Episode 475: Transcript - December 29, 2021

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Sarah Richardson: It's about how you really do manage your wellness. And where do you get the opportunity to link your lifestyle and your habits together inside of a Walmart, inside of a Target, inside of a CVS. Cause you can get a flu shot, you can get cat food and you can pick up some romaine lettuce. And so when you bring everything together, whether it's hitting an easy button or it's creating an easy space that you can go to or get delivered, you're more likely to consume multiples of any [00:00:30] product where you have an affinity and an affiliation and something that you can also get affordably.

The second is you're going to get to meet the team and they're going to come on and talk about things. So this is one of those episodes. Before we get there though I want to remind you that for next year, we have some changes to This Week in Health IT. We're gonna have four channels. Four distinct channels on iTunes next year. We're going to [00:01:30] have this week health academy, this week health community, this week health conference and this week health news. So, if you are already subscribed to the Today show that will become the this week health news show, and you're gonna have the today show and the newsday show in there.

We're gonna have a show called insights in there where we take the highlights from the last four years and we break them down into 10 minute episodes. They're going to air three times a week. I would use this show to mentor people, to talk about what the various leaders in the industry have said over the last four years and how it relates to what you're doing at your health system. I'd also use it to bring people up to speed. If you hire somebody new into healthcare this is a great channel for that. And in this week health community is the channel where we're going to have guest hosts [00:02:30] who are going to tap into their network.

And we have CIOs. We have CMIOs. We have clinical informatics. We have data scientists who I've tapped on the shoulder and asked them if they would essentially interview people within their networks about topics that are a little closer to what you're doing on a daily basis. And we're excited about airing those channels again. Four new channels.

And you can subscribe that way. And we would love to have you be a part of the community again next year. 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. Now onto our show.

David Bensema: Good to be here. Good to see you both.

Bill Russell: I guess the news of the year has to be Sarah Richardson took on a new role as CIO, is that one of the biggest news events of the year?

So that's a, I'm always grateful to my husband for just kind of go along with the show most of the time.

Bill Russell: I was reviewing some of the clips from when I interviewed you earlier for another show we did before our end of the year show. And it was interesting, at the time you were right in the midst of meeting the entire team, the entire IT team, and you committed to having a one-on-one with everybody on your team. In a pandemic world that had to be very different than what you had done at previous organizations I would imagine.

And that was how long before I ever physically met anybody in person, which was kind of daunting at the time. I hadn't never done that before. And I did. I met every single full-time colleague [00:05:00]one-on-one for 30 minutes within the first hundred days. And now I consistently do that with anybody who's new.

And also contractors who are with us for long periods of time. And I commit to it at least once a year with everybody. So we'll start that cycle in about what 31 days or so.

Bill Russell: Are you starting to meet them in person now or are still remote?

Sarah Richardson: I would like to believe it's probably close to 85% of the team I have met in person because we still have two primary hubs.

So that, that space of like meeting people in person, if they happen to be located in Phoenix or Nashville. Otherwise you're literally shipping people to locations for different [00:06:00]conversations, which during travel restrictions and other components of what we've been facing and even going forward still remains a challenge. Not everybody feels safe traveling.

Bill Russell: Your VP team number of times zones?

Sarah Richardson: Four. Like, me, but Arizona sometimes is different, but then I'm the one that gets the short end of the stick because I'm on Pacific time. They're mostly Eastern and Central so if I don't want to schedule them past 4:00pm, ideally, especially noon on Fridaysto give everybody a little wiggle room. My day starts at 6:00am.

Probably one of the busier retirees I've ever run across. But the story of this year has to be the pandemic. Right. So, no matter what we talked about, everything sort of has this backdrop of the pandemic. As you look at this year. again, I'm going [00:07:00] to tap into your physician.

Does it feel like we're making progress with regard to the pandemic? In the beginning of this year, I was looking at some of the shows and we were talking about, we feel like by the end of this year, we'll be stepping out of the pandemic and now we have new variants and other things.

I'm curious, just give us a little of your thoughts on that.

