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now we're finally, I think, getting to that point where we've got the basics. Layer in place to go make things happen and now it's like layering all the cool things on top, right?

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health. where we are dedicated to transforming healthcare, one connection at a time. Newstay discusses the breaking news in healthcare with industry experts

Now, let's jump right in.

(Main)   alright, it's Newsday and today we are joined by Steve Hendrick, SVP of Implementation and Selection with Healthlink Advisors. Steve, welcome to the show.

happy to be here.

a little bit going on in healthcare these days. We're going to try to hit some of the news items but before we get there implementation selection, is there a specific space that you focus in on or a specific set of technologies that you're looking at?

Yeah, so, we do a good majority of the pre implementation planning work for folks looking at transitioning on to an enterprise EHR. Obviously as in the marketplace today, most of those decisions are to take the EPIC path so we help identify benefits what they're going to achieve from an enterprise system implementation.

And then what's going to cost and help them build the overall business case to transition.

Wow. there's a couple of implementations going on. Some really big ones. You got Northwell going on, you have UPMC, you have Intermountain. Is it safe to call them laggards at this point? Because it's not that they're laggards.

Some of them are really early adopters in the EHR space, but they're really late to the game in terms of moving to EPIC. I would assume that they're going to have a lot of benefits of all the rest of the industry having gone first, that they're going to be able to look to and to rely on, I think.

Yeah, and I think, they are gonna get a lot of benefit in terms of implementation timeline. There was an article not too long ago, I think it was Becker's, around how the EPIC implementation timeline overall has been streamlined, I think. The use of external consultants and staff resourcing required to go implement has lessened over time because you're just getting more efficient more repeatable.

Everybody's signing up for that foundation system so they know what's going to be right built at the end of the day. They know what benefits they're supposed to expect.

Yeah I'm expecting some angry emails from my friends at Intermountain, UPMC, and Northwell. They are rarely referred to as laggards, maybe in this one space.

And actually, I think in each case, they were trying to be ahead of the game, and then they just got to this point and said, you know what, there's just too many benefits in consolidating down to a single implementation. But that gets us to our first story. And our first story is EPIC is number one worldwide after adding 356 hospitals last year.

And this is, Talking about that international market share. They're talking about New South Wales, Australia a bunch of places Oracle or Cerner I had that spot. And I think people in the U S didn't recognize that. Cerner still had a significant presence internationally, but even that's starting to get chipped away at as we move forward.

What do you take from this article?

Yeah, and I think Australia was a Cerner replacement, a Cerner Oracle replacement there. So it's almost you look at the, Cerner Oracle specifically and made a big press to get international and build up a big presence.

Well, Epic may have been more focused within the U. S. And building, right? And you see their path to growth, right? They won't jump into anything that they're not able to take on or handle from my perspective. So they're slowly picking up market share and picking up different pieces and they finally got to the point where they can jump into that international market and they jumped in with both feet, right?

So.

Yeah, 191 hospitals in Australia transitioning. To Epic some other stats on this. They have 39. 1 percent market share in the U S adding 153 hospitals and 28, 000 beds in the U S yeah, Latin America adding 147 hospitals the momentum is pretty strong, which gets us to the second story on about Epic and that is what will the EHR look like?

in 10 years. You had a chance to read this story. What are your thoughts on EHRs in 10 years? what's going to be possible in 10 years that we are, I don't know, maybe just at the start of today, or we just Haven't even thought about doing today.

Yeah it's crazy, right? If you look back at the progression, I remember, 15 years ago when I started my career out implementing Cerner at BayCare Health System over in the Tampa area, and at that point it was just getting live with something to go achieve the benefits from a government perspective and the paybacks in that space and start interoperability journey.

But the whole goal was like, wow, it would be so cool if there was another patient exactly like me that had my same conditions and was treated nine times out of ten a certain way and had a hundred percent success rate, right? And we could tie all that information back and have it available.

And now we're finally, I think, getting to that point where we've got the basics. Layer in place to go make things happen and now it's like layering all the cool things on top, right? To make people's lives more efficient focusing on physician burnout in the AI space. I think that's going to continue There's going to be that base EHR level and then we're just going to keep piling on all the cool stuff

the ambient listening is really taking off.

It's not that it's new in healthcare, but it's been democratized. The cost has come so far down that it used to be, hey, which doctors are going to get it? Which ones aren't? And I think that calculus has gone away. I think more and more people are just saying, you know what?

If a doctor wants it, we'll give it to him because the cost has come down that far.

Yeah, and I think that's the first step is the ambient listening, and then you take in the play to the new stuff that's coming out with the camera technology, right? And just think about all the decisions that you're making with your eyes in a room, etc.,

and how much more efficient places can get by utilizing that technology. But then you get in that whole space of okay, if I put a camera and a microphone in a room, how do I go manage that right from an IT perspective? And that adds complexity, but a lot of efficiencies as well.

Yeah, we have several of our sponsors are in that computer vision space and they have connected into the EHR and it's interesting to think about, is that another set of eyes?

