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 Welcome to this Week in Health It. It's Tuesday Newsday, where we take a look at the news, which will impact health it. Today we're gonna take a look at a lot of stories. Let's see. We're gonna take a look at enterprise software, what's going on with enterprise software. We'll take a look at Cerner, AWS, their partnership and how it's paying dividends for researchers.

Uh, we're gonna dig into the financials a little bit. There's way too many stories on the financials and what's going on to ignore it. And then, uh, finally we are going to take a look at, uh, . Uh, C Ovid, 19 Proof It projects 13 health system execs on the, uh, on tech moving forward and what projects they're gonna focus in on.

So those are just some of the stories. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It, I. A set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. This episode in every episode since we started the Covid to 19 series, has been sponsored by Sirius Healthcare.

Uh, they reached out to me to see how we might partner during this time, and that is how we've been able to do, uh, as many shows as we have on a, uh, daily basis. Special thanks to Sirius for supporting the show's efforts during the crisis. I would like everyone who's listening to this show to stop right now and send me an email that is, of course, unless you're driving or something to that effect.

But if you're not, flip over to your email client and send an email to Bill at this week in health it.com. We've done 40 plus CO series podcast one every day for the last seven weeks, and one of the things I want to hear from you is what is the biggest challenge you or your health system is facing right now?

Today, may the fifth, what's going on? Uh, and if you want to go a little further than that, uh, it would be great if you could just, you know, what's, what is the one question we can try to, to field on the show next week or to try to address over the next couple of weeks? That's it. Just two questions. What's the biggest challenge and what's one thing we could do or thing we can address, topic we could address that would really help you out?

That's it. I'm gonna share some of these starting, uh, next Tuesday, and I would love your feedback and your input. So again, stop right now. Just stop, go over to your email client, bill at this week@healthit.com. Send me an email. Alright, it's Tuesday News Day. Let's get to the news. Uh, why enterprise software will be, will be forever changed.

Why will enterprise software be forever changed? Uh, on a, on the, uh, on an earnings call this week for ServiceNow, CEO. Bill McDermott said, around the world, we see that customers who are farthest along in their digital transformation are better equipped to manage this crisis. Companies lagging behind are reali, realizing

That they now have a burning platform. Accelerating digital transformation has become a business imperative. He pointed out that during the next three years, about $7 trillion will be spent on digital transformation, and yes, this process is likely to accelerate. Okay, then what are other people in the industry saying about this?

Because that could be a little self-serving. If you think about the ServiceNow, CEO saying, Hey, our stuff's in high demand. No kidding. Uh. So Soma, the CTO for Infor. Sorry, I, I I, I'm still working on names. Uh, he has this to say, as the demand for automation continues to grow, software architecture must adapt to support the vast amounts of data needed to power automated work streams.

In particular, there will be a large focus on leveraging cloud technology to enable ai. In automated processes. Uh, I think that is really true. I think we're gonna see, uh, automation come to the fore. I think we're gonna see, uh, the combination. It's not just digital, it's not just engaging the consumer, but it's creating these workflows that are automated and you have to bring in tons of data and you have to start to eliminate work and to make it easier for the people who are in that work stream, uh, that information comes to them that's packaged up, that they can review, that they can move it on.

So, uh, good, uh, good thoughts from Infor, uh, Amman. Saeed, CEO of BMC. Both the technology buying centers and gravity in companies will shift to allow for technology buying across the company. If that doesn't scare you, I don't know what, I don't know what's gonna scare you. Uh, this is one of the things we have been trying to reign in for years, and that is, uh, departments going out and buying things.

Uh, but I think what we're getting to is a point where people are saying, look, . Define the architecture, define the framework, and we'll go out and, and find the best, uh, solution for what we're doing. And when you define that architecture, you have to define the workflow. You have to define the data elements, you have to define the things that it brings in.

And you can't, uh, you can't just throw that out when they find a good solution. That becomes what, what you are designing is the enterprise architecture. And then they can plug things in. And as long as they play well within that enterprise architecture, the data should flow. The automation should be allowed across multiple systems or across multiple elements.

Uh, so again, that's what BM C's saying, uh, that, uh, purchasing, essentially purchasing of technology decisions, it's going to, um, is going to go out into the field. Uh, Eric Clark, c do Chief Digital Officer for NTT data. Says clients need to reduce dependency on human interaction, so they're . Looking at solutions that offer contactless operations, self-help, self field tools, and automated workflow, I think that's gonna, that's gonna hit healthcare as well.

