October 15, 2021: Charles Boicey, CTO for Clearsense talks call centers, development, data science and information blocking with Bill. We need call centers to support so many parts of our conversation with the patient but they are not optimal. What is possible? What are the best practices? Where do development projects go off the rails? How do you manage outsource development partners? And where do we start with app development? How are we going to manage the information blocking rule? Is there any way to ensure our patients that the PHAs that connect to our EHR and request data on their behalf are safe?
A CIO/CTO Conversation on Development, Information Blocking and Call Centers
Episode 452: Transcript - October 15, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: Today on This Week in Health IT.
[00:00:01] Charles Boicey: This prescriptive analytics is going to kill us. Those that prescribe do not want to be prescribed to. Give us information that helps us make a better decision. That's all we're asking for. Don't say, you've got to do this. You gotta do that. Just, Hey, here's what's been going on with that patient. Here's what's going on now. Here's what's likely to occur.
[00:00:26] Bill Russell: Thanks for joining us on This Week in Health IT influence. My name is [00:00:30] Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in health IT. A channel dedicated to keeping health it staff current and engaged.
[00:00:38] Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor as well. The first step is to send an email to firstname.lastname@example.org.
[00:00:53] I want to take a quick minute to remind everyone of our social media presence. We have a lot of stuff going on. You can follow me personally [00:01:00] Bill J Russell on LinkedIn. I engage almost every day in a conversation with the community around some health IT topic. You can also follow the show at This Week in Health IT on LinkedIn. You can follow us on Twitter Bill Russell HIT. You can follow the show This Week in HIT on Twitter as well.
[00:01:20] Each one of those channels has different content that's coming out through it. We don't do the same thing across all of our channels. We don't blanket posts. We're actually pretty [00:01:30]active and trying to really take a conversation in a direction that's appropriate for those specific channels. We really want to engage with you guys through this. We are trying to build a more broad community. So invite your friends to follow us as well. We want to make this a dynamic conversation between us so that we can move and advance healthcare forward.
[00:01:49] Charles Boicey: Today we are joined by Charles Boicey the CTO for Clearsense and actually one of my favorite CTOs. And I love having these conversations. Charles welcome back to the show.[00:02:00]
[00:02:00] Hey Bill. Good to be here. Excellent.
[00:02:03] Sorry, I didn't dress up for you but we've rescheduled this three times this week and you happen to get me right after my workout. I'm not advertising Box. They're not a sponsor, but somewhere along the line, I got a Box shirt so
[00:02:15] Hey, you caught me the only day this week with a collar. So what the heck?
[00:02:19] So you're, you're dressed up. We're not playing the right parts here. I'm supposed to play the CIO you're supposed to play the CTO aren't you?
[00:02:26] Yeah, no, that's okay. This is CTO on dress up day. [00:02:30] And this is CIO on dress down day.
[00:02:32] Dress down day. The last time you were on the show, we did a back and forth with you as a CTO of a healthhouse system and me as the CIO. And since you're the best CTO I've run across in healthcare. And it's been a while since we talked, I'd like to continue the conversation if that's all right with you.
[00:02:48] No, that sounds great. And as usual, I have no idea what you're going to ask me, which is typically the case in a CIO CTO. I'm going to call it a confrontation and [00:03:00] or
[00:03:03] Bill Russell: Collaboration.
[00:03:05] Charles Boicey: Absolutely right.
[00:03:06] It is that I have not given you any indication and what I'm pulling from is just conversations I've had with clients, conversations with other guests and just things that are going on in the industry, things I'm reading about and whatnot. By the way, the last episode that you and I did as CIO CTO was really well received.
[00:03:24] It was one of the most listened to shows of that timeframe. So I guess people appreciate this sort of [00:03:30] back and forth and I'm looking forward to doing it. Let's start with call centers Okay you have a lot of background with call centers and in healthcare we have a lot of them and I think that the need for them is only growing.
[00:03:42] We need call centers to support many parts of the conversation with the patient. Our remote patient monitoring group would like another call center. And let's approach this, I think in two directions, but I'm going to start here. Our call centers that we have in healthcare today are not optimal. Give us what is possible. [00:04:00] What are the best practices? And what's possible based on what you've seen out there versus maybe what you're seeing in healthcare today.
