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 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former Healthcare CIO for a 16 hospital system and creator of this week in Health IT at channel dedicated to keeping Health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our new state show sponsors for investing in our mission to develop the next generation of health IT leaders.

We set a goal for our show, and one of those goals for this year is to grow our YouTube followers. Uh, we have about 600 plus followers today on our YouTube channel. Why you might ask because not only do we produce this show in video format, but we also produce four short video clips from each show that we do.

If you subscribe, you'll be notified when they go live. We produce, produce those clips just for you, the busy health IT professional. So go ahead and check that out. Uh, we also launched today in Health It a weekday daily show that is on today in health it.com. We look at one story each day and try to keep it to about 10 minutes or less.

So it's really digestible. This is a great way for you to stay current. It's a great way for your team to stay current. In fact, if I were ACIO today, uh, I would have all my staff listening to today in health it so we could discuss it, you know, agree with the content, disagree with the content. It is still a great way to get the conversation started, so check that out as well.

Now on to today's show today, Dr. Mark Weissman Pinch Hits as a guest host and we discussed the news. One last quick note, we're going to a summer schedule starting on June 1st. Monday will be Newsday. Friday's gonna be the Influence episode with an occasional solution showcase on Wednesday. The big difference is we're making no commitment to doing a Wednesday show.

That's a break for the team, which has been doing eight shows a week. And a chance for you to catch up on some of the shows that you may have missed. If you, uh, miss my commentary, you can always check out Today In Health It, we're still gonna be doing, uh, five episodes a week, one a day, about eight to 10 minutes, so pretty easy to fit into your day.

Alright, let's get to it. Mark. Welcome back to the show. Thanks, bill. Thanks for having me on again. Love it. It's, it's been a while. How, how are things going? Attal Health, right? It's not Peninsula anymore. It's title things are busy. We've got exciting projects going on. We're not only focusing on Covid anymore.

We have a Cerner to Epic conversion we're doing at a hospital. So that'll keep me on my toes for a little bit. , I, I noticed your CMIO podcast has not been staying current. Is that because the demands of the job have been a, a little bit much over the last couple months? It has been. These podcasts take some time.

Uh, uh, you've got a staff of. 50 people behind you. I know. 50. It might, it might as well be a hundred. I think that, that make it so easy for you. So I, I do feel the, the tug to get back to it and it's, I loved doing it. I still want to do it more, but hey, if I get a chance to come on and, and still get my, this scratches my itch to.

Get out in front and, and help educate others about what we're doing. Well, if, if you want to get the CMIO podcast going again and want to tap into my, uh, production team, although my production team is listening to this right now and they're cringing, but, but if you want to tap into my production team, we can probably make that happen.

So, 'cause I, I, I do miss it. You were one of the podcasts I listened to on a pretty regular basis because you were filling in that gap of. Things that was maybe more medically inclined and, and more clinical in nature around the technology side. And that was, that was extremely helpful for me to, to stay current on that stuff.

Any suggestions on who I would listen to today? If, if you're not putting out podcasts? I haven't, the reason why I went into doing the podcast 'cause I couldn't find the content that I want to listen to you with a little more clinical slant. I, I'm a regular listener to your show. I get a lot out of those.

And you'll occasionally have CMIOs on and you touch into great topics. And my interest as A-C-M-I-O has happened to broaden more. I'm, I'm, I'm interested in IT security, I'm interested in, uh, moving to the cloud. Those kinds of things are very exciting for me, so I. Your show is the one I go to, but no, I don't have a clinical show that I can go to on a regular basis.

Well, I'll tell you what, we're not gonna talk about security today. Although I, I did make the joke over the last couple of weeks that we could easily turn this into a security show. There are so many security stories going on right now and, uh, obviously the one that my heart is really trying to get their system back.

I didn't get an update today, but I know that earlier this week they were still down after two weeks, so that is a very difficult situation to be in as a health system, I'm sure. And I hope they're, I hope they're able, I know a lot of smart people are working on it. And I'm sure they've called in some, some really great vendors to help them as well.