I think. I think one of the things you are seeing, uh, through this pandemic is people are getting used to interacting with, uh, machines as media mediaries for, uh, for physicians and for . Uh, office staff and those kind of things. Um, look, there's nothing really special about the office staff within the, um, which, in, within the phys physician practice, if it can be automated, if it can be, uh, if the experience can be improved.

Uh, the, that's what the consumer wants. Now. I understand that they add different value to the practicing physician. Uh, and that's a whole nother conversation to have, but people are gonna be looking for tools that move the process along at every, any given at, at an a, any given, uh, point in time. I recently redid our insurance for our company, and I went to a completely automated solution.

It, it was really beautiful. I'm not gonna give them a free advertisement here, but it was really beautiful. I mean, signing up for it. I had a, I had a broker working for me and they said, you know, it's gonna take, you know, at least . Five weeks to, to get you onto the new insurance. Um, I went out, I signed up and, and by the way, it was like a day before the month end, I went out, I signed up, they approved my insurance.

Uh, they're gonna send me the cards in the next week. They integrated it with QuickBooks. It was like, it was, uh, it was slick. That's what we expect. We expect things that can be done, uh, by us ourselves. That move things along, uh, at a faster pace to be done that way. And so, uh, the broker lost my business.

And it's not that I didn't go to another broker, I just went to a broker whose, whose processes are completely automated anyway. Uh, Yvonne Wasser, uh, SSAR, the CEO of Puppet. Uh, which is a very important company. If you haven't, uh, looked at Puppet. It's, uh, an organization that we used, uh, five or six years ago.

Uh, the phenomenal technology stack, uh, as we head into this, uh, what will likely be a recessionary environment globally. Uh. Uh, that's a recurring theme. By the way. This is not the first person to talk about this recessionary environment. Um, there will be an increased focus on investments that deliver efficiency and optimize the business.

I've heard from fellow business leaders repeatedly how they're reassessing their priorities for the year ahead. Introducing new steps into procurement processes, and many of them are instituting blanket cuts. An ex CIO as an ex CIO, who has lived through several economic downturns, the bar for software purchases has just been significantly raised.

The winning software companies enable cost containment, drive efficiency, and ensure business continuity. Today, without turning their back on innovation, the others most likely will go out of business or be bought. So again, we're not looking specifically at healthcare. We're looking at what's happening to the enterprise software stack, and you have to consider these things as you move forward.

Uh, Adam Mansfield, the practice leader for Upper Edge. I envision a world where there's significant consolidation coming out of c Ovid 19, leaving a much smaller pool of truly viable enterprise software vendors through a consolidation. . Enterprises will be further locked into particular vendors and functionality.

For example, I can see an end state where Microsoft AWS and Google Cloud are essentially left as the last survivors because Google has bought ServiceNow and Workday. Microsoft has acquired SAP and Salesforce and AWS has acquired Oracle. Um, yeah, I don't know about those predictions per se, uh, but you can see that happening.

There are, uh, significant financial pressures. On these organizations, they're, they're missing complete business cycles. Uh, I've talked to and heard from sales organizations that are really struggling. It's impossible to call on sales organizations, uh, on, on healthcare organizations right now, or any organization that is not almost completely focused in on covid and the impacts of covid o.

Uh, so, uh, you could see because of those downturns over, um, the end of Q one, Q two, and maybe even into Q three. If there is a, uh, research in the fall as people are talking about, uh, that some of these companies just lose their bearing and end up getting purchased. So anyway, um, you know, I, I'm not gonna speak specifically enterprise software in healthcare.

Maybe I should, uh, enterprise software in healthcare, we've been slow to adapt. Uh, there's a ton of ServiceNow clients, uh, within healthcare. A bunch of us are using ServiceNow. A bunch of us are using Microsoft Office 365. Uh, we call that essentially, um, our, uh, . You know, our move into the cloud, uh, the, the biggest enterprise software we all run is primarily our, uh, EHR, our clinical documentation system and, and, uh, billing system, uh, as well as our, uh, financials that, uh.

Uh, that we have to run as well. So those are the enterprise solutions. And you could see consol, I mean, the same thing they're talking about in the broader market. We could see within healthcare, we could see a lot of companies fold into each other. So we could see consolidation, uh, we could see a renewed emphasis on driving those companies to help us solve the problem that we have.