[00:04:08] Yeah, you're, you're right in the fact that optimal, I would call it. We've got all of the components in place. We've got the best intentions in place and as usual it's best for us to look out, to see what others are doing. So there are all sorts of BPO's out there. And what are some of the technologies that they've brought in that potentially could be beneficial for healthcare.
[00:04:28] So let's talk about a [00:04:30] few of them. Ones that I've been working with that I think are exceptional that can really, really help us and kind of Bill what always happens when we go down this route, as we can pick and choose a vendor for this channel, a vendor for this channel, a vendor for this channel and channel can be voice, it can be text. It can be some type of automated response. And trying to find a vendor that satisfies all of them is difficult. What I usually start with is what are we really trying to accomplish? Not [00:05:00] just now, but what do we need to do in six months, 18 months, two years out with this/
[00:05:05] And I wouldn't call it a call center per se, but really it is part of that, they're using that term glass door. Healthcare's glass door and whatnot. And this is absolutely a component part of Believe it or not, there are technologies out there that in real time record and actually do not just NLP, but NLU and they can actually bring information back to the [00:05:30] agent in real time.
[00:05:32] So if somebody is trying to schedule and the agents got their location has got their provider they don't necessarily have to go to a scheduling system. This can actually be done from an automated perspective. So they can actually in their ear hear them with the best slot.
[00:05:50] And then as part of the conversation those slots actually get filled. And you can put on some intelligence behind it to optimally fill. We're [00:06:00] trying to fill the closest appointments and so forth. And then from a quality perspective we can do an analytics on that whole interaction with the patient and give a score back to the the agent and whatnot. That's just one real simple example.
[00:06:15] So you've given me a lot to think about here. So, first of all, NLP, natural language processing and NLU, natural language understanding. Wow. So it's actually listening in real time and picking up on [00:06:30] cues. And based on those cues, it's able to trigger workflow or process of some kind in the background.
[00:06:36] That's correct. And that's just kind of the next ladder of maturity, if you will. Some of the work that I'm doing with digital humans is, is very fascinating where the patient has a complete interaction with a digital human that can be either in the form of a. Or it can actually be in the form of a conversational agent where you can actually walk them through [00:07:00] a number of things, triage, you can walk them through scheduling, you can walk them through informational components of your organization.
[00:07:08] You can even fill prescriptions and that can be done with a voice agent and or the proper bot. And I'm not talking about bots or conversational agents where you pre you know canned responses. I'm talking about technology based on graph where the whole organization has been scraped.
[00:07:24] Their whole informational assets have been scraped put in a graph. So when that question comes [00:07:30] across, that comes, that response comes from that graph. So there's a lot of really interesting technologies that really support this activity and it's really satisfying for the client.
[00:07:42] And what's really interesting is especially with these conversational agents, nine times out of 10, they don't even know that they're speaking to a artificial human.
[00:07:49] Bill Russell: Now we're not dispensing clinical information this way at this point, we're just doing administrative stuff, right?
[00:07:56] Charles Boicey: Yes. But if you think about it as part of that conversation, [00:08:00] if it gets to the point where somebody needs to either dial 911, or talk to somebody that call can then be transferred to the proper triage nurses and so forth. But from an initial intake and directional, and I'm not talking the IVR type stuff, pressing one and all that kind of stuff.
[00:08:15] I'm talking about a real conversation back and forth and an understanding of why that person's engaged that call center to properly the call. It could be a direction to another conversational agent, or it could be direct to a human being.
[00:08:29] Bill Russell: Allright. So you're [00:08:30] hitting on a couple of different areas. One is when we're looking at a call center, we're looking at being the most efficient organization we can be. That's one aspect of it. And the other aspect is providing the best experience that we possibly can. And then the third aspect is being as effective as we can with the resources on the desk.
[00:08:48] We have this NLU, as the machines are listening to the conversations, there's something they can really do in all those things. You mentioned that it can trigger workflows and identify the most [00:09:00] optimum appointment that's happening and that makes our system efficient. When we think about the patient experience and the effectiveness of our call center staff. You can also put a score on the conversation, right? I mean there's that kind of, because you and I have talked about this before that it listens and it listens for cues and those kinds of things, and it can actually grade the conversation and say, look, you responded in this way and it would be better to have responded in this way or those kinds of things.
