February 25, 2020: It's News Day! Bill kicks off the show by talking about the vision of This Week in Health IT. As a passionate health IT leader, Bill believes that healthcare suffers because health IT is lagging, and through creating awareness, he hopes to inspire change. He then covers a range of stories, from Ed Marx’s post on LinkedIn about the reasons that digital healthcare lags to AdventHealth’s decision to change from Cerner to Epic. Bill weighs in on all of these, agreeing with some and pointing out the shortcomings of others. The final story Bill shares is one that continues to dominate the headlines: The Epic Story. This time, Bill discusses Don Rucker’s response to it and how he sees this story unfolding over the upcoming months.
Why Digital Health Lags, and Dr. Rucker Sounds Off
Episode 186: Transcript - February 25, 2020
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[0:00:06.4] BR: Welcome to This Week in Health IT news, where we look at as many stories as
we can in 30 minutes or less that will impact health IT. My name is Bill Russell, healthcare CIO
coach and creator of This Week in Health IT, a set of podcasts, videos and collaboration events
dedicated to developing the next generation of health leaders.
It’s Tuesday news day and here are some of the stories we’re going to talk about: Why Digital
Healthcare Lags from Ed Marx former CIO of the Cleveland Clinic. Standardizing metrics for
EHR log data, interesting work that’s being done by the AMA.
VA set to open fully 5G enabled hospitals in California. I have no idea what that means but we’ll
take a look at it. AdventHealth switches from Cerner EHR to Epic, interesting. Providence and
seeders break ground on half billion-dollar expansion.
Bon Secours Mercy Health champions, best idea wins through merger. A really good article up
from Becker’s. And ONC’s Don Rucker calls out hospital leaders who signed Epic’s opposition
letter. He is a lot of fun, we had him on the show, a lot of fun to listen to, a lot of fun to read
about. We will take a look at that story.
This episode is Sponsored by Health Lyrics. I coach healthcare leaders on all things health IT,
coaching was instrumental in my success and it’s the focus of my work at Health Lyrics. I’ve
coached CEO’s of health systems, CIO’s, CTO’s, startups as well. If you want to elevate your
game in 2020, visit healthlyrics.com to schedule your free consultation.
Quick comment about the mission of the show, I got a couple of emails this week which was
interesting, asking me about you know, what’s the show, what’s it all about. It’s really quite
simple. Healthcare suffers because health IT is lagging. We amplify great thinking to propel
healthcare forward. That’s it.
You know, that’s what we’re trying to do with the show, that’s what we’re trying to do. On
Tuesdays we look at the news to keep people current and on Fridays, we interview industry
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influencers so that we can uncover the best thinking within the industry and get it out there to as
many people as we possibly can. So, if you want to help the show, best way to do it, share it
with the peer, get it out there.
[0:02:00.4] BR: Today, it may sound like I’m in a bad mood. I’ve read a lot of things that I’m sort
of scratching my head on. But I try to be constructive on the show, try to present solutions so
you can hold me accountable to that.
All right, let’s go. 10 stories under 30 minutes. Why Digital Healthcare Lags. This is Ed Marx
former CIO of the Cleveland clinic, frequent guest on the show. Ed wrote this on LinkedIn so if
you want to find this article, go to LinkedIn and find his profile and pull it up.
He gives 10 reasons why digital healthcare lags in – I love it. It’s really good thinking. IT
leadership, he says, “Gulp. This is me. My circle. My friends. We unintentionally became inbred.
We believed to be effective our workforce had to possess healthcare experience. We are
special and unique. Balderdash. We stifled innovation that comes with hiring from outside
ourselves to include progressive industries. We insisted everyone have 10 years of this or that
in healthcare. Worse, we specified technical degrees. The best teams have a mix of degrees
and experience in and outside of healthcare. We can fix this.”
All right, he goes on 10 more of these. I’m going to touch on some of them. I’m not going to read
all of them. People development. We stopped growing our teams once they left orientation.
Finance, he talks about old practices and how we had this return on investment metric and
these governance structures. But digital changes things. It’s marked by agility, velocity, return on
experience. But we still employ the old methods.
Supply chain, he talks about operations. “We desire digital technology adoption such as virtual
care, but struggle to evolve because of tradition and cannibalization fears. There are clear use
cases for emergency departments (ED) to adopt virtual care but resist because of possible
revenue loss. Or ED patient volume decreases.”
