April 15, 2022: Here to talk about healthcare through the lens of his technology career is David Feinberg, President & CEO of Cerner and formerly at Geisinger and Google. Owner of the famous quote “We look to eliminate the waiting room and everything it represents.” How can technology, with its unique position in healthcare, address the challenges faced on an everyday basis? What further obstacles remain? How do we overcome the inertia of healthcare? Is Geisinger's 'money-back guarantee' paying off? How do we fund programs that will make American’s live healthier lifestyles? How can we change the EHR to make the experience more effective for everyone involved?
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
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I'd love for every person to have healthy, nutritious food. To have transportation. I'd like to make sure that we're treating loneliness. If we did that list of have purpose in life, have education, treat people respectfully regardless of their background. Make sure they have food etc. The healthcare costs, I think in America overnight would decrease 50% and it would be the biggest boom we've ever had in our economy because 50% of our disorders that we treat are in essence lifestyle disorders.
Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system ???? and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health ???? leaders.
All right. Today we are joined by Dr. David Feinberg, CEO of Cerner corporation. And we're going to have a discussion on health and healthcare really through through the lens of your career, David thank you for joining us and thank you for being a part of the.
Hey bill. So happy to be here.
Yeah. I'm, I'm looking forward to this. you are one of those people that I've, followed. You have said some really provocative things over the years that have caused me to really think. I, remember the, one quote I love and we'll get to it a little later.
We'd like to eliminate the waiting room and all that it represents. I remember reading that I was a new CIO into a healthcare system, and I thought that's an interesting concept because the waiting room was one of those things that no patient really likes the way. It's kind of an interesting thing, but we'll get to that in a minute.
Here's what I'd like to do. I'd like to move through your career. I started at Geisinger talk Google Cerner. your career has veered towards technology, which may be indicative of a larger trend in healthcare. What drives you in that direction towards, the technology aspect of.
Well, bill to start with every time I say one of those stupid things I come home and the wife says, why didn't you say so I got good coaching on it. No, I don't think I'm driven at all toward technology. I would say what I'm driven toward is trying to make care better for everyone. And I think technology is a potential tool and a platform to allow that to happen.
What drives me and it is about the way. And everything that represents there was this kid that was 12 years old that had a first psychotic break. I was just finishing my training in child psychiatry, UCLA, and his dad was a used car salesman, a single dad from Vegas. And I brought the dad in the room to kind of give them feedback about what was going on with his son.
I say a smart with air quotes around it and talking about neurotransmitters and brain and nucleus, accumbens and anticholinergic, and the dad looks at me. He goes, Hey doc, are you telling me I need to build a room out back? And my daughter who's now our daughter's now 29 was one then. So this is about 28 years ago.
And I just started crying. I was like, whoa. The life trajectory of this person has, and this family has just completely changed and I need to talk to people in a way they understand. I got to make things accessible. They gotta be able to get in right away. And so that to me is when I say eliminate the waiting room, it's the anxiety of, of access.
It's the anxiety of not understanding what's going on. It's the nervousness. It's not only the waiting room. You get nervous, even when you're in the doc, when you finally make it from the waiting room to the exam room. And you're looking at the tongue depressors what's going to be, what's going to happen.
And that. that's I hope where my career has gone. I think technology plays a potential accelerant there, and maybe that's why I've had a couple stints at some tech places.
the waiting room is really putting yourself in that. Position the empathy of really understanding what's going on in that waiting room, the, the anxiety and whatnot.
there's a fair amount of inertia in healthcare that, that keeps us from making these changes that I think a lot of us would sort of acknowledge and say, yeah, if we could at least reduce the amount of time. Spending a winning room or changed the language at which we can talk to people or connect with them at a different level.
But there, there is a certain amount of inertia. How do we get past the inertia that, that exists in health?
Yeah, I think it's a really important point. There's so many forces that don't allow us to do these things, how to, however you saw a lot of those forces kind of dissipate. The COVID where all of a sudden the waiting room did disappear and people telemedicine, didn't just go up the curve and went to a whole new curve.
But I think fundamentally the problem is the current system. It is built around providers as opposed to around consumers. And when you build it around providers, the docs expensive. We want to have a lot of inventory, which are patients lined up in the waiting room. So there's no waste of time for the doc.