[00:09:29] So you can [00:09:30] actually grade, how are we doing for the consumer, for the patient and how are we in providing education back to the staff. The support staff, the call center staff, to help them get better as they go forward with the next call.
[00:09:44] Charles Boicey: And Bill this measures tonality too. So if you're not showing empathy those can be absolutely measured and feedback be brought back to the particular agent and whatnot. An actual scorecard. You're absolutely right.
[00:09:54] Bill Russell: Wow. So call centers remote patient monitoring, we're seeing them expand [00:10:00] and there's a need for this. You talked about the approach that healthcare typically takes.
[00:10:04] We go out and we find a vendor, we pop some technologies in there and then we try to weave them all together and whatnot. If we were greenfielding this thing, if, if we were starting from scratch, Greenfield, starting from scratch, and somebody said let's put in a new call center how would you approach it?
[00:10:22] Charles Boicey: Sure. I would approach it in a couple of respects one I'd start with the concept of infrastructure as a service. Infrastructure that's [00:10:30] built not specifically for this purpose, but has this purpose right now in mind, as well as what we're going to be doing in the next 18 months, two years out, and people say what are you talking about?
[00:10:42] And it really is about choosing the right infrastructure and the right place for this, whether it be a cloud multi-cloud on premise, whatever that might be, but really understanding that our technologies are going to be exponentially changed over the course of [00:11:00] time and make sure you do not put yourself in a box and make sure that these contracts that you're making with these various vendors and whatnot have out clauses because you know how awful it would it be to put yourself into a five-year blocks and in two years your vendor didn't quite keep up with it and your competition is killing you and you're stuck with this thing. So it's really important that you future-proof your your assets.
[00:11:23] Bill Russell: That's true of every cloud contract or as a service type contract, but it's [00:11:30] harder, you and I talked cloud the last time you were on, it's harder said than done to just, okay, so the contract didn't work out. I'm going to move from this cloud provider to this cloud provider. Those are serious projects to move from one to the other.
[00:11:41] Charles Boicey: Yeah, I'm not talking about from a cloud providers perspective, but where you decide to put this because I'm going to tell you, it really doesn't matter. A lot of people will argue with me on that, but more importantly, what you're bringing into that environment. Make sure that you can get out from under it if you need to get out from under it.
[00:11:56] So if NLU exponentially improves [00:12:00] and you're stuck with somebody that's not paying attention. You need to be able to modularize that NLU component, bringing in what you need now and then go forward with it. You gotta not think of the technology from end to end. You've got to understand the component parts of that technology and how they play the role so that if there's a change or a need to change it out you're able to change it out.
[00:12:22] Bill Russell: One of the things we talked about in the past was the use of analytics in call centers and how much more [00:12:30] sophisticated they are getting and how much more real-time they're getting and how much more effective that can make an organization.
[00:12:38] Talk about the maturity of analytics on the backend and how that can really set the table for a much more effective and efficient way of working the queue.
[00:12:51] Charles Boicey: Sure. So if you think about if you have this tech in place, and you actually have the data producing the the proper real-time dashboards, if you will, [00:13:00] not only can you solve the quality issues that we talked about earlier, but you know, why are you arbitrarily starting at 7:00 AM and you end at five. You understand the volumes. You understand the most commonly asked questions or the most commonly frequently tasks that these folks are doing and whatnot, and you really have a very, very good handle on day to day and how you can switch and switch things. Even more importantly it helps you get a handle on from a scheduling perspective providers, how they're [00:13:30] scheduled are their hours of operations in line with the folks that are requesting them. So you get a lot of really good operational stuff. I'm going to term it operational research. It actually is a thing.
[00:13:42] And with the right individual or team paying attention to the data that's produced the meetings call centers, you can actually optimize them a lot quicker than you thought you might. Just by doing that research and so forth. Especially on the, on the quality side. And if you think about [00:14:00] future placement of clinics or even moving staff around and whatnot, you get a pretty good idea of t h e population. Their needs and so forth. And when you try new things out, you get the feedback, is it working or is it not working? I'm going to have the agents say this in this situation. Yes, it was effective, no it wasn't. And so forth. Bill one thing I didn't kind of talk about earlier, I want to bring up but it kind of hit me is we can actually by voice authenticate [00:14:30] who's on the other side, it's really quick to walk you through your initial authentication.
