Episode 474: Transcript - December 27, 2021

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Lee Milligan: We spent the last decade putting in place this kind of base digital infrastructure that's been pretty onerous. But it's helped us get to a certain level. But I really feel like 2022, 2023 are the years when we're going to begin to be able to see the fruits of our labors.

The second is you're going to get to meet the team and they're going to come on and talk about things. So this is [00:01:00] one of those episodes. Before we get there though I want to remind you that for next year, we have some changes to This Week in Health IT. We're gonna have four channels. Four distinct channels on iTunes next year. We're going to have this week health academy, this week health community, this week health conference and this week health news. So, if you are already subscribed to the Today show that will become the this week health news show, and you're gonna have the today show and the newsday show in there.[00:01:30]

If you're subscribed to This Week in Health IT that will become this week health conference. And that's where we're going to have keynote. And we're going to have solution showcases and some other campaigns around specific topics. This week health academy is new. It's really around education.

And we have CIOs. We have CMIOs. We have clinical informatics. We have data scientists who I've tapped on the shoulder and asked them if they would essentially interview people within their networks about topics that are a little closer to what [00:02:30] you're doing on a daily basis. And we're excited about airing those channels again. Four new channels.

If you're not subscribed to all four of them, you're going to be missing some content. We'd love for you to subscribe to all four. Go ahead and hit thisweekhealth.com/shows and there's information there on how to subscribe. You can also hit iTunes and search for this week health. Any one of those academy, conference, news or community.

I am excited to do this show. We have Drex DeFord with us, Lee Milligan, Dr. Lee Milligan, Anne Weiler and Frank Nydham have all joined us for this end of the year episode. And we're going to, if you're not watching this on video, it's worth looking at video because we're going to do this Brady bunch style, which we don't usually do on this show.

Two questions sounds pretty simple, right? If we got a two question test in college, we'd be pretty happy, but I have a feeling this one's going to be a, going to be fun. I, I'm going to kick [00:04:00] us off because I did the Today show and I've done 230 episodes. And so I've been following the news probably closer this year than I ever have.

For instance, Haven ended in January. The JP Morgan, Amazon Berkshire Hathaway thing ended in January. And that feels to me like it was a lifetime ago. And it's kinda crazy that that happened this year.

And they're just failing forward. They're saying, all right, that didn't work. What's next? What's next? And I think we're going to keep seeing that happen. I'm not sure that was the biggest moment of the year, but that was definitely one of the moments I wanted to start with. Drex, how about you? WE'll go around the room, give everybody a chance to throw one out and then we'll see what happens.

I mean, I kind of put all of that in one big bundle. It seems like every time we talk and every time pick-up a tablet and look at the [00:05:30] news, there's a cybersecurity breach going on, or somebody is struggling to find their way out of a cybersecurity breach. And that seems to me to be one of the biggest stories for healthcare IT this year.

Bill Russell: That has to be true. One of the things with the insurance I thought was interesting. I'm talking to people now and they're saying heck the requirements that the insurance companies are putting around the cyber liability insurance, at this point, if you follow it, you're not going to get breached. It's like you have to stand up, dual factor authentication.

Drex DeFord: I've seen and heard more healthcare organizations than ever before tell me that they are going to self-insure because either the price tripled, the deductible tripled the, the amount of inspection in control that the insurance company wants, should something happen, is just overwhelming or they weren't able to qualify for insurance.

Bill Russell: So for the rest of you, was there a bigger story than that this year?

I think it was in the Wall Street Journal. The other day, 2 million people retired early and they're never coming back. 16% of nurses leaving. So, I guess I would say what's the impact across the board on all these technologies under people. And I think the good side is stats, show there's more companies are starting up now than ever have started in the last five years. So maybe the dark polite side of this last year being so dark as a people getting out, trying to do these crazy things that they always wanted to do. The [00:07:30] bad side though, is, as being a technology vendor nobody has time to do anything. This has tremendous impact.

Drex DeFord: Is that a general purpose question for everyone?

Bill Russell: I'm throwing that to, I'm throwing it out to everybody because I think it is one of the bigger things that's going on right now. In fact, I think it's one of the top of mind issues for most healthcare organizations, is the nurse shortage and the battle for talent has gotten to be pretty, pretty robust. Let's just say that's the nice way of saying it's gotten pretty robust.

