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 Welcome to this week in Health IT News, where we take a look at the news which will impact health it. This is another field report where we talk with leaders from health systems and organizations on the front lines. My name is Bill Russell Healthcare, CIO, coach and creator of this week in Health. It a set up podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders.

Are you ready for this? We're going to do something a little different for our Tuesday Newsday show. Next week we're gonna go live at noon Eastern 9:00 AM Pacific. We will be live on our YouTube channel with myself, Drexel Ford Sus Shade. And David Munch with Starbridge Advisors to discuss the new normal for health.

It, uh, with you supplying the questions with live chat. Also, you can send in your questions ahead of time at hello at this week in health it.com. Uh, I'm so excited to do this and I hope you'll join us. Mark your calendar. Noon Eastern 9:00 AM Pacific on April 28th. If you want to, uh, send the questions, feel free to do that.

Um, and, uh, you can get to the show by going to this week, health.com/live. This episode and every episode since we started the Covid 19 series has been sponsored by Sirius Healthcare. Uh, they reached out to me to see how we might partner during this time, and that is how we've been able to support producing daily shows.

Special thanks to Sirius. For supporting the show's efforts during the crisis. Now onto today's show, today's conversation is with Dr. John Halamka, president of the Mayo.

Well, good morning and glad we could do this with social distancing . This is, uh, well, we always do this show with so social distancing. Well, except for at conferences, I guess. Um, thanks for taking the time. I know, I know that you're busy. Uh, you, you've been working on this national C 19 coalition. What, what is the coalition?

What have. Sure. So lemme tell you how it started and what we're up to. So it was about four weeks ago, and I realized at about five in the morning that hundreds of companies were contacting me saying, what is the organizing principle by which we could collaborate, communicate, and convene? And it was just at that time I realized there wasn't an organization quite doing it.

And so we decided that. We would put a couple of folks who are willing together. Mitre Corporation agreed to serve as the program manager at no cost, and today we're at over 700 organizations participating and we're, we have 11 different work groups. Working on things from, you know, what ventilators are needed, where of what type, what personal protective equipment can you trust, and how do we route it to places where it's needed?

How do we collect data? D antimalarial drugs work? Do we have an idea of convalescent plasma is helpful or not? So we're helping support the National Convalescent Plasma Program, which now has.

Organically growing thing of people just doing their help each other with no economics, right? No one pays anything. We're just helping each other. That's great. Uh, so what is it, uh, is it a combination of pharma, government, uh, providers? I mean, who, who's, who's a part of it? And so the answer is yes, , all of the above.

And so for example, Google, Microsoft, and Amazon came in early. The entire University of California came in. Early rush. We have pharmaceutical companies, all of these folks, um, primarily private sector, right? It's a private sector driven initiative and although we may have participants from government, it is not government sponsored.

Got it. Alright, so the show is this Week in Health It, and while I would enjoy talking a, a, a ton about, you know, reopening the, the country and, and ramifications of those, I'll let, I'll let, uh, CNBC and, and the rest of those guys really handle that one. Uh, what I'd like to talk about is, you know, things like data.

Platforms platform and, and just see where this goes. So, uh, let's start, let's start with data-driven outcomes. So, you know, what does the clinical care data set look like that, uh, that the coalition's looking at, that, the c d's looking at that researchers and public health officials are looking at? Uh, have we been able to, to pull that clinical care data set together?

So let answer this in a couple of ways, which is suppose that we wanted to get together 200 Epic and Cerner using organizations to ask a question like anti drug efficacy or plasma side effects or such. Can you imagine, and I'm not talking policy or technology, I'm talking psychiatry, uh, of what it would take to get 200 disparate organizations to contribute really comprehensive data sets to a central repository run by anyone in the short term.

The answer is, you know, you can do it eventually, right? Registries? Maybe the answer eventually you're not gonna do it tomorrow. So here's what we did. We went to the EHR vendors and they said, you know. Because each of our EHRs, although standards compliance, still has different ontologies, right? The way we name a field, the data we record, that sort of thing.

