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 Welcome to this week in Health it. It's Tuesday News Day where we look at the news which will impact health it. Today, Drex to Ford is in the house for a deep dive on contact tracing and a special extended edition only on YouTube. On that in a moment. Uh, my name is Bill Russell Healthcare, CIO, coach and creator of this week in Health.

It a set of podcast videos, collaboration events dedicated to developing the next generation of health leaders. Uh, this episode and every episode since we started the Covid-19 series has been sponsored by Sears Healthcare. Uh, they reached out to me to see how we might partner during this time, and that's how we've been able to support producing daily shows over the last couple of weeks.

Uh, thanks Sirius efforts. I thank everyone who.

From you. So please shoot me a note bill at this weekend, health it.com. Uh, you know, just answer the question, what's the biggest health it question you have right now? And you want us to, you either want me to talk to with a a, with a guest about or discuss in the show. Uh, and go ahead and send that over right now.

I love hearing him. Uh, I did get a, a couple, uh, last week.

And we're.

How's it going, Drex? Good. Good. I, I love Will Wieder. Is he not one of like the smartest guys? I mean, I know he is just down the road here and not to blow smoke up his skirt, but I love, I like on Twitter, I, he's just, he's a good, insightful, smart guy. He is absolutely, he's a good person. He's just a good dude.

He is, absolutely. And his, uh, his, uh, email was, was, anything he writes is really insightful. Uh, but my, my audience is not as familiar with him as they should be because he has not been on the show yet. Oh. Wow, this. We gotta fix that. This is an open invitation to Will. As you're listening to this, know that you have an open invitation anytime you want.

We'll, we'll jump on, we'll talk whatever you want. Digital, you know, digital health, we'll talk, uh, innovation, we'll talk operations, whatever you wanna talk. Health it. Open invitation. Good. I like it. I like it. I'll take you up on that. So, uh, people don't know this, but you and I have done our first joint, uh, consulting project and it's always fun to work together.

Yeah, absolutely. You know, for, for us, a lot of our research is done right here on the show. We've done, uh, 50 plus episodes over the last eight weeks talking with all sorts of health systems, vendor partners, and. And we put together a presentation based on what we've heard from the show, and then we mapped it out to what we think is coming next in healthcare and health.

It, and I, you know, I've personally shared that deck with, uh, my coaching clients and we've given presentations to sales organizations and executives and, uh, we're even gonna talk to, uh, some product development teams here shortly. What we're gonna do today, a little different following the news segment.

And so if you wanna see that, that snippet of the presentation that Drex and I are doing, uh, you're gonna have to go over to the YouTube channel, just scan through towards the end, and the show is gonna continue. So, um, and while you're there, we're gonna start doing some fun stuff on YouTube. So, uh, uh, we want everyone to subscribe so you don't miss a minute.

I love how smart you think I am. You send me a 32 page document, 90 minutes before the show and said, Hey, let's, let's cover this. Um, and this is something you share on three X Drex and that's, uh, text Drex to 4 8 4 8 4 8. And you get, uh, get those, uh, emails. But, uh, so we're gonna go through this a little bit and we're gonna talk contact tracing.

So the 32 page document is called outpacing the Virus Digital Response to containing the Spread of Covid 19 while mitigating privacy risks. You also sent another, you sent a couple other stories. Yeah, there's. There, there's a, there's a bunch of stuff. So I was, I was, bill and I were talking before we started recording and um, the only, uh, mostly the email that I get at drex at three Drex is email from myself.

Um, as I read tons of stuff over the course of a week, I start to see things that I think are like, this is an interesting pattern, or that's a thing I need to learn more about. 'cause I'm not, there's just lots of stuff that the, the more I know about things, as with all of us, the more we know about things, the more we realize we don't know or understand about things.

And so things like contact tracing, which seems to be super important and the how are we going to really get over the hump and stay over the hump until we have a vaccine or some other way of helping us get to herd immunity. One of the really important parts of this is, is, uh, contact tracing, which sounds sort of theoretically pretty simple.

Until you get into it and then you realize it's actually really, really complicated. Like if I asked you, who have you seen in the last two weeks, bill, who have you seen in the last two weeks? Yeah. If you were, if we were contract contact tracing you now, maybe because you've been pretty much locked down, that would be a really small number.

