This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this Weekend Health it. It's Tuesday News Day where we look at the news, which will impact health it today, mark Weissman from the CMIO podcast is in the house to do a little. Back and forth on the news. My name is Bill Russell Healthcare, CIO coach, creator of this week in health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

A reminder, we're now doing three shows a week instead of five. We've been dropping. Uh, we'll be closing out the Covid series in June, and we're doing no live show this month. Come with a live show next month where we're gonna talk about bringing people back to work and some of the things that health systems are struggling with as we, uh, venture out into that area.

Special shout out to Ford for his service. Three X Drex, where you get three stories texted to you three days a week to sign up. Just text. DREX to 4 8 4 8 4 8. And it's a great resource if you're trying to stay current. Uh, this episode and every episode since we started the Covid-19 series has been sponsored by Sirius Healthcare.

It is their commitment to making this content available that has made, uh, these episodes possible during the, uh, pandemic. Special thanks to Sirius for supporting the show's efforts during the crisis. Alright, let's get to the news. Mark Weisman, creator of the C Podcast. Good morning, bill. Thanks for having me.

Normally I'm on the East coast where I work and live in Maryland. I happen to be in your old neck of the woods. I'm in Orange County today. It's early. It's 6:00 AM for here. man, I'm, I am so sorry. When I scheduled this, I assumed you're on the East Coast. I happen to have to come out for, uh, some family who are sick, so I'm helping out, but it's early and I'm good.

Well, thanks for doing this. You are one of the shows that I listen to every, every day I get up with a goal to consume some content of some kind. Uh, in, in, in the form of a podcast. I, I realized about. I don't know, about six months into this that I was a hypocrite. I wanted everyone to listen to my podcast, but I wasn't listening to anybody else's podcast.

So I, I started to incorporate it into my, uh, daily schedule. And I, I love your podcast. You, so you're, you're, you're doing, uh, two shows. You do a new show just like this, and you do, uh, an interview, interview show, but you also hold down a full-time job. So sometimes you're not as consistent as, as you would like to be.

I've missed a little bit recently, the Covid crisis, as well as just, uh, I got put as many CMIOs did. They said, here go take this telehealth thing and go do something with it, . And so , that's created a lot of of work that I, uh, suddenly got thrown into. So I've missed a little bit here and there, but we'll get back on track.

But listen. I'm looking forward to doing this. So we have a, uh, we have a few stories each of us, and we're just gonna take turns going back and forth. So it's gonna be the, the same kind of news story. You know, I do a so what at the end of every story, so, you know, for the ones you introduce, I, I'll expect us from you for the ones that I introduce.

I'll, I'll try to do a so what, and we'll go from there. So I'll get us started. CMS. So this is from, uh, healthcare IT News. CMS creates a new office of Burden reduction in Health Informatics. Let's see, what do they say here? The centers, uh, for Medicare and Medicaid services has formed the new Office of Burden Reduction in Health Informatics, an outgrowth of its patients over paperwork initiative whose mission is eliminating red tape in healthcare documentation and officials say permanently embeds a culture of reduction across.

Assessment instrument for home health. It is established within the Quality Payment Program, a consolidated data submission experience for different performance categories of mips and so that clinicians no longer need to submit data in multiple systems. Uh, CMS also eliminates 79 measures through modernizing proposals in advance.

Is to expand that and have it be an overarching element of all the programs that are, uh, being looked at by CMS. You know, I, again, from a, from a directional standpoint, I, I, I like this and I like the stuff that's coming outta cmm CMS, but from a physician standpoint, how, how are you, how are you looking at these kinds of things?

They're definitely helpful. The biggest change, of course, is coming up in January. With the way that we get paid. We no longer have to count the little elements in our note. How many review of systems did I get? I was looking at a provider's. Data their, their signal report out of Epic and it tells us, alright, how many characters does this doctor have?