And I know that the federal agencies are probably helping them as well at this point. I mean, it's pretty much a ransomware situation, so why does it take so long to get back up after we, is it, is it because of the work of putting stuff into servers or is it the bad guys are still in there and you gotta get 'em out?

I mean, what's the, it's it's a combination of things that the bad in there.

Because, uh, a lot of our backups have gone nearline, so they are actually on the network because we have to back up so much data, they have to be faster. And so we've gone away from tapes. We didn't like swapping tapes and sending 'em offsite to somewhere else. We thought, Hey, we'll be smart and we'll start putting 'em on, uh, on essentially storage arrays and stuff that we have in our data center, and we'll trickle that out to other offsite or near site storage.

The problem is all of that stuff was on the network, and one of the first things ransomware attackers do is they follow that trail. They find your backups, and they make sure that you can't restore. They ransom, they lock up the backups is one of the first things they do, and then they start locking up your core systems.

That makes sense. That's why it's so hard. You don't have the backup to back up to you. Yeah, one health system. I did talk to their leader, and it was not on the air, but he essentially said, we've lost every image we've ever done. And I was like, that's serious. I mean, every patient that comes in now has to have their imaging re work redone, but it's bigger than that, right?

So you lost all the historical data, you lost. I mean, it's just, it's just gone. It's nowhere and it can't be rebuilt. So that's probably an untenable situation for scripts to be in that predicament. We saw the, uh, the pipeline, the colonial pipeline. They actually paid the ransom because they couldn't fathom we couldn't

Gosh, if we had gone another couple weeks without that pipeline, we would, we would be back to a work at home situation. 'cause, 'cause there would be no gas up and down the east coast. Right? Yeah. So that's, yeah.

Gosh, I, I, I pulled some things I think are interesting. The, the one of 'em I sent you over a story this morning on a tiny implantable ultrasound chip for physiological monitoring. I thought this was really interesting, uh, really interesting story. And since you're a physician, it's a perfect topic for you.

So, researchers at Columbia University have deployed a microscopic implantable chip for physiological monitoring. It has a total volume of less than 0.1 millimeters. To put that in perspective, the chip is as small as a dust mite and can only be viewed using a microscope. The goal of this research was to create a device that can be injected using a standard hypodermic needle, and which then beams their readings wirelessly to external displays such as patient monitors and smartphones.

The Columbia team used externally applied ultrasound through a conventional ultrasound image to power and communicate with the implant. And we're, we're getting to that point. We're getting to that point where we can actually have things that get injected into the bloodstream that report things back. I mean, what's the promise of kind of technology Do.

So this is remote patient monitoring on steroids, I guess. I mean this is well, or, or miniaturized to, to the nth degree. The device that's in that article is measuring temperature, which is one use case. That's interesting, but probably not where the biggest clinical need is. We probably diabetes and glucose monitoring is the one that, that is the

The use case that would get the most attention right now. So when they have the ability to have something like that, that's monitoring your glucose in real time and reacting, and it has to be incredibly accurate, but then adjusting your insulin levels, that that's gonna be really valuable. Do we need to make it any smaller than this?

This is incredibly small. I think it matters where it goes and, and its ability to not get attacked by the immune system and be seen as a foreign body and kicked out. Those are gonna be the challenges is, is getting it to be implanted and stable. Now they've solved that for, for other, we have other implantable devices that do just fine, but you're talking some, something that's so small you're not retrieving this out.

Again. Once it's in, it's in and you don't want it floating around somewhere where it doesn't belong. So there's gonna be some interesting challenges with it. It can't, can't work forever. And then what, so what's the power source? The power source on this one I recall was ultrasound waves that were exo external that would then penetrate and then generate the power source, which.

Is phenomenal that that concept of not having to walk around with a, a battery, people are gonna , I, this is just the joke. I mean, people are going to essentially say, Hey, what about privacy? And, and, and it's a fair question, but, you know, something like this, it, it just has to get to the point where the use case has greater value than the risk of privacy and.

