News Day – Providence, Microsoft, Novant and Cloud
Episode 10316th July 2019 • This Week Health: Conference • This Week Health
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xperience is top priority for:

Uh, some say data sharing encourages patient risk. We'll look at that. Microsoft and Providence come together. Uh, uh, president Trump shifts, uh, dialysis care to the home. And, uh, Novant migrates to Epic, e h r. I'm gonna talk a little bit about that, uh, from a perspective of what is cloud and what is cloud to healthcare.

I think there's a huge amount of . Uh, misconceptions around the cloud, and that will be the last story we cover. So hopefully you'll stick around to hear that I have a little rant planned. Planned for that. So my name is Bill Russell, recovering healthcare, c i o, and creator of this week in health, it a set of podcasts and videos dedicated to developing the next generation of health IT leaders.

So we have something new for you in that vein of developing the next generation of health IT leaders. Uh, quick question. Is anyone helping you to advance your career? for too many people, the answer is no. And that's really not okay. Uh, you know, every person deserves a chance to learn, but developing people is time consuming and expensive, and, uh, because it's difficult.

Most businesses don't develop their people at all. Uh, this week In Health It Daily is designed to help every professional develop through daily short videos that you can begin to apply today. Subscribe to this week in health it daily at this week,, and get a five minute video in your inbox every weekday morning that gives you insights from leaders.

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Um, one last thing before we get to the news. A quick shout out to Ed Mark CIO Cleveland Clinic. Uh, a huge part of our community who's recovering from surgery to address prostate cancer. Uh, all reports are good. Uh, he even shared, uh, pictures on LinkedIn of his physician and his wife at his bedside. Uh, you know, as only Ed can do, he has written five amazing posts on LinkedIn, uh, to remove some of the uncertainty, doubt and fear that goes along with this, uh, cancer diagnosis.

erience is a top priority for:

d. Top strategic priority for:

Only 35% report using SER centralized customer relationship management platform. Fascinating to me that number, uh, is a lot lower than I thought it would be. Uh, 32% of dedicated C-suite executives, such as Chief Experience Officer oh, have added, uh, chief Experience Officer whose sole role is improving the healthcare consumer experience.

So, um, Yeah, 32%. So a third now have an experience officer. Uh, top three service lines, which this is, uh, being done on our oncology, orthopedics, and cardiology. Again, no real surprise there. And, uh, though 43% of respondents do not yet have patient engagement program, a third of them plan to implement one in the next one to two years.

So there's a new role opening up for those of you in it who are looking. . Uh, to do something a little different. Uh, so what on this, uh, you know, this is going to be the differentiator moving forward. Uh, care is a point of parody, but experience is the differentiator. Uh, convenience is king. Gotta get on this.

Gotta stay ahead of it. Alright, we're gonna keep moving. Uh, healthcare industry adds 35 in June. Healthcare, finance news. Uh, this is from Susan Morris. While unemployment rate remains relatively unchanged at 3.7%, the unemployment rate in hospital stands at 1.6%. That's low. Uh, while unemployment rate remains relatively unchanged, the unemployment rate for hospitals uh, continues to decline.

, intend to increase staff in:

They're in high demand. Um, competition for staff is gonna be tough. You gotta get good at this. Uh, you know, this is what happens in a thriving economy. Don't make the mistake of thinking that a, uh, that strong hiring is necessary. Good for all areas of healthcare. Cost reductions will continue to be the norm, and automation is going to continue to be a theme.

So, uh, I just wanted to share that. Um, unemployment means getting those people is gonna be hard. Keeping those people is gonna be critical. And, uh, and retraining 'em, retooling 'em is gonna continue to be, uh, a priority. So, uh, just wanted to get that out there. Uh, Politico, Politico shared some say data sharing, uh, incurs patient risk.

I've heard this . Uh, a couple times. So I wanted to get it out there. Uh, some say data sharing, encourage patient risk. Okay. Free the data. Then what? That's the question some provider groups have, have, uh, as, uh, have asked as they prepare for upcoming rules, making it easier for patients to access their own data.

Sure, patients should be able to download their own health records and even send it to a health app of their choosing. They say, but are patients really savvy enough to protect themselves from the data mongers? Who want to sell and exploit their information. The answer to that is, who Caress? It's, that's not your

I mean, sorry, this is a rant, but that is not your responsibility. Seriously. I mean, you're protecting me from me. I, this argument really gets me going. And actually there's a quote here from somebody and, uh, I'm gonna leave the name out, but, um, but just to give you a gist of it, there's going to be new apps coming online every single day.

Um, uh, clinical informatics person for this, uh, large organization said most patients who are using these tools don't fully understand the privacy implica implications. You know what? Most healthcare organizations don't understand the, uh, privacy impli implications, the amount of breaches we have had, the amount of information we've had go out of healthcare organizations.