[00:14:34] And then from that point forward, as soon as your voice is heard we know who you are and we can produce to the agent a little bit of information about you to get them acclimated to you as you go forward with a conversation.
[00:14:49] Bill Russell: All right, Charles, I'm just going to move on. So development. We talked build versus buy the last time you were on the show. We're finally going to have to build some [00:15:00] applications or at least heavily modify some tools that we get from various partners in healthcare. And it's been a while since we've done app development and as this is starting to emerge, I think CEOs and organizations are again they're exercising a new muscle.
[00:15:19] We used to all do development back in the day, and then we all stopped doing devleopment and said, you know we're going to, we're going to go more in the build route but now we're standing it up again. Where do we [00:15:30] start with standing this up? We don't even know where to start. So is it processes, procedures? Is it finding the right partners? I mean where do we start with regard to standing up an effective development process?
[00:15:41] Charles Boicey: Sure. We're talking about development from the aspect of, hey, I'm a healthcare organization. I want to build out my own products correct?
[00:15:47] Bill Russell: Yeah let's just, we'll make it easy cause we'll just pinpoint it. It's a digital front door. Your favorite buzzword of the day. So we're going to take our Epic assets and we're going to [00:16:00] start building our own tool and it can be a mobile tool as well as a web tool. And we were a little unhappy with the fact that we couldn't customize it during COVID and we needed to customize some of the things.
[00:16:12] And it was just not as effective as we want it to coming out of the pandemic we're saying, Hey, we want to be more effective. We want to be able to customize the tool, maybe drop some new tools in there, drop a bot in there, drop some other things in there to be more responsive to our community through our digital front door. So that's, [00:16:30] that's the background. We're standing up this capability. Where do we go?
[00:16:34] Charles Boicey: Okay, Bill let's do it. One, let's practice number one or rule number one. Let's not make this a religious effort okay? Let's make this extremely practical. Let's take a minimalist approach. Let's only put in place what we need to get this done, but also to build off of, because we're going to get done with this, we're going to do enhancements and we're going to do such a wonderful job that we're going to have a lot of other [00:17:00] products to build. I'm one for adopting a product development you know product methodology, if you will, or infrastructure. So let's go out and find ourselves a really good product. Somebody that really understands what we're doing.
[00:17:14] And if we use an agile process or whatever the process is, we may use, let's only take out what we need to make this thing work and that let's not make it a religious effort where we're working the agile process, as opposed to building out what we need to build out. And let's spend [00:17:30] a considerable amount of time in the planning phase.
[00:17:33] Are we gonna do this on prem? Or are we going to do this on Azure? AWS Google. And let's look a little bit more broadly. Do we want to be a multi-cloud? We've got a hundred hospitals Bill, what's wrong with a multi-cloud approach where we combine the best of the best in any environment, as well as our on-prem environment, depending on what the workload eventually be. Let's not be really narrow focused on this and let's spend a lot of time on the planning side of it.
[00:17:59] [00:18:00] As we're planning and we understand the different components let's sure we make, let's make sure that we have the proper architect on board. Yes, we can absolutely do this from a consulting perspective initially, but let's use that time to find somebody and Bill, if we're not familiar with hiring these types of people, let's find some folks that can help us hire the right people.
[00:18:21] Because in healthcare we always get ourselves into trouble where we think we know we're the best at hiring. We find out that we've hired a team that's not quite what we [00:18:30] expected and then we've lost six months and whatnot.
[00:18:32] Bill Russell: So let's talk about where we can get in trouble. Where do these development projects go off the rails?
[00:18:38] Charles Boicey: They go off the rails initially when whatever we've conceived, isn't in alignment with the board. It's not aligned with our mission, vision, values and goals. And it's not in alignment with our C-suite. It's when we've conjured up some kind of idea that we think is going to be the blockbuster idea. And then we started going down that route without bringing in the proper [00:19:00] stakeholders and whatnot. So I think that there's a couple of things that we do sometimes, right? We come up with this stuff on ourselves, on our own, as well as what we're asked to build this out or be participative.
[00:19:11] So it's really important that we bring everybody on. That's the first thing that sometimes gets us in trouble and second is not bringing on the right team or that kind of thinking, Hey, you know what? I think I got the right resources here. Well I mean, you have to ask yourself, do you really and that's a [00:19:30] lot of where we get unhinged and I think third is agile has something that I really like, and that's an iterative approach to these things. Where we come up with an MVP that actually works and has some function and we build on it from there and that allows us to because, although we did the best planning, we did the best architecture, we've done the best reach out to the stakeholders and we've done the best mock-ups and whatnot, things change as we're going along.