The convertible individuals we've converted. The hard liners are where they are. But the vaccines make a difference. The place where I see the progress is as we talk about Omicron we already are talking about how does the disease act in vaccinated individuals versus unvaccinated individuals who are already gathering data and disseminating that data?

So we're not light years, but months ahead of where we were the last time we had to deal with the original, the Alpha and the Delta variants. We're light years almost ahead but we're months ahead in our ability to flip and create new products and have disease modifying regimens out there.

And as I was looking at this list, some of the things kind of surprised me. We reported on Haven's end. Right? So JP Morgan, Amazon Berkshire Hathaway go their separate ways. And we have Haven coming to an end. It's interesting because that was [00:09:30] again seen as big tech or the outsiders realizing that healthcare is very hard.

That was one of the lessons that people really felt like we learned. But the reality is there's enough stories as we go through this year of Amazon moving their Amazon care program forward. Signing the parent company for Peloton as a user of Amazon care. And then towards the end of the year, they signed another, big name as well.

When you think about what big tech's doing, when you think about what these outsiders are doing, is that one of the stories for this year, do you think?

And while Best Buy was working on this couple of years ago with some acquisitions, their acquisition of current health this year and their ability to have their call center and their [00:11:00] geek squad supporting the setup and management and support of the products in the home for monitoring seniors, et cetera.

That's been kind of remarkable to me. Showing that in outside the traditional healthcare realm organization can actually have success. But I like how they've done it, because it's seems to have been a very thoughtful, pragmatic approach to it.

Bill Russell: It really is interesting best buy. We talked about it last year Best Buy the healthcare company.

Dollar General. Sarah, you live in this space. Are we starting to think about health more and starting to move [00:12:00] beyond just delivering healthcare and starting to think about how do we keep people healthy?

Sarah Richardson: Oh, absolutely. So many you think about Best Buy getting into the mix. Any of the brands that you trust.

You go to their websites. I teach this stuff for CHIME. We want to make healthcare the easy button. So if you're already remember you, I think bill it was you and Drex that had the podcast about Amazon have handled the vaccinations across the country because you trust certain things to come into your home and your houses.

It's about how you really do manage your wellness. And where do you get the opportunity to link your lifestyle and your habits together inside of a Walmart [00:13:30] inside of a target inside of a CVS. Cause you can get a flu shot, you can get cat food and you can pick up some romaine lettuce, as an example. And so when you bring everything together, whether it's hitting an easy button or it's creating an easy space that you can go to or get delivered, you're more likely to consume multiples of any product where you have an affinity and an affiliation and something that you can also get affordably in most people's cases, because access to care is something that dollar general, I posted on [00:14:00] that article got more comments than anything that I mostly posted this year because people enroll areas like, oh my gosh, my parents love dollar general. It's where they go for everything. Why wouldn't they endeavor at some point, potentially get healthcare at a location like that too.

And if, if that alone happens at Dollar General, that, that could be a big movement. As I'm looking at this, you brought up the episode I did with Drex and we've talked about if Amazon had handled vaccine distribution, it would have gone much better. Because we were trying to coordinate states and new websites and new scheduling things and all this other stuff.

And we get to a certain point and we're ready to do these mass vaccinations. And we covered, two different stories, which I thought were interesting. One Atrium Health, and the other was University of Colorado. Health system. Both partnered with one partner with NASCAR and other partnered with [00:15:30] baseball, MLB. They partnered with Honeywell for some of the systems. They partnered with the state to make sure they had enough vaccine.

I think. It feels to me like we develop some new muscles in healthcare, like how to work with the state better, how to work with entities better. I think for me that feels like it was one of the stories of this year that we got better at partnering than maybe we've been in the past. David do you think that's true?

And so became, state needed the data brought in, they needed to have the immunization rates, et cetera. And the health systems had the ability to collect that data and transmit it, but creating that interface, back [00:16:30] to interoperability issues, creating that interface. And that interaction was a much bigger lift than it should have been at this point in time because of that neglect.

Bill Russell: I'm going to hit a couple more stories real quick, and then I'm just going to, to take the reins off. You guys can talk about whatever you want. Kaufman hall came out mid year and talked about the impact of doing the shutdown of non-essential surgeries and what that did to the financials of health systems.

