Today in health, it a continuation from yesterday Hatco and Summa health. The tech stack. That's what we're going to talk about today. My name is bill Russell. I'm a former CIO for a 16 hospital system and creator of this week health set of channels and events dedicated to transform health care. One connection at a time. We want to thank our show sponsors who are investing in developing the next generation of health leaders.

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They can subscribe wherever you listen to podcasts. All right, let's get to it yesterday. We talked about the Hatco Summa health acquisition. I keep wanting to say merger. It's not a merger. It's an acquisition. That is happening. They're taking it from a not-for-profit to a for-profit. Entity, it starts to go through all the gyrations.

It's got to go through approvals and whatnot. I see no reason why it would not go through these approvals. I know there's a concern about private equity acquiring. You've had the. Honamin thing. Anyway, we talked about this yesterday, essentially. A lot of private equity companies are about wealth management and they are about. Essentially real estate plays and wealth management and those kinds of things that is not what general catalyst is about.

It's not what hat goes about. They're about transforming healthcare. This is a different model and a different play. So we talked about that somewhat yesterday and the foundation for it and the things they're looking to do, if you. I'm not going to do too much of an overview on that. Cause I want to talk about the tech stack and I don't want her at a time.

So if you want to go back, listen to yesterday's episode, you can hear. The foundations for this deal. All right today. I want to talk about the the tech stack and the foundation. And really there's part of it. That's talking about the vision. For where this is going to go. And the transition is also part of what needs to happen. You're taking a fee for service model system. That has some value based care.

Some essentially managed lives under contract and that kind of stuff. And you're going to transform it. Okay, but you have to keep what's running today, running and do you have to do the transition? At the same time, changing the tires of the car while it's moving now tires of the airplane while it's moving, outta whatever you get changing the engine of the airplane.

Once I heard all these analogies, they're all silly. When you think about them. But at the end of the day the health systems in motion and a transition is going to occur. So you have to keep one thing going. You have to have, keep multiple lines of things going at the same time. The V the vision from my perspective is to establish a persistent relevant in ongoing dialogue between the health system and the patient on their health journey. All right.

So the health system is the trusted partner and guide to everyone in the community for their health journey. There are some that are battling chronic conditions. And for that, they have a guide. There are those that are healthy and trying to lose some weight for that. They have a guide there's. The first time mother, who's trying to raise her child. For that. We are their guide and trusted partner. Trusted partners.

Don't surprise bill, their clients. They offer transparency, trusted partners. Don't tell their clients that the next available. Available appointment is in six months. They offer access, trusted partners, meet the patients halfway, or even further bring care to them in their communities or at their home or in their workplace. Let's get to the tech stack. So that's vision of what we're trying to create this ongoing, persistent, relevant. Dialogue between the health system and the patient.

Think of it as anytime they want, they have access to the health system. Knowledgeable health data. Flowing. Health information and knowledge flowing back and forth between the two. So if I am thinking, Hey, I'm thinking about who's epic to lose weight. I don't go to the internet and whatever. I, I. I am interacting with my health system. Potentially with my doctor, but potentially with technology and I'm getting feedback, I'm getting information.

If I'm interacting with technology, that's getting logged into whatever the system of record happens to be so that when they meet with the doctor later, the doctor can say, Hey, I've seen, you had a lot of questions about losing weight. How are you thinking about this? Have you thought about intermittent fasting?

You've thought about other healthier alternatives to what you're thinking, whatever it happens to be, but, you're creating that ongoing, persistent dialogue. What does the tech stack look like? It's flexible for short. It's gotta be flexible. Obviously it's gotta be secure. And I believe it has to have usability at its core, both on the clinician side and definitely on the patient side and more and more when we say usability at its core, its natural language front ends. For for the clinician, obviously you just saw in, I think yesterday I saw Dax is a hundred percent integrated into epic now.

So we're seeing this advent of the natural language front end to the EHR. And so for the clinician, it's gotta be natural language. I think the same. Thing's true. For the patient as well. We've got to figure out the natural language front end for the patient. So usability at its core the data has to be secure.

It is secure, but it's also accessible to various systems and workflow. Not through a proprietary stack, but an OpenStack that allows for agility and flexibility and its design and implementation. It starts with the data. We can be more granular if we want, but for this 10 minute discussion, Let's just start with the data, all systems are designed and selected from the lens of security, interoperability, and usability. Let's talk about the data first though, free the data.