This doctor had over 16,000 characters in their note. On average, it's about eight to 10,000 characters more than anyone else in their specialty. That's not regulatory burden there. That's just the doctor's style and they're copying everything forward from the last notes. And over time the notes have become huge.

He is 85 more minutes a day spent in the EMR on notes than his colleagues. So, yeah, we've gotta get to this. There's more valuable things that we can be doing with our time. So I'm excited to see more efforts around the burden reduction. Yeah. You know, I, I, I love the fact that you brought up that the signal that the e the EHRs have gotten much more sophisticated in letting us see, get, get visibility into how people are utilizing the systems.

And we can identify what of that is actually a government burden. What of that is actually style or, or, or approach? You know, my, my so what on this is, uh, absolutely if we learn nothing else through covid, uh, we were collecting data that now people look at and go, why are we even collecting this data? It didn't help us during the pandemic.

I, I talked to Dale Sanders during the, and how they needed to completely overhaul how collected information, asking too information.

So they just had to get that, the, the, the data down to that, that was very, uh, you know, specific and important for the, uh, crisis that we were in. You know, I, again, great movement, great direction. So what, what's the next story? What do you have for us? So I'm gonna talk about a story out of Jamia. The title here is Rapid Design and Implementation of an Integrated Patient, self Triage and Self.

And this is obviously, uh, an academic institution. The fact that they stood this up in two weeks, we can comment on, uh, later. That's amazing. But, uh, asymptomatic patients were asked about exposure history and then provided some relevant information. But the symptomatic patients were triaged and they had four different categories.

40% were selfcare. So they to conclusion, hey. The, the person to person interaction that would be required to get these self-care patients to do self-care, that that burden was relieved off the health system. And then those who were really sick, they were able to get into care, which is what they really wanted to do.

So Bill, in the past when I've looked at chatbots and self triaging type tools, the legal department, their eyes just get so big. They're like, you mean a computer is gonna be telling us how to do this kind of healthcare? How do you as ACIO bring these new technologies and get them adopted? Get the c-suite to go.

When you, when you live on that side, you, you, you, uh, pick up a handful of things that you have to do. You have to have champions, right? You're not gonna, I mean, that kind of system-wide rollout is possible during a pandemic. It's possible during a crisis because people are stepping back and going, we have to.

The crisis itself creates the demand and the driver for doing it. It's beautiful. That's why we had so much digital transformation over those, those three months, because there was no work to be done in terms of moving the culture. The culture moves because of the pandemic. But if you're gonna move a culture, but generally what you're gonna do is you're gonna step back and, uh.

You're, you're build the case, you're gonna have to introduce people to the technology. You're gonna have to, and you're also gonna have to have a fairly, I mean, you can't, you can't minimize the amount of time that you're gonna have to put in upfront, because if you minimize that time upfront, eventually you're not gonna build the foundation to take it system wide.

And I've done a lot of initiatives where, you know, we, we got the champions, we got people, they got excited about it. But we, you know, skipped a few steps and then when we went to go broader and scale it, we, we fell on our, fell on our face. So it's, it's really important to have that, that, that, you know, the business case obviously needs to be solid.

Don't even start unless you have the business case, uh, business case and healthcare being around quality, outcomes, cost, you know, the, the quadruple aim kind of things. Uh, but once you have that built out, get your champions, get them on board. There's always ear early adopters that you can work with. Get it, get it working in a practice.

I, Daniel Chy did a great job of this at, uh, uh, New York Presbyterian. He got a champion and what they did is that you came in, um, you came into their ED and you know, you could end up going through the ED process.

Them the option of going over into this and doing telehealth literally in the ed. Going into this room and doing telehealth drove the cost down for those individuals and they were able to triage. Now, some of those people, they just said, yeah, go right back over to the ED and get mine. Uh, but the number was not as high as you would think it was.

I, I, I vaguely remember him saying that, you know, 60% of which were taken care of via telehealth, even though they came into that Ed.

