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

 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 professionals. So go ahead and check that out. Now onto today's show, A View from Capitol Hill. With Mari Vickis, with Chime. One more quick note before Mari chimes in, and that is we're gonna go on a summer schedule starting in June.

June 1st. We will have a Newsday episode every Monday, and we're gonna have a influence episode every Friday. Those are the conversations we have with industry influencers. We may drop a solution showcase in there from time to time on Wednesday, but that's gonna be the . Exception. And if you still need more, we have our daily show today in Health it, which is around eight minutes long.

We look at one news story every weekday morning. Those will continue. This is just a chance for you to catch up on some of the shows you missed, or just take a break and get outside. Whatever works for you. All right, today. Mari is in the house to talk about all things from our nation's capital. Mari, welcome back to the show.

Thanks, bill for having me. Always trying to keep it interesting over here if well, you're in the capital. Of course. Things are interesting. There're now we're not gonna necessarily talk about the, the really interesting stuff, but we're gonna talk about healthcare and there's an awful lot going on with regard to healthcare in the capital these days, I would assume.

Yes. You know, I don't, I mean, I wouldn't know exactly Bill. 'cause like the capital's still pretty much shut down, but you can kind of get in if you give away your, the capital shuts down. That's, that's like, so we'll talk about theoretically , the capital is shut down. That's like happiness to everyone's ears.

We're just sort, the government is shut down. I don't have to file my taxes or anything. Actually, tax days come up, isn't it? No, no, no, no, no. It's a big delay. All right. Taxes are delayed. Everything's delayed. I know. Well, hey Mario, I don't often do this, but today you get to pick the topics. We're gonna discuss what you want to discuss.

What is, what's top of mind right now in our nation's capital? Well, everything's, you know, all of our hot topics are always front and center. You know, we've got telehealth. You know, we've got, that's been in the news very recently. We've got information blocking, inoperability, got that 365 days a year over here,

And you know, we've got things like cybersecurity. That's another hot one. So I don't know, I'll just give you a grab bag of three things. So which one should we start with? Well, we, you know, and we're gonna, the good news is we can probably go a little deeper than we usually do on, on any of these. So let, let's start with cyber and.

You know, it's, I covered the most recent breaches on today in health. It, I think just yesterday, and I posted this out on LinkedIn and, and as you, you know, I'm trying to get the conversation started on LinkedIn. People can follow me at Bill j Russell on LinkedIn, and, and this is what I posted. I said, cyber carriers are parked off the coast and they're attacking healthcare.

It might be a provocative statement. If it weren't true, consider this. What would we do if a foreign or domestic group or even a person were to walk into a hospital or a group of hospitals, go down the hall to the HIM department, set fire to all the records, completely destroying them, and once they were done, they would had to just saunter on over to the data center, kick on the sprinkler system.

Turn the computers into nothing more than Paperweights, and then they walk away and start doing it to the ne Next Health system. And I, I go on to say, well, that's what's happening and it's happening with more frequency and bigger targets. You know, this week we, we already know that at least four health systems lost all their records.

I mean, the ransomware came in, essentially annihilated them all their records, all their images gone. Uh, now we don't know exactly what's happening, but Scripps this week is, it's in the news. It's in the San Diego Union. Tribune Union, I what the name of their paper is down there that essentially they're on, on paper processes, that their portal doesn't work, that they're doing diversion and those kinds of things.

But we don't know exactly what it is. But we, you know, looking at it from the outside, it looks like ransomware at this point. What are you hearing on the hill? I mean, is is that overstating? It, it, it just feels like there's an awful lot of . Attacks and activity coming at healthcare right now in the, in the cyber world.

That's really scary, right? ? Yeah. So I've been reading about some of those things you've clearly devoured. The cyber news, so I applaud you for staying on top of that. I just read a statistic that said that every, this is for one big health system in Boston that ev, they're attacked every seven seconds, which is just like, you know, how do you, how do you handle that level of stress?

So let me, let me. Turn off my printer and tell you what I am hearing. Over here, there is funding for csa, right? There's a lot of funding that's being dumped into csa, though none of it right now is especially targeted to the healthcare system. I'm sorry. Background noise, bill. No problem. So I think it was like $650 million is in Biden's plan and that's a lot of money, right?

But we need to figure out how this is gonna actually, I guess that's already actually been appropriated how that's actually gonna be spent in terms of the each sector, right? Healthcare. And we're so interconnected. If you think about some of the storms in Texas, right? Storms in Texas, electric grid healthcare, you kind of don't wanna be the hospital that loses power or gets, you know, like I guess assaulted like you just described.

And so these really are big challenges. I mean, I do think that this is on lawmakers minds. I know that also President Biden is coming out with a cyber executive order very shortly. Expected later this month. So there's attention being given to it. I think from the healthcare perspective, it's just like, how much attention can our sector grab you?

You might say, oh, that's kind of surprising in the middle of a pandemic. Right? Pandemic. But you know, there are, you know, other sectors who are, um, also getting attacked and I know that he's, uh, the president's focusing on a cyber sprint around electricity, and that's, that's laudable. We hopefully would see something similar in healthcare.