With, with smartphones and tracking, I mean, the, the Android device tracks just about everything you do in life, but people just don't care because there's so much value in carrying that device that they, they, they don't really push back all that much. And if, if you have diabetes and this helps you to maintain your insulin levels and, and a bunch of other things, I, I, I have a feeling you're not gonna be overly concerned.

Plus, this thing doesn't exactly have a range. I mean, when you're talking that size. The limited power it has, it's not like it's, it's beaming it from New York to la. It's just not that powerful of a device. I agree with you. If I had congestive heart failure and it was being repeatedly admitted to the hospital, the current technology in remote patient monitoring, you're talking about blood pressure cuffs and pulse oximeters.

We're really not moving the needle from a technology standpoint in changing the trajectory of that patient. Now, if you can get a device in there that measures the pressures inside the vessels of the heart, the the pulmonary artery pressure, and if you can tell what's going on there, there is a study out that says yes, you can start to change that trajectory.

And that's the kind of really invasive, but we've done with such a microscopic level. Maybe it doesn't have to be so invasive in the future where we can make a difference and have remote patient monitoring, hospital at home, all of those exciting technologies. As this stuff gets smaller, that becomes more possible.

Yeah. Well, not to put you on the spot, but conferences. Have you gone to any yet and do you plan to go to any of the big ones, HIMSS 20 ones coming up, health, any of that on your radar, or do you just too much good going on these days? Great question. I have the Go Live happening July 1st, so August conference season.

Yeah. I'm excited. I'm not gonna do HIMSS this year. Uh. We can talk about their health passport. We probably should in a minute. There's an article on that about them checking Covid on everyone. I'm a little, I'm a little disgruntled with HIMSS from last year in their hotel cancellation policy, so I think they blew it on that one.

But I'm gonna do epic, the UGM at the end of August and then chime. I'm gonna catch, I haven't been to Chime yet, so, um, I'm looking forward to doing that in October. Yeah, I mean October seems like a pretty safe time to do a conference at that point. I think the Chime event in San Diego is gonna be pretty well attended.

HIMSS is the first one out of the gate, so let's talk a little bit about that. There's a couple of stories that are out. Theres and Health have both said essentially, if you're coming on site to these uh, conferences, we want you to show proof of vaccination. So. You can do that through. And they have various ways.

Actually, Kims hasn't figured out how they're gonna do it yet. Health has a method for showing your proof of vaccination. For onsite, you have to be vaccinated. You can still do it offsite, virtual if, if you are not vaccinated. And I, I think there's a lot of reasons around that. Part of it's just marketing, right?

So you just look at it and go, Hey look, we're we're putting on a healthcare conference. So a majority of the people we're dealing with are gonna be vaccinated anyway. So number one, you're not limiting your population at all. Number two, you get to sort of tout safe environment, and if didn't tout that, you probably are gonna lose some of the people that.

Are vaccinated. Vaccinated, they're not gonna be able to come because we have to make a case. Right? Because a lot of health systems still are not allowing travel for things like conferences. So you have to make the case for, but this is important enough for me to go to, and oh, by the way, it is a safe environment.

So I, I think it was a sort of put this. And, and that's why they're doing it. Technology's there Bill, though. I, well, let me rephrase that. Do you think the data is there? So I got my vaccine at the hospital, so it put into Epic, it went to the state vaccination registry. So all these apps and I we're fragmented now, right?

There's no one app that you could go to that says, I am the passport app. The federal government has said it's not gonna do that. It's not getting into that business. There's no federal covid vaccine registry out there. So how is Hims by August gonna have a vendor that can connect to all the state registries, bring that data together, no duplication, and have accurate information to tell my covid status when I walk in the door?

I don't know. So, so, so let me, lemme tell you how I think they're going to do this. I could be proved wrong. The vaccine credential initiatives out there, there's 300 participating organizations. But again, I, and, and that's ready to be deployed, but it's a framework that others consume, right? So you have, you have these passports that can bring the information in.

I went to Costco the other day and I'm walking in and I'm searching for my card. I realize I don't have my mask on, and I show him the card. I said, Hey, what's your mask policy? He said, well, if you've been fully vaccinated, you don't have to wear your mask, but if you have not been fully vaccinated, you are, we would like you to wear your mask.

