Episode 472: Transcript - December 17, 2021

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Chris Logan: This is the elephant in the room. So if you go back to think about where we were 20 years ago with technology, it was different. So healthcare has gone through this mass explosion about how do we adopt these technology or these new innovations to provide better patient outcomes. It was not uncommon to have 2000 applications in your health system. How many did you have in your health systems?

I want to thank you again. In December we do a bunch of end of the year episodes. I think you're going to enjoy them. We do two with our advisors. I did one just me talking through chronologically the news of the year, and then we're going to do two, one where my staff selects the best news day episodes from the [00:01:00] year.

If you're subscribed to This Week in Health IT that will become this week health conference. And that's where we're going to have keynote. And we're going to have solution showcases and some other campaigns around specific topics. This week health academy is new. It's really around education.

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 [00:02:30] 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.

If you're not subscribed to all four of them, you're going to be missing some content. We'd love for you to subscribe to all four. Go ahead and hit thisweekhealth.com/shows and there's information there on how to subscribe. You can also hit iTunes and search for this week health. Any one of those academy, conference, news or community.

All right. Here's what we're going to do today. I love doing these clip shows at the end of the year. Normally what I do is I go through for the last three years, I've gone through a bunch of the shows, pulled out my favorite clips and done these end of the year shows. This year, I'm tapping into my team.

So they listened to them. Just to give you a little background. None of them are from healthcare. They have been in healthcare. I think Tess has been in healthcare [00:04:00] the longest. She had just started working with me probably a little over two years ago. And so that is her background outside of all of them being patients and having interacted with our health system in various ways.

She's been in healthcare on and off for about two or three years. She helped me early on in the show with some of the production and some of the work that was going. And then she went off and did something else with it and now it's come back to head up our social media. It really is going to be their perspective on what's important.

Amazon, Apple and some of these other big tech players. They are consumer centric. I mean, Amazon is notoriously consumer centric. They know everything they do is around the consumer and how to make their lives better and how to make it [00:05:30] more efficient.

Health systems are provider centric and have been for decades. And I'm not the first to say this, obviously there's others. This is the famous quote from Geisinger's former CEO who's now acting role. Who said, the waiting room is indicative of everything we think about the patient, which is you will go into this queue and wait for us.

And I'm not against making it better for the provider. I'm just saying, is there a gap there that health systems have to close in order to not be evolved, I guess is what you're saying? I would say disrupted but evolved.

That's not what consumers are used to anymore. Again they're seeing these experiences. They're having such as, you know, with retail applications that they're using that financial applications they're using, it's very seamless. You can walk near a Starbucks, you're not going to get a coffee, but you go walk near it.

Bill Russell: Thank you for reminding me that I'm thirsty and I wanted one of your coffees.

The context for this clip is we start talking about Microsoft Viva, the new product that was launched. And she started to share how different companies build empathy into their technology and why some work and some don't work so well. So, that's the setup. Here's the clip.

Your first meeting is at eight. And I was like yeah, I do. I do have a busy day. Thank you for noticing iPhone. And it felt, you know, like, okay, my phone is looking out for me. Let's compare this to something that Microsoft did which is, you know, Outlook gives you your productivity stats and they do it in arrears.

Bill Russell: Now you want to get in an argument with it and say do you not understand what I'm going through?

It's a little bit squishy of thoughts but those are all the things that came up. And I was particularly like, do you want your portal every day to ask, like, are you happy today? Like, I [00:10:00] don't know.

Bill Russell: As you know, on This Week in Health IT we try to pull stories out and then have a discussion around them in this clip, Dr. Justin Collier with WWT, World Wide Technology we have a conversation around making the EHR work for the nurses. So here's the next clip.

Dr. Justin Collier: I think the systems that do the best job. I'll frame it that way. So maybe best practices rather than pitfalls. Obviously the other side of the coin is not doing those things well. But I think the systems that do [00:11:00] best are the ones that have nurses on the informatics team. Nurses who have been at the bedside and understand the workflows personally. That makes a huge difference. And then the second step is engaging all of the stakeholders during the build process. So that they are part of that decision-making. Certainly that helps quite a bit in terms of adoption as well as potentially improving the usability. Third thing that really makes a difference too, is not stopping with installation or implementation or [00:11:30] the build. It's going back and doing continuous cycles of optimization. So continuing to improve that.

