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 Welcome to this week in Health IT News, where we looked at as many stories as we can in 23 minutes or less that will impact health it. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

It's Tuesday Newsday, and I'm going to tell a story, my healthcare journey for the last week. Uh, what I saw, what I learned, and what we can do better. This episode is sponsored by Health Lyrics. I coach health leaders in all things health. It Coaching was instrumental in my success and it is the focus of my work at Health Lyrics.

Uh, he was a site director for a hospital and one of the best sources of ideas, new ideas, uh, that we had in our health system. Uh, he did crazy things. He did things like he spent the night in a bed just to get an idea of what it was like just to. Uh, feel the experience. Um, he asked a patient if he could, uh, escort be with him the entire day while he went through his series of appointments.

He met him in the parking lot and followed him through that day, uh, to understand his experience. Uh, he's watched surgeries and done, uh, a million other fun things. You see, Mustafa understood the power of walking in someone else's shoes for a day. And you'll actually hear from him on, uh, February 28th as I just interviewed him.

And David Baker on the topic of innovation. A fascinating person. Great show. Uh, well, this week I got to walk in the shoes of the patient, as many of you saw on social media. My 87 year old father-in-law came down with ammonia, uh, this past week and we had to take him to the emergency department. I'm gonna tell you about the experience, talk about how he and my wonderful wife experienced it.

Uh, make a few observations on what we can do better and hopefully . Uh, we'll still give you a bunch of things to, uh, think about and to talk about. Uh, alright, so here's, here's how it sort of went down. Uh, he started to shake uncontrollably vomiting. Uh, we decided to drive him to the E ed, which was the closest hospital, uh, which is a very good hospital.

Good reputation. I know a ton of people there. Uh, tons of philanthropy. Uh, I'm not gonna give you the name. I'm not sure it's really all that important to communicate the story. Uh, valet car service wheelchairs right there. Uh, he was in the room within minutes. . Of the time we pulled up. . Um, just to give you a little background, he had moved out to live with us, uh, in the spring of last year.

Uh, he is an accountant by trade religious about his, uh, appointments, uh, to see the doctor. He has a ton of records at two health systems back in Pennsylvania. Uh, both of these health systems are epic shops, and I would've consider them both to be really well run it shops and, uh, with e excellent implementations of Epic.

Uh, one of their CIOs has been on the show several times and is someone I greatly respect. Uh, the health system we were checking into was a health system that I was also extremely familiar with. As I said earlier, I, I know many of the people who work there. C-E-O-C-I-O, former C-I-O-C-M-I-O. Um, you know, this is gonna be relevant in a minute.

Um. You know, so he already had records at the health system. Uh, the health system we just checked into from urgent care, uh, which we, we visited several times before we changed insurance carriers. And, uh, he identified a new PCP and actually ended up, uh, with a different system. Um, the, you know, that made the, the collection of information easier in the ed.

But easier than amazingly hard. So still extremely cumbersome. Uh, what happened is they stationed a nurse practitioner at the keyboard, uh, which she only left a few times. I kid you not. Just a few times while other nurses came in, took vitals, drew Labs, uh, did all the busy work of bringing a new patient in.

Uh, and you know, I really marveled at the process. It was really well orchestrated and I could. Only imagine what it would've been like in a hospital with less staff. This is a pretty affluent hospital that we, uh, stepped into, uh, you know, and I just sat back. I sat behind her watching the screen intently.

Uh, you know, she would ask about medications. We have, we've gone through this a number of times. So we had the list. We just handed her the list. Uh, she asked about pain and, uh, she clicked on a certain pain and it popped up a whole new series of questions. And, uh, I, I could feel her hoping that he would answer no to the next pain question so that the number of fields that she had to fill in would, would be lessened.

Uh, the staff was really amazing, empathetic, helpful. . Um, informative, willing to do whatever, to ease the situation. You know, I'm very aware of the fact that we work alongside heroes, um, some more than others, but all do the all, all really have the best intentions. Uh, you know, I try not to divulge when I'm sitting there, I'm trying not to divulge anything about, um, who I am in these situations.

