot of interesting back and forth. And that's always my intention, right. Is to get the conversation and get people to, you know, start uh, Start commenting on, you know, what's, what's going on in the industry and whatnot. The poll was. You know, given the investment and everything that's going on with the uh, V H E H R, EHR project, should they stay the course more oversight, change leadership, cancel the project. And it's interesting. 24% said, stay the course 14%.

Said said more oversight. 37% said change leadership and 25% said cancel the project. And so this is Oracle's response to cancel the project. Ken Gluek, G L U E C K executive vice president of Oracle urge Congress to continue to support the Cerner EHR rollout at the department of veteran affairs. After legislation proposed two bills, legislators proposed two bills aimed at scrapping the entire project.

he wrote on February 10th, Oracle blog post that scrapping the sort of roll. which has been ongoing since October, 2020 We'll take healthcare. For veterans backwards as the move would cause the department to revert back to a legacy BA EHR system. The point of the modern EHR is so that interacting with the health record.

Is as easy as interacting with the Starbucks barista. Mr. Mr also pointed out that the bill Uh, calls for putting some VA centers on a more modern EHR system while leaving the rest of the VA's legacy EHR system Vista in place. , you would create an untenable patchwork. I would argue they already have an untenable patchwork.

And part of that is politically driven. And part of that is. Driven by the fact that, and I talked about this on a earlier show. The reason epic is successful in their roll-outs is they are highly prescriptive. They come in and say, a successful EHR rollout will look like this. You will do these things. And they essentially say, if you're not gonna do these things, we're not gonna give you our software. We're not gonna let you use our software cuz we're not gonna be part of a failed implementation.

Now Cerner Oracle did not have that approach, never has had that approach. And it's like, Hey, we can morph our stuff around your dys. Essentially. Well, the VA is dysfunctional. They have, , fiefdoms across the entire country. It's not a single unit that operates the same way. They don't have the same, , buying standards, the same, equipment and all that stuff. It, or even procedures or operating procedures in all of their VA centers.

It's all over the board. And if you're gonna allow people to have that level of autonomy across a 10 20, I mean, we had 16 hospitals. If you, if we allowed that level of autonomy. we we would've failed in our EHR implementation and we didn't do epic. But we drove an awful lot of, , uniformity in the practice of medicine.

We were trying to reduce uh, the variability in the delivery. We tried to reduce the, , the steps and the procedures and those kinds of things. You have to do that. And that takes strong leadership. It's very hard to do. And, you don't make a lot of in that process and the people that you are standing toe to toe with know a lot more about healthcare than you do, but at the end of the day, you know, a lot more about implementing a successful enterprise-wide system.

than they do. And, , there's somewhere in the middle. That this whole thing comes together and works like magic. And, so if you're not gonna be, if you're not gonna take on the dysfunctionality and , And really address the variability across the entire system. you could implement anything. It's just not gonna matter. You have to take on the the challenge, the political challenge and the, disparity across the entire system.

That's one of the things, one of the reasons that uh, a successful EHR project on the other end leads to a much more efficient healthcare organiz. All right. I'm thinking I'm gonna stop with this one. That's enough. Uh, why Novant charges for MyChart messages. And UNC health doesn't. to bill or not to bill MyChart. messages to North Carolina health systems have different answers to that question. Winston-Salem based Novant health decided to charge.

For the patient portal messages after an influx of them in recent years, while chapel hill based UNC opted against it after evaluating the pros and According to the North Carolina health news and the Charlotte ledger. We believe that charging new fees wouldn't significantly reduce virtual messaging. Won't help physicians.

manage the request for information more efficiently and will likely make patients unhappy. Said the chief clinical officer of UNC Still Novant has billed for less than 1% of MyChart messages. Since the charge went into effect last July. For an average charge of $10, according to the story.

The fees only apply to new healthcare complaint or a problem that hasn't been discussed recently. So there you have the two sides of that. I could go either way on this, to be honest with you. if if I'm looking at it through the lens of the clinician, they're overwhelmed, we have too many messages coming in. So one of the easiest things is to create a barrier and that barrier is, Hey, you might get charged for this message. And then people will think twice about it. On the flip side, is that going to create some level of friction for people to access care and that conversation needs to happen. My, my coaching on this is get the Get the data. , do a pilot, get the data. Do surveys get the data. , surveys are not nearly as, complete as pilots Cause pilots actually show you. If, if there is going to be reticence to use the system or not. So, two different approaches to using MyChart messages definitely worth. , pursuing either one of those, or at least knowing why you're doing one or the other. 

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