So how about this? We'll define numerator and denominators comprehensively for any of the measures you want. For Epic, for Cerner, for all scripts, et cetera. And then we will build those scripts at our customer sites so the customer can now run it against their live data and report the numerator and denominators, which are by sort of definition aggregated de-identified don't fall into any regulatory framework, and that has worked amazingly well.

So what I'll call is like near real time capacity to do cross organizational analytics. All that's running over the next couple of days on the areas that I describe anti-malarials and the use of convalescent plasma. That, that, I mean, that's, that, that's amazing. Um, so, I mean, not to, well, I mean, I guess it's a broker question from, from a privacy standpoint.

You're just, you're just getting analytics, right? You're not getting any, there's no records moving around. Right. So if you were to ask Epic, epic, do you own your customer's data? They would say, um, well, no. , right? We're a software company, and although they might have a cloud hosting service, most of the epic instances are locally run.

So what you would say is, even if Epic wanted to run analytics across every one of its sites, it. Can't, I mean, that's just not the way the data is distributed, but to write the queries in Epic so that each customer could then run the numerator and denominators and share them, of course they can do that.

So this is a federated analytic approach that really gets beyond a lot of the logistics and data use agreements and that sort of thing to create a registry. Well, will that, will that expand to like Meditech and. I, I have every expectation that this is going to expand, uh, because there are really two ways we know to do analytics.

One is, is that you create a federal certification requirement where every EHR vendor submits an HL seven V two or a US CDI payload to a place, you know, right. That could be c.

Industry based registry. I mean, that's one way to do it. The challenge with that is sometimes that's identified data and Right. It runs into a lot of interesting issues on how data used, who can look at it and how you protect it. Whereas this federated approach. Leaves the data within the firewall of every organization and everybody feels pretty comfortable about doing that kind of thing.

Yeah, it does. Uh, it's a pretty elegant solution actually, but not, not to get too far ahead of ourselves, but, um, coming out of this, is this gonna be a, the way we sort of design this for future pandemics or. Are there other things we're thinking about in terms of the data and how to, how to respond a lot quicker than we we did for this one?

Well, sure. So that's just one use case. We're asking, you said data-driven outcomes, right? So that's an outcome, but wouldn't you like to know, here it is, April 21st, how many ventilators are gonna be needed in Florida, two weeks from today? How many are in use right now? What's the delta? Challenge with that is, do you have any idea how the CDC is collecting this information?

I, I, I assume it's like little, uh.

You got it. You know, and then you hand type it into Excel and email it. Right. As opposed to Keith Boone, audacious Inquiry, HL seven, Chuck Jaffe, they're working on a fire situational awareness standard by which. There's just an AP sitting on your EHR that says, well, oh, how many people are in the ICU on ventilators now?

12 , right? I mean, it's no spreadsheets or smoke signals or Morse code here, . And so it seems to me that if we are gonna be ready for the pandemics of the future. Not only do we need all the outcome stuff, we talked about Federated query, but we need situational awareness. APIs using fire that enables our public health entities to say, ah, you know, whether it's how many are immunized, how many ventilators do we need?

What PPE do you need? All this stuff is not that hard to automate if you have a standard. Yeah.

Around the country. Uh, so we probably have enough ventilators, but if they're in the wrong location, it doesn't do anyone any good. And so a fire, API is also kind of a, an elegant solution for determining where that is and, and getting that stuff moved around the country, I would think well, as well, you have to recognize that.

Is a very unevenly distributed infection, right? And so that is, you might very well today have few infections in Iowa and lots in Boston, but you know, wait, two weeks, and, and so what you're gonna need to do is put together the modeling of the epidemiology with the personal protective equipment and ventilator and staff capacity, and begin to shift resources.

You know, a great author once said, famines don't exist because of a lack of food, but a lack of a distribution of the food, right? And I think we're seeing actually the same thing with personal protective equipment and ventilators right now. And this fire approach is something we'll learn a lot about in the next few weeks.

You, this might sound like a self congratulatory thing industry, but could imagine through.