Is that a, Set of eyes that can run through AI, a set of rules and reasoning and say, this bed needs to be cleaned or this patient needs to be turned or this patient's getting out of the bed or, That kind of stuff. But man, just to think about, it used to be a nurse or a nurse station would oversee, 10 rooms or something like that.

And now there's going to be a camera in each one and you could have a nurse overseeing 20 or 30 rooms from a distance. And just having those alerts pop up and be able to really hone in on those individual rooms. you think? We will see I'm already talking to people, there's a lot of the forward leaning organizations that are thinking about and looking at pilots around these cameras, but do you think In 10 years, we're going to go into, it's just going to be second nature to have that camera and that microphone in every one of the rooms that care is being provided.

Yeah, I think that's highly possible, right? And it might even start with the rural locations. And the rural hospitals don't necessarily have the budget to go do it, but they would achieve the most benefit by doing it starting off in that space. But yeah, I think it's highly possible that happens.

And to take another spin on it from hospital operations perspective, if you think about all the value from like a supply chain perspective, How many people are still doing manual inventory counts? Now you could just have an audits on a regular basis. You could just have a camera sitting in that supply room monitoring consistently, right?

Automatically ordering. There's deficiencies across the board and that might happen faster than the patient side of it.

Yeah it probably will happen faster than the patient just because of the risk associated with patient. And then. I'm not sure we figured out the camera thing yet.

Yeah. CIO is still struggling with that. It's like what kind of camera are people going to be comfortable with? And there's people talking about cameras that droop down to let people know that they're not on camera. There's some that have talked about cameras that have a cover that goes over it.

Others are just using the light and, the lights on when they're recording and they're, it's not on when they're not. But, I think there's a significant amount of value. in that camera being on almost all the time. And culturally, I don't know how we get patients comfortable with that, except to say, maybe those aren't being monitored by a person, maybe it's just going through an algorithm.

I don't know. Maybe there's some privacy trade offs in order to provide a higher level of care in each one of those rooms.

Yeah, I think the younger generation might be more and more okay with that, right? As opposed to the older generation, it might be one of those things where you opt in automatically and you've got an option for them to opt out long term.

thinking about the CIOs challenge, in their seat, There's obviously the security, the privacy with the patient. And then how do you get to a point where you just got like maybe one device in the room? Because we had a newborn, not too long ago.

I think she's my wife will Not if I'm wrong on this, I think she was 11 weeks old now. And they had a Alexa. Oh, thank you. Thank you. They had a Alexa in the room and the Alexa had the ability to sync up with their call system. So we could be like, Hey Alexa, can you send the nurse in? Without even having to page the nurse, it would go to their call center and then the nurse would get sent in.

But that's one device. So when you get the camera the other microphone, how are you going to manage that longterm? So you don't have 10 different things for one off use cases in there.

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don't know if you had this experience, but one of the most challenging experiences for me was building a building.

Because I'm with the health system, we're building some stuff, and they're asking me questions like, hey, how do we future proof this patient room, or this or this whatever I'm looking at. I'm like, all right, define future proof, because this stuff is changing pretty rapidly. They're like we don't want to have to come in here and redo the room in five years, that kind of stuff.

I'm like, okay we have to think about power, we have to think about network connectivity, to start, we have to think, are we moving wireless? Is five years enough time to say everything in this room is wireless? Most people would say, no, that's not going to happen. You're talking about telemetry devices, so that has to be wired.

It is one of the most challenging Puzzles, and you can't do 10 years out. You almost have to sort of plan for a certain finite amount of time, put enough stuff in there and then, made the right decision. Have you ever had that experience? crazy.

No. But Moffitt over in the Tampa Bay area actually some of their folks did a presentation on their new hospital at one of the HIMSS chapter events and talked through all of that, right?

Like how do we go design this hospital? Why technology is moving so fast? And what do we put in here? How do we set it up? And the process that went through that. plan as best as you can and you set up for the unknowns and try and get out in front of the technology that you're implementing.

One last thing this article talks about is interoperability. And, it's such a difficult topic because the belief was, actually the belief when we went to the EHR was built on interoperability. Like we would tell people, Oh, this is going to be great. Because, we're not going to have to ask you 10 times for your information because your medical record will follow you.

And it seems like we're getting interoperability through consolidation. Because now when you talk about the EHR, essentially you're talking about Epic, Oracle, and Meditech. We're getting to the point where it used to be you had 150 different EHRs you had to connect in and whatnot.

We're consolidating that down pretty dramatically. But there has to be more in the way of interoperability than just a consolidation of EHR vendors and formats that gets us closer to that promise of the medical record following us through our health journey. What did you pick up in this article as you looked at interoperability

Yeah, and I think like you mentioned it's happening through mergers and acquisitions.

You look at some regions, the entire region or area is on the EPIC platform. And that's how they've almost diminished the need for an HIE, right? To go do that in that regional area. But, question is, again like you phrased it, right? Long term, will you really be at a space where your record can follow you around wherever you go at the end of the day?

And it's easy, right? If you go from Epic Shop to Epic Shop and then your consumer experience is all within MyChart and that information's exchanged easily. But if you jump to a Cerner shop, a Meditech shop, and then an Epic shop and you're, You've got all the ambulatory folks involved in your care.