I said, okay. I said, well, I've been fully vaccinated. I'm like, would you, would you like to see the card? He goes, oh, no, we're not checking. I'm like, okay, because I have my card with me just because I had it with me for whatever reason. Plus, I have it.

Hand signed little thing, and I thought, I even said to the guy as he was writing it, I'm like, how hard would that be to forge? He goes, not hard at all, . I said, how's that? And I also asked him, I said, how's that gonna get into my medical record? He goes, it's probably not gonna get into your medical record.

I'm like, yeah, that makes sense to me. I don't know how you would've access to my medical record to get it in there, because it wasn't done by a health system. It was done by, by by the health department. And everything was really paper based. And so here's what I think is gonna happen at the conference.

Okay? You have to provide proof of vaccination, which a lot of people are gonna have the card, and you can provide that card, and they're gonna say, okay, you've provided proof of vaccination, and it becomes an honor system. Really? Yeah. Because if I wanna forge the card as an.

I'm not sure why I would do that, but I guess I could do that from their standpoint. Hey, we checked everybody to the best of our ability, given the technology that's currently available. We didn't like scour the, the registries or anything, but we, we checked everybody. And at the end of the day, to be honest with you, and again, you're a physician.

I'm not a physician, but this just my, I'm, I'm just reading the data that I.

Two shots of the Moderna or Pfizer vaccine. Actually getting Covid is 0.07. All right, so if my chance of getting Covid is 0.07, that is well within my parameters for leaving the house and interacting with people, because I do that every day when I get in my car and I do other things. So I recognize that there's a chance I.

The other thing I would say is there's no surge going on in the hospital, so I'm not really concerned if I have to be taken to a hospital. The third thing is that the vaccine is actually proven to reduce the impact of the virus on me. So that's the third thing. The fourth thing, quite frankly, is we know more today we're, we're over a year into this.

We know which treatments are working, which treatments aren't working, and we're just better at this. I don't want to like unduly increase the risk of getting covid for any reason. But I'm also not worried if, if a handful of people happen to be there that have, uh, covid, because first of all, it's in Vegas.

You're gonna run into people who have covid or unvaccinated. You're gonna sit at the blackjack table, you're going to, uh, interact with the hotel staff. You're gonna Uber, you're get on a plane. So there's no way to really create a, a true bubble around this. So that, that's just my thinking. So how, how crazy am I with.

I think you're spot on. I think the question is more about will you get the experience that you're used to getting at himss where I've gone to to go get into a presentation and you can't get in the door. Well, now they're going to block off seating. It sounds like on their webpage, they're talking about how they are gonna separate the.

Presenter's gonna have a shield, a face shield on, is the experience gonna be the one that you want? The downstairs floor, the vending, they're gonna space them out differently. Maybe they have less vendors coming and so that's my question for, for him is can you pull off the production? Can you the show that that is hymns that, that, that circus atmosphere, and maybe it's good.

Maybe change is good. But I think people have certain expectations around hims and I wonder if this year's gonna meet it. Well, you, you mentioned a bad taste in your mouth based on the hotel. I'll tell you the vendors I, I've yet to talk to a vendor that hasn't had a bad taste in their mouth by how HIMSS handled the cancellation.

Last year, and I think that is gonna be one of their challenges. I, I think people are gonna be there because they paid the money to be there from last year and that they have to carry it over and and whatnot. I don't think there's a bunch of 'em that aren't gonna be there, because again, their travel policies as a, some global companies are essentially saying, look, we're still not, our travel policy isn't get on a plane and go visit whoever you want.

Now with that being said, a lot of my clients, a lot of health systems now are saying for the.

Whereas just even three months ago, people were still saying to me, no, we, we still don't have any vendors coming on site. So things must be a factor. Don't you think, bill, that budget's gonna impact now? 'cause the hospitals, we're not, at least the friends that I'm talking to, we're not getting travel budgets like we were in previous, uh, years.