I, I find people to be more forthcoming if they don't think I'm interviewing them or collecting information, which I wasn't. I just wanted to understand, uh, a few things about the process and how they were feeling. Uh, you know, she started asking questions about his history and I asked her if they had pulled up the Care Everywhere records as the health system he saw in Pennsylvania was also on Epic.

Uh, you know, and her antenna went up and she said, uh, how do you know about Epic? Are you a doctor? No, I just follow the health IT industry. Uh, she said she had already looked and there was no records. Uh, the doctor then came in, I said, you know, he, he has records in Epic from Pennsylvania and they should really look for them.

Uh, he asked name, date of birth, and then he said there are no records. Okay. Um, this is the point at which I sort of wanted to, uh, play out the scene from Saturday Night Live. I don't know if you remember these, these are a little ways back, but they had the tech support person who would jump up and say, step aside, they sit at the keyboard and they would do it.

Um, but I, I relented and I did not do that, although I could tell my wife really wanted me to do that. Uh, she was, uh, really growing tired of answering the same questions over again. You know, at this point I put a post out on Twitter and LinkedIn that stated the following. Checked my 87 year old father-in-Law into a hospital tonight.

Moved from Pennsylvania to California earlier this year. Records from one Epic hospital to another. Not available, you know, what was available. A patient's mobile phone, which could have easily stored the record. Enough already time to free the data. We can do better. Um, we can do better. That was the end of the post.

Um, . You know, I post a fair amount on social media and, uh, so I, I know what a average response is, what a, what a, uh, significant response is. I have about 7,500 followers on LinkedIn. Um, this was one of the most viral posts I've ever put out there. It garnered, uh, over 45,000 views. Um. You know, most of those coming within, uh, 24, 48 hours, uh, over 150 comments over, uh, 450 reactions to the post itself.

And we're gonna look at some of those responses a little later in the show. Um, when it was just the nurse practitioner and the doctor, I asked how they liked the new installation of Epic. Um, the, in the installation they were working on is about two years old, and they communicated some frustration with the system.

what I heard from them was mostly around governance, to be honest with you. Governance and training, but really governance. And what they talked about is how they had full autonomy of the system when they were on, um, SCM, uh, sunrise Clinical Manager. Uh, and they were really the masters of their own destiny.

Uh, but for various reasons. This large health, uh, health healthcare system, they have multiple sites. Uh, was on community connect of a larger health system. Um. and what they felt right now was really restrictive. They felt like they had to follow a set of, uh, rules dictated by someone else from afar. Uh, you know, and I could really feel their pain.

It would be like, uh, you know, buying a high-end kitchen and telling, you know, telling my wife, Hey, you can only cook these meals in this way, in this kitchen. Uh, she would just look at me like I was insane. Um, so my father-in-Law back to that, so his condition stabilized. They did the normal battery of tests and determined that he had pneumonia.

Um, which as you know, is not a good condition for an 87 year old. They showed us the x-rays and explained the courts of action. Uh, so here's the next plot twist. The doctors come in and say, Hey, our hospital's not in network. Our caseworker is trying to determine if we can transfer him to a new hospital.

The doctor said he has stabilized, uh, enough to move him to the new hospital. So we're gonna order the ambulance, and at this point, it's now approaching 11 o'clock at night. ambulance comes around, they transfer 'em to another hospital. It's, uh, part of a large national, uh, system, and they're running Cerner.

So you already know where this is going. Uh, I'm not gonna try to explore what the ambulance that transported them. I don't really know what systems they were using and what information they needed or had, uh, although interesting topic for another day. Um, so it begins all over again. Let me ask you a few questions.

Uh, I can see my wife just rolling her eyes. Um, . , you know, consider also that we had never been to this hospital. So my wife begins to answer all the questions again, and then they go to order the chest x-ray. And my wife says, wait, he just had one done three hours ago. Do you think it's changed? No, not really.