The data is locked. In our modern health systems today, it is locked. Now people are going to argue with me, but I believe it's locked contractually. I believe it's locked in technology silos and I believe it's locked within the business model. Let me unlock. Unpack that just a little bit In this context.

It's locked contractually. So if you read your EHR terms and conditions or any of the other systems, a lot of times you'll see that you have seated a lot of control of that data to that third party, or you can't get the data out, or you can't interact with it in certain ways, you are limited in what you can do.

So the data is locked contractually. It is locked within technology. We still have way too many silos of information. And that the mistake we make is, oh, the EHR is open. Now it's connected to TEF guide. We could do all these things, but the reality is the EHR is still a subset of the information. Yes, it is a system of record, but there are other systems of record and there are other systems that are holding patient data.

It's locked within our technology stack. Primarily because of the complexity, but there could also be other reasons. The age of the technology that we're using to try to free that that data and how it in the forms that it presents that data out. And finally it's locked within the business model.

I can, the. The number of times I thought, Hey, we've got this breakthrough. We can do this with the data and whatnot. And then you sit across the table with somebody else and they go, I don't want that data share. Don't know we can't share that data. So the business model does not accent people to share data in the best interest of the patient.

Now, with that being said, we have a lot of people who act in the best interest of the patients. We, a lot of health systems that act in the best interest. But the business model itself, if you just looked at the capitalist business model. Around healthcare. It does not. Lend itself well to a Bismal that shares. The data.

So it's locked. Contractually, it's locked. Technology-wise, it's locked in the business model. Now. We have to move beyond the EHR where health actually happens. We're going to come back and talk about the HR, but that is one of the distinctions of transformation. It is not built around the system, but the system is built around the right workflows and processes.

We have to engage in an ongoing dialogue that only technology can facilitate at scale. All right. So the key word there is at scale, clearly individuals can interact and have these ongoing dialogues, but you can't hire enough people. You can't have a call center. Big enough. You can't hire enough. PAs and nurse practitioners and doctors to have all these conversations.

So only technology is gonna be able to do this at scale. So we have to figure that out. We have to be able to reach people at their home, in their car, at work, in the line at McDonald's, as they're about to make a bad. Decision. We have to impact care in the community. Scale dictates a bunch of things, but scale definitely dictates the use of technology.

Another thing scale dictates automation. You have to be able to automate things. If these conversations are happening, it has to take the next step and potentially the next two or three steps. So therefore you have to have a workflow engine, a solid communications platform. If you're going to be interacting with people, they don't all have the same habits around communication.

Some people will receive texts. Some people will receive phone calls. Some people will receive emails. And amongst other various things. You need a solid communication platform. Again, that's open that allows the data to come in and out that allows for automation. You have to be able to handle hundreds of thousands, even millions of healthcare discussions at once.

If you're thinking beyond the Hatco Summa thing. If you're thinking. At scale, it has to be able to handle millions of healthcare discussions at once. Human interaction is reserved for only those places. Where either only a human can do something or does better for a human interaction to occur. Okay, let me say that again.

Real quick. Human interaction is reserved for those places where either only a human can do something or it is better for human interaction to occur. We have to leverage that. That finite resource, that incredibly valuable resource. All right. Let's go through some of the other points on that tech stack.

I think we need to leverage LLMs significantly, right? We need that natural language front end. We need something that can have a dialogue. We need to train these models, whether they are external models that we're bringing in, or we're training our own models. We need an ongoing relationship and healthcare conversation with people in the community. LLMs are uniquely designed to do that. If trained adequately and correctly. I think the other thing is we need a better picture of our patients. We've always needed a better picture of our patients.

But if this model isn't going to go from fee for service to more value based care and caring for them. We need to be able to impact. Care where the decisions are being made around care. And we think it's about care, but it's not. Those decisions we make every day. Did we go for a walk? Do we do we get that cheeseburger?

Do we or do we interact with people? We talked about mental health and wellness and those kinds of things. And I think in order to do that, we need a whole patient profile. I've talked about this on the show over the years, this whole patient profile, understanding how people make. Decisions.

We talked about psychographic profiles and psychographic data. It identifies our motives, how we make decisions, what our intentions are. These drive our health decisions in they're different for everybody. And if we treat everybody as a single population and say, Hey, here's how we're going to impact their healthcare.

We're not seeing the whole picture of who that person is. There's a whole bunch of research and studies that have been done around this that needs to be integrated into our systems, into our interactions with our patients on a daily basis. Wow. We're running out of time. I need to move here. Again, we just need to engage where health happens during the daily decisions.