I mean, it, it is getting attention. It's just like we're trying to get them to focus in on healthcare is something that we're working on doing. Yeah. You know what's interesting? I I, I used the imagery of cyber carriers parked off the, off the coast and in the Gulf of Mexico. I used that, that imagery on purpose because if there were carriers off our coast, it would be the federal government's responsibility to, to do something about that.

We wouldn't expect the state of California to their militia. You know, start sending boats out to, to, you know, look at nation states and others that were coming in. We'd expect the federal government to do that. And, and I, I use that imagery to say, I, I think we're at that level now. I think we're at that level where the, the attacks are so sophisticated and they're so violent.

I mean, they are setting, they're, they're destroying records. They're, uh, really going after healthcare in a, in a strong way. You know, I think it's more than just, I mean, this, again, I. To a certain extent, I get to say my opinion, but you, you have to work in that space. So I understand you maybe not being as strong with your opinions as I, as I would be in this case, but it, it feels to me like the federal government needs to step up almost with like a military action to protect our health systems and to have that level of preparedness and funding and sophistication in order to protect our health systems.

It's, it's one thing to look at a large health system with 50 hospitals and a, you know, $200 million IT budget and say, yeah, they could probably figure out a way to protect themselves. But it's a completely different thing to look at a federally qualified health clinic or some of the smaller health systems and say, Hey, why can't you come up with enough budget to protect yourself against this?

Syndicate that's trying to get in. Well, they just don't have that kinda money. I mean, there's nothing you've said that I don't disagree with. I mean, if you want me to get all spun up, I mean, people who know me pretty well though I can get pretty passionate , so I mean, it's not, it doesn't take that much for me to get all riled up.

I don't disagree with anything you said. In fact, I love your, your analogy or your imagery about . The pirates offshore and that, you know, usually it would be like the US Navy or something would go after them. I mean, so we need some sort of like cyber, you know, rescue plan. I may have to like GNA on that one.

I like your like, like where you're going with that. So, you know, there's, I think some of the challenges we face are a few fold. We have, we're in the middle of a pandemic. We have . Bailouts and rescues and you know, stimulus packages for not just healthcare but multiple sectors. We have now the infrastructure package that is being considered.

Right. And like the Republicans and Democrats are in very different spaces in terms of like what the price tag will be. You know, I know like the Lyft Act has. Something that's been driven by the energy and commerce Democrats that, you know, that has some cyber pieces in into it, and that's really helpful.

But what the ultimate plan will look like for the infrastructure is, it's hard to say. I mean, I think right now there, the talk in Washington is like, oh, we're gonna do this in a, um, bipartisan manner, but. Ultimately because the, the price tag that the Republicans want versus what the Democrats want is so vastly apart.

Like they're not even in the same ballpark that this will probably be done through reconciliation. So like a straw mark tactic. It's hard to say if cyber will make it in for healthcare. And to the end of that, I mean, we certainly hope so, and we'll keep advocating for that. We've been pushing pretty hard and I'll turn to some again, like reminding people about some of like the positive things that we've gotten lately.

Just to kind of bring back, you know, try to look, I'm a glass half full kind of person. These aren't, not to say that what you've said is we, we need more help. Absolutely. We do. Like, absolutely. And so, uh, to pivot just for a moment on the positive, I would say that, you know, first thing Bill is like, let's, first thing is acknowledging we have a problem.

Right. So sometimes we have to start there when we're talking in with policy, right? Several years ago. No, I'm, I'm being, I'm being serious. Several years ago would have a situation where certain Major P policy makers would not even acknowledge that. Cybersecurity incidents against healthcare systems and on clinicians and hospitals and so forth are, were a patient safety incident now that is standard like they standard accepted, you know, parlance.

But we weren't even there a few years ago. So, okay, so finally we admit that we have a problem. Yay. Now we need some more funding for it, right? So we did on the last podcast I did with you, we talked about HR 78 98, which is gonna bring forward some instead of like the, the penalty approach. It'll be more carrots than sticks, offering some relief by adopting voluntary best practices.

Now, we haven't seen the, the, the rule yet that just happened. It wasn't just passed a law in January. So like something to look forward to everyone. So, you know, that's one good thing, right? Cyber donation, policy star get kickback. That's, you know, still, probably still like there's hesitancy around that though.

You can do some donations of hardware. That's good. So these big ticket items, and I was just looking up, I, sorry, I don't have every single figure committed to memory, but the president's skinny budget calls for 2.1 billion for cisa. Again, not targeted towards healthcare, which is what you're getting at here.

We're gonna keep shipping away at that. I'm President's skinny budget. We have a skinny and a fat budget or a, I mean, help me with the lingo here. I'm just, I'm learning here. See, we're in the beltway here. So for your loyal listeners, what happens is, is usually they call it, I mean, we have all these weird terms here in dc, like skinny budget.