[00:19:57] And how can we pivot and make these applications pivot [00:20:00] as we go forward. Yeah, those are the ones that I kinda think get us in trouble and what we don't get feedback, looking at the EMR is, are still looking at the wings. It looked like there were the same thing that I use when I was using a paper chart. It hasn't changed.
[00:20:12] It was a replication of the chart. What are we trying to do? What are we trying to accomplish? How do we fit it into the workflow?
[00:20:17] Bill Russell: I agree with all those things. I would say there there's a handful of other things. One is we don't begin with the end in mind. So we sit there and go, all right, we're going to develop this app.
[00:20:28] And we've included the stakeholders and [00:20:30] we're getting input from the clinicians. We're getting input from the patients and we're building out what they really want. But we get into it and we don't recognize, Hey, we're going to roll out a mobile app and a web app. That's all well and good. But what's going to be our update procedure?
[00:20:45] What it's going to be our keeping it current procedure? Cause every time apple comes out with a new iOS version, there's a whole bunch of stuff that gets deprecated and you have to come out with a new version. So you're going to be recoding. You're never going to stop coding this [00:21:00]application or it's going to die. That plus Android is a lot harder. If you think that's arbitrary and hard that every time iOS comes out, they, deprecate something and you have to rewrite. Android has like six different flavors you have to write to. So if you're going to write a mobile app, it's not like, Hey, I wrote a mobile app and away we go, and you could write a a responsive app and just put that on your iOS device or your [00:21:30] Android device, but at the end of the day, responsive apps have some limitations that you're going to want to consider as well. So we need to start with the end in mind. You're going to constantly be updating this app. You're going to be adding new things so architecture is gonna matter. So you can remain agile. You can continue to add things to this all along the way. The other mistake I see people making. I see CIOs making is I'm going to see that code. You should see code all the time. [00:22:00] New code should be coming across your desk weekly that you're looking at.
[00:22:05] And it could be a simple function, like let me see the two factor authentication and oh, that's how it works. Yeah that workflow will work fine. They could do that in a box and it's modular. And then they could do the initial screen and they can do whatever you should be seeing code all the time.
[00:22:21] I think one of the places we get in trouble. If you haven't done development projects, agile is neat and nifty, but if you're doing agile, you should be seeing [00:22:30] code early and often all along the way. Everyone who has done agile well, will tell you, you're looking at code all the time and you're looking at progress all the time.
[00:22:40] Any vendor who's sitting there saying, Hey, we'll have something to you and you'll see something next month. And if you're not actually working with real live code in a couple of months, then something's broken. You shouldn't be looking at PowerPoints two months in. So those are some of the areas that I've found that we just get in trouble.
[00:22:57] Charles Boicey: And Bill let's not forget security and [00:23:00] bringing security in early on to ensure that there's no vulnerabilities built in. And folks that are using low-code, no-code environment, make sure that you bring in security early on so that you don't no code, low code yourself into a vulnerable application.
[00:23:16] Bill Russell: All right. So you're going to have to define low-code, no-code. What does that look like?
[00:23:20] Charles Boicey: Yeah. So basically you are I because we haven't done any development in a long, long time basically have a menu. We kind of drag and drop different components and functionality in and out. [00:23:30] And at the end of the day we have a functional app. But we just gotta make sure that we can do the sonar cube tests and make sure that there's no vulnerabilities in it and we're not putting a field in there that somebody can drop malicious code in and really causes the problem later on.
[00:23:46] Bill Russell: So Charles, one of the things I've heard is people saying I'm not going to build out my own team. I'm going to partner with somebody. So they find a local partner who has some chops of some kind. They've done some things in the industry. Can I take [00:24:00] advantage of a partner or how do I manage that outsource development partnero once I do identify the right one.
[00:24:06] Charles Boicey: Yeah. If I was going to do outsourcing and I do if it's totally off shore that's not one for the timid, if you will. It takes a little bit of time, the experience.
[00:24:15] Bill Russell: So let's stay on shore, but I will come back to the off shore. So I hired somebody in Baltimore to do this.