Bill Russell: Our next clip highlight Drex DeFord. Drex has been a phenomenal friend of the show. He's an advisor to the show. He's also been on probably more shows than anybody else. Since we started the podcast some four years ago. I love having conversations with Drex We have a very good chemistry and just sort of go back and forth. And we start talking about how you have conversations, how you prepare CISOs for conversations with the board. This was actually from an [00:12:30] article that was pulled out. It was the ExtraHop VP wrote an article on the things that a CISO needs to know before addressing the board. So Drex and I tackle this, this conversation. Hope you enjoy.

But it didn't mean that we didn't have to really be very clear and very basic about some of the things we were doing. We couldn't just speak to that one person on the board because our subcommittee of the board that handled security. We had to bring everyone along. We couldn't just speak to that one person.

Drex DeFord: I think so. If they don't have somebody on the board, they probably have somebody on one of the subcommittees of the board, like audit and compliance.

And I think the transition that has occurred, he talks about leading with resilience and managing fear is that yeah, of course, you're going to be afraid of what might happen. Nobody wants to be in the newspaper. Nobody wants to be the person with the microphone shoved in their face, but really the story has to be now I think and based on what he's saying, I think he thinks that we've created this situation in healthcare now where you can't provide modern healthcare without digital health. Without [00:14:30] the tools that we have EHR and DRPs and the thousand other applications that many of us run, which runs on, has to run on relatively modern networks and is connected to the internet because we're doing a bunch of this stuff, as we talked about earlier as a service.

And what are the things we can do to make sure that if something happens and we go offline, we can come back as quickly as possible to deliver great care to our patients and families, because that's what they're all about.

Let's hit this Wall Street Journal article. Wall Street Journal is "Remote work may now last for two years, worrying some bosses." Many employees develop new routines during the pandemic. Swapping commuting for exercise or blocking hours for uninterrupted work. These sound like good things. Even staffers who once [00:16:00] bristled at doing their job outside of an office have come to embrace the flexibility and productivity of at-home life over the past 18 months. Many say surveys have shown enthusiasm for remote work and has only increased as the pandemic has stretched on. And they talk about return dates being postponed by many companies. It seems like mostly they're talking large organizations here, but a lot of health systems would fall in that category.

Sue Schade: [00:17:00] I don't know that my thoughts have changed significantly in the last few months. I continue to be concerned about IT direct support and engagement with our clinical users. The value of our folks who support those symptoms having close and in-person relationships, rounding, we were just talking about, I think is critical and that is very difficult in the remote world. And I think [00:17:30] that IT organizations need to find ways to accommodate that and structure it. And not assume that it can all be done remotely. That's the biggest, most targeted I know that for all the infrastructure work we're doing, we're making it happen.

Bill Russell: There's a handful of things I always say to people. One is you can't replace face to face. There's something about being able to read the person. Being able to sit across the table from them. Sitting in a restaurant.

I know this is effect. I I get emails every now and then on this, I know it's effective. I know you can be effective at home. I know that you can do your job at home. All those things are true. But I worry about the next generation missing out on the relational aspects of working with [00:19:00] colleagues. And I worry about them missing out on promotions that are going to go to people that have relationships.

Sue Schade: I think it's a valid concern. But if your whole team like take IT as primarily remote or some hybrid then everybody may be in the same boat, right.

Bill Russell: This is going to remain an interesting [00:20:00] challenge and opportunity, right? So people really do like working at home. We're seeing the statistics and they continue to support the fact that people like the flexibility, the autonomy, maybe even the quiet space that a home offers.

And so this conversation is with Dr. Sanaz Cordes with World Wide Technology. And we are really exploring some of these statistics and what they mean for us as individuals from a mental health standpoint, from a work-life balance standpoint, if such a thing exists when your home office is right next to your living room.

Have you worked from home a fair amount of time?

Dr. Sanaz Cordes: Yes. I mean this last year and a half, every day.

Bill Russell: Prior to that.

Dr. Sanaz Cordes: I worked from home in the office and then on airplanes.

And I think [00:22:30] some people who are used to the office where they can compartmentalize it, I'm going to the office. Now I'm coming home from the office. They weren't used to that. And some of the things that took me 15 years to sort of develop . I think people are sort of getting buried under that weight of not being able to make that transition that quickly and that they are responding to emails.

Dr. Sanaz Cordes: I thought you were going to say 46%. I don't know where that billion ..

And I think people are potentially resenting this. I think it's one of the findings from this survey. So as a manager, how would you approach that?