Well, do we really need the chest x-ray? And she said, uh, can't you get it from the other hospital? She says, okay, no chest X-ray. We'll get it from the other hospital. Uh, my wife finally leaves so her dad can get some sleep. Sleep is good, right? we're supposed to sleep in hospitals. Well now, you know, at least here's how I'll say it.

It didn't seem to be a priority. You know, he was, uh, at this point, it's like 1:00 AM he gets woken up again at 3:00 AM gets asked a series of questions. Uh, a couple hours, every couple hours they wake him up to draw blood. Um, but again, I wanna reiterate, he received great care at this facility and we were really grateful.

The next wife the next day, my wife heads back and uh, you know, she's informed that they did a chest x-ray. She calls me up and she wants to know why they would do a chest x-ray, another chest x-ray when she specifically told them not to, and one had already been done at the previous hospital. Um, I do my best to sound supportive.

I do my best to try to explain, you know, workflow and um, you know, shift changes and all sorts of other things. Um, but can I just say without my wife in the room right now? Um, . There was no good reason for them to do another chest x-ray. Uh, it, if at the, at the worst, it undermines the clinicians and health system's credibility with my wife.

They went around her wishes, uh, they didn't really need to do it. Again, I understand how it happens, but, um, it, it was, it was a bad idea. I might come back to that later. You know, he got, he got better. He came home two days later. He's actually doing really well. Uh, we're grateful he received great care, uh, from great care providers.

Um, I think I'm gonna update the story again once we start getting the bills. I think that'll be an interesting part of the story. And, uh, something I, I want to sort of explore. So that's my 72 hour healthcare story. Here's what I learned. Not all epic implementations are the same. Uh, training is critical.

Um, . I, you know, I had forgotten how valuable the experience of walking in the patient's shoes is. And as A-C-I-O-I got the chance to, uh, experience things that as a civilian, if you will, I don't get to experience as much. And, uh, I welcome that it was, uh, again, it was great, uh, experience for me. Um. I want to, I will really drive this point home.

Uh, interoperability should have the patient as the locus of data and as the, as the locus of movement of that data. Um, and my point on this is always the patient is the only constant at the point of care. Epic isn't Cerner, isn't, Meditech isn't. Um, each point of care could have a different EHR. Each point of care could have a different physician, each point of care.

You, you name it. The only constant at the point of care is the patient. I think the patient needs to be the locus of the data movement. Um, other thing I learned, duplicate tests are prevalent. Uh, clinicians need to listen to the caregiver, uh, primary caregiver when they make requests. And uh, you know, one of my personal parts of my personal mission, mission statement is that healthcare suffers because health, it is lagging.

Um, it isn't the only reason for sure, but it is a primary contributing reason. . For duplicate tests, poor experience and lack of information at the point of care. So, um, let me tell you how my father-in-law's visit could have gone . with patient-centric interoperability. I wanna explain this as it could have gone.

Uh, so I hopefully will do it as clearly as I can. So, record firmly in hand in on his, uh, in the Apple Cloud or wherever it is on his phone he presents. Um, we pull out his or primary caregiver, my wife's phone, and which will have the record on it. And we select, you know, a handful of things, emergency, a few parameters, how long they can add the record, how they can use the record.

And it generates a barcode. I present that barcode to the hospital we're checking in at, and, uh, they scan it and the record goes into their EHR. Um, they view an ad to the record during the visit. When it's determined the transfer is required, they download it back to the, um, to the patient's phone or cloud solution, whatever it is.

Uh, they keep the information as required. I understand they have to do billing, they have to do, uh, they have to have legal review capabilities, uh, maybe an archive of some kind, and they have to be able to do, uh, some training and stuff out of it so we can grant them the rights to use those things. But nothing else.