When you do something from a consumer standpoint. You'd have care available to you 24 7, it would be the right place. Your information would flow smoothly. So no one would ever ask you again, excuse me. Did you have a colonoscopy or what did the specialist say? Right. If we really built around that consumer Th the inertia or there be issues, but it would be very different issues than trying to kind of tweak a system that's built around the provider, as opposed to the patient.
you brought up the, pandemic. it's interesting in terms of a change catalyst. I remember early on in the pandemic, I'm talking to a lot of different healthcare leaders. And they're like, everything just changed. I mean, our, how we're thinking about things just changed. We, we don't want people to come into our EDS.
but we also didn't want people to wait on their care. We had this sort of thing going on of, we don't want to put them at risk and bring them in, but we want to continue to care for them. Talk a little bit about how, how things changed early on in the pandemic. And maybe through the lens of the patient, have they changed from that perspective and then transitioned to talking a little bit about the provider?
Yeah. So during the pandemic, I was actually leading Google's efforts at health. And when the pandemic came we were a small part of Google, but all of a sudden it was very clear on search and YouTube and maps that the only thing people were looking for was information around. What's the story on the virus in the beginning, it was flattening the curve, then what about the vaccines does social distancing work.
And we really leaned into that. And what you saw was if you were able to provide, in this case to the world, we had. 50 billion impressions of our COVID information, page 50 billion on YouTube. If you're able to provide people with accurate information, that's not that's authoritative and understandable.
It could have a dramatic effect on literally saving lives. So we saw. Social distance thing ability to get that de-identified data out was allowing governments to really make decisions around when to open up and not open up, et cetera. In partnership with apple, we did the exposure notification, which really took off with the exception of parts of the us, but took off worldwide and we saw a dramatic decrease in, in mortality.
So it was really clear that when. There's a health crisis. People, families, communities, governments, and nations want to know what's going on and to be able to get that, I'm just using Google as an example, but be able to get that type of information out think about it. But pre pandemic, no one knew MRN, a flattening, the curve like these are all new words that we all picked up.
I, I joke now everyone is a virologist, but whatever, and, and the. People needed that information because your life depended on it. Your family's life dependent on your livelihood, dependent on your kid's education. All of that was really, really important information. The liberal, what happens when we do something around the consumer, wow. The vaccine, I mean, it just a whole day. Pace then when we do things kind of in the provider world and the doc goes, well, I don't really know. I want to change that. I don't want to give up my schedule. I like to see patients at two o'clock on Tuesday that have an EEG already.
the power of Google. I mean, I almost understand that move from, from Geisinger to Google. Cause the power of Google that the number of searches a day, the amount of information you get, you can almost there was people who were doing predictive models based on searches and saying, look, we think, we think. An increase in cases here.
And we may have to increase capacity there and what not. I remember talking to somebody at some point and they were at some point during the pandemic and, we were sort of comparing different states. They're like, where are you getting your data? Google search. How many cases, how many, I mean, there was a time where you had to go to Johns Hopkins and go to the thing and look at the great data science that they were doing.
And then at some point it just came right there to just say, Hey, how many cases in my county, how many cases? And in my area, there's, there's a certain amount of power. We joke about Dr. Google and how many people go to it. But there's a power of the reach of that and the simplicity of access to the information isn't there.
Yeah. So about 15% of the 20 billion or so Google searches a day are health related. So that's a lot and yeah, I think, look, I practiced medicine prior to Google and that's back to that case where I knew everything and the patient. didn't know anything Then Google came out and man patients came in with printed things from the internet and you're like, why did you do this, this isn't cancer.
Like your, you went down the wrong rabbit hole, but over time I think the available of good information. And now there's studies to show patients actually do better when they do Google searches, before they go, 70% of people do a Google search within 24 hours of an ER visit. And the, and there's evidence that you actually get better care and the docs are going to YouTube before they take out your thyroid To look how to do the surgery and people go, oh my God, I hate that. They're going to YouTube. I'm like, wait, when I was a doc, I had a book in my pocket and I would look at how to put the chest tube. in Now you can actually see up-to-date videos. So it's not only helping consumers. It's actually helping the professional side too.
Yeah. pretty amazing.
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At Geisinger you, offered a money back guarantee. What was the driver for that concept? Of a money back guarantee. And what exactly was that when people hear that, they're probably thinking all sorts of weird things.
Well, it really, it really started at UCLA where, where I was for 25 years and at the last half of which I ran the health system. And we really, really focused before anyone else was, or most others on patient satisfaction. And we went from a health system that I used to teach. Our mission was where UCLA aren't you lucky you get to see us to one of Healing humankind, one patient at a time by alleviating suffering, promoting health and delivering acts of kindness and our patient, despite being us news and world report.
Number three in the country, inventing the pet staff, pet scan, inventing Herceptin, diagnosing the first case of age, Nobel prize winners, nicotine packs, like it's one of these amazing academic medical centers, two out of three patients when we're first. And we flipped that. And we became, we went from 28th percentile to 99 percentile and patient satisfaction.