Uh, it's really disingenuous for health organizations to look at me and say, you can't have . Your data about your health, there will be an ecosystem, there will be accountability. Um, I've covered this in detail on previous episodes. Uh, I quite frankly, if you gave me my data, I'd like the ability to click a button and not have it on your system.

I, I'm not sure you can be trusted with it. I'm not sure you can secure it, but, uh, I think I can find a group of people that can secure it. I can do it for myself. I can do it for my 87 year old father. Uh, father and father-in-law, I can do it for my family. Uh, I can, I can secure this data better through a series of people that I select than, uh, than than most health organizations.

And quite frankly, my family isn't as much of a target as your health system is a target. I don't have to defend against China. You have to defend against China. So this is silly. Uh, let's see. So others say , this is, this is part of my argument right here. Others say that the, uh, perspective is paternalistic.

Pointing out that consumers regularly download apps outside of healthcare and can be trusted to protect their own privacy drafts of upcoming information. Blocking interoperability rules from the O N C and C M S suggests that H H S believes patients are responsible for their own information.

Cedar-Sinai, c i o, and previous guest Darren Din said at the end of the day, we're entering a brave new world where patients will choose what they wanna do with their information and how they wanna share it. Darren is right. Give the patient their data. Okay, let's move on. Microsoft joins hospital chain Providence to build Hospital of the Future.

Uh, Christina Farr, C N B C. Uh, this was published on the ninth, so, um, Microsoft and Providence Health System are working together on a new high-tech hospital. The site will be in Seattle area, Providence, c e o, rod Hockman said also a previous guest. Uh, let's see. Uh, they're both headquartered in Seattle.

Makes perfect sense. The two companies have discussed this vision. For a hospital of the future for months, Hockman said, including during several one-on-ones with Microsoft, c e o, Satcha, Nadal, and I can't think of a, a better dream team of people to be together than, uh, Dr. Rod Hockman and Satcha Nadal. I think that is a, uh, that that is a strong pairing.

And, uh, I'm excited to see what they do. The strategic priorities for the new effort involve improving the, uh, improving the electronic medical record so that it is easier for doctors, nurses, and other health providers to find and share information. The companies also plan to use technology like natural language processing and machine learning to help clinicians diagnose and treat patients.

I know some people from U P M C are gonna be saying, Hey, we did that. You know, half a decade ago, uh, a decade ago, if I think about it. Um, and we had, they had a Microsoft platform and they had, uh, tiles which brought, uh, e M R data to the forefront and those kind of things. I, quite frankly, I think the technology's different.

I think the leadership is vastly different. Uh, Satya Nadal is, is a far cry from, uh, previous leadership at, uh, Microsoft. I think cloud, the adoption of cloud technologies is gonna make this . Uh, uh, potentially a, a new interface for getting to the E H R. And I think we do need other interfaces to sit in front of the E H R, uh, that help the, uh, physician, uh, in ways that we haven't imagined.

Uh, and part of that, quite frankly, is you just cannot hire enough people at Epic. Enough people at Cerner, enough people at Meditech, and the rest. Uh, to move this forward. And so if we can open this up to the, uh, innovative community to take clicks out, make it easier to interact with the E H R while maintaining the integrity of the data, the integrity of the workflow, the integrity of the, um, uh, workflow really covers what I was gonna say.

So, uh, the care protocols and other things. So, uh, let's see, what else did they say? Another focus is on improving healthcare and lowering cost by working closely with Seattle's largest employer, Amazon, another Seattle company. It's also looking to focus on employer experience through its partnership with J P M and Berkshire Hathaway.

Uh, the effort was called Haven, as you know. So what I love the concept, uh, choose a hospital. I, I think every system should do this. Choose a hospital that's maybe lagging within your system and make it the hospital of the future. And, uh, start innovating around the experience in that, uh, specific hospital.

Is Microsoft the right player? Um, uh, for Providence, absolutely. They're headquartered in Seattle. The teams can get together, they can have offsites. There's not a lot of travel involved, so it's absolutely the right partner for, for Providence. I think that goes without saying outside of Seattle. I, I think you have to examine a lot of different factors.

But in many cases, Microsoft makes sense only from the fact that it's existing technology. Your team's used to SQL here they'll be used to Azure there. Um, you know, it, it's just a natural migration of skill sets. Uh, with that being said, I'm gonna say something negative here about Microsoft, I apologize, but, you know, Microsoft eats up a bunch of the health IT budget every year, and, uh, and there's no alternative.

There just is no alternative. I, I, I looked at it, you, you say, well, you can go to, you know, Google's platform or, or something to that effect, and you really can't. I mean, it's so, uh, it's so tightly ingrained, uh, into these large health systems and in integrated with the E M R and some other things. Uh, that it, it would just be a very difficult process.