There's no other way they can use the data except what is dictated by the patient. So then my wife presents at the Cerner shop. She pulls out her phone, makes the same selections, presents the barcode, even though it's a Cerner shop, they inherit all the information, including the chest X-Ray, which can automatically go into the workflow from the previous location.

Um, you know, my father-in-law gets the sleep that he needs, uh, because the questions have already been asked. They just need to verify them. He gets discharged, the entire record comes down to his phone. We moved to Florida in two weeks, which we are, and the next health system picks up where the last one left off.

Are there holes with this? Sure. But let's choose to solve the right problems. Right? The problems we're trying to solve now are kind of silly. We should be trying to solve the problems. Like, okay, we give, every patient has access on their phone. How do we, uh, ensure that we protect them from nefarious actors?

How do we ensure, um, . You know, that those kinds of issues, uh, don't come up. You know, if somebody, invariably, somebody says to me, what if the person's incapacitated? And I'm like, we've already solved that problem. It's called Break the Glass. We know how to solve that problem. Let's solve the problems that we need to solve.

Um, you know, with this type of solution, we end up with a better experience for the patient. We cut down on duplicate tests. We, uh, reduce costs, we reduce burnout. Uh, we improve quality by having the complete record at the point of care. Seems like . All the things we're trying to strive for. So I say, let's get to this solution and then we can, uh, solve the problems around this specific solution.

And I'm not saying that there aren't some challenges to it, I'm just saying it's a better place to start. Alright. So I wanna get to LinkedIn and some of the observations that came from that. So, . The, uh, the comments fall into a, a really, a handful of categories. Uh, there's the, I've been there, there's the call to arms, there's the, um, what we should do or what we can do.

Um, there's sort of this problem opportunity category, and of course there's the category of who's to blame. Um. So let's start with the, I've been there category. Mitch Parker, cso, Indiana University Health, uh, is responding to Ed Marks who also relay a story where he had a similar problem. He said, ed, I feel your pain.

We had the same issue moving between Pennsylvania and New Jersey and Indiana. This is a major issue, especially for parents of children with special needs. Every parent of them has to have the binder with all the relevant info. And, uh, he goes on, you know, we can do better and we should do better with exchanging info.

First CTO of the federal government and inter interoperability champion, uh, a woman implored us to do something about this. She told us of her story of taking her child around the country, a complex case, and she was carrying multiple binders with her, and she was terrified that, you know. Transporting the information that way, and, and people were just flipping through pages like this, she's like, you know, there's something important on page 110 that she's afraid they're gonna overlook.

Um, I left there with, this is a problem I wanted to solve. Uh, we built the case, we got the funding. I. Invested in several startups to see what we could do. Uh, we invested in clear sense and heart. You've heard me talk about them before. Uh, both were, and I own no interest in them whatsoever. Uh, both were designed to be an aggregation layer for all healthcare data with a set of APIs on top of it, security layer.

Um, not just the EHR data, but all the health data. Uh, we designed the, uh, clinical viewer that would aggregate the data and present the record. Uh, at, uh, from across various EHRs, uh, we created a patient app that allowed them to share a one-time use record with any health system. Sound familiar? Um, many years ago, by the way, uh, we could aggregate Meditech, Allscripts, Cerner, practice Fusion a ton, uh, epic, other EHRs.

Um, we did this through connectors. Uh, we did some reverse en engineering of the data stores, uh, to make sure that the, the fields were going into the right place. And, uh, you know, we overlaid machine learning to make the ingestion process, uh, quicker, better. Uh, so what happens? You know, why Bill? Where are these solutions?

Well, what happened is, uh, there was a merger. I left as CIO. Uh, both companies are still around doing really well. Um, but they lost that vision, that original vision, um, because they lost their benefactor and the health system that took over the health, uh, system innovation group, um, didn't see the value of it.

And didn't see the value of a health system platform. And quite frankly, I'm a huge proponent of platforms being the, uh, the mechanism for change within industries and not point solutions. This health system innovation group seems to be focusing on, uh, point solutions and, uh, it's really kind of sad. Uh, they are really did nothing with these two companies.