So we were the highest rated health system in the country on what you would call net promoter score or patient satisfaction. And we did a one patient at a time, but just delivering really kindness. So I get to Geisinger and Geisinger had done amazing work around getting variation out, starting with cardiac care and had given guarantees on heart surgery.
And now they called everything at Geisinger proven, so proven heart or proven hip. And it was basically Care pathways. And they knew the rates of re of reinfection or the need for re to do surgery again. So for a lot of these surgical procedures, if you had it and you needed to come back in, they covered it.
So they already had that piece. And I get there with this experience around patient satisfaction. I said, well, why don't we just guarantee the whole. So why don't we just do proven care because we have all these click care pathways, but if we answer the phone the right way and we get the parking, right, and we get the bill right along with the surgery, we should be able to guarantee it.
So we, we came up with this program called proven care and it was a money back guarantee on any part of your. With no questions asked, but the lawyers made us change it. There were questions we needed your name and address so we could send you the check. So it literally, wasn't no questions asked money back guarantee and we had an app, or you could just say it to an individual employee, but an example would be a woman comes in for bariatric surgery and on the app, she leaves feedback.
The nurse was incredible. The doc was great. There was noise in the hospital, on the floor above me. They told me it would be done at nine at night and went till 10 at night. And one time when she got a vena puncture, the lady didn't do it very well. She has been $2,000 out of pocket. It was her deductible for that bariatric surgery.
We had a sliding scale. She asked for $200 back and it was amazing to kind of see and then think about it. We had this secret shopper program of what's going well, what's what the noise like. So it was incredibly worth it to be able to refund money to people who we didn't do right by and learn where we did.
Right. But we also were learning where we're doing really well. So it was literally, it's still there. If you had any the same way as if you went to Nordstrom's and you didn't like it, we take it back or you want your money back. We give your money back. It was great.
Was there a takeoff of other people trying to do that in healthcare? Or was that just one of those that, that stayed within Geisinger? You think
there were a couple others. I forget where they were, but a couple of folks called us. We're thinking about doing, I know a couple of implemented. I mean, as it gets to more consumer paying for healthcare, everyone's going to have to do this, that, that the secret here.
That we don't love to, or I didn't love to talk about when I was at Geisinger, but now I guess I can, the secret was actually the amount of money we gave back was less than money we gave back before the program. So every hospital in America gives money back, right? Hey, this didn't work. The whatever, here's your copay back.
Our patient satisfaction improved so much that our actual refunds were less than where our refunds before we had a refund. So it was a money saver. Well, it was a money saver because we got better at taking care of patients.
Geisinger is provider. Right. Cause, my parents rave about the Geisinger they're outside of the Philadelphia area and they, they just rave about it.
My dad's he talks about the, he came out to California and visited me. He had to go to the hospital and he got this massive bill and, and he sent it over to them and he said, I don't know why you got this belly. Did you know, don't pay it. And my dad just looked at. How often does this happen in healthcare, where you get this bill and you just pay it because you get a bill, you pay the bill and sort of how we're response.
and that team on the other side said, no, no, this, this is covered by this and this, you really should not have gotten this bill. And he ended up having to pay the bill. But that is a little bit of the disconnect that exists between the payer and provider world. And, the other part that the patient has to deal with is navigating this. that's still fairly complex in terms of what, what do I have to pay very few industries? Do we get something that says, Hey, this is not a bill, but it looks exactly like a bill.
I like to tease out. I have an MD, I have an MBA, I've run health systems, I've run insurance companies and we get an EOB at home and I can't understand it.
So I wonder if with people with less than medical literacy to get it, but back to your dad. So when I was at UCLA and Geisinger called. I thought, wow, I'd love to go there because I'd love to learn the payment side. And I did, but what I learned, I guess, which was a way better lesson, was what you can do when you love your community and the way you just described how they treated your dad and stuff, and how your dad likes the place.
This system. It's pretty cool because it's payment. Provider of care together, but more importantly, it is so ingrained in that community that that's where all the innovation comes from. So we started a program for type two diabetics with food insecurity because it made sense it's turned out that it made hemoglobin A1C dropped twice as much as Metformin.
I took the cost of some patients from 160,000, a year to 30,000, the rest of the family doesn't get diabetes, coach providing food. We created the largest, whole exome sequencing program in the world that had return of results. But all of these things that the proven experience, the refund program, all of it were done because these were art people.
They don't move. They live in their same house for multiple generations. They grew up with this health center. You're going to see him Friday night at the football game. So you got to do right by him. So it was really about trust and love. That's what I ended up learning at this integrated delivery system. In addition to some terms around insurance companies and stuff.