And we're, we're doing everything we can to understand what this new landscape looks like. And I don't know that anybody has this perfectly figured out. I do think one of the main keys is to be open and creative to new ways, to engage with folks who perhaps will work here. And we have to kind of understand that historical ways of doing business may not be the best way to approach it [00:09:00]moving forward.

So here within our system, we have a whole group of folks we're focusing on. But we also have docs who are leaving as well. I, I was talking to one doc who's a really respected cardiologist here who was considering as, as was mentioned, just hanging it up for a little whil e and just be done for 18 months and then maybe come back at some point.

Pay is obviously huge, right? You gotta make sure you get the pay piece right. But that's not the only piece and pay alone will not keep people around. We've got to figure out a way to have a balance, true balance for folks so that they can have a real life while they're also contributing. There has to be flexibility built in so that it is kind of normal, like clocking in at eight o'clock and clocking out at five o'clock.

Bill Russell: I notice you're in your office.

Lee Milligan: I am.

Bill Russell: So was the number 15% or 17% open rate right now?

Lee Milligan: 16.1 right now.

Lee Milligan: I can't give you that exact number. I can tell you from an IT perspective, 85% of my staff is work from home right now. So we got, people have to stay on prem are networking folks, some of our folks working on the servers. Engineers, field support and then biomedical engineering. Those are kind of the main areas that are on prem. Everybody else is work from home.

Lee Milligan: Yeah, the rounding piece has been interesting. We've kind of gone back and forth on rounding, depending on what kind of, where we're at with our numbers. When the Delta surge was, was really at its peak around here, and we had 190 inpatients with COVID and 60 on, on vents. At that point, we were backing off on rounding.

Bill Russell: Interesting. Anne you did a lot of work with health systems and you saw the value of rounding and those kinds of things. Are we going to lose something from a culture standpoint of that interaction between the analysts, the technologists and the and the clinicians?

We sat beside [00:13:00] the surgical schedulers all say to see what they were doing as they were moving from you know this screen to this piece of paper. So I think it's a matter of like understanding the right times and I'm hoping what it also does is, for startups as well, and not just for startups, but for the environment that health systems realize that an awful lot can be accomplished on a conference call. On a Zoom.

You end up in a situation sometimes where it's like, if you can't drive there and talk to them, then they don't want to talk to you. And it's very hard to run a global company that way.

Frank Nydam: I don't think we ever go back. I don't think we ever [00:14:30] go back. They're going to work full time and the office. I don't think anything goes back. You know to your opening question, what was the biggest story? And I think all you will laugh at this. Remember three or four years ago, a healthcare would say no way would we ever go to the cloud and now look at this.

I mean, thank goodness for all the clouds out there. Thank goodness from work from home. And I just think people have gotten so used to it. We've gotten good. Tons of Startups, we don't really need to be all over the place. So I don't think we ever go back again. I think that's going to be good for technology.

Drex DeFord: Yeah, I definitely, I would agree. I don't know that we're ever going back, but I mean, I think Anne's caution is a, a really good one for us to pay attention to. Health systems and other organizations have years and years and years and years worth of habits built up that say, nobody works from home. Everybody has to come to the organization and [00:15:30] work.

And at the beginning of the pandemic, you saw organizations who said, nobody can work from home. On Monday, on Wednesday, say we're sending 6,000 people to work from. And I don't think they've gotten over that habit yet. And so to Anne's point, I think there's organizations who are leaning back into their old habits saying, you have to come here and you have to work in person.

Lee Milligan: And I thought that was a really interesting conversation on one of our executive team meetings where one of our senior executives asked, asked the question, well, let's get everybody back on prem. Let's put together a team that's going to be able to kind of, create a framework to make that happen.

And there are other scenarios where from a practical and efficiency perspective, it's just way better in a virtual environment. And I don't know that we figured that out. The other piece that kind of [00:17:00]is separate but attached to this a little bit is we've introduced so many communication mechanisms.

Drex DeFord: There's also the Box and SharePoint and you've got four or five of those things that you're dealing with too. Like trying to remember where have you put things or where did somebody send you something?