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[0:03:41.5] BR: This is all true. Clinics. “Digital is synonymous with transparency, simplicity,
service and automation. Bottom line, the experience. USAA, Marriott and American Airlines
know me and my family better than the healthcare system. It is easy to communicate through
multiple channels. It is easy to make appointments. Easy to interact. Easy to share information.
Easy. We can fix this.”
He talks about fear, fear of failure. People have said, “you know, fail fast.” This is what they do
and then healthcare says, “Hey, we can’t fail fast. We’re talking about people’s lives.” He talks
about failing safe, Utilizing the technology and in areas where you know it’s not going to impact
patient care but you can see how it impacts the overall environment and then slowly adopt it in
other areas. But failing safe but still failing fast. We have to be able to make mistakes within
healthcare. He talks about the lone ranger mentality.
And then the last one is chiefs. I like this one, I will read this one. “Each year we fall further
behind digital, CEOs get increasingly frustrated.” I’ve seen that. I’ve talked to CEOs who say
that. “Appropriately. So? We hire more chiefs. We don’t address culture. Too difficult. Too
controversial.” Too confrontational.
“Easier to hire more chiefs. We see rise of the chief data officer,” knowledge officers, business
development officers. “New chiefs plus existing chiefs makes a bunch of chiefs.” You can see
where this is going.
“Inadvertently, gridlock multiples. Smart ideas and people, but execution paralysis given
competing agendas, silos and duplicative teams. Costs go up. Frustration increases. Gap
widens. We can fix this.”
You know, as you know, I try to end each story with a so what? The so what on this is, I have
nothing to add other than, Amen! This is a great, really well written article. LinkedIn, hit Ed's
profile, you can download it, take a look at it.
All right, next article, standardizing metrics for EHR log data could help combat clinician
burnout. Healthcare IT News. I pull two things from the bottom of the oracle just to highlight this.
Mayo Clinic study, from November 2019, linked EHR usability with clinician burnout with the
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usability of current EHR systems receiving a grade of F by physician users. When evaluated,
using a standardized metric of technology usability.
[0:05:57.0] BR: Mayo Clinic study found F in usability. July 2019 study in Health Affairs
meanwhile found that EHR messaging improvements could be key to reducing physician
burnout. And concluded health systems should reconsider whether system generated,
automatic messages are the best way to ensure quality of care. All right, you have these two
Now I’m going to go into the article. “The research was led by Dr. Christine Sinsky, vice
President of Professional satisfaction at the AMA and an expert on physician burnout.”
"The report notes the use of EHR log data to further understand the clinical environment is a
nascent science, and Sinsky proposed standardized metric is comprised of seven core
measures for auditing EHR log data, which reflect multiple dimensions of practice efficiency.”
“Those encompass: total EHR time, work outside of work, time on documentation, time on
prescriptions, inbox time, teamwork for orders, and an aspirational measure for the amount of
undivided attention patients receive from their physicians during an encounter.”
That’s the undivided attention metric. That’s a good set of metrics. You know, my so what on this
is, good work, good approach.
I’d love to see us to really tackle this problem of clinician burnout as you heard in last week’s
show. I experienced some of this with the poor nurse practitioner sitting in front of the EHR and
not leaving the side of the EHR.
If I had to say you know, which one she cared for more, she cared more for the computer than
she cared for the patient. Now, the good news is, there is a lot of nurses coming in and out. That
was sort of her prescribed role is to sit in front of that computer and they orchestrated it in that
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[0:07:42.4] BR: Here’s something I want to make sure that we don’t do. Don’t treat this as a
potential leading metric. It might be a lagging metric. You know, this could be the result. You
know, we’ve talked to other people in the industry about clinician burnout.
And it could be a result of changing business practices, compensation practices,
reimbursement, bad policies, business, culture as well as bad software and bad implementation.
But there’s a lot of things. If we wanted to create a clinician burnout metric, it would have to
encompass more than just these things. Although this is a great set of metrics to start with and
I’m sure Dr. Sinsky’s gone ahead in that direction, once they really tackle this, the burden of the
technology on the practice of medicine. So, I just want to make sure we see the whole picture
on this and keep our eye on the greater problem that is out there.
Next story. VA set to open fully 5G enabled hospital in California. Healthcare IT News. Here’s
what it has to say.
