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Today, the state of data in healthcare.


Today in health, it, this state of data in healthcare. My name is bill Russell. I'm a former CIO for a 16 hospital system. And creator of this week health, a set of channels, dedicated to keeping health it staff current and engaged. We want to thank our show sponsor shore investing in developing the next generation of health leaders, Courtney and dynamics, Quill health Taos site nuance, Canon medical, and current health. Check them out at this week. Health.

Dot com slash today. All right, I'm doing a podcast this morning. Somebody else's podcasts, healthy dose of data, I believe is what the title is. And this is happening more and more. I'm being asked to speak. I'm being asked to be on other podcasts, and I think I'm going to do it. More in the coming year. We'll see.

How the schedule holds up. , and so this podcast, this morning is killing two birds with one stone. I'm going to discuss the state of data in healthcare and in, so doing prepare for my podcast, which is in less than an hour. So. , cut it close. All right. So state of data and healthcare, I am optimistic and I am pessimistic as well. So let me break that down a little bit for you.

, I'm pessimistic because for all the fanfare. I'm not sure that the use of data is much better than it was when I was a CIO over five years ago. , we haven't addressed the fundamental problems of data collection, and that is the conflicting business models, overregulation and concern over legal liability.

All our attempts at standardizing docentation have led to a greater burden on the clinicians and more pajama time. And we haven't moved the needle much on data, quality and interoperability. I am optimistic and I'm optimistic because I see a focus. From the ONC towards patient centric, interoperability supported by 21st century cures.

I see solutions that understand that all the data doesn't reside in the HR and the EHR centric. Interoperability is the absolute floor. For healthcare interoperability. I see digital solutions stepping into the gap that exists and progress being made towards empowering the patient slash conser. With their health data.

So that's why I'm optimistic. Let me, let me break some of these statements down. Cause there's, there's a lot in there. Eight years ago, I was brought into a discussion between our health system, our organization, and a payer. Organization in our community. And we had done a partnership. And as a health system, we were taking on risk for a population.

That we were going to care for. And we were going to do that across our clinically integrated network. Now that network was not standardized on a sale, the HR. We had a. You know, just a lot of disparate practices and they practice, they split, they were splitters. They practice at our facility. They practice with others, but our clinically integrated network was.

, chosen for its ability to deliver things in the state of California. If you know anything you can't directly employ these practices. So therefore. You have to, , build coalitions and whatnot. And therefore we didn't have control of the tech stack. So we had to provide an underlying technology foundation that would enable these disparate practices to act as one unit.

In the delivery of care. , with common messaging, data sharing and quality measures. And that task was virtually impossible back then. And it is still virtually impossible today. If I said across 50. I want you to build a, you know, , a network of people that had the ability to message each other.

To share data readily across all 50 of those CHRs and to deliver a level of quality across that. , I think you would, , quickly get to the point of realizing how challenging that that is. And now we did deliver a dashboard of metrics across the clinically integrated network. We did provide medical record sharing between the systems. And we did provide a secure messaging platform between the practices.

That isn't what I'm talking about. I'm talking about the ability to deliver health to that community. Remember we were being measured on at risk, so we needed to keep them healthy out of the health system. And that was, you know, a technology challenge to say the least, there's also a cultural challenge.

To say the least as well. It was, it was a new endeavor for us, but the technology to support it was patchwork at best. So the first problem is that the medical record only accounts for about 20%. Of the factors related to health. We know this social determinants is 80%. The medical record is about 20%.

And we need to stop acting like it is greater than that. We need to integrate a lot of other data. The second problem is that most of healthcare, , not this contract, specifically pits organizations against each other. Payers have already been paid and their goal is to make sure that they retain as much of that money as possible. They're looking to ration care.

While health systems get paid when tests, labs, and images. Are done in a fee for service model. , the more the merrier. Neither of these models is in the best interest of the patient. I don't believe, , they're really both broken. However, the pair model is less broken. They are at least incentivized to keep the person out of the healthcare system. And, , the best way to do that is to keep them healthy.

, why does this matter for the use of data? Conflicting. Business models are centered on the business models. And not on the health of the person in the community, in a majority of the cases. Okay. This place is the data in service to the business model and not the community's best interest. Which is the health of those people in that community.