Bill Russell: Did you guys ever see the McLaughlin Group? And he used to do this show and you would try to pinpoint it. So Frank's saying, we're not going back. Drex hedged and said, yeah there's, there's some, whatever going back, Lee, are we going back or have we fundamentally changed? One of the two?

Bill Russell: Fundamentally changed. Anne going back or fundamentally changed?

Anne Weiler: Fundamentally changed. And I'll use this to talk about what I think is its still the top story of the year, which is COVID.

So I was nodding a lot about the, which you know, which communication channel do we use. But you know, our, our customers are health systems and governments sending COVID notifications, vaccine appointments, contact tracing all of this to their constituents. And those governments got up and running faster than I've ever seen.

I'm thinking also about like, the things you get about well, old people can't communicate this way and you're leaving them behind. Well, my parents are walking around with their COVID passports. They are in Canada but other COVID passports on their phones and showing them when they go to a restaurant or, or whatever.

Bill Russell: If it weren't for one other factor, I think we would absolutely go back. Like a hundred percent snapback and that other factor is labor. There's just a shortage of labor. If we didn't have this shortage of labor, I think health systems right now will be planning on how to bring [00:20:00]everyone back.

And if not today, within the next 48 or 24 months everyone would be back because it's what we know. It's how we operate. And for one team. And you have this idea of fairness, all of our clinicians have to come onsite. Why do these people get to live at the beach and work at the beach and that kind of stuff.

Anne Weiler: I think like for us, everything that we're talking about, all these trends have happened because of COVID. And I think as well, when we were talking in 2020, I don't think we knew that that would still be the biggest story of 2021. And the changes and the repercussions would keep happening.

And they were around contact tracing and just general stuff. And then the customers were telling us, and this was state and local governments and hospitals like, oh, we're going to stop sending so many messages because this [00:21:30] event is ending. Well, guess what? They had vaccine appointments, they had vaccine availability, they had new regulations.

They had the, where to go get COVID tests. Like the messages are still going and so I was actually prepared for it. Okay some of these customers, we have to figure out what they're going to do next. Don't. We don't. Cause they're still doing these things. And now that they're doing them, like there's absolutely, I don't see us. Why wouldn't we send flu shot notifications now that we can? We will. Most basic one. I don't know why everyone's not doing that.

And so we had a changing of the guard and changing presumably, a changing of approach and those kinds of things. So we had a minimal amount of vaccine early in the year, so that was the big story. What are we going to do with the, we didn't have like a full supply. We had people driving 200 miles to get their first shot and that kind of stuff.

It was a big deal. It was a huge deal. I mean, Disney World had opened. What were they going to do? And they had social distancing in their lines. If you thought their lines were long before their lines were massive with social distancing. I mean, it was, they wrapped them around, outside the park. I mean, it was, they were [00:23:00] all over the place.

I think for the first time. I can't remember a time in history where we sort of did it this way or at least tried to enable it digitally. A couple of really cool stories that you had Atrium Health, do it on one of the NASCAR speedways. So the people drove in, drove onto the NASCAR track, drove into the pit, got their shot and drove out on the pit.

Heck it's hard to get a hundred percent of my family to do anything if I tell them to do it. This was an interesting learning year. Lee, I'm going to go to you. I mean, what have we learned going through this year, since you're the only physician on the call. I, I feel safe going to you.

And although they had good people, great intentions, trying to help and partner with that. They certainly did not have the resources and the infrastructure to partner in any meaningful way associated with this work that you were just describing. And so we really fell to the individual health [00:25:30]systems to put the that responsibility on their shoulders to carry the communities to be able to make this a reality. And if you look around the country, really the points you made were, were, were accurate. Really amazing and creative ways to deliver this medical scenario to huge, massive amounts of people in innovative ways. So I think, to me, it's a testament to the creativity of the individual local geographies and making this work within their system.

Drex DeFord: It's hard work too that they're doing in a system where they're not being reimbursed to do that particular kind of work, right. They don't get paid for the 20 minute, 30 minute conversation they may get into around this.