Well, I used to love, I go to the JP Morgan conference every year, and I used to love the presentations that you did when you were with Geisinger. Just the because it, it addressed that aspect of loving your community because you guys did a lot of really interesting things around food, around making food, available to people who were struggling for that.
you've talked a lot about healthcare is 20% of the equation of overall health, then there's that 80%. where are we seeing more creative solutions around that 80%, the social determinants and other aspects education and the zip code barriers that exist in healthcare.
Yeah. Cause I think your zip code and your genetic code drive all of the health minus the 20% of when you go to the doc and the, first of all, at Cerner, I have this amazing opportunity to see how healthcare is delivered around the world. So we're the largest EHR company worldwide. And when you go around the world and you see it, I just got back from Sweden.
Like you can prescribe opera in Sweden really? Right? Yeah. Because and the same in the UK where they put social care and medical care together, It's if you're in a value based situation where you have a or Geisinger where you're responsible for the outcomes of patients, you start thinking about the things that drive better outcomes and things that drive better outcomes are not just making sure they don't get an infection during surgery, but figuring out how you can avoid surgery altogether.
Right. And so it moves you upstream and. The rest of the world. And we are also privileged to be the EHR provider now for the department of defense and the VA and the coast guard here in the US and that's a value based system, too, right there. They have a fixed budget and they want good outcomes. It's the other folks in the U S mine, is that the Kaiser's and Geisinger's, and Intermountain's, that are just starting now to move to this value based mentality.
But when you move to that value based mentality, All of a sudden the person who comes in with an infected valve in their heart because of IB drug abuse, not only do you have to treat the heart, you've got to make sure that they're not back three weeks later with another infected valve. So you now started having to think about what happens when they're not in the ER or the ICU.
And I mean, you just follow the money when you're prepaid, whether it's Medicare advantage management. You start thinking about these other things that drive health outcomes, like. Transportation loneliness, all that kind of stuff. Yeah.
what do you wish you're traveling the world now, you're seeing the EHR. What do you wish you could prescribe in the United States that we can prescribe to that? I mean, you talked about prescribing opera don't, you wish there was some things in there. What things do you wish you could prescribe to people?
Oh, I think that I'd love for every person to have healthy, nutritious food. To have transportation. I'd like to make sure that we're treating loneliness. People stopped shooting each other, and people have a sense of purpose. I think if we did those things in kind of that list, like, come on. That's just what our moms told us. Right. If we did that list of have purpose in life, have education, treat people respectfully regardless of their background.
Make sure they have food etc. The healthcare costs, just do the healthcare cost. I think in America. Overnight would decrease 50% and it would be the biggest boom we've ever had in our economy because a lot of that would then go to wages and everything would get better. 50% of our disorders that we treat are in essence lifestyle disorders, they're lifestyle disorders, because there's no access to food where I live or I'm always stressed because of my skin color.
And I'm afraid of what's going to happen to me from my, my blood pressure cortisol's out. Or I'm in an unsafe relationship or I'm a kid that's not getting a proper education. Like those things are what's driving now. Yes. Bad stuff happens that doesn't fit into that category, but I'd say 50% of it could be fixed by doing those things. So that's why when you see in Sweden, they talk about the opera. You're like, wow.
it's interesting. One of those things that you mentioned earlier was isolation. And I think we saw this through the pandemic. When we isolate people, you have the opioid deaths go up, you have suicides, go up, you have all these other things go up and I don't know what you've prescribed there. Having people being community or having people check in on people and that kind of stuff. Yeah. You just that's all part of the 80% that is, it's hard to quantify and hard to figure out. But. I think we're getting better at quantifying it. Now it's a matter of somehow integrating it into the overall delivery around that when I first came into healthcare, I was looking at the various different systems and what they do. And I remember talking to a doctor who'd been in healthcare for some 30 years. He was an administrator well-respected in the industry. I said guys, what can I say?
You're an Intermountain are doing your. And I was in Southern California and he just looked at me and said, you cannot replicate it in Southern California. But it's interesting to me that you mentioned Kaiser, because Kaiser was one, our biggest competitor in Southern California. So they had, they had replicated some of that and Southern California, is that model replicable in, large urban areas.
Yeah. I mean, I think Kaiser is a perfect example of that, right? So if you look in Southern California, Where I was for 25 years. And you ask somebody where's the most complicated heart surgeries. In Southern California and people say, oh, UCLA or seizures or something like that. No, it's actually on sunset Boulevard at Kaiser Southern California.