Both companies were really forced to pursue clients, uh, you know, . Through things that health systems are paying for, application rationalization, EHR, consolidation, archiving, leg legacy systems. They both are doing pretty well today. But focusing on the, uh, the basic blocking and tackling and plumbing of healthcare.

Um, you know, I say this to say this topic isn't new to us. It's been around for a while. There are solutions that are designed to . Address this. Uh, let's take a look at some other aspect. Oh, actually, let's get to a couple more. Uh, I've been their stories. Uh, Scott Wynn, healthcare Life Sciences Enterprise Sales Leader.

Uh, God bless, bill. I had the same experience in Hawaii with an emergency situation I was in. I. They had no access to my Epic records from Hogue and came out immediately saying they needed to do surgery, when in fact it was a flare up of diverticulitis. Scared my whole family. The surgeon even said we may need to stay on the island for two more weeks before transported back to the mainland.

Uh, another, uh, been there. It, it's still spotty. I was surprised at, um, NW. , uh, this is Fred Dempster, executive recruiter. Uh, I was surprised that NW immediately, uh, immediate care when their Epic had a record for my wife's EKG from other, uh, from another hospital system. The, the thing that I've said to Fred about this is, it, it's a shame that we're surprised when it works.

You know, it's a, it's a shame when we're surprised that the records actually came across. Here's an example of sort of the call to arms. Uh, Neil Stein, senior Vice President of Technology Services, ortho Carolina. The data belongs to the patient. Open access is key to Seamless healthcare, and I agree with Neil.

And, uh, I sort of made the case that the patient doesn't own the record. They only own the record, uh, explicitly in one state in that state of New Hampshire. Then I ended up with a back and forth with somebody who's in HIM saying, you're wrong. The patient owns the record. Um, I happen to know that the patient only owns the record in one state.

There are 27 states where it's, uh, ambiguous. Who owns the record. It doesn't clearly state that the patient, and it doesn't clearly state that the originator or the creator of the record, and in the other states, it clearly says that whoever creates the record, um, owns the record. This is actually actually a tricky situation when you think about it, um, because what we're saying is if I take notes about you, I, I, I'm sitting there with a client and I take notes about that client because I wrote about that client.

They should own the record. Right. I don't own the record, even though it's my, my book, my pen, my paper I'm writing. Uh, I don't own the record because I wrote about somebody else. They own the record. Uh, this is a tricky legal construct, if you will, who does own the record. And it has far reaching implications.

So it's not as simple as saying all 50 states, patient owns the record. Away we go. 'cause now we get into, uh, an interesting place. Uh, you know, another example of this is, uh, Lisa Conley, vice President, so many great minds in healthcare across, uh, organizations. How do we make sharing happen? We've been talking about it for over 20 years.

We've, we, uh, when we become patients and realize the impact, we personally start to dig in. Let's make it happen. Absolutely. Call to action. There's a whole category of how did we get here. Uh, Jua Kinin Award-winning digital products and solution producer. . Uh, company's cut off so I can't tell you who it is.

He said sorry to hear about your frustration and Yes, uh, lived it too. It's unfortunate that many of the excellent Rios and HIEs I helped stand up in California eventually withered away. And it, it's an example of, we, we stood up these Rios, we didn't fund 'em real well. My experience as ACIO was we had a Rio that went out of, just ceased to exist on a Friday afternoon and we had to scramble to come up with a sharing solution in one of our markets.

Um. Ryan Yost, uh, experienced Chief financial officer, uh, federally qualified Health Clinic rural hospital, uh, talks about, um, you know, he talks about the training, uh, and, uh, uh, training possibilities overwhelmed the hospital personnel. The move towards national data exchanges was supposed to alleviate this problem, but several of the systems don't talk to each other, which the government did not mandate when they invented and didn't need, uh, this didn't need to be this hard or waste so much money.