I don't know. I, you know, as a, I, I keep coming back to it as a physician, but you know, as A-C-M-I-O, how do you get things adopted? Similarly, it's finding that physician champion who's going to support you, and you need people out there who, who have the same belief and are interested in that technology or, or you will hit a lot of resistance out.

What on this story I. Health systems are putting these tools in place, that digital front door, they're capturing these patients and then making that seamless transition to the, to the provider. And as CMIOs, as CIOs, we want that transition to happen to be on our health systems website, not on someone else's.

So if you haven't adopted this kind of technology, there is a business case and a reason because your competitors in town, they are doing it So. So, yeah, so let me, you know, instead of going down this path of, I, I, I had a, a, a chat bot, uh, conversational technology story here, and it was screeners, navigators, nudgers, the future of conversational AI in healthcare.

By the way, I think there's a, a great future for this, and I like the, the terms screeners, navigators, and nudgers. Technologies, right? Because we need, we need, we are not gonna be able to impact the health of a community until we're able to nudge behavior. I actually love that word, nudge. When I'm standing in line at McDonald's, I need someone to nudge me to say, are you sure?

Let me give you the statistics of a 52 year old man who eats, you know, who eats multiple Big Macs a week, and what that does to your, you know, your, your blood sugar levels and, and those kind of things. I need nudges, right? Navigation is another thing that chat bot.

What technologies.

I'll give you another one, and I think it's, and I'm gonna record a podcast on this. It's gonna get released on Monday, and it's actually yesterday because we're recording this ahead of time now. I gave away the illusion. But anyway, we're recording this ahead of time. The, the other one is thermal imaging, and as I talk to these people as I'm, I'm getting ready for this podcast, I got.

To make places safer and to give people more of a peace of mind. I, I think that's a technology you're gonna see proliferate not only within hospitals. I think you're gonna see that at sporting events. I think you're gonna see it at, uh, office buildings and other places as well. What, what technologies do you think took a big leap forward?

I think it's. The use of the technology that we already had, that's taken a big leap forward in terms of being able to interact with patients in between their, in-person healthcare visits. Just the, the two-way communication systems that have taken off the, uh, whether it's the patient portal or use of text messaging, we're reaching out and touching people.

Checking on them, Hey, you've got Covid. We're following up on your symptoms today. Are you still doing okay outside of our hospital? We don't want you here. And that's just, it was been a different message and a different paradigm. So that technology, the adoption of that technology has really taken off.

And it's about time this.

Software defined, fill in the blank. Software defined networking software defined WANs. I, I think what we learned in the pandemic we in which we weren't ready for is I don't think any of the disaster scenarios that I had had us moving this quickly. I mean, even, even an earthquake as you, you're in Orange County, I don't wanna, you.

Rapidly, it's a different set of would

fundamental

s. Understanding, but in order to change rapidly, it has to be software. If it's hardware, we saw constraints, we saw a lot of our hardware comes outta China, unfortunately, you know, end up with those constraints at the very time that you need the hardware the most. So software defined is, uh, is something that's gonna take a big lead forward.

Alright, what, what's your, what's your next story? So my next story, I, I've actually got just a few that all relate to the same topic around telehealth and I thought we touched on this article. It actually comes off of the, the US uh, Senate's website. And there there've been some congressional hearings around telehealth.

And this, uh, senator, this is Chairman Lamar Alexander. Was talking about the temporary changes in the federal policy that made Telehealth explode like it has, and talking about how the federal government should permanently extend policy changes that allow physicians to be reimbursed for a telehealth appointment wherever the patient is located, including the patient's home, and extending the payment model around that.

Senator quoted in healthcare it 19th. What she was talking about is about the need to continue the audio only. Telehealth type visit because there's a segment of our population that doesn't have access to broadband. They live in rural communities. They tend to be poor. They don't, they can't afford a hundred dollars broadband bill a month.

And so she comments that based on a PEW study, a pew research study that was from last year that identified that it is minorities that tend to get hit the most. These kinds of policies, they tend not to have the broadband more than white people do. And so what is the implications of cutting off audio?