Uh, which is to drive cost containment, drive efficiency, uh, and ensure business continuity. Business continuity is gonna be a much bigger conversation coming out of this, obviously. Alright, next, next news story. Cerner AWS partner to make c Ovid 19 data available to researchers. This is not, um, you know, I, I'm, I'm only highlighting this because it was a

Uh, I, I think it's an interesting aspect of the partnership with Cerner and AWS. Uh, they're joining to offer access of, to de-identified patient data to researchers fighting c Ovid 19 epic's doing this as well as are others, uh, through various things, uh, various platforms that are out there. Let me give you a little detail, um, stored on Cerner's Health Data Lab platform, which is hosted by AAWS, the de-identified patient data will offer healthcare researchers a slew of Covid 19 related.

Demographics to help track the spread and surge. This is a healthcare IT news story. By the way, the data sets are also, uh, also include lab results, underlying illness and chronic conditions and clinical complications. Among other statistics, an advisory committee will choose recipients. Of the free offer.

By, uh, by combining and utilizing different types of clinical patient, social determinant, and other open source data, researchers can build intelligent models, which could, in theory, anticipate patient outcomes and help improve predictive analytics. Uh, again, I, you know, towards the end of last year, I talked about the fact that I believe that this, um, this partnership between Cerner and AWS has some legs to it.

And, uh, of course then everything sort of got thrown into a, um, into a whirlwind with c Ovid 19. Uh, but I still think it has promise. I still think it, uh, will, um, from a, a data and analytics side as well as, uh, interoperability side. I think it will level the playing field in a lot of ways. So it'll be interesting to see where this goes.

Next story, and we're gonna delve into the financials a little bit here. So outpatient visits down 60% because of C Ovid 19 study fines. This is Becker's article from mid-March through mid-April. Outpatient visits have declined nearly 60% due to C Ovid. 19 according to research from Cambridge, Massachusetts based Harvard University and healthcare technology company free.

The decline is largely due to the cancellation and deferment of elective procedures and preventative visits for their analysis. Researchers from Harvard, uh, andreia, uh, analyzed visit volume data from their, from, uh, companies more than 50,000 provider clients. Uh, researchers found. The New England and Mid-Atlantic States saw the largest declines in the number of outpatient visits.

As the number of inpatient visits dropped, researchers saw the number of telehealth visits increase. However, the increase only partially offset the drop of in-person visits. I. . Okay. So, uh, I've been consulting a fair amount recently with, uh, different companies via Zoom, which, uh, which has been interesting talking to various people.

And one of the things we've been talking about is, uh, we've done a phenomenal job, a phenomenal job of telling people stay away from the hospital. It's not a safe place. Essentially, that's what we did. We said, stay away from here. Go through the drive-through clinic, get your testing done there. Don't come into the er.

We did a really good job. Well, we better get together with marketing and figure out how we're gonna undo that job because, uh, because our, our livelihoods, our revenue really depends on it. We've gotta turn this thing around and we have to make those hospitals a safe place. Last week on the show, I talked about atrium's, uh, movement in that, uh, direction.

And what Atrium did essentially was . Uh, they're utilizing their, uh, digital capabilities. They're utilize utilizing telehealth, uh, digital hospital, bunch of marketing, to be honest with you, and, uh, and their testing capabilities. And they've packaged all those things together to create safe space for people to go, uh, and continue to get care that they need.

I've also been hearing some just horrific stories of people, you know, . Heart attacks didn't end, strokes didn't end as a result of covid. Um, and we're, we're hearing some stories of people actually having strokes at home and not going into the hospital because, uh, because they're afraid of covid. And so, to a certain extent, we have some work to do here to undo what we've done, um, in terms of cementing in people's minds to stay away from the hospital, which is, uh, now we've got to,

Just completely undo that and get them to understand that a hospital is a safe place and we have to make the hospital a safe place to bring people back in. Uh, USA today went, uh, even further, coronavirus strains, cash strapped hospitals could cause up to a hundred to close within a year. And they have some, uh.

There is no other hospital in town, Italy. All of those in, in jeopardy are in rural counties. As the virus spreads into rural America, sometimes . Weeks after the Urban Hotspots, many small hospitals must wrestle with the choice of laying off longtime staff members. Okay? So rural healthcare is going to struggle.