It's, it's pretty lenient now, so, well, yeah. I mean, it's always the first budget to go right. The travel and the education budget. It's one of the reasons it's so valuable, the CMIO podcast, and it's so valuable. What we do and what we see ourselves as is really a conference that goes on all year. We bring on great guests.

We have the conversations, we do round tables. And the podcast has become sort of the, the conference that can go on year round that people can, uh, attend those things. It's not a, a, a complete, clearly it's not the same because you don't have that face-to-face interaction. That's I think, what we really miss.

Mm-Hmm. , I agree with you. So, all right. We have a bunch of different stories here. We have interoperability 3.0. Prior authorizations. We have a telehealth reimbursement parity has insurers worried about over utilization. We have Amazon. There's always an Amazon story. They're launching a home medical testing.

Ascension is group laid off, 651 employees. I lay all those stories out to say pick one. Which, which direction would you like to go? Let's cover the Ascension story. It, it, it came out a few weeks ago, but I want, I wanna pick your brain on this one, about what this holds for our future. 'cause I think it, it raised some alarm bells in, in the back of my head.

The, the article is, it's out there in a variety of different places, but I think the one where I saw it on was Becker's. Yeah. So here I could set it up. So it's Becker's ascension technology business to lay off 651 employees. And St. Louis based plans to lay off estimated 6 51 remote workers. This year, according to the St.

Louis Post-Dispatch, Ascension technology said it will begin working with a third party to take on the tech support for EHR and revenue cycle management responsibilities. Its employees had been performing, the company said, and April 27th, uh, notice that it filed. None of the employees affected in the layoffs are based in Missouri.

All the positions report to an office in St. Louis. This is obviously from the post Louis, is the reason they're Ascension technology plans to facilitate the layoff between August 8th and December 10th. So what's your question on this? So I'm not so worried about the employees here. This is an epic shop, I believe Ascension is and and they're gonna get picked up in, in a heartbeat 'cause they can work from home, they can work anywhere.

There's hospitals clamoring for Epic analysts all over the place. But the question is, as a smaller health system that's on Epic. What should I be thinking about? Here's a large health system outsourcing. Should a small health system have 50, 60 Epic trained analysts to hang onto on our budget? Or is outsourcing attractive for this kind of work?

Well, you guys look at the product I want. I remember why I like talking to you. So you're putting me on the spot. I'm So, here's the hard thing about this. I don't think you have that choice. By the way, as an epic shop, Ascension is not an epic shop. Ascension is an everything shop. They have 105 locations.

Literally, they have everything. It's one of the reasons they did the Google deal that they did was to pull all their information, all their clinical information into one repository, and then they created an interface that you could see the entire clinical record normalized across

press.

A really nice Google searchable method, and it's, it's, it really is slick. I saw a video on it. It's really slick. With that being said, 105, they're cutting those people. The reason I don't think you have that choice as, as Epic is there's no way for you to stay on honor. Roll epic. In their wisdom. Put financial, one of the things that Epic does is they're very deterministic.

They make, you're gonna be successful in your implementations, but they do that by taking a lot of the levers out of your hands. As ACI. They were like, Hey, we can't allow these systems and these CIOs and these CEOs to cut the budget in places that hurts the Epic implementation. So they create this thing called honor roll.

There's financial incentives around it, and if you don't meet it, that money goes away. So when you're sitting there going, Hey, we could, we could cut $10 million here if we, you know, cut this stuff immediately, you come back and go, yeah, but we lose honor roll and if we lose honor roll, we lose 15 million.

So that cut doesn't make any difference. Look somewhere else, which is really interesting because there, there's a fixed cost to doing epic, and there's decisions that you cannot really make. So you, you're not gonna, you're not gonna make any cuts there. You could do it with outsourcing, but when you outsource one for one, there's almost no savings.

Sure, sure. As we grow our health system, we have found, okay, we've added another hospital. We didn't have to add another 50 analysts though. So there's, it is not a linear, as systems start to combine, there's not linear growth in your Epic team. So if you could get a pool together. Of hospitals and have it centralized epic team that manages them.