It's not really a skinny budget. It just basically means like the high level numbers that are presented, it's not the granular details that fall underneath. And so some, I can send it to you afterwards. But the high level numbers show you what is, uh, being presented, and then a more robust, detailed budget is put forth.

It's later this year, I think, because of, just because of the way that it's, this year got started, but when the fuller budget or the more detailed budget is released, we'll have a little bit more idea about where, what's, like, how each pot of money is intended to be spent. You know, it's interesting. I, I, I think there just.

When I tend to go back to my role, we all go back to.

We were a little more ahead of the curve back then. They were not getting in as often as they are now, but they're getting very sophisticated. These ransomware attacks, these malware attacks are getting, uh, much more sophisticated. They're finding our backups and destroying our backups. They're also not as, as overt.

I mean, when they get in, they don't like celebrate, like, Hey, we got in and we're stealing records. They look for the most opportune way to, and I think most of it's about money, most opportune way to, to make money. And I, I don't think a lot of these attacks we're reading about right now are nation states.

I think they are organized syndicates and, and. Is trying to extort money outta healthcare, but healthcare seems to be susceptible. I, I think what I'm asking for when I think about it as ACIO, my budget went from 2 million, the first year to 6 million by the time I left for cybersecurity on an annual basis, and that wasn't enough, and part of the reason it wasn't enough.

Uh, we're protecting 3 million patient records. The reason it wasn't enough is because, you know, we're trying to defend against people that their budgets are far greater than ours, and they're hiring teams of people and they only have to get in once to start. You know, making their way through our, our health system.

This is where I think I would want to, here's what I'd wanna say to congressmen, senators is, is, is look, I, I think it's a military response and I, I'm not saying a military aggressive attack. I'm saying it's a military defensive posture. Where they are working with us to create a defense around our health system.

Just like they're talking about creating a defense around the electrical grid and our water supply and those kinds of things. If our hospital systems go down, yes, we can go back to paper and, and a lot of us do throughout the year, we have, uh, systems go down and whatnot. But at, at the end of the day, you know, to lose all the images, uh, for a health system or to lose all the medical records is a.

To, to our nation, to our trust in, in healthcare and our health system. So I, I'd almost like to see a coordinated response, and I keep coming back to the military just because they tend to not put, you know, $10 million in this budget, $8 million in infrastructure, you know, 2 billion over here, 5 billion over here.

I'd like to give it somebody who's at. Creating a defensive, protect the assets of the, but again, one, but I, I appreciate what you're saying. Half full. You know, we little relaxation on the stark laws. We can now help. Some of the, uh, physician offices and that is helpful. And we're starting to see, uh, some carrots instead of sticks.

So cyber's interesting. But do you wanna go to telehealth next or do you wanna go? Well, well, I, before we, before we move on, I don't wanna leave any of your listeners with like, the impression that we don't like think this is like as bad as you say it is. 'cause it absolutely is. I mean, I would challenge the listeners of like, if you have ideas about how to crack the code on this, I.

We'll give you my email at the end of this and I'd love to hear what your listeners have to say about what we should be asking for. 'cause we, you know, don't have enough time to spend talking about all the different things that we do ask for. But I'd like the door's always open over here and, you know, I'd love to hear like, I like this interesting idea of a military response.

You know, we can, I'm gonna GNA on that one, but have your listeners send ideas over our way so we can try and, you know, crack the code on this. Yeah, it's, it, it, but that's what you guys do. You're on the hill representing us and , right? And I, like, I live and die by stories, right? Like your hearts and minds.

I always say this about hearts and minds in Washington are one story at a time. So right now there's like a story, right? You talked about four health systems being under attack. You know, like I read about the scripts one, they're like, they're on diversion. That means that literally, unless you're having, you know, like, like trauma, you are, you're getting sent to another hospital.

Which is really not great. Right. . So that's a patient safety issue. So just send your ideas to me please. Yeah, yeah. Diversion's bad as bad when technology has. That's yes. Say the telehealth a little bit. We were getting so many conflicting things about telehealth. It's really interesting. Healthcare, finance, news.

Most consumers wanna keep their telehealth. I think that's the most common thing we're hearing. I saw another study where people said, Hey, you know, I wanna get back in front of my physician. So you have conflicting sort of stories there. The healthcare finance news said almost 88% of Americans wanna continue using telehealth for non-urgent consultations after Covid 19 has passed.

And I, I think that's true. New York Times had a, an op-ed by Elizabeth Rosenthal, who is a doctor, a former emergency room physician. And you know, she, she talks about the challenges of telehealth and I actually, I'm gonna read a little bit of this because I, I thought it was interesting, but again, it's an op-ed, this isn't like research piece that, you know, we need to give as much weight as some other things.

But it is, it, it was interesting. She goes on to say, by.

Compared to 5% a year earlier. And that was really true. They looked at those claims, COVID-19, led virtual medicine out the bottle. Now it's time to, and this is one of the few, the reason I pull this up, because it's one of the few articles I heard about like this, and so I wanna discuss with you if we don't.