“The advanced seller or networking capabilities will enable the delivery of tele surgery services
to veterans, allowing physicians to consult during surgery, even across the countries said
secretary Robert Willkie.”
“Along with decreased wait times for appointments and better overall care, the secretary pointed
to several other programs designed to provide better Veteran care, including a pilot program to
develop exoskeletons that stimulate the spinal cord.
"’Instead of the exoskeleton moving the patient around, the patient can increasingly control the
exoskeleton as their own muscles are reactivated,’" said Wilkie. "’With further research at VA,
we are hoping to turn the exoskeleton from a mobility device into something that trains injured
people to walk again under their own power.’"
Not to call anyone out but this story is probably goofily written. It’s a goofily written article
because if I’d looked at these two things, this article is really about the exoskeletons.
[0:09:31.7] BR: Wow, awesome. I mean, this is awesome stuff. It’s the stuff that the VA should
be leaning on given the mix of their patients and the things that they’re dealing with, it’s exciting
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stuff. You have neural connectivity to these exoskeletons. You have the ability for them to start
to control, to regain movement. That’s exciting stuff.
Now, maybe it doesn’t get as many clicks as 5G today and maybe that’s why it was highlighted.
The 5G stuff quite frankly, you wouldn’t make a hospital 5G enabled. It’s – I’m not even sure
what that means. You're still putting in fiber optics, you’re still putting in CAT6e. 5G would not be
able to run the entire hospital so you have this underlying network that’s still in place.
All the things that are talked about in this article in terms of being able to do consults and tele
surgery across the country, even across the world, have already been demonstrated. There’s a
surgery that was done between the US and India where the patient where they were in.
I mean, we could do this across fiber optic, we could do this across CAT6e. And actually, it’s
preferred to do it that way. It’s much more reliable. It’s a bad title for the article. VA set to open
fully 5G enabled hospital.
I don’t think there is a fully 5G enabled hospital metric at this point and the exoskeleton stuff is
really awesome. I would love to hear more about that and love to see the VA really pump a lot of
money, research time, report, give us you know, information. How is this progressing? And how
are we going to see this come out into the commercial hospitals as well?
Exciting work. Like what the VA is doing. I like that secretary Willkie is really pushing the
envelope in terms of advancing the VA through technologies. Exciting work.
All right, AdventHealth switches from Cerner EHR to Epic. I got this from Becker’s. This was
reported in a lot of places, as you would imagine.
[0:11:13.9] BR: I really like the way Becker’s writes their stories, this is bullet point format. It
helps me to do my show but it’s also, you know, it’s how we operate, you know? The bullet
points are really nice.
“The Epic rollout will include more than 1,200 AdventHealth care sites, including 37 hospitals.”
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“The health system initially implemented a Cerner system in 2002 when it was still known as
Adventist Health System. AdventHealth completed its rebrand in January 2019.”
“AdventHealth will implement Epic's EHR software as well as its revenue cycle management
system to operate on a single, integrated platform.”
Here’s their statement:
"AdventHealth is making a multi-million-dollar investment in its transition to a new, enterprise-
wide platform – and it is an investment that we see as necessary and essential in keeping our
promise to our patients and caregivers. In light of that, a significant portion of that investment is
focused on ensuring that our entire team is properly trained on the new platform – helping to
ensure a safe, secure and smooth transition."
All right, just in the interest of time, you’ve read a hundred of these articles you know how it
goes. So, what on this, my take is the best EHR is the one that you are on. I maintain that this is
the case unless there are extenuating circumstances.
37 hospitals it is going to take a billion dollars or more to complete. This one is going to be a
bunch of time and focus for the health system and the people involved in it. When they’re
complete, they’re going to be where the rest of the industry was five years ago. They’re going to
be completing their EHR implementation and starting their optimization process.
I will admit there could be cultural reasons to do this. There could be operational reasons to do
this. There could even be clever reasons to do this but I doubt you could convince me that any
of these couldn’t be overcome with far less than a billion dollars in five years of time. That plus
the fact that the market is moving. There is new entrants, there is new digital solutions, there is
new requirements. The other thing I would consider is Cerner’s partnership with AWS may
propel them ahead of Epic in the next five years.
Won’t this seem silly if that is the case? I am not a fan of switching EHR’s unless the case is
really compelling. Solve the right problems. Stop switching EHR’s. That is what I maintain to be
the case. Again, I am more than happy to discuss that with anyone. I’m sure there could be valid
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reasons for doing this. I just can’t imagine the amount of time and the amount of money that’s
going to be spent that it makes sense plus I really do think Cerner’s AWS implementation.