Yeah. And, uh, you know, it's interesting, this has been put out there as, you know, one of the, uh, core tenants to a solution, bipartisan. And so everyone's saying, Hey, contact tracing is a, a key part. We've seen it in South Korea work pretty effectively. And, uh, uh, and, uh, Singapore, I think, or some other places, well, China as well, uh.

But there's a lot of challenges. So let me, let me tee up some of this stuff. 'cause I, I love the fact that you sent this over 'cause I had the same thought of, I don't know enough about this topic. And so, you know, Mm-Hmm. just reading this stuff has really helped me. So here's, here's the setup for it. So the, the, the virus is, is novel, which means there's no current defense, uh, for this version, unlike the flu where we have.

Vaccines from year to year. Uh, this is novel. Uh, the virus has stealth transmission incubation period of 14 days. Uh, the lethality of the virus is believed to be many times higher than seasonal flu, and the virus has a very high natural transmission rate. Um, contact tracing fully manual, as you said, relies on, uh, a lot of workers.

Uh, to go through that information. Um, and it relies on my memory quite frankly. So, you know, some of the options for contact tracing are fully manual, encrypted peer-to-peer protocol based on something like Bluetooth and, uh, a location-based protocol. These are just some of the things that are highlighted in this story.

I'm just.

So again, relies on human memory. Uh, manual contact tracing takes time. A lot of time with probably too much time, uh, manual. Uh, you, you that, or just tons of people. So manual contacting takes tons of people. Yeah. Just, you know, you have to train and just a lot of people. And, um, and it's been proven insufficient to contain Covid 19 on its own today.

So. Comes, uh, technology, you know, it's more accurate. It's, uh, fast, it's low cost, and it's been proven to work Taiwan, South Korea, and other places, which is, you know, which is pretty exciting. But then you get into some of the, you know, some of the challenges with it. So, privacy. So before we get into the privacy problem, let's talk about how this would work.

So, um, Bluetooth, well, I don't know about you, but I don't have Bluetooth turned my most of the.

Yeah. So in theory, and this is um, probably something that I'll post on three extracts this week too. There's actually a cool little MIT video that sort of describes in about three minutes how this works. But, um, you would, uh, download an app. And it would use, uh, sort of the capabilities of your phone, uh, through Regu and, and the Bluetooth capability, um, to, as you walked around and did things.

And if it saw other phones that had the app and the Bluetooth turned on, it would record that it had talked to that phone, that it had been in contact with that phone. And I would be able to say I was, I was in contact with that phone for like five minutes or. 20 seconds. Now, you could build a protocol around that that says if you were only in contact with another phone for 20 seconds, maybe that's not enough to notify you if somebody comes up positive.

But if you were there for three minutes or four minutes, maybe that's enough. Um, and then, uh, basically what happens is that your phone, so it's not. Uh, you know, it, it's a, it's a piece of data that's de-identified, goes into a big master database, and then, um, if somebody comes up positive, they would say on their phone that they've, they've come up positive for Covid-19 that would send a note to the database, and the database would look for all the phones that have been in close contact to you, and it would notify those somebody.

Had been in contact with them probably around this date and probably for about this long, and that would then trigger what could be a lot of different responses, including, you know, a recommendation if it was above a particular threshold to get in touch with a public health person or a public health person might actually try to reach out to you because of that.

But you're right. A lot of this gets into privacy, right? How much information do, do you disclose? How much information does your phone disclose? Um, do you wanna walk around with these apps on your phone? Would you use them If it's, uh, if it's optional, there's a lot of people who won't do it if it's, uh, optional.

A lot of people who don't do it, is it worth the effort? Like, you know, is it sort of partially effective? And I think those are all things that I'm. Um, but, uh, but there's a, there's a lot, you know, it, like I said in the beginning, it kind of, it feels like it's probably a pretty simple thing, but when you start to sit down and just work through a single scenario of me talking to you about who have you been in contact with for the last 14 days, and then we rely on you to tell me who all those.