And about 30 days where they were without their EHR and had to go on diversion for much of that time. As I look at the rest of the year, we had some interesting things. The vaccine credential initiative came out as we came to the end of the year, and people wanted to know, is it safe to be coming back together?

Of those I think 4,200 or something to that effect people that they tested, there was only three positives. Two ended up being false positives and one actual positive from that event. And I didn't hear of anyone going away from that event. HIMSS came back together this year. The CHIME fall forum happened this year.

Sarah Richardson: What I see being most impactful and continuing on through next year in the next couple of years is the space of both M and A as well as overall partnerships occurring. It's not a [00:19:30] day that goes by that there's not an M and A conversation that's, that's hitting the news wires or something about a partnership that's occurring. Or even some cases, some of these healthcare systems or insurance companies earnings. Even today on the news wire, I think United is reported that they're going to have a huge quarter and a lot of that's from that delay in services. But we saw that in 2008, when the housing market crash, there was a gap of a couple of years of people getting the healthcare that they needed, that acuity rose. And then there was this massive expansion of people needing different kinds of services.

There's a space, we talk about consumerism and write up fresh on the heels of fall forum was the talk about the [00:20:30] humanism approach to what it is that we do. And so for all of the complicated M and A partnership activity we have, at the center of all of that, we are all patients and we are all human. And the need to be able to bring experiences forward, to create something that is bigger than just your wellness. It's the actual affinity of wanting to be associated with something that makes you feel better overall. And so, as a CIO, our role has completely shifted because the [00:21:00] technology's there. I say the technology often is the easy part of our jobs. It's that ability to be that true leader, influencer, strategics, and innovator, and bringing all those pieces elegantly together that is making the biggest difference, at least for me and how we strategize and deliver our plans for 22 and beyond.

Bill Russell: As I think about that, Sarah, the question is who's going to build the experiences and I'm sure you've seen this study, this trusts survey that they do and the the nurses, I think are the most trusted.

Is that the player that's going to build the experiences that we as a customer finally go yeah healthcare is starting to feel like it's moving into the 21st century.

And for the most part, leaving them alone to flourish. They just say fund them to be the best version of themselves. And then when it's something that can be replicated more effectively, [00:22:30] that's what they go and do. I've got that background from being with Optum, obviously. And I trust them in the sense that they're not going to buy something or they're not going to invest in something that doesn't significantly move the needle forward.

Bill Russell: David, do you wanna weigh in on this?

But I think, the one that's been most interesting to me, again, getting back to my Best Buy I guess, obsession at this point, is Best Buys ability to create this in-home relationship and social work relationship and call center support for emergencies and folks are really comfortable with that.

Then you add home health and remote monitoring and all these the IOT [00:24:30] the home monitoring of products. As a health system, if I was still a CIO, I'd be really happy to have that come through a vetted partner, like Best Buy. And Best Buy, then single channelled, transmitting that into my EHR where they've already done some of the protection, some of the filtering so that I don't have those incredible innumerable sites of access or points of access.

And I think that's one of the lessons of this year. And one of the things the insurance companies already understand. There's certain things they're not great at, but they can acquire that capability. Hospital systems thought we were going to be good at primary care. We really are not [00:25:30] for a cure hospital.

Thought we could be good at home care. Well, it's nice to capture that loyalty, but we're not really great at that because you got to maintain that workforce in a geographic dispersion. And it's hard to maintain the control that at least acute care hospitals that I know of like to have. So we have to think about how do we collaborate?

Bill Russell: The complex [00:26:30] word is is pretty interesting to me. It seems like every company is trying to become a different company. You know, United, Optum hiring a bunch of physicians.

So they're becoming a different company. You have Providence and all those players launching Truveta. Providence, Ascension, there's an article about Ascension Ventures and the fact that they're pretty much a massive VC firm. They have invested in a lot of different companies and they're in a lot of different businesses serving healthcare.

And that's now an [00:28:00] arm of Providence and you sit there and wait a minute. They're serving health systems across the country with their Meditech and their Epic implementations and those kinds of things. And you sort of step back and go isn't that what, a lot of these and they acquired blue tree and others.