That would be a great way to save money. There's probably a business in there somewhere, but Oh yeah, no. Look. Look, there's a lot of players you could go to. Providence has a team that does that. Sirius Healthcare, who's a sponsor of the show, does that as well. There's a bunch of players out there that you could go to that are leveraging their capabilities, multiple clients.

Something that you can do. I, I, yeah, I, part of me is, I'm choosing my words here because it's an interesting, it's an interesting challenge. It's an interesting problem to have. I, I'll just go ahead and share the story. When we did our analysis of what it was gonna cost not to implement, but post implementation, so we looked at Cerner, we looked at Epic, and we were on Meditech and we were, again, 16 hospital system, about six, 7 billion in revenue.

And what we, uh, had was we, we were running all those on Meditech. And the reason where they were on Meditech is they all started as individual hospitals and then they were brought together as an operating company, uh, as opposed to a holding company. And so now we had all these disparate systems and now it was time to bring 'em all together.

And so what we ended up doing was we just upgraded to a single instance of Meditech. And one of the reasons for that was. Ongoing cost to maintain Meditech from just the ongoing staffing to maintain it was about two and a two and a half times less than maintaining an Epic system. And those are just the numbers.

And it was a long time ago, and maybe those numbers have changed. That was our experience and it requires you to add a lot of staff, to have a lot of staff dedicated to that system. And again, with honor roll and other things, it's really hard to cut that staff. Or to make any adjustments to that staff. So finding savings in that area.

The best way is, the way you just said it, is to grow, is to buy another hospital and another hospital and another hospital. That is the best way. Scale is the best way to make that investment in those people Make sense. That makes sense. So you call the, the show, the education of Bill Russell Today it's the education of Mark Weissman.

So I appreciate that. . Well, I mean, one of the misnomers we think every major system is, is on Epic and Ascension probably has some epic, if you think about it, five hospitals. But you know, there's, there's still some Cerner shops out there and there's still some, some Meditech shop there. Actually, there's a fair amount of Meditech shops.

The smaller health systems have a choice of going community connect or going in the, uh, Meditech direction. And if you wanna have any autonomy whatsoever, you don't go in the community connect direction because it's, you give up a lot of autonomy when you go in that direction. I, I was hoping to do the.

The interoperability article. Alright, so I'm gonna throw this one at you. Interoperability, is that top of mind. Does you guys, have, you guys have a group of people leading your IT efforts? Are you guys talking about interoperability as you're getting ready to do a new, uh, standing up a new EHR. It is the biggest thorn in our side, and clinically, when I'm in the exam room, it's the biggest thorn in my side.

I think about it constantly. Now, other doctors probably aren't saying, oh, I'm thinking about interoperability in those terms. But what they are saying is, I can't see where my patient went when they got their colonoscopy, and someone's gonna fax it to me if I ask for it three times. Then I'll get a piece of paper on my desk.

Is that because they're moving in and out of your system, your health system? They do. Sure the world's great if everyone's on the same electronic health record, but when they're not and you need discreet data that you want to alert off of or trend off of, now we don't get any of that coming in through the care everywhere or, or the care equality and all those, those, even the state HIEs, we don't get discreet data in a complete data set.

There's some errors that can happen that are quite scary. The EHR is a very dangerous tool in the wrong hands. And when you try to bring in this data and if you have matching problems or things that error out and go to pools that no one knew about and is not being monitored, you can get yourself in some, some pretty quick trouble.

Yeah, it's getting the longitudinal patient record into the hands. Of the care provider at the point of care has always been a challenge here. Here's my question. I, I mean, I've sat across from doctors who were like, look, I don't even care because I have a series of questions I'm gonna ask anyway. Now, once I ask those questions, I'm gonna wanna do some research into the medical record and, and hopefully find things that, that I need to find based on those questions.

But for the most part, if, if I don't, I'm just gonna order a test. I mean, is that still the, the thinking. Very much so, although many of our doctors now have their staff go out and pinging individual databases that are out there to say, okay, for tomorrow's schedule, every patient, go look and see if they've been to those locations and bring that data in.