Um, with that being said, I'd like to see Microsoft's pricing models changed. I, I, I think they're, I think they're goofy. I think they're of, they've, they've moved their technology stack to the cloud and they're going to the cloud, but their pricing models haven't gone to the cloud. Uh, and they need to be more cloud-like pay for what you use.

Uh, too much of the license agreement today, you know, never gets implemented. I've seen people with these agreements, they go, I have these 16, 20, 30 apps that we've never implemented but we're paying for from Microsoft 'cause we, you know, check a box or because they're included. That that's a, that's a, that's a bad model.

It's time to change that model. If you're moving everything to the cloud, move the pricing model to the cloud. Um, so, you know, we're gonna, I, we're reached out to BJ Moore. We've we're corresponding when he gets back from vacation, I'd love to have him back on the show. Talk more about what this means and, and where they're going.

This is exciting stuff. Uh, let's see. So Trump did this little thing using odd, oddly enough, using the Affordable Care Act, uh, authority, um, to shift dialysis care to the patient's home. This is from Kaiser Health News. Uh, Phil Gitz. So, uh, Trump announced Wednesday bold plan to improve care for patients of kidney disease, which he claimed could save thousands of lives each year, and billions of dollars for taxpayers.

Uh, it could be higher if it works as anticipated. Trump boasted that in, uh, 25 minutes speech, ba blah, blah, blah. Uh, the initiative aims to dramatically increase the number of patients getting dialysis at home. Rather than costless costly dialysis centers and double the annual number of kidneys available for transplants, about a hundred thousand Americans are waiting for kidney transplants.

10 Americans die each day because of a shortage of organs. Trump said, um, I mean, I can't speak to, you know, the, the viability of this. Uh, here's what I will say. So what, uh, home care is a thing. It's coming. It's been coming. Um, and there's really gonna be no excuse for health it once it gets here. If you're not ready for, um, you know, internet of Things collecting, uh, device data, uh, and empowering your, uh, physicians to interact with the E H R when they're out of people's homes, or your physical therapists or whoever happens to be doing the home work in the future.

So get ready for that. Be ready for that. Create your, uh, security models around that. Create your . Uh, your user interfaces around that as well. So here's our last story. I tried to l save some time for this. So, Novant Health migrates to Epic e h r system in the cloud. Uh, it's being built as one of the biggest yet cloud migrations of an epic electronic health record deployment.

Novant Health has moved its mission critical applications to virtual streams, cloud hosting servers. Now this, a lot of this article is an advertisement for virtual stream. So that's the last time you're gonna hear that name. Uh, a way to streamline efficiencies and more EAs uh, this is why it was done a way to streamline efficiencies and more easily comply with e h r security and value-based care requirements.

rolled out the EPIC system in:

So it looked at new ways to ensure, among other goals, a more predictable cost model and approved agility for clinical and operational innovation. Uh, Novant can make future enhancements to its system without having to re-architect its system every time. New changes were necessary. The vendor said, noting that Novant and Extreme Care service team were able to complete the cloud migration in just six months.

forward. Uh, this was done in:


Um, the reason I point that out is to say we can still be making those same mistakes today. We can still be rolling things out thinking, uh, you know, this architect, we can stay on this old architecture. Um, and the reality is business is changing. The business requirements are changing. You need to, um, look at the business requirements and where, where healthcare is going.

It's going out of the home. Uh, more and more, uh, devices are gonna be connected. Internet of things. Uh, artificial intelligence is, uh, is a thing. It's a trend. Um, uh, machine learning. These things are all trends. . How are you gonna access it? Uh, architecture matters. We talked to, uh, Eric GI Blanca about that architecture does matter.

And if you make the wrong architectural decisions today, you will have to re-architect to take advantage of some of these things. So here's the larger trend. More and more health systems are deciding that the cloud is right for them. Attracting, um, attracted to its agility and resilience, and having been convinced that security of remote hosting has sufficiently evolved in recent years.

Uc, San Diego switched. . Over to E Epic, hosted cloud e h R two summers ago, for example, citing an improved operational efficiency and enabled allowing it to invest more resources in patient care, as well as the ability to share the E H R with partners such as uc, Irvine Health still, uh, just this week we showed that even health systems are more intrigued with cloud hosting.

Many are still slow to take the leap, uh, either wary of lingering security concerns or hampered by tight budgets. And has a great quil from class here, which I think really gets it. So the majority of the organizations we speak to are doing more in the cloud or considering a move to the cloud. Explained Ryan Oliver, research Director of class.

Uh, cost and security are usually the first considerations mentioned, but it's important to maintain a disciplined approach to decisions that also include considerations for scalability, uh, integrations, governance, operational readiness to manage multiple cloud vendors, impact of staff, and total cost of ownership.