Only telephone visits gonna do to a minority population that needs access to care? And we will periodically say, Hey, we don't want you coming into our waiting room. You have underlying conditions that we think it's not safe. If you got exposed, you'd get really hurt. So we need to be thinking about that.

And I know this is a touchy subject when you start talking about racial disparities, but there, there's a reality here. There are patients out there that will not be able to get access. And I know you've touched on telehealth a bunch of times in, in your podcast here. What do we do as a country? What do we do as CIOs and CMIOs to help?

The political process along here. I could give you a quick story, bill. When I was at Sentara in, in Virginia, nurses in Virginia were not allowed to refill prescriptions. The the law said it must be signed by a doctor, and I had never had any reason or desire to get involved in politics, but I was like, this is silly.

Nurses can refill Lipitor on a patient who's been on Lipitor for five years and has heart disease. They do chronic disease management, they do education. We should allow nurses to sign prescriptions and just for refills of chronic meds. I happen to have a patient who's a state senator. I ask them, can we change a law?

He's like, sure, change the law. And so as A-C-M-I-O, I, we tend to politics. We don't wanna be too political, but in a case like this. What do you think should CIOs and CMIOs step in and give their technology expertise to congressional leaders around what we need to do to keep this going? Yeah, so if I were sitting in the CI chair right now, I would be, uh, collecting.

Massive amounts of data on how Telehealth worked within your organization. How much of it was, uh, voice only, how much of it was video, what modalities worked best, what the service lines worked the best. And I would break that down by, I would've my data science team all over this right now. So that's, that's the first thing, because you have to.

For some additional investments as well. So this would, if a CCIO is listening right now, cm I is listening right now. If your data analytics team isn't crunching the numbers backwards and forwards on telehealth within your organization, you're missing the boat. The second thing is there's regional groups.

There are, we all have 'em. And Southern California, there's a group called Chiefs.

From San Diego up to and including LA County and even out, uh, out a little further into, uh, some of the other counties. But essentially we got together as to say on a quarterly basis. That's the kind of group that you can get together and say, look, we want to impact what's going on in California. Here's the data I brought together.

Do you have data as well to support this? Here's what congressional leaders need. They need the story and they need the, the data, just like your CEO needs. They need the story. They need the data. Don't think that they're thinking about this every day of the week. They have to think about this. They have to think about the riots.

They have to think about covid. They have to think about whatever. It's your job to build the story for them. If this is the most important thing for you. Give them the data and don't take pride ownership when they stand up on the floor and are sharing your data, by all means, just cheer and applaud. Two things need to happen in telehealth.

One is broadband access, is defining the haves and the have nots in the United States. We need to address this in a big way, and the FTC is addressing this in a big way. And I think we just need to continue to, to push that. The other is we need to really do the analysis around this. And again, I'm not gonna throw out the the numbers because I'll get in trouble here, but the sisters were always saying to me, because we were doing a lot of technology pushes, and they were saying, we're leaving people behind.

What about people? What about the disenfranchised? What about, and you know, we did some analysis.

The people who don't have home, the homeless and others, they have smartphones. Their lifeline to the world is through smartphones and four G. So if you're defining any technology you need to, you need to make, if you really wanna, that pipe now there's gonna be some that they have to go somewhere to, to interact with the health system.

I understand that.

These medical kiosks and all these, uh, places where the homeless go for dinner and lunch and those kind of things. But we have to be thinking about our technology needs to be able to work across four G for the foreseeable future. And we've gotta address broadband. 'cause at the end of the day, the, the biggest telehealth workstation is gonna be this and.

Just, uh, passed something where they're essentially the allowances that have been going on, they're Idaho conversation on in bipartisan. But again, we have to, we have to load 'em up. We can do that through Chime too. Chime has people there. We can just give them our data and have them go and load them up.