Right. So we got here through the federal government mandating the use of, uh, medical records without really understanding over, uh, overall the implications of it. So that's one of the ways we got here. And, um, you know, somebody, uh, . Subo Chatterjee, PhD, digital Transformation Technology Operations executive goes on to talk more about that.

This is after 24 years of HIPAA and 10 years of ACA, this is still, there's still an unbelievable distance to cover. No wonder cost quality curve is still and will continue to rise. Okay? So that's what people are saying. There's, they're saying, ah, you know, how did we get here? And, uh. They, they talk about the government mandate, they talk about the lack of standards.

They talk about a lot of different things. Okay, what can we do? Let's get constructive. What can we do? Uh, Dan Brown, CSP, senior Account Executive for Mag Magen. Magenic, M-A-G-E-N-I-C. I'm gonna assume the G is AJ Magenic. Uh, he says, is this a potential blockchain opportunity? The answer is sure. It's not necessary.

I don't think the immutable record makes it better, but sure could be. Um, Craig Evans Precision Healthcare Consulting said, uh, the sad part of this story is he essentially goes on to say, Hey, we have this mechanism, ccrs CCDs, we have this mechanism to be able to send this across, but health systems, you know, uh, don't use it.

To which I say, I've sat behind physicians who are using their CCDs and whatever. And, uh, to be honest with you, I don't wish this on anybody. I've seen records with hundreds of PDFs of CCDs in, in PDF type form where people are trying to string through these. Now some of that, uh, we can use NLP, we can make it into, uh, discrete data elements.

But until we're, we're using the raw record, until we're using discreet data elements and we're moving those into, uh, an unverified state, but still moving them into the EHR, um, I think we're gonna continue to have this problem. More what we can do, bill. My vision is one platform that allows the patient to have full control over their data.

This is Coolen, uh, Heini healthcare technology business leader. And you know, my only thing back to him is you know, who owns the platform. If it's a single vendor, you're gonna end up with a monopolistic type problem. If it's the EHR company, you're gonna end up with innovation slowing way down. Uh, and if it's the government, I have privacy concerns.

That's why, uh, you know, I still think it's gonna be . You know, it, it's gonna be multiple companies, common plumbing instead of policies. And that's the direction I think we're heading and I think it's the right direction. Um, you know, and then somebody says, you know, if it's epic to epic, the rep records should definitely, uh, be available.

And I do wanna point out, I did call the C-I-O-C-M-I-O the next day. Um, they looked up my, uh, father-in-law's record at the other health systems in Pennsylvania, and they found them. And they determined that, hey, this is a training issue. We're going to go down to our ED and, and really help them to figure out how to use care everywhere.

Great. Fantastic. My only problem with this is, um, you know, are we suggesting that every health system should just get to Epic When people give me this, like, Hey, this works, this is great. It works for 40% of the population in the country. Or this many records because it works in care everywhere. Uh, is, is, is that enough for us or should we be okay with that?

And, uh, I, I almost look at um, I almost look at some of these epic shops when they say that to me. And I'm like, so you're done. You're not working on this problem anymore. This is Epic's problem. If they choose to work with other EHRs, you're okay with that If they don't choose to, you're okay with that too?

Uh, I think that's really abdicating our . Uh, responsibility to our communities that we serve, which is a higher call than our, uh, than our loyalty to our EHR provider, be it whoever it is, quite frankly. Um, I think if there's multiple EHRs in our community, that has to be a call to action for us. We either need to do that, uh, through the technologies that are available or be searching out new ones.

Uh, you know, this goes on a little bit, uh, a little bit further. Uh, . Kyle Johnston, uh, VP of Client Services, uh, said, you know, if all EMRs could talk, that would be awesome. As you looked into hospitals on Epic, should be able to work together. Uh, but don't believe the same is true for Cerner and Epic and others.