There's a danger that it will stealthily become the mainstay of our medical care. Deploying it too widely or too quickly risks, poor care inequities, and even more outrageous charges in systems already infamous for big bills right now. There's a lot of focus on shiny objects, ideas that sound cool rather than solving problems.

Said Dr. Peter Pro Pronos. A national expert in medical innovation at University hospitals in Cleveland, who has written about finding the value in virtual medicine. We know, we know preciously little about its impact on quality with telemedicine generously reimbursed. Many practices are offering even encouraging patients, patients to visit virtually.

But intentionally or not, that choice becomes a revenue multiplier to the patient expense. And then they give this this example, which I hadn't really considered when you notice. When he noticed a curious rash, a relative was first directed to practices telemedicine portal and billed 35 for a five minute video appointment.

Since rashes are often hard to evaluate in two dimensions, he was told he needed to see a doctor in person for a diagnosis and then charge hundred $60 more for that visit. I worry that the pandemic era re reimbursement practices have taken traditionally free screening calls. We rebranded them as build visits with no value added again.

Mm-Hmm. Op-ed piece. And I don't wanna, I don't wanna give it the same legitimacy, but one of, one of the things I, I find when we're talking to technologists is we just say, you know, telehealth visits, they're efficient, they're, you know, practical, they're a, you know, increases access. It's, you know, a, a convenience.

Factor. You know, we just assume that everybody wants it and we have data to support, but everybody wants it. Is is that the current sort of mantra? Everybody wants this. This is good.

Is backed up by it and we should be running after this or is there, is there any hesitancy around this? There's like so much to unpack here at the top of the call before we all went live, you said I could ask you questions. So we're both patients. Let me ask you, we know what's your opinion of what, you know, what you just articulated and in Dr.

Prognos is a. Well-known patient, uh, safety and quality expert. So, you know, he, his thoughts, you know, carry some merit. But I, I think I'm interested in hearing what you have to say first. Then I can dive into my diatribe. Yeah. So couple things. One is we have to define telehealth before we have the conversation.

'cause when we say it.

Video, video remote monitoring, and each one has its, and each has application every time we.

We're seeing a growth in remote patient monitoring, and you know what? Video consults between doctors and those kind of things is highly efficient and should continue to grow at whatever pace it could possibly grow at as fast as it can. Remote patient monitoring will be. Interesting to see how it grows because we need more use cases.

But it gives you more touch points around, between the patient and the, and the doctor, especially chronic conditions, you know, type two di diabetes, type one diabetes, you know, Livongo and, and other things to that effect are, are good ways to get more touch points. But the, the video visit. That, you know, if I'm getting a $235 bill for a five minute video appointment where they didn't diagnose every anything, yeah, I'm gonna have a problem with that.

And by the way, I'd have a problem with anyone who did that to me that, hey, you know, hey, we, we, we couldn't really diagnose anything that five minutes.

If anyone did that to me, I would be upset. And so that kind of pricing model needs to be looked at. We need to dig into the claims data that we got for the better part of a year and say, okay, what are we finding? How are people using this? How are they billing it? What codes are they using? And we should have a ton of CMS data.

We should have a ton of commercial data to see where this is working, where it's not working, and then tweak the dials around this. But. I love video visits. I think it's convenient. It saved me an ER visit during Covid, which was great. So I like that aspect of it, and it creates more of a relationship between me and the health system, which I think long term is good.

I think there's a lot of benefits to be had now. My mom will have none of it. She's ready to go back and see her doctor. She had. AFib and the doctor caught it in a visit to, in a, in a routine visit. And her thinking now is that would not have been caught caught if I wasn't sitting in front of that doctor.

And I probably would be dead today if I had not been in front of the doctor. So she wants to have nothing to do with video visits. And so that's sort of where I come down. Once you've seen one patient, you've seen one patient. So there's probably like a lot of different. Views on, you know, what the future of telehealth should be for, for citizens.

I mean, like, I personally am the mother of a special needs, uh, child and I typically travel two hours to, you know, world renowned, definitely well known in the United States facility to get his care navigating two beltways and then him, who is, is hard to manage. Now during the pandemic, I have the luxury, is that the right word?

The luxury of speaking to, uh, this clinician minus having to like, you know, mask up and drive two hours and all. So it's been actually incredibly helpful, but that's, I'm only like one pa, like one patient, one use case. So I think that there's, I agree with your, your sentiment that it has to continue to be studied and that's something that Chime has supported.

We actually do think it should be monitored. I don't think that Covid is like the perfect use case. We were thrown into a pandemic, and yes, there's a lot of data. But it's not, it wouldn't be like an apples to apples comparison, right? There's still people who had to hold off on getting care that maybe the, maybe the health system felt wasn't like needed in like urgently, but they still wanted to get done.

You know, there's still probably some, there were. Cases where you had a hold off care that really should have been taken care of, right. Because of covid. So it's not the perfect example of apples to apples comparison, this data that we have now for about a year. Right? So it's, I agree that it needs to be studied.