Copy and paste it into my note, prep my note for me so that I'll have all that data so I can make a decision. With that patient at that moment, not, they don't wanna have to go back and do research and, because that's what's called pajama time now. Now that work gets done after five, they wanna do it with the patient in front of them and have that conversation wants.

So the interoperability, pain points that clinicians experience, yes. They will simply go, oh, I'll just order another test. Quite frequently, they wanna compare to old tests. They wanna understand how things are changing, so they still want that data. Yep. No, I can see that Brett Oliver, who you're familiar with from from Baptist, put a post out on LinkedIn about this.

What would the, what would it look like for a physician? I would have a complete data set in my EHR. That is accurate without duplicated data that. The patient has given consent for me to bring it all in together so I can get that view. I don't have to send off a release of information form to, to get it.

It's like real time. It's all there where I can get it into discrete data. I, yes, I'm bringing in a note, but I wanna be able to extract from that note the important parts so that I can fill in my . Health maintenance or my, my quality metrics that need to be satisfied, or if I want a trend of 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 that easy button of all the data right in front of me. Curated and then I wanna be able to ask my EHR, Hey, I'm dealing with an abdominal problem today. Show me the relevant data. But EHR can't do that until we have a complete data set.

Yeah, it's interesting when Brett posted that I was a little bit of a wise guy and I, I, I just kept posting, I, I think I did four. If interoperability were perfect, this would happen. This.

Anish Chopra call them. But healthcare fiduciaries who I could give access to my information and they would provide me value in some way, shape, or form. They would either provide value in caring for my parents, they would provide value in caring for me, and to a certain extent, I. I could be the carrier.

When I go to your health system and you say, Hey, we don't have your complete medical record, I could say, okay, this app, I, I made the request with just a click of a button. I made the request from the 15 health systems I've been to over the 50 some odd years I've been on this planet and I have the complete med medical record.

Would you like me to, you know, click this button and give your health system access to it? And so as the carrier, as the common person at the point of care, I would be able to give it to whoever is caring for me at that moment, whether it be EMT or a primary care physician or, or whoever. It's, that's that, that to me is sort of a nirvana from the patient perspective.

I would think the doctors would love that, that there would be no pushback. Some doctors are, this is my medical record. No, we, we just want data. That's for the most part, clinically, that's what matters. I. Personally, my wife's going through some health issues right now and trying to get a prior authorization and the data that has to flow back and forth between provider and insurance carrier to get that prior authorization inter, what would interoperability look like?

That we wouldn't have that. That we would have real time authorization based on algorithms that say, okay, you've gone through X, Y, Z. Yeah, you got a tumor on your spine. We know we're gonna approve this every single time. Absolutely. So why do we torture our patients? So, so let's step back. So this is this week in health It.

So we have a bunch of technologists, they may or may not understand. Prior authorizations. Help us to understand what are prior authorizations and . I was gonna say, why are they the bane of some people's existence, but, but what's the challenge around prior author authorizations? I guess I can't use a lot of curse words on this show, one as I described prior.

No, that wouldn't be good. Alright, so I'll clean it up. So as a physician, I'm seeing you for a medical issue and we want to do a test. It could be a genetic test, it could be an imaging study. Your insurance company gets a say in this. They want to make sure that we're not ordering unnecessary tests, and so there is a authorization that is needed.

Well, because that problem does exist, right? There is, there's an over i, I forget what the word is. Utilization. It's over utilization. Over utilization, okay. Yeah. So that does exist and. They're insurance companies have a business model to, oh, I'm just, I'm just ratcheting you up. Alright. Just by asking that question.

I'm sorry. Oh, any doctors. 'cause they're insurance companies, they're not doctors or, I don't know. So they're essentially questioning you whether this test is necessary. Correct. And. They will use evidence-based guidelines to give the, to have a fair and balance show. Here they do. They will have evidence-based guidelines, but they need data to see does this patient meet our evidence-based guideline.

And so there's this game of if we frustrate the patient and the doctor enough, they'll give up and we'll give up on the test or the problem will go away. Or that they'll end up in the hospital and we'll deal with it then. 'cause you don't have to do prior authorizations when you're in a hospital bed for the most part.