So I've learned just in the last year and a half watching what it's like for people who aren't used to that environment, how to adjust. And I think one really important thing, and my boss does this and this is and I was not good at this is to tell people I'm not going to respond to your emails after a certain hour.

I need to be engaged and when it's 24/7, and like you said, in your house it's hard to kind of turn that off. So I think that's important. Setting the standard top down. Not going to answer, work-life balance is important. Take your weekend time. Words that we should have been saying all along, but really important now.

So health interoperability outcomes 2030. In a perfect world if interoperability worked the way it should work. Mark, what would it look like? what would it look like for a physician?

It's like real time. It's all there where I can get it into discrete data. Yeah. So I'm bringing in a note, but I want to be able to extract from that. Okay. Note the important parts so that I can fill in my health maintenance or my quality [00:26:30] metrics that need to be satisfied. Or if I want to trend the lab values that are being reported by a consultant, that's what it feels like.

It feels that's the easy button for healthcare. For me, that's what I want. I want the easy button of all the data right in front of me. Curated. And then I want to be able to ask my, EHR. Hey, I'm dealing with an abdominal problems today. Show me the relevant data, but EHR can't do that until we have a complete set.

And he has a great way of building culture and really connecting his IT team to the mission of the organization. So I decided to pose that question to him, to capture it for all of you. So here's the discussion with Dr. Lee Milligan.

Lee Milligan: I try to find something that I feel strongly about. It makes it easier to flow when you feel strongly about it and then kind of focus on those things. But I also want to see through their lens, like, what are the analysts?

Drex DeFord: It is the connection to the mission and the connection to you. We hear this all the time. People don't leave jobs because of, I mean, any number of reasons they leave bad bosses. And when they have a connection with you and they have a connection with that mission, I mean, we have the greatest mission. That's our biggest advantage, right? We, we work in a [00:29:00] mission that everybody's a part of at some point.

Lee Milligan: One of the things we started doing within our our ICF division meeting every other month is we have our CMIO present some sort of clinical scenario where it played a key role in a clinical outcome.

And the order set was so detailed and so specific. And so in line with best practice recommendations that frequently nowadays they turn these patients around so fast that when the hospitals comes down to admit the patient, they're asking, why am I admitted? And so the last time the CMI gave this example of this scenario, it was really all due to a great collaboration between the CMIO the clinical staff, and then the Epic, a set analyst who built this [00:30:00] whole thing out. So I think those kinds of things really connect us to why we're in business.

And we close out with a conversation with Chris Logan. Chris Logan is with Sensinet Used to be with VMware. Has been in healthcare for quite some time. And we just talk about the ever expanding attack vector that is healthcare applications.

And more than a third said, the assessment conclusions were ignored. The report found. Gosh, I'm going to stop there for a second and say, does that surprise you? That so few are being assessed and the ones that are being assessed as being an org, it does surprise me by the way that the findings are being ignored.

It was not uncommon to have 2000 applications in your health system. How many did you have in your health systems?

Chris Logan: And so managing that portfolio, right. There's gaps. There is opportunity for improvement there. But what's most critically important here is availability. Right? So think about this for a second. When we were pen and paper for healthcare delivery, it was simple. You had somebody push the cart from medical records department. You got that full record. Maybe you could read it. Maybe you couldn't. Electronic medical records come to bear right now I can read the note. Is it the right note? There is a whole litany of conversation you can have there, but the availability of the system is [00:32:30] so damn critical now to ensure that patient's safety. At the end of the day, if I don't have that information how can I treat that patient? If I don't know what their background history is, right. If I don't know what their previous inter allergies are related to specific medicine. So availability attacks are nothing new. I mean, ransomware really is an availability attack. This has been taking place since way back. 2003, we went through this. It was not our medical systems. It wasn't on the EHR. It was [00:33:00] on all the administrative systems because it was really making the endpoint unavailable. Now it's, it's matured and it's grown because the bad guys have figured out that there's money to be made here and in, especially in healthcare, because think about this for one second.

What are the mortality rates related to, if the EHR is not available. How do we start to quantify that? So I think it's good now that's out there. We're having a conversation. I know in certain circles that I'm running in, we're starting to have deeper conversations about what ransomware means to the mortality rate.

I really appreciate them. I used to do this whole thing by myself and now I couldn't possibly do it all by myself. We produce way too many shows. And are doing way too many things in the industry. So again, really appreciate the staff and all the things that they are doing. And we really appreciate our sponsors.

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