People were including maybe a bunch of people that you didn't know, but you know that you did go to the grocery store on a particular day, three days ago, and you were in the store for about this long. So there's a lot. Now we start with a lot of head scratching, like, who else was in the store and which checkout did you go through and did you touch?

Did you take a cart? Or you didn't take a cart? Um, there's a lot of other things that kind of. Confusing really fast. And you talk to guys, I, I hear Mark Cuban on the air. Um, talking about things like, uh, maybe the con the human contact tracing program is a good way for the government to employ a bunch of people in the near term who are unemployed as contact tracers, but that also gets back to.

You have to have some particular kinds of skills, and you have to be trained and you have to know how to ask questions and all of that. So it's not easy to just turn somebody on as a contact tracer either. Well, this is, this is where Hollywood has done a, uh, good job of educating us on what the, uh, dystopian outcome could be.

Right. You know, so total recall or, or terminate or Skynet, you know, this stuff starts with. This, but this is where it gets, this is where it gets complex, right. So I, I like this article because it, it, it, um, or white paper really, you know, 'cause they, they talk about, you know, how much of the data actually stays on the phone, uh, stays local, how it, uh, rotates the hashes.

So that is almost, you know, impossible to de-identify. But they also talk about how laws should come alongside of this and make it. Um, you know, essentially a federal crime to even attempt to de-identify this data. Mm-Hmm. , I mean, you have to protect the integrity of the people using this for the good of the community so that they don't, I don't know, get tracked for some other reason down the road.

And so that. That becomes, and this goes through that, it goes through hashing, storing locally. Um, the, the centralized server, quite frankly, needs a bunch of information that it doesn't have in order to, uh, decrypt the location and the ID of the phone. Mm-Hmm. and those kind of things. But as, as you know, they sort of piece this all back together.

Once you are covid positive, it has a, um, you know, it has a chain to back and identify.

To give them to.

Uh, you know, the, I mean, I mean the bottom line is, um, as hard as we can work to de-identify and make things, uh, very difficult to reassemble. There are people out there who are willing to work really, really hard to figure out how to undo the work that you've done to make things, uh, anonymous and de-identified.

So, you know, nothing is foolproof. And some of this ultimately just comes down to what's the right. Solid single answer for that either. What's the right thing to try?

So, yeah, it's a, it's definitely a tough one. And there's, there's also bills out there. You know, there's a couple of bills that have been introduced about, uh, contact tracing and the data that's gathered for contact tracing and what it can be used for and how long it can be retained and what the disposal and destruction process has to be for it and all of that.

So, um. Are thinking about, you know, all of those issues. Well, and it's interesting because this article, again, doesn't shy away from that. You get down closer to the bottom. Page 26 starts talking about, uh, what, what, uh, groups like the ACLU have written and put together around this. Uh, because during H one N one, they actually.

Approach then and, uh, let's see. Previously the ACLU literature on the individual rights in times of pandemics, particularly white papers written during the H one N one outbreak focused on maintaining public trust and public health authorities and encouraging public cooperation and efforts to mitigate disease.

I, it just goes, it has that, it has, uh, indef freedom at a time of crisis. So it, it actually touches on. And there's a fair amount of it that's been written around. Okay. Uh, around the time of a pandemic, around the time of a crisis, uh, what is the trade-off? And it does the trade-off change for a period of time where, um, it's, you know, we give up some of our personal liberties in order to protect the, the common, the greater good.

And then as long as, I think a lot of us would do that, as long as we were assured that. Bounce back, like it would not be a indefinite kind of program where, uh. Right, and I mean, we've seen examples of, um, you know, laws, uh, regulations, rules that were created, um, you know, specifically after nine 11 that, uh, that continue to this day that allow some pretty significant surveillance of the public and monitoring telephone conversations and other things.

Those are the kinds of things that have put a lot of people in this position of saying once you lose those liberties, you never really are able to get them back. Like the government's never going to give, I mean, you know, there, there's a lot of paranoia around it, which I understand, but I'm also with you that, you know, I would be willing to give up some liberties for the good of the, of the group.

If I knew that everything bounced back after the fact, it's just that, that part of it. How do you know it bounces back after the fact? That's, I mean, you either have not watched any movies or you have no imagination if there isn't a certain amount of skepticism on how this is gonna be used. I mean, it's um, you know.