The other thing that is in question and, and you brought up some equity issues, and I, I don't know that I have a good answer for that. That's part of the study thing is, uh, audio, that's one of the issues that's being discussed in Washington DC. There's a ton of support for moving, at least among provider associations and, and other stakeholders moving some of these telehealth flexibilities over the finish line conclusively done.

But, you know, whether that's gonna happen is really an outstanding question. You know, if I, if you gave me some money and said like, go to Vegas today and start throwing down, you know, where would, like, where would my bet come down? My bet would come down. You know, and again, being really optimistic, I think what you're gonna see is a situation where Congress kicks the can down the road, you know, where it's like a middle scenario.

It's not, no, you can't have it, but they're gonna say, well, we're just gonna extend the pandemic authorities a little bit longer. Right? It's a kick the can down the the road approach. Are you gonna see the Connect Act over the finish line? I mean, I think if you talk to the most optimistic people in DC they'll say, oh, sure, it's gonna happen.

But you know, that has to be balanced against the backdrop of all the other spending, and we don't know what the score is. So, I mean, we, we support the Connect Act and you know, there's a lot of good changes that can happen. It's not gonna deliver everything. You don't wanna be perfect to be the enemy of good.

But there, there are these outstanding questions that you've raised that have not been completely ironed out. Fraud abuse, like our program integrity issues. Some lawmakers have real big concerns with that. So there are, there's a lot of merits. I, I mean, I don't think that we would disagree at all that this stuff has to continue to be studied and there has to be quality improvement and, and some of the other issues that you mentioned have to be examined.

Here's the thing I'm saying to my clients and health systems, is there. There is a business model to make money out there and Amazon's approaching it and running after it very quickly. Oh yeah. It makes more sense on the payer side if you're getting that first dollar for the care to keep people healthy.

Mm-Hmm. There, there's a business model I, I think they need to be exploring. I think health systems need to be exploring that and stop sitting back and waiting so much on how is the federal government gonna reimburse how Medicaid? The, the equity conversation is, is interesting to me. I, I, I don't think people recognize, I, I read a study, I wish I had it in front of me.

I think the number was, it was in the sixties, 60 some odd percent of the telehealth that was done. The video or the visits, visits that were done was telephonically. It was not video visits. It.

A digital divide that exists. And I used to think it was just rural and urban, but it turns out within urban areas that digital divide was really revealed during Covid that there was, you know, when you tell people, Hey, stay in your homes and you don't get to go to the public library or wherever they normally go to get a broadband.

Mm-Hmm. , they now, they have no way to get broadband. And so even within the cities, there's. I don't know what we call 'em, but let's just call it broadband deserts for people where they do not have access. And so the, their only option is telephonic, uh, care. And you know, at this point we could probably argue is it that much better for video visit versus a telephonic visit?

Quite frankly, if I, if I'm talking to my question. I tell them some things, a lot of times they can say, yeah, it's an earache. I'm gonna prescribe, fill in the blank. But there are times where that, that video visit, they look at you and say, nah, there's something else going on here. You should go to the, you should go to the ed.

So clearly video would be better, but, but still a 60 some odd percent is still telephonic. It's crazy. Yeah. I, okay, so yeah, there's so many things like Kelly, we could get into. So like on the phone thing for a moment here, you know, I think it just depends on the situation. Like, I've also read like conflicting articles.

I'm not, I don't consider myself to have equity, you know, issues for myself, but I don't have good broadband where I am. I'm 40 miles outside of Washington, DC and I have three forms of internet here. And none of them are high speed. So I'm speaking to you on a satellite internet, which is, um, unstable. And then two, I have two hotspots as a backup, and it's, so, it's spotty.

I mean, there's also, I think one of the things we might see in infrastructure is some broadband funding, which will be really helpful to healthcare sector. So that's good. Back. Go back to the audio for a moment. So I was just looking, we have this great resource. I can send it to you. It's a little dated, but I can send it over.

So Medicare, right? What does Medicare do? They, they move forward recently with like these, what they call technology services. They're not, how is under the typical, again, here we go with . Like Washington DC like splitting hairs, but they're not under like that bucket of the majority of telehealth services that Medicare's prohibitor from really doing unless Congress changes things.

They said, oh, okay. You know, we'll, we'll let you do phone calls. You know, doctor, doctor can look, can look at a video or a. Sorry, an image and decide if you need to come into the office. So there's, I could send this to you that might be helpful for your, you know, your listeners to take a look at that.

There's like these little toes in the water, but these absolutely have to be studied. Like I don't purport to be, um, some sort of expert on like equity and I, I think it really depends on like what situation you're talking about. Some people may, again, based upon the articles I've read. Some people may prefer the phone because they don't like it's phone or nothing.

Right. Phone or not. Or not gonna, the doctor like that becomes an access issue. But then you also don't want it to be a crutch where they get like poor care over the phone. Right. So you could go like down many rabbit holes there. With that, I, I'll tell you, one of the models I and RPM is definitely also something that has to be strongly considered.