So yes, there are, but the prior authorization process is slow. It is labor intensive and it is typically frustrating. It's being done by first. The first review is gonna be a clerk, and then maybe it goes to a nurse and eventually you can escalate it to a doctor. And you usually can have a, a conversation, but you gotta take time outta your day to go talk to a doctor who about this case and explain why you think and justify your your medical reasoning, which is uncomfortable.

So this house bill is gonna mandate Medicare advantage plans, adopt electronic.

It's on the insurance carrier side, right? I'm gonna be able to submit it electronically and they need to respond electronically. And in theory, that should take that, that gap down for the amount of takes. And it does. So we have this in the prescription space. Now, there are vendors out there that offer the ability to do electronic prior authorization of medications because that's another area you gotta go and play.

Mommy, may I, and get your approval on the drug you want to use and it works. But again, you. It, it's not complete interoperability yet. So we'll send it electronically and we'll get back APDF that someone wants. 'cause if they're not playing with that particular vendor, well you don't have interoperability.

So then we get APDF that someone has to fill out. It's gonna go back, uh, by fax or filled out on the PDF. That's not. A, a electronic automated response. We want, if the insurance company feels they need something, let them pinging the record, see if the patient's had a prior MRI or a prior that they've done physical therapy before they get their MRI of their spine.

Sure. Go ahead and look. Give me an answer back and I'll move on. Yeah, this is, this is that that use case that Halamka was using AWS for the, the prior auths would come back into a fax and he was using NLP essentially in the AWS cloud. He was reading all the faxes as they came in. If any of 'em were prior auths, he was actually using a.

I don't know if he was using fire back then, but essentially he wrote the EHR that they were using at Beth Israel. So essentially he was, he was funneling that information right back into the record. So it was as quickly as you could get a response. It was getting back into medical record and he took out any manual back and forth that might happen in that process.

So, uh, it's. Prior author without going too far down the insurance side, and it is this right? Is it wrong kind of thing. Is it a form of rational rationing or that kinda stuff? The, the electronic aspect of this really should be basic blocking and tackling. At this point. We have an electronic medical record there, I would assume on the insurance side they're using or something to that.

Funnel back and forth between the medical record, the algorithms are computerized. I, I don't, don't think they've got people going through paper, uh, turning the page. All right, let's see if you're on the flow sheet. There it is. Computerized. They do buy, the insurance companies will buy this, these algorithms, they're not usually coming up with them on their own.

Yeah. And yeah, I think, I think this should be faster. This is a pain point for the patient, frustration for the doctor, but it's the patient who has to wait. Or hear from their doctor, I'm sorry, your insurance company didn't cover that. Let's go to plan B. Wait, why am I getting plan B again? , I didn't ask for plan B.

So yeah, and I, I can be critical of healthcare's experience that we're creating for patients from time to time, but this is the underside of it that people don't see and they say, well, the health system, this.

It's not the health system that's slowing it down at all. It's this process that's behind the scenes and health systems are doing everything they can. Uh, with regard to that, I, I don't have the answer for this. Obviously, one of the first steps is to get it electronic. The next step I would imagine is to, you know, publish those algorithms so that the physicians are looking at 'em going, look, I'm ordering this test.

It meets algorithms, you know, instantaneous. I, I can get my loan approved almost instantaneously now. Yes. You would think that this could be done in that same manner. Well, we have a discreet data problem, don't we? I mean, we, we have this unstructured data that until we can, that's where, that's what the insurance company wants.

It's the stuff that's in that unstructured data, and they want it in discrete fields, which is why we are manually typing into their portal. The information so that then they may have some automation on their end. It's getting it there. That's where we have the trouble, gosh, shoot me typing into their portal.

What's wrong with that sentence? Manually portal. Anyway, mark, thanks for coming on the show and pinch hitting. It's always great to catch up with you and I really enjoy the conversation. It, it always challenges me, so I, I appreciate you coming on. Thanks, bill. It's a great time. I always love coming on the show.

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