Paper, other

national broadcast.

To every foreigner. Just think of that. Every foreigner and Thai who has traveled from countries that have been designated as high risk for covid-19 infections at the time, China, Hong Kong, South Korea, Italy, Macau. I thought Macau was part of China, but I guess not. Uh, the app will track the phone's location, position for 14 days and alert authorities.

Yeah, I mean that's like a, that's like a ankle bracelet or something, right? In some ways. Yeah, it's, and, and then you go, you know, what's the next step and the next step after that? Like, once you start down the path, how far does it go? And, and are there things that are going on that you don't know about?

Because we're all really, not all of us, I guess, but a lot of us are pretty suspicious about what's really going on in the background. So, uh, with our phones, we all laugh from time to time about how you talked about kitty litter, and suddenly there's an. On your Facebook page. Um, and maybe that's just coincidental or maybe there's something weird going on, but Yeah, I think we're all a little paranoid right now.

Yeah. It's, uh, yeah, these are, these are definitely interesting times. Uh, the, uh, yeah, so that's, I mean, that's contact tracing how we, how we integrate.

Trying to figure it out. Um, you know, I, one of the articles I threw out, I threw out a bunch of articles. Um, I'm gonna save that one for the end. But the, you know, health systems must restart now to map out safe back to Work Strategies, this healthcare IT news, uh, article that was put out there. And it just, it talks, uh, you know, just some of the challenges that we have in front of us.

I was reading the article, I, I was doing research on what health systems are doing, the most prominent being Atrium. Atrium has created their, their safe atrium, places to go, and they're encouraging people to come back to the hospital and they're expanding their, uh, surgeries and they probably did the best job of integrating marketing and, uh, operations for creating that.

But then I ran across.

And if you haven't seen this, this is worth looking at it. Uh, uh, university Hospital outta Cleveland. So, uh, uhhuh uh, hospitals org and they have healthy restart for the community. It's phenomenal. So they have, uh, it's essentially a playbook for any business that wants to go back to work and what you should do for your employees.

And it has a whole bunch videos. Keeping your employees safe, environmental, uh, environmental safety in the workplace, building trust with your workforce. Um, frequently, frequently asked questions. They have a, uh, uh, healthy restart playbook. Uh, you know, this is, this is the kind of stuff that's, it's just, it's really good.

Loaded bullet points, uh, on, on, you know, communicating with your customers and how to do that effectively. Um, there's just so, so much in this that I was like, you know, this is one of those things that we should as either be borrowing or whatever, but isn't this the kind of stuff that people are saying?

The information we want right now. And, and a health system is uniquely positioned to be that trusted source of information to say, okay, we're gonna partner with the, the, um, the org, uh, the businesses in our local community to help them go back to work effectively. Um, right. Are this.

Uh, and Atrium at this point, I, I actually, um, I probably have about eight or 10 of those articles that I've fished out of the news over the last, uh, seven or eight days. And every, it's, you know, it's everyone from health systems to companies like Salesforce who are talking about here are the things you need to do to make sure that you're building trust employees.

You need to, you need to figure out deep cleaning. Like many of you have never really done that before, and now that needs to be a thing and you need to talk about it and how it works. You gotta have hand washing stations, you need to have gel. You need to maybe rethink how, if it's an office, how you lay out desks and how people travel up and down the aisles.

Um, and, and there's a lot of that stuff, but I'm with you, bill. I think this is a real opportunity leadership community. People who are public health and infection control experts, and they really can provide great coaching free services to other people in the community about this is the way that you should behave.

These are.

We're still in the middle of all of this. And, um, you know, this is, this is your obligation. If you're open, things you need continue. And, um, and there's a lot of stuff that is not, it's not. Super expensive or really complicated. It just needs to be talked about by experts that you know and trust. And in most health, I mean most, most communities, the healthcare organizations are the organizations that are probably, when you look at the trust index in most communities, they are the, they are the organizations.

The communities trust more than anybody else. Yeah.

But have a video, video, you know, a physician standing next to the, the of university hospitals, Cleveland Medical Center, you know, lab coat, purple tie glasses. Mm-hmm, . And talking about what antibody test and who needs it. Um, and then you go down a little further, you know, I'm sure a physician in the, uh, lab coat as well.