I mean, it seems like everybody's trying to get into a different business than the, than the one they're in. Is that just the nature of where we're at today, that you have to diversify?

And I guarantee you, every board is telling their CEO of their health system you got to find a way to smooth out the curve. You can't keep having these abrupt drops and then climb out and you can't climb out. And the climbing out is done by increased schedule or expansion of schedules operating the, or until nine o'clock, 10 [00:29:00] o'clock at night wearing out teams that are already wiped out anyhow. That's not a viable option for these health systems to recoup lost revenue. They need to have that diversification to smooth out that experience.

But the reality was it had gone from, maybe a 1% usage to now, you can almost see across some health systems you're seeing a maintained rate of somewhere between 15 and 20% telehealth usage. And that says that's a significant uptake. If somebody had told us two years ago, without the pandemic, [00:30:00] we would get that kind of growth in telehealth we would be doing cartwheels. What's the future of telehealth? Where are we going from here with it?

Sarah Richardson: I'd like to look at it as a space of more of the on demand activity. And I literally say that because. There are certain times when you want and need to go to the physician, like not get your annual physical on in theory, some of your preventative care, just doing a video visit.

You don't have to really, unless you're going to obviously going to get tested, you don't have to go to the doctor for that. You don't have to literally physically go into the office and say, I need this or this component, if it's a recurring type of thing. And so the convenience factor for so many people, I remember five years ago, having calls with our pediatrician groups.[00:31:00]

They wanted like five things that parents could just literally do a video visit form. One of them was pink eye. When you're a parent, if your kid has pink eye, you don't want to drag the whole brood in because everyone's going to get sick or kind of thing. You got three kids at home and one sick.

You don't want to go to the doctor, especially when you know what's wrong with them. So the convenience factor back to the, the human approach. If it's an on demand capability for that percentage of all of us that want to be able to do then absolutely. My father-in-law's 93. He hates telemedicine as he should at his age with all of this, all of the different things he has going on.

So until it becomes more of mainstream for people for certain types of conditions and we start to learn those more effectively, that on-demand component of what telemedicine is from the ease of convenience is what attracts people to a brand and the repeatability that they can expect from receiving that type of service from a [00:32:00] place that they know they're gonna have a good experience.

Because every time I do telehealth, I'm not going back to the same doc. It's kind of a different kind of deal. And maybe that's my age, right. So I'm only. I actually I'm 54 now, I got to think about that these days. I'm 54. So maybe I should have that recurring primary care, Doctor,Bensema is going to shake his head here in a minute and tell me I should have that ongoing relationship.

David Bensema: The other thing that's going to happen for telehealth is as more states get legislation that requires parody and payment to be sustained. You know Obviously during the pandemic we had a Medicare jump up. And so then the other payers came along. But in the state of Kentucky, we [00:33:30] passed the parody law almost three years ago now. We're way ahead of the curve. For the anyone who thinks that Kentucky is a laggard at some things we lead in and one of them was parody for telehealth. But with that, we have physicians in the state now who are saying, I want to set aside 20% of my time. And have open hours telehealth meaning, from eight to 10 in the morning or eight till 11 four days a week, I do telehealth and patients can [00:34:00] access pretty much on demand. It's not quite as fluid, but you do get to see your regular primary care physician. And so we have a lot of folks in the state of Kentucky doing that. And I talk to a lot of my friends at the American medical association who would love to do that. If they felt that it was going to be a sustained model for them, then they would be willing to be participants in telehealth.

That has been huge. And that's gonna continue for sure. Mental health is going to stay kind of the lead or the, the yeah, the leading wave of telehealth going forward. But I think you're going to see most physicians being willing to do 20 plus percent of their time as tele-health once they know that it's a sustainable business model.[00:35:00]

Bill Russell: It requires policy change. It requires funding. And so just for clarity, is that Medicaid and commercial, because I mean, clearly

David Bensema: I stayed in Kentucky at the parody laws for all payers.

Bill Russell: All payer. But not CMS?

David Bensema: They cannot do it through medicare. Yeah. So getting Medicare to sustain that would help.