[00:24:21] Charles Boicey: Hey, you got peers, you ask around. Really ask around, because right now it doesn't matter whether they're in Baltimore or California [00:24:30] or you know Oregon for crying out loud.
[00:24:32] Just make sure that they have some background in healthcare. We've actually worked with healthcare organizations and they got a portfolio. They got something they can show you. They got some wins and whatnot.
[00:24:42] Bill Russell: It's probably not uncommon to say I hired somebody from Baltimore, but they're actually using overseas resources
[00:24:48] Charles Boicey: That could very well be true. Absolutely.
[00:24:50] Bill Russell: So you've gotta be careful on that. Oversee your resources. What's the upside downside?
[00:24:55] Charles Boicey: Sure. Upside because Bill that I've been doing this for [00:25:00] 15 plus years and I picked the best of the best out of best universities. So from a skill perspective phenomenal, from a cost perspective there's a savings there, but that's not necessarily my thing.
[00:25:11] If you're not familiar with the culture, the time difference, the business practices, it can be a little bit tough. I would definitely recommend going through a local agency for those types of resources unless you've done it before.
[00:25:25] Bill Russell: All right, let me switch the gear. I always want to talk to you about data cause you've [00:25:30] architected a great solution over at Clearsense and anytime I get a chance to talk to you about data, I'd like to do that. Information blocking rule is coming down the path a little quicker than the last time we spoke and we could be facing penalties if we don't share the data through APIs with personal health apps. In addition to the proposed HIPAA rules are now calling for moving the sharing of information with the patient from 30 days down to 15. It's 15 business days. So what does that, that's 20 [00:26:00] some odd days. I guess as a CIO, if we're just still role-playing, I would look at you and say, how are we going to do this?
[00:26:08] We're going to share information with personal health apps that we cannot really verify much. And we're being asked to move a little quicker than we have in the past with getting this information into the hands of the patients from 30 business days down to 15 business days. How should I be thinking about this? How are we going to [00:26:30] approach this? How are we going to comply with this rule?
[00:26:33] Charles Boicey: It's good. And Bill, you're absolutely right. It's absolutely gonna happen. There's no getting around it and and we probably can't hang out and wait for our EMR vendor partners to set the stage although that's kind of what we're doing right? Would you say that's a fair statement?
[00:26:51] Bill Russell: Unfortunately yes. But if I'm of a certain size health system, I almost have to rely pretty heavily on my EMR partner.
[00:26:59] Charles Boicey: Yeah. And [00:27:00] you're going to have to totally, totally understand that. And in the interim from an education perspective you know, I understand that backwards and forwards as a CIO, you absolutely have to.
[00:27:11] And then from a technology perspective what are some of the things we've got to get ourselves prepared for? We're going to be charged with the responsible and ethical transformation or transmission of that data. And we're going to be on the hook to one, make sure that it gets where it needs to [00:27:30] get.
[00:27:30] And two that it's done in a secure environment and we're sending them what we're supposed to send to the right party. It's a tough one. Do I have like a, the answer right now? Absolutely not. All right. So are there some things that we're looking at? Absolutely.
[00:27:44] Bill Russell: So let me ask you, I'm going to ask you more specific questions. A lot of times we hear APIs from some sides of the world and they talk about it like it's magic. Like, oh, we're just going to share the information through APIs. [00:28:00] But it's not magic, right? First of all, you have to write those APIs and it's just like any other code.
[00:28:05] It has to be secure. It has to be stable has to be all those, all those wonderful things. So the APIs have to be written. You have to get the data into the form of that can be delivered through the APIs is another thing. Wwe're going to rely on our EMR to provide those APIs as a lot of people are. They're coming down with the FHIR APIs and whatnot. Okay. That's all well, and good. We're now going to start [00:28:30] having to share that with personal health apps and that could be you and I in a garage. We just wrote an Android app. And we're going to start collecting that information.
[00:28:39] So let's assume we are devious actors. We're not, but if we were devious actors, we would write in our T's and C's multiple ways for us to make money. One is, Hey, as the patient, we're going to collect your information, move it into a personal health record, and we're going to bring you in. Your exercise data into a personal [00:29:00] health record, and we're going to bring some other data into a personal health record and you know what we're going to do for you.