It's gonna create a challenge to say the least for, um, for those rural health systems. But you know what? It's also gonna create an opportunity because there's gonna be a gap there that needs to be filled. And there are large health systems at some point, right? Wherever the large, um, . City is, that's not in the, that's not too far off.

Uh, should figure out a way, not necessarily to, to save that hospital. 'cause I'm not sure that if it hasn't been making money for years, that it is saveable per se. Um, but to provide the level of care that's required in those communities, or the best level of care that they can in those communities is gonna end up being a significant, uh, amount of work that we're gonna be doing over the next couple of, uh, years, I believe.

Um. One more and then we'll get to it. Projects. So 227 hospitals, FURLOUGHING workers in response to c Ovid 19. And, uh, they just have a list. Uh, it's a pretty, it's a Becker's healthcare story. Uh, it's pretty sobering when you, when you read it. Uh, children's Minnesota, uh, 181 Nurses, Providence, Rhode Island.

Um. It doesn't have the numbers. A portion of its staff. Um, Indiana Mu Health and Columbia, Missouri, uh, traveling nurses. It's primarily, uh, people that aren't directly related with Covid Care. Uh, but the question you have to ask is, are we gonna be able to bring these people back? And it's 227 hospitals, so almost everybody is feeling a pinch that is going on.

They're now looking at the financials very closely. Uh, and this is . Uh, you know, primarily, let's see. I think it's primarily larger systems or primarily smaller systems. You have some here. Hey, here's one. University of Virginia Health System citing revenue loss of 85 million per month due due to c Ovid 19 pandemic.

Um. You know, those are the kind of numbers I'm hearing. Losses of 10, 20, 30, 50, a hundred million dollars a month-ish. Um, and that creates a situation that is not sustainable for any length of time. And so hard decisions have to be made. Hard decisions. On Furloughing staff on letting staff go. Um, we're gonna have to establish new normals.

No one knows what the new revenue normal is gonna be. If you came into this thing as a billion dollar health system, you might leave as a $800 million health system. Uh, it, it does, it remains to be seen. There will be some, um, there will be some revenue destruction as a, a result of this. Um, and I'm not sure we're gonna capture all that revenue.

I, I've heard people talk about the fact that, you know, these, these cases haven't gone away. Well, . Some will have gone away and uh, it's just there, there just is destruction, uh, revenue destruction as a result of this. Alright, final story. Uh, let's see. IT projects that are gonna continue health systems around the US are reporting significant revenue decline due to covid to 19 pandemic, but many also see it projects as crucial to providing patient care.

I will tell you in my informal conversations, I'll, I'll cite this story in a minute, but in my informal conversations, um. The projects that people are saying are gonna continue, are all over the board. It really depends on how you experienced c Ovid 19. If you experienced Cvid 19 and said we couldn't, uh, gather all the data we wanted to, there's probably a big data project after this.

If you said, uh, we couldn't track. Uh, PPE, there's probably APPE project after this. There's probably dashboard projects. There's probably business continuity projects. Um, some are saying, look, we're doubling down on our EHR strategy. We're gotta make sure that . The next time this happens, the, our EHR we are on a single EHR from one end to the other.

So I, I'm just, and some are saying digital, front door digital, digital, digital consumer. So, um, it is all over the board. Here's what, uh, here's what the story sites. Uh, UW Medicine, Seattle University of Wa, uh, Washington Medicine has been an ambulatory and revenue cycle epic customer for a long time. And we are in the middle of a project to expand our epic footprint into inpatient and ancillary departments.

Across our hospitals, we are not going to stop this project. Our experience with c Ovid 19 has further cemented our commitment to give our providers a single EHR in standardized and improved workflows. Um, interesting that they would say a single EHR and they say, you know, we are epic from one end to the other.

Clearly they're not epic from one end to the other. Uh, or they would already have a single EHR with standardized and improved workflows. So, um, that is the case probably in most health systems. It's not that they haven't committed to Epic. , it's that they haven't finished, it's not across the board or they've done acquisitions or they've done m and a and they haven't, uh, brought everything, uh, in, in inside.

Or to be honest with you, there could be two or three different . Variations of epic within a health system. I like when a health system says, yeah, we're epic from end to end. And then when you actually talk to some of the people that are running the system, they'll say, well really we have multiple instances of Epic.