And he's right. He captured an awful lot of the things that . Uh, need to be, uh, considered. Uh, cloud hosted, uh, cloud hosted environment for Epic will help the health system meet all of our business security technical and cost requirements. He added, noting Devon's plans to expand, uh, in the use. This is the vendor talking, uh, cloud going forward.

Uh, that's a, that, that's a sales pitch. So, uh, so what, there continues to be a fundamental misunderstanding in healthcare of what the cloud is and what it does. So in two minutes or less, as you gimme two minutes, I'm gonna tell you what it is. So the cloud has five characteristics. Number one, pay for what you use.

So if you have a hundred users, you pay for a hundred users. If you go down to 95, you should pay for 95. You shouldn't have to keep paying for a hundred if you have 95. So it's pay for what you use, which gets to the next point. Scalable, scale up, scale down. The ability to do that without costly infrastructure associated with it.

The reason you go to the cloud is 'cause you don't have to have a data center and crack units and air conditioning and, uh, fixed building. You can get out of that, uh, heavy capital resource intensive, slow moving environment. So pay for what you use. Scalable programmatic access to resources. Cloud is written in a way that you can create automation, automation of just about everything because you can access it programmatically.

The fourth thing, granular accounting. You should be able to tell how much each resources costing you. Most IT organizations can't do that today. Uh, you know, a lot of 'em spend, spend some money to, uh, install things like aptio just so they can get to that granular accounting. Cloud is designed from the ground up to have that granular accounting.

And then the, the fifth thing is ubiquitous access. If your person is on the road in, uh, wherever, as long as they have an internet connection, they can provision new servers. They can provision new users, they can fill in the blank. So ubiquitous access. So five characteristics, pay for what you use, scalable, programmatic, access to resources, granular accounting, ubiquitous access.

There's probably more. Those were the five that I generally focus in on. Uh, remote hosting of e Epic isn't cloud, uh uh, unless it has these characteristics. Or remote hosting of any EHRs, not cloud, unless it has these characteristics. It's a form of outsourcing. It's not really cloud. It's a way of saying, I don't trust our IT department to run this anymore.

We're gonna, we're gonna move to a third party because they will take care of the servers better. Their, uh, their data centers better, whatever. It's just transferring costs from one to the other. More times than not, that is not gonna save you a nickel. So anyway, that's, that's that . I have very little time left.

The, the models really haven't changed much for cloud. I mean, new ones come up and down, but at the end of the day, there's three infrastructure as a service. That's where we get our data center through, uh, equipment and networking, all provided by a player. This is what a W Ss is. It is what, uh, Azure can be.

Uh, and some other players out there. There's a, there's a lot of them. So, uh, platform as a service, this is a, a more, uh, solutions that you're gonna write code on top of. You're gonna write applications on top of it. Um, you know, like, uh, Salesforce started off as a, a, a software as a service and still has.

Components that are software as a service, but you can actually write code and write applications on it, platform as a service. Azure is a good example of platform as a service. So is, uh, again, Amazon is, is a pretty good, uh, solution as well. And then the final is application as a service or software as a service.

Those are the three primary, and you know, these, I mean, it's Workday, it's, it's fill in the blank. There's a, there's a, a jillion of them. So it's generally those three models. . cloud can cost less, but it's, uh, it's not necessarily one of the primary benefits of cloud. The primary benefit of cloud is getting to yes, most health it and most it, prior to moving to cloud models, were just, no, it's, it, you know, it's gonna take, uh, you know, thank you for the request.

That'll take six months and $3 million. And when you get to the cloud, you're able to do things in a granular fashion. You're able to scale up and scale down. You don't have to do a lot of the heavy lifting, 'cause the heavy lifting is being done by the cloud so that you can focus on your client requirements, programming and access.

Um, so, you know, businesses, uh, you know, businesses moved from old tech models. And healthcare needs to do the same. Cloud is the only thing that, from an architecture standpoint that we have today, that is going to be able to keep up with the business demands and the business requirements as they, uh, come down.

So that's all I can really cover in three minutes or less. If you have other questions, you know where to reach me, bill it this week in health So if you wanna support the fastest growth, that's all the news for this week. If you wanna support the fastest growing podcast in the health it space, uh, here are five ways you can do it.

Share it with a peer, follow our social accounts, LinkedIn, Twitter, YouTube, uh, interact and repost our social media content. Uh, the fourth thing, send me feedback. You know, did the broad, uh, broad, not deep, uh, approach these things work or not work? Tell me if you like, uh, this format, not like this format. Uh, tell me what guests you like to have on the show.

Really appreciate it. Bill it this week in health and you can subscribe to our newsletter. And now you can subscribe to, uh, this week, health Daily on the website. Uh, this show is a production of this week in health . Uh, for more great content, you check out our website at this week in health or the YouTube channel at this week in health

Actually go to this week in health and click on the YouTube link. Plus all a ton of the videos are on our website. Thanks for listening. That's all for now.



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