Uh. Well, I know exactly right, and and so people say, oh, the EHR, of course has had a burden, which it has. The challenge has been in the past, we haven't returned anything to our clinicians from the EHR. They put data in, they didn't get much out . And now the ability to say, oh, well now we've put this data in, we're going to get coordination of care and supplies and learning and cures.

Aha. There's a benefit finally at the end of the rainbow. Alright, so let's, let's start talking, uh, digital tools and I, I wanna start with contact tracing. Um, we know that Apple and Google are working on solutions

are.

So let's talk about the multiple approaches that have been used. So MIT at the Media Lab with Mayo and MGH working together, this was about a month ago, created AGPS tracker and here's how it works. Basically, you consent. And you say, I actually would like to track my location so that if there is someone I cross who's positive, you know, I can submit my GPS tracing over the last month to a registry at public health and see if there was crossover.

So the, and that's great, but it has one challenge. Um, you said you're in Naples, Florida. Your GPS would have your home location in your GPS data. That's not exactly de-identified. , right? So you'd have to then, as a public health department, sort of redact an individual submission, uh, you know, might be the place they work or the place they live, or you know, something that would be truly identifying to them.

So what Apple and Google have done is really interesting. Would you agree that if you want to do contact tracing, you would simply turn on your Bluetooth function on your phone? And AAPI would be available to public health from your phone. That does nothing more than collect the Bluetooth signatures of the people within six feet of you

Right? So it's not identified. And in fact, the global universal identifier for the Bluetooth, uh, uh, that is, it's actually changed quite frequently so that there's really no mechanism of hacking and figuring out people's movements and Gs. Is just to say, who have you been close to ? At which point then when a phone is identified as being a covid positive person, anyone who was near that phone could be notified.

Uh, so, so it was really a kind of an elegant privacy protecting way of doing contacting, yeah.

Would there be a situation where a health system would, would try to do this lift or, or essentially, I mean, is there a need within a care delivery platform to have this kind of mechanism, or would you just tap into Google or, or Apple's solution? Yeah. The challenge is, is that your contacts are bigger than any one health system.

Right. And so I think the answer is, is that many of us will wanna contribute to these contact tracing efforts by providing clinical expertise, privacy, oversight, uh, maybe even create some novel apps. Uh, and we're working on some, some novel apps to help with return to work and things like that, but, uh, it's, it's truly gotta be a national scale effort.

So what, what other digital tools have you seen be effective during the, uh, pandemic? Well, and, and so, I mean, there's a couple of threads that I wanna work on here. Um. Mayo has recently released what's called Mayo Expert Advisor, which is traditionally a tool that is not available to the public. We're putting it, uh, now in a place where all physicians in the country can access it and soon even the public will be able to access it and it provides accurate advice.

So here's a problem. Do you think eating twice your body weight and garlic is gonna. Well, there are websites that suggest it. . Well, well John, obviously it's gonna, because it'll keep people away from you, I would assume. Well, there you go. But so the point being is that part of the apps have got to be just getting rid of the misinformation.

Right? Right. So we're all, a lot of us working on just getting the right information out, getting the data out. If you go to the website. The Covid Coalition, there are over 700 publicly available data sets on that website and data visualizations that anyone can access. There's password needed. And so I'll, I'll get you the, the website before we finish, but, so, so, you know, it's situational awareness, it's knowledge and getting rid of misinformation.

And then of course I think there are a number of, of interesting apps that are being deployed. There's a nonprofit in Seattle called RE A-U-D-E-R-E, funded by the Gates Foundation and. What are your signs and symptoms? It does a screening to determine if you need to be tested, and then if you need to be tested arranges for.

And so figuring out who needs APCR molecular test as we get past the infection and get into return to work, then there's a question of tracking the serological tests. Immunize, you know, do you have IgG? Do you have demonstrated resistance? Because you could imagine there will open the economy by bringing people who have already had it and recovered back to the workplace first.