[00:29:04] We're going to make your life easier. We're going to provide you an exercise regimen. We're going to remind you to take your medication. We're going to all those things. We're going to do this amazing stuff through this app, but because we're entrepreneurs, we say, okay, how much is the consumer really going to pay us?
[00:29:18] Well, they're going to pay us $5 a month. $60. Well we're going to have to get a lot of patients and unless we figure out another way to make money. Another way to make money is there's value in that data. [00:29:30] And so in our T's and C's we say, Hey, we're going to help you with your health. But we also retain the right to use your data and sell your data and do whatever the heck we want to with your data.
[00:29:43] And that's buried in a 14 page T's and C's document that no one reads. They just click on because they look at what the benefit is and they go, we want that. All right. As a health system, is there anything we can do to and I'll just tell you, I [00:30:00] talked about this today on Today in health IT. And what I'm proposing is we should have a clearing house of some kind that reads the T's and C's. At a minimum. Reads the T's and C's identifies maybe some outliers of what people are doing. And we create notices for our patients. So they sign up for this app and they S they request the information. And as they're requesting the information, we just pop up a little message that says, Hey, just want to make you aware of the fact that the T's and C's from this applicatio will share [00:30:30]your information with this, this and this. If you still approved, go ahead and click. Okay. And we will share your information. Its that kind of framework possible?
[00:30:38] Charles Boicey: We do that research. If you look at the state of New York was their HIE it's completely opt in. So what you're doing is you're putting it together and I agree with it, where the patient has the right to opt into those types of ventures or not. Totally agree with that. And Bill, here's kind of where the work that I'm doing currently with the ethical and [00:31:00] responsible use of this type of data. Once you've anonymized it and you've made it so that there's no token attached to it.
[00:31:06] If I'm a researcher, if I'm pharma or doing genomic research. And I find something that previously was undetected, I now have no way to get it back to the patient. So I'd like to just put it out there. Yeah. We're doing a lot of stuff with monetization of data. Yes. Patients are approving of that, but are we putting the place guards in place that if we do make a discovery, that we can [00:31:30] get that back to the provider and the patient. I know that's a little bit off topic, but folks aren't thinking that way and they absolutely should.
[00:31:37] But going back to your example. Yes, yes. We absolutely have to do that and we're expected to, and if you look at our consents there's a line in there that your data and, or your specimens may be used for research purposes and you can either opt in or opt out of that.
[00:31:53] So yeah, we have to give them total control and Bill I'll even take it a little bit further that we need to think [00:32:00] about is allowing those patients to keep resident on the phone. Information that does not go any farther than their environment. So yes, they got the the app builder that's putting all this together and whatnot, but Hey, I don't mind your exercise stuff coming on the phone but my personal health record information is going to stay on here. And guess what? It's not going back to you or anybody else for that matter.
[00:32:28] Bill Russell: Charles, I'm going to give you the [00:32:30] opportunity to pick the next topic. I've done call centers development. We've done some data and information blocking. Is there any topic that you've been running across that you think it would be interesting to chat about?
[00:32:41] Charles Boicey: Yeah. I'd love to talk real quick if it's cool. And bill, if it's just between you and I. And it never makes it to the airways. That's that's totally cool too. And it has to do with, one of my passions is is data science. And I believe in explainable data [00:33:00] science. And I believe that data science products that we're building, these algorithms, these models and whatnot absolutely have to be explainable. And the participants, those folks that are using them have to be participating in the build adults. And what I mean by that is they have to understand that data sets. They have to understand the features even if it's a neural network. They have to have understanding and they have to be there when those results are known and the train has done. And that confusion metric is [00:33:30]produced and they have to be there to make those decisions on, Hey clinically I'd rather have a few false positives than false negatives.
[00:33:39] How can we move this model to they need to be there for that. These black box type stuff. It's hurting right now, Bill and we've gotta all be okay with putting the math out there. It's all math for crying out loud. It's not proprietary. It's not secret. We need it to get out there. And then Bill, I think the last thing I'll [00:34:00] say is there are applications now out there that allow a clinician like myself or others to build out and do that. And I called citizen data science to be able to build out those models and actually deploy those models. And they understand the data from the beginning all the way to the end. I have a hypothesis, I can now prove out a hypothesis and then throw it off to the data science team. I'm worried Bill that too much black boxing is going to hurt healthcare.