So when you have a large population of 5 million patients and they do great primary care and secondary care, you do have enough that end up at the top of the pyramid, the deep, complicated cardiac surgery, and actually the place that's doing the most is that place down there called Kaiser. So the academics bet there.
Brand on, we do the complicated stuff, actually the complicated stuff's done at this HMO down the wall. So that to me is an example of, in an urban, very urban, very diverse area. This integrated payment and provision of care model being incredibly successful. Now Kaiser has expanded, but they've also had some difficulty when they've gone into other areas and have radical loud.
and we try to address. It's hard. You need a lot of components. You need docs who believe in what's going on. You need some market share in the insurance side, you need a provider an acute provider. So there's a lot of pieces that make that hard to do. But you see a lot of the insurers now getting into the provision of care and providers becoming payers.
And they may not look just like Kaiser one day, but there is this concept of going towards that. And taking full risk to use kind of inside baseball terms, but it's basically, we're responsible for a group of people. And if we do well and keep them healthy, we do well.
Yeah, there was a, an article where they asked healthcare leaders what would transform healthcare? You gave three things, two, which you've talked about already free, nutritious food to all Americans. And the second was transportation. The other thing you mentioned was closed the majority of the hospitals and reassigned doctors, community, and home-based healthcare roles that help people get or stay healthy.
I wouldn't mind talking about home-based care and the movement there, but the challenge though was here is funding this, right? So where, where do we go for the funding? And there's a group of people that say, well, let's go to the government for funding. And there's a group of people that say, well, now we're, we're now going to become, we're going to do managed care.
So we're going to end up being payer provider and really taking responsibility for this population. But what models seem to be working, or, do you think will take our healthcare system?
So I think more than kind of getting pigeonholed on that cancer, it's more cultural. And when you see it really working it's because. We saw here in the U S with COVID, for example, I keep saying it's called the statue of Liberty, not the statute of community. Like, so the us is not built on take care of your community. You see pockets where they do really well. And then you go to other parts of the world during COVID where community really, really matters.
Public health really matters. And I think they did better. The history books I'll have to tell me if I'm right or wrong, but they did better with COVID. I think it's really a community grassroots. Do we really care for one another and our friends and neighbors and want to keep them healthy? If you do that private sector will respond or the Governments will respond. I don't know that it's top down. I think it's bottom up.
Interesting. I do want to get to the HR people are, are saying we spend a lot of time on, on topics that I'd love to hear your thoughts on because it, it does cause us to think about potentially doing things a little different than what we've done in the past.
And I love your quotes because they're almost designed to make their provocative enough. That they caused us to think and have conversation, but they're also grounded enough that anyone who's ever been a patient looks at it and goes, yeah, that makes sense. So it's it's good stuff. So, but here's the average us health system has 18 electronic medical record systems and our doctors and nurses feel like data clerks.
I think that's one of your quotes rather than healing. I feel like the old guys from a cartoon where to say 18 electronic medical record systems at our health system, it was more like in Southern California, we couldn't employ the docs. So it was a foundation model. We literally had a hundred different instances of EHR that we were trying to.
To help people to use use effectively in our clinically integrated network, we were trying to get data out of. It was it was really one of the biggest challenges that I've I've ever faced in my career. what changes do you think with regard to the EHR that we're going to be able to make in order to improve the experience? Especially let's start with the clinician, the experience for the clinician then.
that's a great question. And I've been now here about six months. And I, I like to point out I'm the only one running an EHR company that's ever had to use one of these things to take care of something, and none of them are great, including ours.
And so our focus first and foremost is what you just asked is to improve usability and improve usable. Means no pajama time for docs to have to do their charting. At night. You look at nurses are spending 50% of the time of the terminal. 30% of the time looking for supplies and 20% of the time doing what I would call the nursing.
Hey, we need to cut that 50% down dramatically. How can we use technology to allow them to get their work done, which is more important at the bedside than the terminal, so that improving the clinical usability. Of our products is our number one job. And I don't want to go incremental. I want to go leap frog.
I want to really, really change how we do it. That being said, I'm proud that the records have been digitized. So no one during COVID couldn't find somebody's chart because Dr. Smith locked it in their office over the weekend. So we have digitized the record. Now we need to make it usable. We also have to make it usable for the non-clinical pieces.
So. We got to get the bill out the right way. We got to make sure that we tell people how to connect a postdoc seminar from home for home health, how the rest of the medical equipment can be connected. So it makes it easy to run your health system inside the walls and outside the walls. And then finally, after you talk about the non, the clinical and the nonclinical, I said, we got to get grandma's blood sugar to the right person.