You mentioned remote peace and monitoring. That's like with all the burgeoning technology. And then like one last thing I like, I'm trying to keep all your strains of thought here, . Let's go back to what you said about some of the technology, uh, giants and companies. So I know I, I'm, I'm throwing the question back to you.

Are you suggesting that that providers, traditional healthcare providers, replicate a model akin to the one that you referenced where they just maybe charge like a flat dollar amount and skip insurance? Is that where you were going? Could you explain what That's absolutely where I'm going. It's kind of funny.

I mean, one of the most egregious money that was spent was all this money systems endowments of billions of dollars. It was the dumbest money. Uh, uh, now I understand why it was needed for federally qualified health clinics, for rural healthcare, for some of the smaller health systems to shore up their balance sheets, but some of the larger ones did not need that money.

And tho those, those organizations have plenty of money to invest in a different form of delivering care. The problem is it cannibalizes some.

of healthcare or is.

It's not healthcare provider that comes forward with it. It's gonna be, it gonna be a oc, it's Amazon, somebody else who comes forward with it, and healthcare providers are gonna. I mean, you, you may be right about that. That's somewhat scary. I will say though, like many of the members, um, of Chime are not, you know, those are some of the bigger ones at the top right?

And then you have maybe the federally qualified at, on the other end of the spectrum, but you have like many community-based hospitals in the middle, right? What I would call like the bread and butter of. Membership who, you know, without the right reimbursement, are not gonna be able to continue, you know, offering the same level of service that they were before.

And so that always is what, those are things that keep me, um, up at night. Not the ones that who are so big that they don't even have to like, charge for telehealth. You know, it's more the ones in the middle. Right where your community hospitals are disappearing, they're being bought up. I mean, how do, how do they make those, make that that accessible?

You know, I'm, I'm, I'm near a community hospital here. I don't go to that hospital. Hopefully I don't go to the hospital ever, but, you know, whatever, if I have to, there's one not too far from us, and I don't know what their telehealth situation is. I haven't had to use it, but they are the bread and butter of the backbone of America.

So we have to think about the folks in the middle. But I agree. I mean, you're. And I, it makes me a little sad what you're saying. Again, don't disagree with it. Well, actually, here's what doesn't make me sad. I'm, I'm looking at Firefly Health, which is Jonathan Bush, his, uh, his, his new thing that he's doing.

And they essentially have this model for care that they've set up and now they're launching a, an insurance product to go along with it. And they, they published their, their findings from the first year and their average patient talked to a clinician 65 times last year. And his comment was, that's a good thing.

I mean, they're calling about nutrition, they're calling about, I mean, they're calling about everything and it's encouraged because they want to develop a stronger relationship between the clinician and the patient. And I'm looking at that model going. Yeah, that's right. I have questions all the time that I would, I, I go to, I go to the internet.

Mm-Hmm. . I would never think of, you know, talking to anybody within a healthcare provider because first of all, it would be too hard to figure out who to call and how to, how to get in touch with them. And second of all, they would look at me like, Hey, I have no way to bill you for this. And, and to which.

And they're thinking about keeping me out of the hospital. We still have a sick care model, remote patient monitor. The thing I like about remote, remote patient monitoring is it keeps people out the hospital. It keeps readmissions from happening, but at the end of the day. That means hospitals make less money.

I mean, I know who Firefly Health is. I'm not sure I, I'm not familiar with their business model, but I would say that, that with some of these companies, you know, like if it's a concierge, concierge model, you have to be careful, right? Because you know, only certain people can pay into a concierge where you get to talk to someone 65 times in one year.

So I'm familiar with those. And I was thinking back to the example you gave at the top of the call about a skin, uh, issue being . Improperly or not diagnosed on the telehealth. But I was thinking too personally from me being as a patient having been misdiagnosed on what ended up being shingles . Yeah. Got shingles, a gift that keeps on giving and that was sent home like, oh no, no, that's not shingles.

And I'm like, and then two days later, back, so I ended up having to pay for being at the urgent care clinic like twice. So there's, I mean I think that that goes back to quality, right? That goes back to quality. We're, we're still in a fee for service system that pays for the unit of care, largely not the overall value of the experience.

These are issues that are systemic to our overall healthcare system. And so I'll have to go look up fireflies business model, 'cause then you have me interested. I think that's interesting. I, I do want touch on interoperability with you. And by the way, for people, I mean, this is, this is why we do the show, is just sort of have these conversations and you might disagree with me, you might disagree with Mari and just shoot us emails.

We're more than happy to talk about it. We. We're mining ideas. We want ideas. We wanna have conversations around these things so that we can, I think the word is better. We wanna be better every day, getting a little better at what we're doing. Interoperability, so, gosh, a lot happening in interoperability.

Fill us in on some of the things that are happening from an interoperability standpoint. Obviously we had the information. Was it two weeks ago, three weeks ago? I, I forget the date exactly, but there there's a lot going on in interoperability. I have no idea what you're talking about. Oh, . I'm joking. I'm joking.