If you've got a complex condition who are on the Athenas, And then you've got the PE backed firms that aren't touching the Epic space. So what, what is going to be the answer? I think it's going to get better from my perspective. But it's going to be through mergers and acquisitions, the consolidation of health systems, I do not think we'll be at a point right where they're.

Easily transmitting information between an EPIC, an Oracle, MediTek.

Well, Steve, this is one of my favorite topics to talk about is interoperability. And I know people find that hard to believe, but one of those things that I think about that I believe is possible, but we have to think opposite.

And we have to think that the patient being the locus of the medical record instead of the health system being the locus. of the medical record. And I would love it if I go on vacation in a remote place and I get injured that somebody just scans, picks up my phone or scans something and my medical record is there because I'm the locus.

I'm the one carrying my medical record with me either cloud based or on my phone or whatever it happens to be. So that my entire medical record is literally following me. Wherever I go, wherever I present, and it's not matter of, Oh that technology can't move that record or we have to call their medical records and get those papers sent over or whatever it is that becomes a thing of the past because a number of things that follow me wherever I go.

You ask me for my bank information, wherever I'm at, I'm going to be able to give you that bank information. And I'm going to be able to go back a long time. And not only my primary bank, but other things have been pulled together over the years. And I think we can do that same thing in healthcare, but it requires us to think differently and act differently in terms of really empowering the patient and giving patient access to That medical record, wherever they go.

Yeah, no, I think that's great. And you probably might be out in front of me in this space because I think you know, years ago, it was hot for a little while where I think Microsoft and Google both came out with like products where you can store your health information.

The old health

vault days, I remember

that. Yeah. Yeah, and then like it like died out, right? Like to a certain extent, we stopped getting publicity and stopped being oppressed towards something. And the two

problems with it is, one, there's no economic model behind it, and then the second is it opens them up to regulatory scrutiny.

So Google doesn't want to store the medical record because it opens them up to the same kind of regulatory environment that health systems have in housing the medical record. And Microsoft had a similar issue and they both were like regulatory too big. And, but at the end of the day, there was no economic model around it.

It's just for the common good of the patient. So that's what killed them both. I believe.

Honestly, even happier from a consumer perspective. We get to the point where I just got one portal I could go into for everything, cause now we've got the two kids, my, my wife and trying to figure that out, we're, we've probably got I don't know, seven different portals just within my immediate family.

Wow. Yeah, it would be nice. You don't see a lot of healthcare places either, right? It's just and maybe,

maybe for your kids it'll be different. They were born in an Epic Hospital. They're going to go abroad and be at an Epic Hospital, and they're going to be local and they'll be at an Epic Hospital.

My only point to that is I hope we never get to 100 percent Epic. Because that would, I think, be the definition of a problem.

Yeah. But I think that's where it's heading, right? If you look at it, that's literally where it's heading and nobody's jumping out in front because They're picking up all the large health systems who are out there doing the acquisitions.

It's almost there's going to be a not for profit healthcare organization, EHR. There's going to be a for profit EHR, and then there's going to be a government EHR. And they're setting up in that way where it's like The government, obviously, right? Oracle doing the VA, the DoD deal, Meditech being used broadly within HCA, and then and it's like that, you look at the rural space, and that's one, one space where Epic's not winning, right?

They're going Oracle Community Works that smaller, Space, but now right garden plots coming out. Who knows how fast that will be pressed out But that's where Epic right is actually hosting right acting as the host for the EHR I think they're starting with orthopedics that pilot might be in process.

But

yeah

Getting against healthcare systems for that Community connect business.

Yes. It's interesting how you frame that it's like The cost conscious are going in the Meditech direction, the not for profits going in the Epic direction, and then the government's going in the Oracle direction.

It's going to take me a while to get used to saying Oracle instead of Cerner. It still doesn't just flow at this point, but

yeah. And somebody else going to jump out, right? You look at ERP, right? Like Workday kind of came out of the woodwork, obviously ex PeopleSoft folks, but it came out and they really jumped out in front of everything that was being done in that space.

Is somebody going to do that in the next 10 years from an EHR perspective?

Yeah. One of the biggest problems of a monopoly is people worry that they're going to, flex their muscle and their control over an industry. But to be honest with you, the thing that has always fascinated me is, you Every time I talk to an Epic client, they will say some aspect of this sentiment, which is best vendor, best partner I have is Epic.

They listen to me, they respond to my questions, they, all this other stuff. And if people are worried about them being a monopoly, they're not acting like a monopoly. So Kudos to them for not taking advantage of that. And 39. 1 percent is technically not a monopoly at this point.

It is something other than that. So, we ended up talking about that for a while, but that's the end of our show. So, Steve, hey, congratulations again on the addition to your family. And thanks for coming on the show. Appreciate it.

Yeah, I had great time, Bill.

Thanks for listening to Newstay. There's a lot happening in our industry and while Newstay covers interesting stuff, another way to stay informed is by subscribing to our daily insights email, which delivers Expertly curated health IT news straight to your inbox. Sign up at thisweekealth. com slash news. Thanks for listening. That's all for now