And we, we got it to take disparate data sets normally. And give them back to people in way they can make actionable decisions. Like that's the true promise. We've got a couple of examples that I think are incredible. I just met with Dr. Cowan and whirl in, I think just north and north of London in the UK, she's using our HealtheIntent product and found that there was a six times increase.
For hospitalization during COVID for flu, for people with what they call learning disabilities versus things like COPD or bronchitis, asthma emphysema, and learning disabilities over there are, are things the nomenclatures will look different, but think of autism or severe neurone parents.
That we would have never known that if we couldn't pull up large pieces of data. And then that led to a flu vaccine, specifically designed for that population and their caregivers. And they started to dramatic decrease in hospitals. Like that's the promise of pulling this stuff together and being able, we have a team in the middle east who really now decides the government decides.
If a fast food restaurant is going to get a license to open because the health doesn't look good versus are we going to approve a gymnasium? So that's the, that's the promise. And then we got to make the thing usable. It's got to be able to work so you get your bill out, but then we got to take the data and be able to have these kinds of insights that can really improve an individual using AI can, can help you with.
Case management can help me with HCC. Coding can help me with a leakage, can help with my population. It doesn't really matter. It's the same data. It's disparate data sets pulled together in a way that's actionable. So that's what we're trying to do.
the clinician experience. I remember. We did a significant EHR consolidation, which essentially was a new rollout of a, of an EHR. And I remember the conversations with the clinicians and and I actually got to sit in there and watch them. And it sort of shocked me the amount of data that is unstructured in the medical record and I just looked at it. I'm like, how do you read that? It looked like a file drawer full of.
I don't know, 50 to a hundred PDFs. Right? How do you, how do you read that? How do you know that? And they just looked at me and said, I asked the question every time they come in, I ask the questions and I start over. And so when people want to know, why did, why did they ask the questions again? It's because there's no possible way to read all that information.
That's what we're really relying on, on on technology to do is to sift through some of that. Knowing full well that there's a limitation in the amount of time that a clinician has. And the ability to go through that. You were a part of bringing, bringing a Google care studio to life. I th I think I'm making an assumption here.
You were at Google and that was a significant move there. We're now starting to see that we saw it at Ascension. We're now seeing in a couple of other places and it's, it's really unlocking that unstructured data . How are we going to bring the data that is relevant to the care of that patient at that moment, front and center to.
Yeah. So I'm just super proud of the team at Google that did care studio, and they're still working at it and I'm still in touch with them. And I hope that it's part of our future too. So the concept was to take the solve the problem you described. So if you're a new dog, Coming in as a hospitalist at seven and nine, and they tell you got 14 patients and there's three down in the ER.
And then the nurse says the patient in bed six is having some GI bleeding right now. Doc, can you see that patient? You could spend an hour and a half going through that chart and understanding that patient, but you will now be behind for the rest of your night and not be able to, they'll be calling you from the ER and yelling at you.
So you've got about five minutes to figure out what's going. It's impossible. The way the charts are currently organized. So what care studio did was take that patient's entire record outpatient inpatient. It happened to be built on Cerner and Athena, but it would work on any EHR. And that doc could have a Google search bar on top, and we don't have to train anyone how to do a Google search bar and they could type in a bright red blood per rectum or sepsis or DM type two, just regular.
Like you're doing a search, you could misspell it and everything on that patient that has something to do with that medically tuned search would be put forward. So you type in D. Roman numeral two for diabetes, type two, if that patient had it, cause you want to know what's going on and an OCR that was faxed in that show diabetic retinopathy pops out as well as of course, hemoglobin A1C and blood levels.
And then also something that's. We don't see an LDL on this patient. Maybe you want to order one because we've looked at 10 million diabetic patients and they all have LDLs or on sepsis, there's no lactate. So not only help with discovery of information also discover what information is missing, which is actually really important.
That's what care studio started with and the goal would then take it into. That would be the read part, the right part where it'll help you write your note, et cetera. So it was to make it so you could take care of that patient and you'd only need five minutes and you get all the information you need. that was the purpose.
I hate to bring this up because I do every time I talk to somebody, cause we just interviewed I think Metatech actually implemented Google or studio. And when I was talking to Helen Waters, you have to bring up the privacy aspect of this because Google has very different businesses and people assume they're the same business.
And while they operate under the same umbrella, they're very different businesses. And the structures of those businesses and how the data gets handled in those businesses is very, is very different. But. Th that you spend a lot of time having to talk about that, especially after the essential work came out and Ascension as a unique problem, they never consolidated their EHR.
So they have. I mean, I don't know the number, but of disparity HRS. And they were trying to create a system where people could interact with the EHR. They could actually do training on a system-wide basis and not have to do distinct kind of things, but people were worried about, Hey, is my data leaking into a Google search and those kinds of things.