Uh, COVID 19. Why we should wear masks. One on physical distancing and, and how we social distance in the workplace. Uh, you know, these, and those are short and sweet and easy to understand videos. They're the kinds of things that you could actually have your employees watch before they come back to work as part of their reentry program, right?

I mean, you know, to make them and the organization more comfortable. So I love, I love that, uh, is doing that. I think, you know, I'm, I'm with you a hundred percent. It's a great thing for healthcare organizations to, you know, take the task of helping the rest of the community come back and be healthy. And stay healthy and know what to do, know how to behave.

'cause it's different from how we were behaving three months ago. Yeah. Hey, I'm gonna close with this question. Okay. The podcast with this question, um, which, uh, David Chow asked out on, uh, LinkedIn and I, I thought it was a good question. It's an interesting question, and I've been asking people recently, I'm, I'm curious what your thought is, when will revenue, hospital revenue return to.

Man, I mean, great. Great question. , this is where you earn your money. Drex right here. Great question. So, I mean, I think even if we clicked to on, you know, right away and said all the elective surgeries that we're doing, we're gonna start doing those again. I don't think we could cram all those through the system.

In the new system that we've probably created or the new system that we need to create with all of the new screening processes and getting people to and process the way they do, uh, you know, people that we would, we would test now that we didn't have a testing step in there before all the PPE changes and swaps that we have now, which we talk about the consumption of all the PPE, but there's a big time factor in all of this too.

I don't know if you've ever actually watched. Or doctors. Uh, you know, pull this stuff off and then put it on again. But it doesn't happen in like a minute. It, it takes them a little bit of time because it really is like a decon process that they're going through to make sure they're not contaminating anything else.

So I think capacity has also shrunk, which means that we're gonna have to probably think about how we do a lot of the stuff. We more efficient so.

Man, when though, uh, we're, I don't know, maybe we're a year away from being back to, to, uh, pre covid, uh, you know, revenue numbers or even starting to get close and figuring out how we need to, you know, color right up the line to be able to get back there. It's gonna be a while. Yeah. And um, you know, I I, on his post, I, I answered Q 3 20 20 or I'm sorry, Q 3, 20 21.

And so that's not too far from what you're saying Yeah, a little over a year. Yeah. Um, I, but I, to be honest with you, there's part of me that says never. Um, and the, the reason I say never is, you know, we, we've known for quite some time that there's an awful lot of stuff we do as very precautionary. You know, putting people in a hospital, running a battery or te battery of tests and true, you know, some surgeries and, um, I don't know, just we, we, we've just known that we, we err on the highly cautious side and, and it generates an awful lot of revenue that, um, you know, you go for a couple months without it.

You change the model of care with, uh, the advent of telehealth and, and remote patient monitoring and other things, uh, we, we may not see those revenue numbers again. That's the bad news. The good news is we've introduced some really efficient and lower cost ways of providing potentially the same level in quality of care for our communities.

I think too that if we think about the work we've done with telehealth and, and, um, you know, al alternatives to coming to the hospital and going into the hospital, that really plays nicely into the. Transition from away from fee for service. Right. To to, to, you know, the, the, the models of, uh, yeah, the pay.

Right. Exactly. Pay, pay us a fee and we'll make sure that you stay healthy. I mean, it's, it's almost like there's. You know, did we have, we did we get some wires crossed in the middle of all of this? I think there's a real opportunity to take advantage here now of some of the things that we've learned in the new model of healthcare.

We just. Yeah, absolutely. All right, well, you know that's all for the new section of this show. Special thanks to our sponsors, VMware Starbridge advisors, Galen Healthcare Health lyrics, pro talent advisors for choosing to invest in developing the next generation of health leaders. This show is a production of this week in Health It.

For more great content, check out the website this week, health.com. For our YouTube channel as well. Uh, if you wanna support the show, best way to do that is share it with Peter. Second best way is to, uh, subscribe to the YouTube channel. And if you wanna catch the tail end of this show, please jump over to the YouTube channel right now, uh, to watch Drex and I talk about a, uh, business-centric IT approach to reopening.

Thanks for listening. That's all for now.