Um, actually it can work. We choose not to make it work. Is is sort of my point on this. And then he referenced somebody else who said, Hey, this is really hard again, which I say, no, it's not. It really isn't. I mean, it's complex from a data quality standpoint, from a semantic interoperability standpoint, from from a technology standpoint.

It's not that hard, quite frankly, to write a set of APIs not that hard to aggregate the data, not that hard to aggregate it and withdraw form not that hard. Okay. Now there clearly, there's nuance to it and not everybody in the world can do this. Uh, but there are definitely companies out there who have been working on this for close to a decade and in other industries for multiple decades.

Uh, we can do this. In fact, you can see this in a Google Health Medical record that they're doing for Ascension. You can see that they're pulling multiple EHRs together, that they are harmonizing the data, that they're making a medical record across multiple EHRs for those, uh, for those patients, I. And, and they're not the only ones.

However, the value and accuracy of that data concerns me because of the documentation burden, burden on a lot of EMRs. Are just copy and paste and every point has a, uh, respiratory rate. Every patient has a respiratory rate of 18. Um, and I agree with her on the, uh, data quality problem. Here's what I found on data quality.

Transparency is a powerful data quality tool. Patients are the best data data stewards, and when you shine the light of day on data, uh, it, it really starts to move very quickly. Doctors see other date doctor's, uh, information, um, patients see the doctor's information. They start to ask questions and, uh, that whole thing accelerates to which, uh, Claire again came back and said, couldn't agree more.

Healthcare is right for disruption, especially the EMR. And she goes on to talk about, um, how data quality, uh, can help. Alright, who's to blame? I know you're waiting for this category. Um, you're . Uh, 'cause everyone wants to know who's to blame on this, and I, I'll just tell you what some of some people have said, and I'm gonna tell you my take on this in a minute.

So, Ashley Altman, nursing leader, uh, in psychiatric mental health care, uh, agreed. EHR companies claim they keep data from being shared due to HIPAA laws, which is just an excuse for putting profits before patients. It can be done and still protect patient privacy. In the words of the $6 million, man, we have the technology.

So let's use it. And we do. And I agree. We can, uh, we can make this happen, but it also gives you an idea of the, the sentiment on this also, who's to blame? I, I like this one because it's gonna make an interesting point. Helen Waters, EVP Meditech, uh, board member. Somebody I greatly respect. Hope your father-in-Law is doing well, bill, great point on freeing the data overdue progress and commitment to true interoperability across the EHR is.

What we all need to be committed to fully execute on doable today drives better outcomes and inform clinical decision making. So Meditech supports interoperability per Helen Waters, who's extremely high up in the organization. Uh, Cerner has come out and supported the ONC rule. Who's missing? Okay. Greg Deros.

Uh, D-E-S-R-O-S-I-E-R-S-P-M-P. Senior it Project manager, couldn't help himself. Could not agree more. And you can thank Judy Faulkner, CEO of Epic directly for this problem. She has been stomping her foot in protest of interoperability when it is exactly what is needed at this point. Shameful. You knew somebody was gonna jump on this, right?

I. So here was my response to, uh, Greg. Greg. Judy Faulkner is not the villain. This is a complex issue. Yes, there are monopolistic tendencies of markets at work, but health systems talk the talk and don't walk the walk here either. If health systems wanted to share records effectively, there are a hundred ways outside of the EHR to make it happen.

The federal, federal government messed up with mu. In high tech and funded these EHR monopolies without the proper controls. Now they're playing catch up. Judy's actions make her the poster child for a much larger problem, which is really true. Uh, and so here's my word to epic on this. I do, I highly respect Judy and what she has done for the industry.

Uh, you have to remember where the EMR was. When Epic really started to come into its own, uh, systems were making the move, um, making huge mistakes. And, uh, there were headlines in major newspapers and EHR implementations were going wrong. Uh, and Epic stepped into that void and they stepped in with a highly prescriptive model, uh, to ensure that implementations went well.