, sure. There are examples of models that support community health. , but I think greater than 90% only see the light of day, if they also support the business model. , that exists in that ecosystem.

I want to go further in terms of the data we collect. I had a CTO, give me this phrase and it is one of my favorites. , why did it only take God seven days to build the world? Because he didn't have to deal with legacy. I believe we need a reset on clinical docentation, what is really needed and what isn't needed. We need a reset of the complexity of the billing system, which is what.

The I'd say about 85% of the EHR. Functionality. Is designed around. We need docentation standards focused on health. We need billing standards designed to drive costs out of the system. We need docentation workflows that aren't a burden. On the clinicians and allow us to bring the joy back to medicine.

So, those are just some of the things I think they're. , Let me hit. It sounds very pessimistic. Last pessimistic item. I promise. , we have a system that, , , actually we have systems that promote duplicate tests. This is driven from a business model and a legal liability challenge. We we've already talked about the business model, which benefits from more tests, but there's fear of litigation that drives physicians to order tests that are redundant in many cases. And.

You know, it just, it causes them to be more cautious than they need to. Even if they have a test in hand, they want to order a test from their own system. This same liability also leads to physicians, not wanting more data in the EHR, which they, they may be liable to review. Right. That's the nber one reason I hear it's like now don't give me more data. I don't have time to review it. And if I, if I do have time to review it, I'm going to be liable for that data.

So just keep it out of there. Then I, you know, there's no liability. , you know, we've already determined that they don't have enough time to review what they do have in the HR. And now we're looking to bring in more data. They're just overwhelmed. The data is needed to provide better care, but the liability and the workload cannot be dropped on the physicians lab.

They're already overburdened. That's the main point I want to make there. I hope you see that the data problem is not a data problem in most cases, but a system problem, any business model problem. All right. So that's a lot of pessimism. Why am I optimistic? Well, I believe the answer to the problem doesn't lie within the healthcare system itself. I believe it lies at the patient.

, patient centric, interoperability. The 21st century cures act is a great piece of legislation bipartisan, and it is all about empowering patients and freeing up the data. To be used in developing cures, free the data, get the data into the patient's hands. There's a, a belief that once we do that, a digital economy will develop around this data.

The business model will. Obviously fight against that, but the potential is there. If every patient in the us has their data in a digital format. , we might see someone develop a health score for patients guide them. To the best care at the best cost, we might see the integration of social data along with health data to get an accurate picture of what is hindering my personal progress towards health.

The solutions are, are, are still fuzzy and a struggle for a business model, but we can see it starting to form. If we look hard enough. , apple has connected to many health systems and pulled in pieces of the health record. To my phone. They pull in physical activity as well. They linked to sensors early on in development for sure. But, , also, you know, in the watch they collect even more data. Right.

So now. The physicians don't want that data, but the patients want to be healthy and that data is valuable to them. What if there was a service say for $5 a month that, , that compiled all the data and, and started to do some predictive monitoring, our predictive analytics recommended checkups found.

The best path to care at the lowest cost. You know, I I'd buy that for me. I'd probably buy it for my family and my employees. Right. It takes us in the right direction. I believe that data has the power to change the health of our communities. For that reason. I am optimistic. I believe that with steady progress in the direction of empowering patients with their data, we're going to see new models emerge. That will be. , challenged by the incbents and the income and business models for sure. But I think eventually we'll prevail. If they make the experience better, reduce the overall cost burden of healthcare on the economy and on the individuals and deliver better health.

To our community. I was going to say health outcomes, which just deliver better health to the community. Anyway, that's how I see it. I'd love to hear your thoughts. Drop me a note bill at this week. Love to get a dialogue going around this. All right. That's all for today. If you know someone that might benefit from our channel, please forward them a note.

They can subscribe on our website this week or wherever you listen to podcasts, apple, Google, overcast, Spotify, Stitcher. You got the picture. We are everywhere. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders, Gordian dynamics, Quill health Taos site nuance, Canon medical, and   📍  current health. Check them out at this week.  Thanks for listening that's all for now

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