[0:13:35.0] I think their new leadership. I think has they lost their way and that’s one of the
reasons that this switch is probably happening but I think they are heading in the right direction.
All right next story, Providers must invest in consumer technologies, or risk irrelevance.
Healthcare IT News. Let me sum this up. This is an article written really an interview with Aaron
Martin from Providence and I can sum up this article in three sentences.
Health care is behind. Digital engagement is necessary. And if you can’t get there with yourself
you should partner with somebody. That’s essentially what this says. This article could have
been written eight years ago, six years ago, four years ago, two years ago. I could republish this
in two years without changing a word and it would be true.
So here is my take, my take is know what you are reading. Providence is vendor.
They are not the only one but Providence is a vendor. There are a bunch of health systems that
decided that they are going to be in the business of selling things to other health systems. So
just know what you’re reading. Aaron is smart and I appreciate a lot of what he says and as I
said, there is nothing really new in this article.
The only thing that’s new is that Providence has a new digital engagement tool that they are
taking to market. They also have several other point solutions that they’re investors in. They
may be good tools. They may be great tools. My only point is to know what you are reading.
This is a pitch from a vendor. There is another story out there with some good thinking in it as
well but it is marketing. Know what you are reading. Take the good ideas, evaluate the tools for
what they are.
[0:15:01.3] So, another Providence story. So, Providence, Cedars-Sinai break ground on
$542M expansion at jointly owned hospital.
“Providence and Cedars-Sinai broke ground this week on an expansion project at their jointly
owned hospital in Los Angeles, according to the San Fernando Valley Business Journal.”
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“The expansion at the newly named Providence Cedars-Sinai Tarzana Medical Center,” that’s a
mouthful “is expected to cost $542 million and is slated to be completed in 2023.”
“The expansion includes building a six-story, 223,000-square-foot patient tower, expanding the
medical center's emergency department and adding space for more outpatient services. The
project is a joint venture between Renton, Wash.-based Providence and Los Angeles-based
Cedars-Sinai. The two organizations signed a co-ownership deal for Providence Tarzana early
last year. Providence will retain controlling in the medical center.”
So what? Actually, to be honest with you, I don’t know what to make of this. I think we are going
to see more of it but it’s kind of perplexing to me. Cedars has the brand in LA, Providence has
bought into the market. I guess they call this co-opetition is what we have heard it called.
Cedars had the money to do this themselves. It is just a curious thing. But let us talk about IT for
a minute on this. If this becomes the norm, I have a couple of questions.
You know how much will IT be a consideration or will IT be required to adapt to these kinds of
models? When someone checks into this hospital are they a Cedars patient or are they a
Providence patient? Who owns the record? Who controls the record? Can one health system
still access the record to pharma without the other one knowing? When they select a PACS
system, will it inner operate with Cedar’s platform or will it inter operate with Providence’s
[0:16:37.1] You know these are interesting deals. I am more curious of what you think of this
deal and what it will require of health IT moving forward. I think it’s an interesting question. I
think we will see more of them but I think there is a lot of complexity to this. So, it will be
interesting to see.
The next article, Bon Secours Mercy Health's CIO champions 'best idea wins' throughout
"When Marriottsville, Md.-based Bon Secours Health System and Cincinnati-based Mercy
Health finalized their merger in September 2018, the philosophy was never for one system to
take over the other. Rather, leadership, including CIO of the combined Bon Secours Mercy
Health Laishy Williams-Carlson, worked to merge the best practices of each system.”
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“She follows the model set by CEO John Starcher of moving with alacrity and zeal.
‘He would say, 'we are not going to have the Noah's Arc model,' with two of everything. This
model leaves your organization in a state of limbo for a longer period, and it's destabilizing,"
said Ms. Williams-Carlson. ‘It's important to move quickly and thoughtfully when making tough
So, what on this is we talked about this before. We talked about this because I heard John
Starcher, the CEO speak at the JP Morgan conference last two years and two years ago he
talked about the merger and then this year he gave an update on the merger.