Um, they really should be applauded for this and not villainize. Um. Now, what does Epic do next is important? Um, you know, I personally, and I don't think anyone cares if Epic has a hundred percent market share of every health system in the country. I don't care what transactional system of record my health system uses, I do care if Epic uses my health record as a part of a bargaining chip to, uh, solidify that a hundred percent market share.

As a patient, I didn't choose Epic. I chose the insurance carrier. I chose my doctor, and now what I'm doing is I'm not asking Epic. I'm asking my health system. I'm asking my doctor, my insurance carrier, my health system to give me my record, all of it raw format on my phone. I want to be able to present at the physician practice I the health system, and provide them my entire medical record.

Uh, like these poor families have to do with their binders. I wanna sell my data to p to, to, I wanna sell my data to people who are willing to buy it. Um, that's my prerogative and I wanna be able to share it with research. If I choose to do that. When I'm told that my house system can't because of their EHR, I really get angry.

Um, you know, this should be an election year issue. It probably won't be because Epic is situated in a swing state and no one wants to upset the . Great. The people of the great state of Wisconsin. Um, here's my note to Judy. You know, the health systems that use your system revere you warts and all. Now it's time to focus on winning the patient's confidence.

I would say partner on this, the most important, this is really the most important topic of the decade, and uh, I think it's really epic has a chance to be the hero in this. By stepping up and taking the mantle of making healthcare data exchange across all EHRs work. And in order to do that, you have to lay aside some of the natural competitive instincts and say what is in the best interest of all patients?

Alright, so what's next? Patient-centric interoperability requires a mechanism, a mandate, a champion, and a means, okay? The mechanism is fire. The mandate is the 21st Century Cures Act and Public Pressure. The champion right now is ONC and that bipartisan legislation. Um, and really the team at the ONC and the means is gonna be the free market economy, not a federal solution.

Apple, Google, Amazon, Microsoft Health Catalyst, and others. Offer platforms that can pull this off today, and that's what's gonna happen if you put this data in the hands of the patient. There will be this ecosystem that emerges and it will be those players and it will be other players that emerge to say, Hey,

We will, we will handle your data for you and we will provide value. On top of that, we will provide care navigation, we will provide, uh, second consults. We will pro and you know, in some cases this is gonna be health systems who are smart enough to take advantage of this. This is gonna be the Mayos of the world who say, look, you want a second consult from Mayo?

And we're gonna stand up this mechanism for looking at the medical records of everyone in the country to identify ways to, uh, to do this. This is platform thinking. This is what John Halamka is working on. So. There is an opportunity here. Smaller players like M-P-H-R-X, heart clearsense are ripe for investment or, uh, or even purchase for the players who can't figure out the technology.

When I hear of EHR players not being able to figure out how to write APIs, first of all, I sort of scratch my head because this is not hard. The second thing I, I scratch my head and I say, just buy somebody. You got billions of dollars. You could buy these guys for, you know, a rounding error on your financials.

Uh, here's the situation. This is all falling into place. This is not gonna move at the glacial patients's moved over the last decade. This is going to move at an increased speed, and, uh, there will be renewed urgency to do this for the good of the patient. So that's the journey. That's where I get to in my head.

That's the area where I think this could get a lot better, uh, across health systems and, uh, to deliver. . On the, uh, the promise of great care for everyone in our country. Uh, I'm sure this went a little long. Um, I may just stop saying 23 minutes at the beginning of the show, 'cause I, I keep missing that Mark.

Uh, that's all for this week. Special thanks to our sponsors, VMware Starbridge advisors, Galen Healthcare Health lyrics and pro talent advisors for choosing to invest in developing the next generation of health leaders. This show is a production of, of this week in Health It. For more great content, you check out our website this week, health.com or the YouTube channel as well.

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Uh, and myself are just gonna talk news, uh, on that Tuesday episode before himss and, uh, hope you guys will tune in for that. Thanks for listening. That's all for now.