I'm joking. , there's an information blocking rule. You're kidding. I just like talk about this all day long. It makes, just makes me a power nerd. Yeah. Okay, so April. Fifth deadline came and went. The world did not cease to exist. Still like turning on its axis. You know, I'm practicing yoga bill, so I, I say to myself every day when things get stick out, it's like, deep breath in, long breath out.

I say, not mistake, it's gonna be okay. So yeah, there's, you know, the day came and went and everything's fine and we still get a lot of questions and there's still like a ton of anxiety. You know, I, I have a great team behind me. Andrew Thomason is the one who's spearheading our advocacy and like he's just like, you know, just doing this entire, like regulation after regulation.

We have info blocking center.org that we keep pushing a lot of information out to. But I'll say we got a lot more questions and we have answers sometimes, and that . That has, and the questions are getting more granular. We, he just did a webinar this week actually with the, um, American Psychiatric Association, and it was on mental health and information blocking.

How do you, how do you parse through some of, like, there's a lot of complexity here, right? So yes, we have the, it came and went. There are still are, no everyone, all listeners, there's no penalties yet for providers. So keep your shirt on. It's gonna be okay right now, but still keep moving forward, right?

Swim in the same direction, like try to, you know, document, document, document. So you have to, information blocking is a thing, even though we don't yet know what HHS is gonna do. I'll take a deep, deep breath here. We could, I can go on and on. Just pull the string bill. So let, let's talk about this very pragmatically.

And by the way, I don't expect you to know everything about everything, especially with regard to interoperability. I, I'm reading documents all the time and there's just a lot to sort of take in here. But in.

You and I are going into business. You, you left Chime. I left. What I'm doing, we're going business. You and I are gonna develop an app and we developed an app so that patients can download their medical record from their local hospital. And you and I are smart enough, we hired some good people. We, we have a HIPAA high tech compliant data center.

We, we have TLS two, we're, we're doing all the things we need to do to secure it. It is a, you know, secure framework. And, uh, we created an iPhone and a Android app for patients To do that, it only has two buttons. One is request the information from the health system, and they put in the health system information, or it says, you know, log into your portal and we'll get the information through there.

All right, so that's one button. The second button is report to the ONC non-compliance. I have two button on this. And this obviously for simplicity in our business's not gonna do that well, but, but that, those are the two, those are the two buttons. We have a completely hipaa, high tech certified, built by professionals kind of, uh, environment.

So we put that in the hands of patients today. How many patients are gonna be able to get their medical record from their local hospital? Do. Today. Today, I think there's still challenges. I mean, Mo here's the other, here's the thing that remains to be seen is like how many people are gonna use this? So I'm really curious to see as this continues to take shape, an email from a member.

In fact, she was in the media, I'll send you her article that was talking about, she's been asking for help with her, from her vendor to facilitate some of these pieces that are needed. And it's, it hasn't been. Been successful, but I mean, I'm not trying to use that as a scapegoat. So how many, I think systems are swimming in the right direction, but not everybody can do it.

There are exceptions in the, in the information blocking. But you know, like I, I think that most patients, they're not looking for their entire like kit and caboodle of their record. They're looking for one thing in particular. Like, I had to get a X-ray the other day. Maybe I just want the X-ray. It's not likely X-rays are still complicated.

So that one is one where it falls, you know? More in the grayish area. I mean, you, I might be able to get the, the readout of the X-ray, but not the actual X-ray. I could get it. It's just not gonna be over, you know, your app. Right. So then the, then I guess the patient says, I have been blocked. Right? So then that starts the investigation and.

I don't know. You are scaring me with like, information blocking cover , you know, Mari, I didn't get to the second button yet. You scared me. Which, which is, I, I report that I'm scared about the second button. So the second button, I report them to omc. There's, there's no penalties at, at this point. I mean, so.

I mean, is there really gonna be an investigation and am I gonna be able to get the data? That's not how No, no, no, no, no. Everybody listening, listen, don't, don't take bill's advice there, act like it's still a, it's still a thing just because there's no penalty in place. I mean, here's what I've been saying to our, our

Folks like, is that you? You gotta start. Not every CIO has HIM under them. Did did you? Okay, bill, back to you. Let's ask you a question. Did you have HIM under you when you were ACIO? No. And it's, and I know it from my clients. It's about 20%. Okay. So it's so. There's so much that goes into this role that involves HIM.

It's so much about it. Is it involving education and down to the frontline staff who you're, you're interfacing with like, oh, can I just get a copy of that? Or, you know, and someone who is at the, you know, intake desk or, or the front office staff and it's gonna be a lot of education. So I, I don't always think that, and this is back to me being like the glass is half full, but does, sometimes I just think it's like people just don't know what the rules are.

Have you ever stood in line at a provider's office and been like, that is not correct. That is not a hip, that's not according to hipaa. Then you have to educate them on like, no, no, no, no, no. So is that nefarious? Either way, the patient should get their information. I also wanna say that like our position is that patient has a right to their medical records, chimes supports that.

I support that as a patient. Do you, I mean, I imagine that you want your access to your medical records bill if you need something so. I don't know. I think there are varying states of readiness and we just gotta keep making sure that everybody is as ready as possible. It's gonna be more of like an evolution than a revolution.