Bill Russell: It's amazing. Who has another story or another event from this year. Clearly, I mean, COVID the vaccine labor cybersecurity. These are some of the biggest things that happened this year but anything else that you think really shaped this year?

And we had to work through a lot of those issues, including kind of restructuring our conversations with patients about what to expect. And what those results might mean, but the reality is patients have a level of transparency to their own individual health that they've never had before.

Cause I asked a couple of, of the investors, what's the number one indicator of success for you? And they say someone who's done it before. So a leader who has successfully gone through the gauntlet and gotten through the other side. And so that's why someone like Glen Tullman has no trouble raising a hundred million, but somebody else might have trouble raising five million.

Bill Russell: Yep.

Drex DeFord: Because they've been around for a while. Doing some stuff yeah.

Everything I see is like, wait a minute, we've seen this idea before. I saw Jack Starter, his new thing. I'm like, I don't understand the difference between this and Iora. The money. I think that's the thing with COVID is actually the VCs suddenly went, oh, healthcare.

Frank Nydam: Is that a bad thing? I throw that out there. Right? I mean, maybe for the LPs are throwing you know, good money after bad, but again, to my opening statement about the great resignation, everybody's changing jobs, or just thinking about the folks that have been working at hospitals, vendors always have this good idea and finally got the money and an opportunity to go do it. So let a thousand different companies go to try [00:31:30] solve XYZ. I think we'll all be better in the end. It does look frothy from the outside and your, your right Drex, I mean, even in my company, David Ting with this is his second company. I think they're looking for leaders who have been through it before and understand health care, but I think it's a good thing. There's really no downside. Save some of the investors.

Drex DeFord: I, you know, so I think, we've passed the infrastructure plan. That's really big news this year. I think next year is the year when a lot of this really begins to shake out and we start to really understand what a lot of that spending means for healthcare in cybersecurity, in broadband and telehealth, how [00:32:30] fast it's actually going to happen. I think that's a thing that I'm going to be watching for throughout next year.

Bill Russell: Fantastic. Lee?

So for example, the OR. I really feel like this concept of a single surgeon going into OR after they've you know finished their residency and have their board certification and then practice for 40 years in a silo, that's going to be blown out of the water. I feel like ORs are [00:33:30] going to be digitally connected. There's going to be surgeon A and surgeon B having a conversation over this. I think augmented reality is going to play a role in that as well. And I really feel like the patient ultimately is going to be the benefactor of this digitization in the OR.

Bill Russell: Fantastic. Anne?

Anne Weiler: No, I actually don't make predictions.

Bill Russell: Is that your, is that your final answer?

Bill Russell: We're printing money. So the value of everything has gone up. A gallon of gas is now a ton more money. So I think that's one of the things that's driving is the returns that people are getting in the market and whatnot have really driven them to be a little bit more aggressive with their money.

Frank Nydam: I agree with Anne. I think there's going to be a lot of consolidation, but maybe from an IT perspective, honing in on my, my first comment about IT labor shortage, rationalization of everything, facilities, applications, what have you. I think just there's just too much stuff in [00:35:30]the system. I think Lee also said it or Drex. There's so much stuff that people in the hospital's have been doing for so long. Giving that up is tough. And I think there's going to be a mass rationalization. I'd say if I had to put right behind it, automation. Again, tying back into this labor shortage. There's just so much stuff that involves people every day. Companies like UI Path. There's just amazing amount of robotics automation going on up there. Just again, not enough skilled labor, IT shortages what have you. [00:36:00] So my 2 predictions. Rationalization and automation.

So I guess we'll figure that out in 2022? We'll have no, no, no more. Draex, just out of curiosity, which way is your, because you track this, which way is the breaches going? Is it still growing every year?

Bill Russell: Fantastic. I want to, I want to thank you guys. Not only for coming on the show and doing this end of the year show, but just thank you for your ongoing partnership with This Week in Healt IT. And helping me steer the ship and figure out what we should be doing [00:37:30] next. It's greatly appreciated. So thank you again. Thanks for for all you do. And thanks for your insights into what's going to happen next year. We'll put all these on paper.

Frank Nydam: Thank you for everybody out there. I think you've got a great service and people are learning a lot and bringing people together that probably have never talked before, so.

Drex DeFord: For sure.