You know, assuming that they're immune. Yeah, absolutely. All right, so let's talk platforms and, uh, if we have any more time, I mean, I've, I've got like 75 million questions, but, um, from a platform standpoint, so you're the president of platforms now, which is great title, uh, platforms help us to move quicker within or within a crisis or outside of a crisis because, you know, key components are already.

Access to the data security, you know, it's already already baked in the platforms. Um, so you can really focus in on the problem at hand. How, how have you seen platforms or even the absence of PLA platforms come into play during the, uh, during this pandemic? So a number of us have completed an article.

Which, uh, has been submitted. We hope it gets published soon in the scientific literature that says, we're gonna look at the medical record of every covid positive patient that has been tested in our organizations, and we're actually gonna start to look at characteristics about them who had a severe infection.

What were the earliest signs? Can you predict severity based on early signs? Well, imagine this. Suppose you wanted to go to a study that required you to access 20,000 medical records and do a comprehensive analysis. How long is that gonna take you? We did it in a week , and that's because we had a mechanism in place to de-identify data, place it in a container where then we could bring analytic tools into that container, run the analysis and.

Not share the data, but exfiltrate the knowledge. Right? And so this is what the idea of a platform does. It creates these reusable components and modules, these processes and these policies that enable you to do this stuff just really fast without having to re-litigate, you know, with, uh, teams of lawyers.

The process from the very beginning, every time. Yeah, you talked about that at the, uh, JPM conference and, and we'll probably come back and, and talk more about that as we go forward. You know, as, as sort of a set of closing questions. Uh, talk to me about testing. I know I'm gonna get outside of health it here, but I'm more curious than anything, you know, how much testing do we need?

We have obviously the molecular testing, which is pretty, uh.

The, um, the antibody tests, which, uh, looks like it's gonna start ramping up. If the releases from Abbott, uh, the press releases and things, uh, are hold true, which is, you know, 20, 20 to 30 million tests a month coming forward. Uh, I mean, what is, what is at an adequate amount of testing to get us moving back into this?

As you might guess, there are many models here, which, uh, Amazon's. Um, is that they think in order to get the Amazon supply chain back, that they, you probably read about GE and Jeff Bezos blog about this, that they need to really do very rigorous testing of each of their employees on a regular basis. I mean, this could be hundreds of thousands of tests a week just to keep that workplace safe.

And that's not actually so different to what some countries have done, kind of aggressive testing and contact tracing and that kind of thing. I think our challenge at the moment is we just don't have easy access to either the molecular testing or the serologic testing in the numbers that are needed for diagnosis and return to work.

So you may have seen, again, we're not getting into politics here, but, uh, the Senate help committee last evening, this, uh, put together a writer on the new, uh, what we'll call sort of paycheck protection program successor Bill for 25 billion. To just be routed, to get us the adequate number of these PCR and serological testings wherever they are needed to get people diagnosed and the economy back on its feet.

And the number is $25 billion needed to really ramp up our testing capacity because just look at the number of tests we can do every day today. It is a small fraction of what is needed.

But it's still a small fraction. That's interesting. Um, well.

That would be a short day. Uh, so I'm, so for the last four weeks I've been averaging 18 to 20 hours a day. And, uh, but yeah, so one, once in a lifetime opportunity for us to do good here. Yeah. So I, I, if Zoom were smart, they'd offer, uh, frequent flyer programs and, uh, you know, they could, they could replace all the miles you were putting on airplanes, I guess.

That's great. Now, one thing I just wanna leave you with is the website for the coalition https c 19 hcc.org. Https c 19 hcc.org, and it's all free and it's all open source. In the resource library, you'll find hundreds of great data visualizations and training and all kinds of coalition based resources.

Fantastic. John, thanks again for your time. I really appreciate it and look forward to having you back on the show. We'll, we'll get an update in, uh, in a little bit. Oh, great. You have a wonderful day. Thanks. Take care. That's all for this show. Special thanks to our channel sponsors VMware Starbridge Advisors, Galen Healthcare health lyrics and pro talent advisors for choosing to invest in developing the next generation of health leaders.

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