I mean, it's, it's gonna take some time to get everyone where they need to be. Right. I mean, we still have a long journey ahead of us with the fire APIs and all the stuff you mentioned, and I'll be looking for my, your app on my phone when we get off. I, I went back and forth with a high ranking. Vendor, somebody who I really respect and whatnot, and I said, look, this, this app could be developed very quickly.

I mean, at the end of the day it's, it's, it's not that hard. The information blocking rules say you have to provide to me, the US CDI I dataset via fire and writing that app for somebody who's, who knows healthcare data and whatnot. Again, not that hard. And I sort of made half jokingly, I said, this could be written in a week.

By the way, it probably could be written in a week. It's not that sophisticated to make that, to make that call, and especially to make it through a portal. It's not that sophisticated to do. It could be written in a week. It needed to be tested and, and, and all those other things, and it would need to be certified and whatnot.

So it would take more than a week to actually do it. But at the end of the day, writing that app to get the U-S-C-B-I data, and I'm not talking about I need my images, I need all this stuff. I just want. The, the, the core data set that is, is being supplied today. Now, in a year, that data set goes to unstructured data, and that's a different, different case.

And by the way, I could think of a hundred reasons that patients want their entire medical record, not the least of which is we're, we're sort of beholden to our local healthcare provider and our local insurance carrier. And part of me wants to enable a new ecosystem where let, let's assume millions of people had access to their entire medical record.

Well, HIPAA stands for portability. It doesn't stand. I mean, it's not a security framework. High Texas security framework. HIPAA was about portability. It was about moving your record when you left an employer. It's about portability. Why did we want portability? Well, we wanted the patient to be empowered.

If you give a million, if you give 10 million people their medical record, their complete medical record, I guarantee you an ecosystem of. Of clinicians, of technology companies, of remote patient monitoring will start to evolve around that. Now, some of those will be providers and some of them will be payers, but there will be a whole host of new options for you to care for your son and for, for, for everyone who's who's, who's sort challenged, but.

I think, you know, the part of the, part of the reason I hate that money that flowed to all those companies, all the healthcare providers, was it just, it, it, it essentially continues a model that does not work for a lot of people. It is sick care. It's kind of barbaric health. Health system providers get paid when people are sick and don't.

And it's a backwards model, and we need to open that up. And I'm not saying that healthcare providers don't play in that model. I'm saying we need to figure out a way to get them incentivized to play in that model. Instead of talking about it like, Hey, we're gonna do population health. Isn't this a great thing, blah, blah, blah.

No, let's actually change the, the, the economic model where there's a whole bunch of money in the wellness category instead of.

I, I, I probably talked more on this episode than I usually do. I apologize. Well, you know, I feel like we could have part two next week. I mean, there's just so much to dive in here too. I mean, yeah, I mean, that's the patient access to records is, is every patient has to have it. Absolutely. I. And because I don't have some life-threatening illness, I have to appreciate those patients who really desperately need their records.

Like right now, immediately. Right now, I challenge you to go out to five of your CIO Friends and ask 'em can they send the U-S-C-D-I today? And I will do the same on, I'll just randomly check in with like five members and they'll reorder next week. Okay? So we'll find out who can. I'm pretty sure that the five I reach out to you, we'll all be able to do this.

the thing that keeps me up at night now are things related. You talked about apps. We could have to do a whole other show about this. Have you seen the finish like coverage about the, it's getting very personal. They're taking your information and they're holding you ransom or otherwise they put all your personal information on the internet and it's just happened in Finland and it's really, really scary and it's just destroying patients and patient privacy.

Everything you hold dear. It's, it's, that's scary. That's, to me is like one of the things that was on my mind this week, but I'll share that more so with you. Yeah, shortly. Well, it's interesting because that argument's used, I, I get that argument all the time and people are like, if we give the to to the patient, this is what's gonna happen.

And I'm like, Hey look, we left it at the health system. And it gets destroyed. No, not not giving it to the patient. No, no, no, no. I mean, just, but, but you, if you're giving your information, whether it's through an app or to a provider, to, to anyone that you think it's gonna be held securely, it should be held securely.

Right? It shouldn't end up on the internet. Ransom Mario. It is always fun. I know, I know it's hard to leave, but we're talking about what's going on in the beltway and whatnot, and this is a fun conversation. I look forward to, I think you're coming on again in, in, in, in a couple weeks and I look forward to seeing how the conversation progresses.

What a great discussion if you know of someone that might benefit from our channel, from these kinds of discussions. Please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show. It's it's conference level value every week.

They can subscribe on our website this week, health.com, or they can go wherever you listen to podcasts. Apple, Google. Overcast, which is what I use, uh, Spotify, Stitcher, you name it. We're out there. They can find us. Go ahead, subscribe today. Send a note to someone and have them subscribe as well. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders.

Those are VMware, Hillrom, Starbridge advisors, Aruba and McAfee. Thanks for listening. That's all for now.