In our day, we need to provide nudges to help people make the right decisions and lead people to healthier decisions. Healthier. Lives right. And above all, we need to be a trusted source for information trusted source for that dialogue. Trust and influence are inextricably linked in. And I'm required to change outcomes. I said yesterday, I'd give you the answer to the million dollar question, which is the EHR. What about the EHR? The HR is a system of record.

This is the million dollar question. The health systems will require a system of record period. Without any changes to the business model of the EHR will likely be the best way to handle charges. Generate a bill and handle revenue cycle. This is where more information is required to make this decision.

Will there be changes to the business model? Is the intention of general catalyst and Hakko to transform health care without swapping out the EHR. Do they want to provide an epic user base a way to transform without changing the system? In a, in any way, right? So you can transform, you don't have to swap out epic, all these bolt on command and. It, And make this happen. Is there a bolt on way, a way to use interoperability to build out a flexible and agile system? I think that answer can only be found at the negotiating table. Let's start with the question who owns the data. How can that data be used?

Can that data be accessed by external systems? Can data be brought back into the system of record? Is epic or others. Are they willing to change their terms and conditions based on the future that Hakko envisions or do they envision a different future? The HR providers amongst many others do benefit from the status quo.

I would imagine. This is a difficult path to gain the agility that is likely going to be required to make Hechos vision a reality. I had a conversation recently with John Halakah, president of Mayo clinic platform. And one of the only CEOs. One of the only one I know of. Who has written a working EHR. So Beth Israel, Deaconess for years ran on the EHR. That John Hawker wrote.

We talked about the amazing flexibility that is enabled. For their system, physicians had an amazing amount of say in what was rolled out. There were hundreds of releases a week to that system, right? So you have these point releases. Making the system more usable, more friendly, more interactive with the patient. I'll give you one other story, but this time we're going to align it more with health healthcare.

Since I actually have told this story before on the show. The CEO with Ford was describing their control systems. In their Ford car and he was asked, how does Tesla have such an advantage over Ford? And he said we have 120 control systems in a Ford F150. I'm making this up.

I forget the. The exact numbers and the car he used, but it was roughly that it was a little over a hundred. Control systems in a car. And he said if we wanted to do a change on one of those control systems, they are written by 60 different companies. And so we would have to go to that company and that company would have to approve that change that we were going to do, because sometimes they use that same control system in another car. Right now they're creating complexity in their development environment. And so you get that approval, but then you have to think about how it's going to interact with the other control systems in the car, the other 60, some odd companies.

And Hey, we're going to make this change. You have to go to 60 companies. As far as let's say, you go to Tesla and all 120 of those control systems are written by one company Tesla. And when they want to do a release, they have to talk to themselves and then they release it. That's why you see so many releases in the Tesla and they ask them, what does that mean for you?

He goes, we are right now hiring. Massive amounts of internal developers to write those control systems ourselves. They're actually going to change the way that they build cars. To be more agile and nimble in order to be competitive. In this new world. I've heard CEOs of health systems and other leaders describing their EHR and the ability to make changes in the same way. During the pandemic, a system wanted to make a simple change to their portal and were unable to, because their EHR provider wouldn't allow it. The other things to consider is that the greater the market share of any one player in the EHR space. The longer the cycles are for change. And the stronger the pool. To a core set of code and minimal customization is the EHR as, as they exist today. We'll likely hinder the objective of Hatco in general catalyst.

Long-term. So am I recommending, ripping out the EHR and coding their own? No. At least not on day one or potentially day 3, 365. But I will say that I'm not sure they will find a partner in the EHR space that will take them where their vision is going. I hope to be proven wrong on that. But if this truly represents a new business model, then it will likely require different foundational systems. And some development capabilities within the partner ecosystem and likely within the health system itself. Let me close with this I'm way over.

What does day one of this deal look like? I think it's aggressively moving on items, which add costs and adversely impact, agility and flexibility. Simplify the environment, consolidate eliminate systems. Free the data for partners to interact with an enhanced security and privacy measures to go well beyond traditional healthcare.

Sure. Up. Communication systems, workflows processes. Establish automation as the default begin the work of aligning the architecture to the vision of the organization. I want to say that again. That's really key. Begin the work of aligning the architecture to the vision of the organization. Technology is a wonderful servant and a horrible master.

Get them in line. All right. So those are some of my initial thoughts. Love to get your feedback, please shoot me a note. If you agree, disagree. If there's something I missed something else you'd like me to talk about bill at this week, health.com. All right. That's all for today. Don't forget.

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