[00:34:29] Bill Russell: [00:34:30] So Charles, if I'm an entrepreneur trying to money in the data science world or the AI world, it's based on the algorithms, right? That's my distinction. It's the intellectual capital, I guess, that we've brought to the table. The people we've brought to the table. How do we do that? I mean, how do we do that without jeopardizing our revenue?
[00:34:50] Charles Boicey: You can do that. They don't need to see the math, but they need to see the process as you walked it through. And more importantly, Bill, they need to understand that this model [00:35:00] that we built for your town Baltimore, he said before is going to have to be tuned for Southern California or Sarasota, Florida.
[00:35:07] It's not one size fits all. We're not telling anybody what to do. Right. We're giving them information based on these models that help them come to a conclusion or cause a cognitive trigger, whatever that might be, this stuff should be considered intelligent assist as opposed to and this prescriptive analytics is going to kill [00:35:30] us. And I'll tell you why. Those that prescribe do not want to be prescribed to. Give us information that helps us make a better decision. That's all we're asking for. Don't say, you've got to do this. You gotta do that. Whatever, just, Hey, here's what's been going on with that patient. Here's what's going on now. Here's what's likely to occur.
[00:35:50] Bill Russell: Interesting. So that's still happening essentially. We still have black box models that are coming out there.
[00:35:55] Charles Boicey: Yeah, we still got the lockbox stuff. Synthetic data. Let's get off the [00:36:00] synthetic data thing. Let's use real data. Okay. Let's use the real deal. And if you're a brand new startup AI, there are places you can get de-identified real patient data. If I'm building models out to help clinicians work with and treat patients that are in advanced heart failure, whether it's category one through four, whether they're on an LVAD or some other type of device, and they're on 15 drugs, synthetic data is not going to help me build that out. [00:36:30] I need the real deal.
[00:36:31] Bill Russell: So how's it going teaching the next generation of data scientists. Do you still teaching at Stony Brook?
[00:36:36] Charles Boicey: Oh, you'd better believe it. And again my first lecture talks about it's 80% subject matter expertise, 20% programming and 20% stats. And I'll tell you a Bill, Mary medical college in Nashville, they actually have a data science program as part of their medical programs. So they are graduating. Medical [00:37:00] students right now, certificates and data science, but they're well on their way to masters and PhD. I'd like to see that in all disciplines, because to me, a physician data scientist is really something to strive for and bringing data science and clinically, whether it be physicians, nursing pharmacy, I think this is something that this is my passion so I'll take this all the way into my eighties, teaching at that level. So yes, explainable AI is what I teach.
[00:37:28] Bill Russell: Is that still the best way [00:37:30] to get educated for the clinicians and people who sort of backed into data science is still to find a program like that? Or is there a way to learn from within the industry itself?
[00:37:42] Charles Boicey: Sure Bill we can learn from within the industry itself. Also we can take advantage of Coursera and others. So let's say I've been in healthcare for 20 years. I was phenomenal at stats. I need some programming skills cause we gotta figure out how to work with our [00:38:00]Python and some other programming languages.
[00:38:01] But just the fact that I hav 80% subject matter expertise. I know healthcare backwards and forwards and I have a passion for it. Yes, you can get to that point. And I'd say, how do you do that? Gt on the data science team with your organization and just start helping them. And that data scientists that you know, PhD or master's guy is going to point you in the right direction.
[00:38:22] Bill Russell: Fantastic. Charles, always a pleasure to have you on the show. Always fun.
[00:38:26] Charles Boicey: Yeah I hope it wasn't to let go. But I enjoyed it. [00:38:30]
[00:38:30] Bill Russell: No, it's always fun to have a CTO in the office. I keep a little special section over here where I write down questions. We definitely have more to talk about. We'll have you back on after the first of the year. Can you believe we're talking about after the first of the year?
[00:38:42] Charles Boicey: No I know 2022.
[00:38:44] Bill Russell: 2022. We couldn't wait for 2020 calendar to turn. I'm not sure we're not going to be equally as excited to see 2021 turn. This has been, especially with the surge towards the end of the year here. It's been a challenge for a lot of people.
[00:38:58] Charles Boicey: It's been interesting to say [00:39:00] the least.
[00:39:00] Bill Russell: Yeah. Well, Charles, thanks again for your time. Really appreciate it.
[00:39:03] What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It's conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You [00:39:30]name it. We're out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That's all for now.