And uh, and, and it's a problem for them 'cause it's different, builds, different, uh, cycles and they have to bring all that stuff together. So a lot of health systems are talking about that. Still, still a, uh, focus. Uh, Jesus Delgado vi, vice President and CIO of Community Health System in Munster, Indiana.

I'm gonna read most of this 'cause it's pretty good. We are fast tracking our out implementation of telemedicine. During the next couple of months, we are going to be onboarding hundreds of physicians. We are also enhancing our telemedicine by incorporating remote patient monitoring with full integration to our EMR.

I'd love more details on that. Um, and if, um. Jesus Delgado would like to come on the show. I'd like to hear what you're gonna do in that area. It's pretty interesting. Uh, we are realigning and re reprioritizing our data analytics projects. They're already into, there is already anticipation that we will have a covid 19, uh, back in the fall.

We will have covid 19 back in the fall. We want to have better data insight. Into our patient population specific to covid 19 sym symptoms, which is again, people are saying analytics is big and we are also going to focus on it projects that can present opportunities for cost savings or operational enhancements that can lead to better cost management.

Uh, and I think that's gonna be a renewed emphasis is getting those projects. Scott Kelly, uh, president, CEO of Asante. Says in point of fact, all of our enterprise ITS initiatives have clinical, operational, or financial consequences if they were canceled. It's imp i i, I really wanted to highlight that, that comment.

It's not like we went into the year and said, let's do a bunch of frivolous projects. We had projects that were tied to reimbursement, to revenue, uh, to better, uh, to address physician burnout, to address clinical workflow, to drive out the costs of within healthcare. So it's not like we should have a whole new set of, of projects because quite frankly.

Um, unless we just completely missed the mark last year and we're planning projects that were, uh, kind of frivolous. Um, with that being said, no one's doing that. And so to a certain extent, we're gonna have to continue the projects we're doing and augment them with a set of projects that come about as a result of this.

So, uh, he goes on to say that, uh, they're categorized, categorizing each of their projects into three categories, fixed timeline. Uh, COVID, irrelevant, uh, can be pushed out three to six months in projects, which are more discretionary. So, uh, I like the way they're thinking. They're, they're categorizing their projects.

They're sort of looking at what can we do now and what can we delay? Uh. And what things are just in cement. Like if you're building a building and you can look outside your window and see girders up, you're gonna finish that project. You're not gonna leave a, uh, a tower half finished. Right? And so there's a bunch of fi fixed timeline projects, plus there's a whole bunch of operational projects we still have to patch and fix everything that's out there.

Uh, I have pretty much run out of time. There's a bunch of really good stuff in here. At the end of the day, the, it's, uh. I'm gonna say it really depends on how you experience c Ovid 19, what you are gonna prioritize going, coming out of this. Uh, I will also say, I've just reemphasize, I think there should be an exercise going on right now, uh, uh, around a handful of things.

What, what are those projects And, and this framework's as good as any that, uh, that we got from Asante Fixed timeline. . Projects that can be pushed and projects which are more discretionary, probably that's a good high level place to start. And then you start to move down from there and start to, uh, determine which ones have a financial impact, uh, either reimbursement or or otherwise.

Which ones have the assumptions completely changed? , by the way, we did this with every project, every six months. You know, we, we would start projects, they'd be multi-year projects. We'd get to the end of the project and realize the assumptions have completely changed because we weren't agile in how we looked at these things.

Um, I would revisit all the assumptions of just about every project you have going on within your health system and determine, uh, when this project launched, are we in the same world that we are going to exit? and do the same assumptions hold if telehealth reimbursements go up significantly. Uh, are we in a situation where it doesn't make sense to, I don't know, launch this thing over here when we really should be standing up a significant telehealth capability?

And, uh, and, and really integrating that into the, to the larger, uh, health system, uh, processes. So I. Uh, I've actually gone over, so I'm just gonna end right there and there's ton more to talk about. That's all for this week. Uh, don't forget to send me an email bill this week in Health Bill and this week in health it.com.

Uh, what's your biggest challenge and, uh, what can we address in the show over the next couple weeks? That might help you. Uh, let's see. Special thanks to our sponsors, VMware Starbridge Advisors, Galen Healthcare Health lyrics, pro Talent Advisors, and Sirius Healthcare for choosing to invest in developing the next generation of health leaders.

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