And I mean, I've spent a lot of time on this show, talking to people about these are very different contracts, very different data structures, they're disparate. talk a little bit about that, about that privacy aspect.
So the privacy is ironclad, but no one believes it. So I mean, The Ascension data, for example is encrypted in transit. It's encrypted in rest in Google cloud. The only one who has keys to it is the Ascension folks and everything is locked and it has nothing to do with search your ads. It's in different buildings, different servers, completely different. Now people don't believe it.
Now we did need and got here. And it'd be a VAA approval to be able to sometimes see personal information because when we show these tools to Ascension docs, they go, this is amazing, but can I see it on my own patients? Yes. So we do elbow support on that particular patient. So we would act like any other vendor that essentially would do a BAA with.
That's the whole story. The reality though, or the perception is still one where trust and privacy freaks people out. I mean, the reality is it's separate data, everything, follow the rules. It's going to help people save lives and help docs. Like it's pretty straightforward. Yeah. To me, the trust issue, if you're going to fundamentally change healthcare, I think the first thing you need is trust and.
That's a big issue for some of the tech companies for a variety of reasons. Some of them Facebook does something bad and everyone's mad at Amazon. I mean, it doesn't mean that it makes sense, but that trust thing is absolutely crucial. That was a big reason for me to come to. I'm like, I know Cerner's products, I've used them.
They're far from perfect, but we know healthcare we're trusted in the industry. We have the largest installed base in the world. I say we have more grandma's blood sugar than anyone else. And with that platform, if we get the usability, right, right. Et cetera, could we do things that really put a dent in that in the world around health so that everybody gets care, that's more equitable, dignified, more cost effective higher quality. So that, to me, that trust thing was a big part of my decision.
I'd love to walk through some, different tech with you and get your kit, your comments. I'd like to start with, with voice and ambient clinical listing and all those, those tools. How are we doing in that area? And is that, is that making a dent in the clinicians experience today?
I think we're doing well and it's not yet making a debt, but I would imagine that in a number of few years, not a lot of. It's going to be fundamentally different. So I just saw a demo, one of our products that we do with Microsoft they have this nuance products called Dax and we have forget what ours is called a virtual scrub.
And. It was pretty amazing. So doc sees the patient. The patient says my elbow has been hurting since they're playing tennis. Remember I played tennis in high school. Oh, by the way, I went to the French open. How's your wife like just a regular doctor visit talking back and forth machine learning looks at the, at the transcript and creates a Dr.
And in this particular case that you played tennis in high school is important that you went to the French open is not important for your tennis elbow and the computer picks that up. It's pretty amazing. So that happens. And then our product is such. You could press a button and it immediately goes into Cerner and write your orders, et cetera.
So now this is a visit where the doctor and the patient tall, the doctor checks what the computer does. There were a couple of blanks that you needed to fill in and every one and they were like, wow, that's pretty good. And now the order's done. So you've taken doctor time from, I dunno, 10 minutes in the computer to about 10 seconds.
Are still people behind the themes. Cause you got to train the doc five, you got to, you got to do 500 notes. So we really can use you. And maybe it only works in ortho. I mean, so this is not yet ready for Showtime, but the, the technology around voice understanding, who's talking and understanding what's important and creating documentation and orders is in our lifetime. And I'd say it's in the next few years,
it's exciting. And that really addresses that pajama time. Yup. Yup. Fantastic. Talk to me a little bit about cloud Cerner's. One of those platforms that's been hosted for quite some time, but the cloud is really changing the dynamic of this. what are you seeing with regard to the movement to.
Yeah. I think that being on the cloud allows better security allows better updates, allows us better to understand what's going on. I think we're in this transition phase and it will be completed in the next couple of years. Healthcare world have officially moved to the cloud. We're excited about our Oracle future where we think the Oracle cloud can be really helpful, especially in outside the U S where we're thinking about a lot of expansion internationally. So I think we're here and we're in this transition process.
Yeah. So to me AI. Amazing. We gotta be really careful because if we use models to train AI that are based on data from healthcare that we have, I know that our healthcare is biased and racist and we will then train models that will perpetuate that.
So we have to be very careful, but there's no question. If, if I have diabetic retinopathy, I want a computer to read it and a doc. If I have a mammography, I want my daughter or wife to have it read by a computer and a doctor like it just improves accuracy. I do believe we'll see where we're able to make predictions around. Who's going to go into kidney failure or, or who's going to have a heart issue based on EKG is that you just can't see as a human, that computers are better at looking at a lot of stuff. Predicting what's going to come next. Now, what we want to do is really hard in our EHR so that it can be configurable on the top and the AI pieces and the ecosystem will create, so health systems can decide how and when to use it. And what makes best sense.