That'll work. Yeah. So that's my, so what is that? Get the data. Look at your data. We looked at our data. We are seeing what you would expect. That we have connectivity issues in rural areas and the minorities are being disenfranchised and being left behind. So yeah, as CMIOs we, we do have an obligation to treat.

Everyone and make sure they have access to care. You know, I just did a podcast with, and it actually hasn't aired yet with, um, the CIO for the health system of the Cherokee Nation, and they covered almost the whole state of Oklahoma. And he addressed this specifically. He's like, you know, at the end of the day we have to, we have to do all sorts of things because, you know, we provide telehealth in.

Said, because you know, quite frankly, the whole state of Oklahoma is still not covered by cell coverage. Just hard to believe in today's day and age, but that is absolutely the case. He told a story if somebody had to drive 30 minutes to get a cell signal so that they could have a conversation with their doctor.

So I wrote to Verizon, been talking with them a little bit, and, uh. They, we said, Hey, we've got coverage issues in our area. What can we do? How can we use some of this FCC money? Can we get a cell tower put in somewhere? Trying to think out of the box a little bit. 'cause we have dead zones. And the, their initial response has been, we have the best coverage everywhere.

This one guy wrote to me and said, look, I, I coach, uh, softball in, in your area and when I'm on the softball field, I have no problem getting cell reception. I didn't write back to 'em, but I wanted to so badly to say, I'm so glad that you have coverage while you're on the softball field. But my doctors who are trying to treat cancer patients can't connect, and they're not on the softball field.

That's why the softball field's in the middle of town and they live on a farm, so need to. Take a step down from the arrogance here. Understand the position the doctors are in. We are trying to treat patients who are very sick and cannot get access to care. We need you to step up and help us out here, so, you know.

Absolutely, absolutely. Mark, I, I, I appreciate what you're saying. The hard part of that though is if I work at Verizon, my job is to make money. I'm not a mission. I, I mean, the sisters would be horrified with me saying this, but, but Verizon is not a, you know, a public service kind of thing. Uh, at least it's not a utility.

At, at least not yet. And the reality is they're looking at it going, all right, am I gonna put a four G tower in that remote place in Virginia or am I gonna put G all over New York City? No doubt, and that's where regulation, I mean, I'm not one who always says we need regulation. As a doctor, I want less. I want less regulation.

But in order to protect those who can't protect themselves, there's no way the poor farmer in the middle of a field is gonna be able to convince Verizon they need a cell tower, or we have to figure out other technologies that can get help to these remote areas. Yeah. And this is what, this is absolutely where the government has to step in.

You know, if I were, if I were at the FTC overseeing that, the, the deal between Sprint and T-Mobile, I think those are the two that just came together. Mm-Hmm. , uh, part of that for me would've just been, okay, look, you guys can come together, but if you come together, you have to put a cell tower. There, there, there, there, there.

You know, I, I've.

To expand your coverage. I wanna see this. I know you show this map is completely covered, but that map does not indicate how much density you can actually handle in those locations. And, you know, we wanna, we wanna build that out and the next time, Verizon, because Verizon's gonna come and ask to buy something and they're gonna have, that's, that's when they have the most sway over these, these organizations.

And then the f.

Fill doesn't building a.

So, hey Mark, I, you know, as always, I didn't get through all the stories. We'll, we'll, we'll get better if you're open to it. I'd love to have you on again, and we'll, we'll, we'll keep, uh, doing this format from time to time. You can bring your best stories from your show. I'll bring a couple from mine and we'll, we'll try to do this again.

Thanks. Thanks a lot for doing this. That's all for this week.

Health it. Check out our website this week. Healthcom. Check out the channel as well. Best way to do share with Peer. Also share the CM I podcast with peer as well. It's a great show and they, they lean more on the medical informatics side as you would imagine. Uh, I'm picking up and learning a lot from it.

So highly recommend the show as well. Please pick, check back every, you know, we're now dropping a show every Tuesday, every Wednesday and every Friday, and that's gonna be our schedule moving forward. So thanks for listening. That's all for now.