It was interesting when he talked about it the first time. He said, “We made a bunch of decisions
right out of the gate. We knew which EHR we’re going to go on. We knew which ERP we’re
going to do. We knew which PACS system we’re going to do because we made those decisions
very rapidly. We also identified the top 30 leaders within the health system very rapidly and we
identify the next layer underneath that of leaders and we identify them within the first 30 to 60
[0:18:20.3] The removed a lot of the fear, uncertainty and doubt associated with the merger.
And then what they did from IT standpoint is they picked those right solutions and they started
work almost immediately.
Too many of these mergers come together and then they start the work of, “Oh what are we
going to do?” And then they spend the next six to nine months or a year or two years with
committees trying to make decisions on what systems to do.
The problem is that that just breeds a bad culture. When you’re making these decisions that
quickly you start working together on a shared and common goal of eliminating these
applications, bringing these systems together. If you keep people working towards a common
set of objectives and goals, they are not going to have time to get all bogged down in it. “Do I
have a job? Do I not have a job?”
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They have a job. There’s a lot of work to do. We’re always saying this in mergers. There is a lot
of work to do. They did this well, They did this right. It is a model. I hope we get more
documentation out of this merger and how they did it because it is truly exciting.
All right last but not the least. The story I will leave you with. ONC’s Rucker calls out hospital
leaders who signed Epic’s opposition letter. Fierce Healthcare is where I am pulling this from.
“Speaking at Health Datapalooza on Tuesday, Rucker—who is the head of the Office of the
National Coordinator for Health IT (ONC)—acknowledged that privacy in a digital world is a
challenging issue. But he reiterated his perspective that patients should be able to easily access
and share medical data. ‘It is our human right as patients to have access to our data,’ he said.”
"’Most of their customers did not sign on to that letter,’" Rucker said. "’If you parse out the big
academic medical centers, only three out of 100 AMCs signed on.’"
"He also called out hospitals that signed the opposition letter due to their claims about data
privacy concerns but then disregard patient privacy when filing lawsuits for unpaid medical bills.”
[0:20:06.0] "One of the signers of the letter is known for taking thousands of patients to court. If
you take someone to court, that information becomes public discovery. Their medical care is
now public. It's part of the court record," he said. "Looking at protecting privacy, we need to walk
the walk here as we look at who is saying what and letter-writing campaigns."
I said this a couple of weeks ago when people signed this letter. I said I would stay out of this.
The reason I’d stay out of it is because big punches are going to be thrown in both directions.
You know what happens when you get in the middle of a big fight with prized fighters? You get
hit and that’s what is starting to play out. This is going to start to play out in the court of public
I think we may see someone political candidates start talking about this type of issue. It is really
interesting. He went on to say, “APIs are the technology used to link IT systems, such as EHRs,
with apps and will help bring healthcare into the modern app economy, according to Rucker.”
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“’ONC's vision is for patients to choose what apps to use, he said.’ We've often looked at
interoperability in a narrow view, which is just as a replacement for moving the patient’s chart.
Modern computing and APIs offer a vastly richer and more empowering global computing
environment. Well-built APIs can do almost anything that your creativity allows,’ he said.”
Here is my so what, he’s not wrong. You may not like how he says it but he is not wrong. API’s
and we have experienced this. We used to have green screens and then the Internet came out
and then we had visual internet and graphics and if you click on images. And then we had API
come about and then we had apps start to come about. And I don’t know about you but I would
rather interact with there is a whole host of things now I’d rather do on my phone than on the
[0:21:57.6] And that is just the morphing of how data moves and how we interact with data and
how data is used in our environment and that’s going to continue. The ONC is going to win this
by the way. The government is going to win this, go figure and this is going to become the rule,
the operating rule. We are going to have to figure out how to operate with this and we should,
quite frankly. This is the future. We say we’re about technology and moving healthcare into the
And we are about what’s best for the patients, this is what’s best for the patients. This is what
the future is.
[END OF EPISODE]
[0:22:27.3] BR: That is all for this week. Special thanks to our sponsors, VMware, StarBridge
Advisors, Galen Healthcare, Health Lyrics and Pro-Talent Advisers for choosing to invest in
developing the next generation of health leaders.
The show is a production of This Week in Health IT. For more great content, you can check out
the website at thisweekhealth.com or the YouTube channel. If you want to support the show, the
best way to do that is to share with a peer. Send an email, let them know that you value the
show, you are getting a lot out of it. That is greatly appreciated.
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We’ll be back again on Friday with another interview and on Tuesday we’ll be back with another
news story. Thanks for listening. That is all for now.