It was interesting. I just had a conversation with Michael Pfeffer. Who's now up at Stanford was that UCLA. we were talking about the data and he was talking about how much more important his data is, then the global data, because his data is the data. And then he goes, and then I have to even look at the subsections of our data based on the community that it serves based on the hours that we're serving these people.
And he made an interesting point to me. He goes my dataset between 10 o'clock at night and six o'clock in the morning is almost, it's very different than my. Between eight o'clock in the morning and six o'clock at night. And he goes, those datasets matter. They matter for training these algorithms. You go. So I'm curious on the algorithms and I want people to bring the algorithms, but I want our team to really understand the data and to use the right data, to train the models for.
So I hired Michael Pfeffer, the CIO at UCLA, and. I now that we're doing this podcast, I want to say publicly, whenever Mike wants to come work for me again, he's gotta be off. I'm always trying to recruit Michael Pfeffer. He's the greatest nicest guy and a brilliant in this space.
He is fantastic. All right. I want to, I want to talk big tech and healthcare a little bit with you. When you moved from Cerner to Google, it, it sparked another round of headlines of is healthcare too hard for big tech. And I would think your, your vantage point gives you an interesting perspective on. Hospital system, big tech, traditional EHR. Now what do you think when you hear those headlines? Is healthcare too hard for big tech?
Well, I mean, I can talk with some insight on Google. I would say Google in a lot of ways is a healthcare company, 70% of people before they do an ER, visit, go to Google search docs are looking at YouTube all the time.
Anytime you get a new medicine or, or Agnosis everybody's Google. So in some ways tech is in healthcare, right? In, in, in that case now you may say, well, that's more kind of on the consumer side, et cetera. But when you really look at starting with whether it's Google, Oracle, Microsoft AWS, like you see a lot of these health systems, at least moving their records to those clouds.
So that's into healthcare. All that being said healthcare to me fundamentally is people caring for people and technology is a tool. And the times that you see tech tripping up, it's they get it backwards They think they can solve health through some really cool app that treats urology. It just doesn't work like that.
It's great to have that, but it's really about connecting with people, connecting with Kenyan communities, connecting with families and tech can be a great tool for that. So I think the time tech messes up is when they think it's a tech problem to be fixed as opposed to a human problem to be fixed. That can be tech enabled
That's interesting. hear people within health care, talk about big tech, they love when they're coming, alongside, making their lives easier. The other, so we talked about Google care studio a little bit before when I talked to Eduardo and I talked to others who are actually using the system.
They're like, you wouldn't believe. I mean, when we sit there in front of this with clinicians are like, thank you. I mean, this is, this is what we want. But yeah, it's, it's those times where. Big tech comes in and says, here's the solution that's going to solve interoperability. And people just look at them like now when you help us with the interoperability problem, not trying to solve it. Yeah. It's interesting.
just got back from London. We had, we have 8 million Londoners, all of London go on our HIE every day. I mean, it is the pipes for all of London. It's like, wow, we kind of solved interoperability in a pretty big city.
that's pretty amazing. gosh, I would love to talk to you about interoperability in healthcare, but we're final question though. more career related than anything. I talked to doctors all the time and they'd say I I'd love to head up Google's healthcare or Apple's healthcare, Amazon healthcare, and you have a good perspective here. What kind of things do physicians in those roles do for big.
Yeah, that's something I think about a lot, right. As I'm now transitioning our team into Oracle I, I think what we need to do, and I don't know that we always do it. We need to be unapologetic and declarative that we actually know how healthcare works and that the technology should be a facilitator or an accelerant to improve it. A lot of times, or I could say me personally, you get to a place like Google and you're kind of overwhelmed by the tech and you, you put it's, you put your healthcare second.
And so I think to those that are in these potential roles, go in as a nurse, don't lose your physical therapy skills, go in as a doc, we know healthcare, and that's actually something that's really valuable to these brilliant big tech.
Yeah, fantastic. Dr. Feinberg. I want to thank you for your time. It's great to catch up with you.
I was with a group of 13. CIO's. And at the end facilitated some form. They said, is there any way we can help you? I said, there are five people in healthcare that I've wanted to have on the show since I started the show and I haven't been able to get to them, at least three of them said, I know Dr. Fine. and I really appreciate you responding to them and coming on the show and, sharing with the community. So thank you again for your time.
My problem, and I hope you get the other four. Let me know if I can help you on the other.
I will, I will do that. Thanks again.
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