He doesn't want to come in out of his business or have to figure out what to do with his son. So telehealth is great thing for those groups. So the United healthcare is the Anthems, the Humana being on a parody with in office visits has been a huge boon in Kentucky.

What's the big movement we should be watching for in 2022.

Sarah Richardson: I'm going to go with two brief items. The first one is paying attention to the future workforce. And literally, like we learned all these adaptations throughout the first phase is what I will say of the pandemic to wait to the endemic state.

Who say, oh, you're that kind of programmer? Oh, you're that kind of individual. We want you to come work for us. You can be remote. We're going to pay you this much. Here's the experience. And so, the leadership qualities and the capabilities that are needed to be attractive enough to bring people in, because to David's point, he may be able to [00:37:00] source the things that you're not great at doing, or that are not in your particular wheelhouse with different partnerships, even acquisitions etc. At the end of the day, you seem to have fantastic leadership and fantastic skillsets in your organization to still be true to what is at your core. And so a lot of that is then to the medics piece, being supplemented with the greater and deeper understanding of things that you, that you can't give away.

That takes up way more time than anything I've ever done in the past year. It's rewarding work, but it's also something that is not necessary fluent to most of us that have grown up as technologists, like literally shifting all aspects of things you've ever done and in a data center and other [00:38:00]components to do work that needs to be invisible and allows the provider, especially we talk about nurses being the most trusted individuals on a healthcare. Nurses are asking to be able to literally just hold a patient's hand. So how do we make that possible? It sounds so simple. If your job is to make a nurse, make time for a nurse, to be able to hold a patient's hand because they don't have anybody or the family hasn't been able to come in because of the pandemic cetera.

Bill Russell: Wow, fantastic. I'm glad I'm not following that. David?

David Bensema: Actually, Sarah has set me up for one of my two, which is ambient technologies. Ambient listening technoligies. Because how are we going to get the nurse to be able to hold the hand? How're you going to get the position to maintain eye contact with the patient?

I think this is still a nascent area. But it's evolving very, very rapidly. The quality keeps getting better. I don't think we're that long way. Of course I used to always chide the people who said, oh yeah, we'll have this in two years. And I'm like, no, we'll have a prototype in five [00:39:30] years. And we've only had have the technology for 10.

And I said, but we haven't had a breach. He says, yeah, but I can't keep up on the current budget. And what I ended up creating the analogy with my team was that we were in a race with the hackers with the nefarious [00:40:30] actors. And we were at risk of losing sight of them. It's not just that they're ahead of us where we're going to lose sight of them if we didn't start investing.

And I think we're back there again, just because of how rapidly we had to roll things out. And I think we've got to get back to where least, or within striking distance or vis visual distance of those nefarious actors. They're always going to be ahead of us in this race. If we think that we can get ahead of them, we're delusional.

I think it's going to become much more [00:41:30] precise in the coming year, and we're not ready to catch up with that yet.

Bill Russell: Well, the old adage is if you're the smartest person in the room, find a different room. So clearly I'm in the right room. With the other group, what I said was automation is going to be key.

And if you're not a good manager, not a good executive, you're struggling to keep and build that culture. As a result I think there's going to be a call for much more automation. We also have the nursing shortage, which is going to be close to 500,000 down. And it's not like in 10 years, they're like saying in two years we're going to be half a million nurses short.

Now we have some interesting things that were going on at Cedar Sinai and some of the other academic medical centers, but I think it, it starts to become mainstream. I think with the launch of, of Metta and other things that VR is going to take a significant step forward. And we're going to have really smart people stepping back and saying, okay, how can we [00:43:00] almost help to create these environments that people can heal better in and those kinds of things. And also along with VR in healthcare comes the downsides of VR. We're going to have a new rash. I'm not sure what symptoms or conditions that are caused by people spending too much time in VR.

Sarah Richardson: I love it.

David Bensema: You're in mental health already. So you're, you're not far off,

Even just pain management in general. And what VR can do for people that have pain management. It's pretty incredible. You look at the research it's out there today.

Bill Russell: So another year is in the books. I want to thank you guys for being advisors and people from time to time will come up to me and say, it's amazing how far that you've gotten in this thing.

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 [00:45:00] 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 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.[00:45:30]