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 Welcome to this Weekend Health It. It's Newsday. Today we're gonna talk about the vaccine. We're gonna talk about that later in the show. We're gonna take a look at AWS outage. We're gonna public health data, 21st century cures and information blocking rules, some CMS home flexibilities as well. Some interesting stories out there this week.

My name is Bill Russell, former healthcare . CIO coach, consultant, and creator of this week in health. it. I wanna thank Sirius Healthcare for supporting the mission of our show to develop the next generation of health leaders. Their weekly support this year has allowed us to expand and develop our service offerings to the community.

I'm gonna have a revolving group of about six people that come in. Every six weeks, they're gonna come in and discuss the news with me, sort of like what I do with Drex today. And Drex will continue to do that. We've added S Shade and I'm in conversations with a couple others to join the show, to talk about the news from various perspectives.

I've, I find that that's a, that has resonated with you and you've given me good feedback on that. So we're gonna continue to do that. But what's gonna happen is. This show where I talk about the news is really gonna go away and so to, in its place. What we're introducing is today in Health It, and it is a whole new channel.

You're gonna pick that up on a different channel within, within Apple Podcasts and Google Podcasts and Spotify, all the places that you get your podcasts. Uh, we're gonna drop a show every day of the week where we cover one news story. The show's gonna be about five to seven minutes in. And we really feel like this is in support of our mission and in response to your feedback, this is a great way for you to stay current.

You can listen to these every day, uh, for five to seven minutes and get up to speed on one news story that we've handpicked and we talk about. Or you can batch 'em, listen 'em to 'em all on the weekend. It's really entirely up to you. This is actually a major undertaking for us and something I've wanted to do since the beginning of the show, but a daily commitment to doing a show is kind of daunting, but I'm looking forward to it.

I think we've, uh, learned a lot over the last three years and we're ready to do it. So. We are also excited that Sirius Healthcare and VMware have stepped up to sponsor the new channel. We still have a couple of sponsor shot spots available. If you're thinking, wow, it would be great to have our company be highlighted on that show, feel free to, uh, reach out to me, bill at this weekend, health it.com.

To subscribe to this, you're gonna go to, uh, this week in health it, click on the subscribe button and we put a little section in there for the . For the new show so that you can subscribe that way. We're still working through some of the logistics, but you're gonna be able to find this on iTunes over the next couple of weeks in, in December, it will start showing up.

It's already in Spotify and the others. It just takes a little while for them to. To approve the show, to be published on the platform. So, so go ahead and get signed up as soon as you can, and we'll start dropping one show a day starting on January 4th. We've already dropped a sort of an intro show out there so you can listen to that and know that you're subscribed.

All right, let's get to the news as we, uh, we start with the stories that I've posted on LinkedIn. And we do this so that you can engage in the stories and we can go back and forth if you wanna participate in that conversation. Go ahead and follow me on LinkedIn at Bill j Russell and just follow me every day.

Go out, see the story and go ahead and post. Alright, the first story, let me go over here to LinkedIn. There we go. The first story is AWS had an outage. . And uh, the question I ask is, does your health system have a mission critical, have any mission critical workloads on AWS and what is your uptime performance that you have had thus far?

I think one of the things is when AWS has an outage, the world knows, right? It's a huge deal. When your health system has an outage, the world doesn't know, but your doctors know, obviously, your clinicians know and. And so it's a big deal when AWS goes down and it's the people who are against the cloud will say, Hey, look, here's what happens.

The reality is AWS is a really tightly run ship, really well done and all those things, but at the end of the day, it's still technology, it's still software, it's still processes. And even though those things are buttoned down pretty well within the AWS platform. There will be outages. All right, so here's some of the things from the article.

The outage began on November 25th and lasted for hours as Amazon team worked to restore functionality. By the early morning on November 26th, the company returned to normal operations. Amazon warned customers via Twitter that the outage could cause product disruptions. Operations at the Wall Street Journal were affected by the outage, as well as the Chicago Tribune.

The programming interface for. Kinesis data streams product was affected by the incident, and customers weren't able to write data tied to the streams. According to the report, Amazon said it identified what caused the issue and is working to prevent it from happening again. And I've actually watched these Amazon outages almo for over a decade now, to be honest with you.

And the thing that impresses me is if you really wanna see how to handle an outage. Go ahead and watch Amazon. They're incredibly transparent. They're producing information, highly detailed information, and they're making it available to the world, essentially. Uh, because I, I'm able to read it and I'm not necessarily, I don't have massive workloads on, uh, AWS and so they make it available.

It's available to the press, it's available to the public. It's available to, to their customers, and . They really, they handle this really well. So not only is it a good model, so that's one of the, so what for this really good model to look at is how Amazon handles their outages. But another thing is, what are your expectations of a cloud provider?

I. Right For uptime, recovery time, data loss, and really communication during the outage, what's your expectation of them? Is it higher than you have for your internal systems? Is it the appropriate level of expectation for that? You should probably figure that out. Now, if you have any workloads in the cloud, what's your expectation?

What do you. It's, it's one thing to have those expectations in to state 'em up front. It's another thing to state your disappointment in how the cloud provider performed. But the reality is, from our perspective as a user, our job is to ensure that we are communicating well with our vendors for starters.

And then the second thing is. That, that we are identifying any potential issues before they happen. Right. So next story, and this is one I've been talking to a bunch of people about how good or bad are public health data systems at the state level. I. The Ohio Department of Health. This is from the article of the Ohio Department of Health's.

Covid 19. Data has been skewed by technical issues related to lab reporting. Although Ohio Governor Mike DeWine noted the virus is still spreading quickly across the state according to local A, B, C affiliate news five Cleveland, the state reported C 19 cases were artificially inflated, so forth and so on.

You get the picture. These state systems, I, I talked to a bunch of CIOs just. Just last week on a, a panel, and we were talking about this, uh, uh, the, the states are not getting high grades for their ability to receive the data. They're asking for the data. The data's required by the CDC. It's required by, well, at one point it was required by HHS and CDC, but it's required by the CDC.

It's required by the state. They're saying, we need this data, and then they send it. And they really don't have great mechanisms for, uh, collecting that data and collating that data and. And that's pushing the burden down to health systems, which is, uh, pretty interesting. One of the things I, I talk about a lot, people say, why don't we have interoperability in healthcare?

And one of the things is, I, I go back to a story when I was this CIO for health system and, and I sat in a meeting and I think it ended up going about three hours. It was ridiculously long where we were trying to define a, a something that I thought was like a pretty simple. A pretty simple definition.

It was something like discharge or something like, so something. So it was a simple definition. I really wish I could remember which one it was. But anyway, the, uh, the process went on for three hours and we ended up with six definitions. Now the problem with that is with six definitions and the information showing up on, uh, to the better part of a hundred to a thousand reports within our health system, we have to be real clear what the definition of that.

Of that data is on each report, because if it can be six different things, it will be six different things, and it will be based on whoever's seeing it in whatever the lens is. That's a problem for another day and, uh, a discussion for another day in terms of governance and the work, the hard work that we have to do around governance, but with regard to saying, Hey, the federal government should, uh, define these things more clearly, or the state should define these things more clearly.

When I hear that argument, I sort of laugh 'cause we can't do it within our own health system to define the data. And now essentially what we're saying is, Hey, let's pass the buck. Let's get the federal government to say, Hey, the definition of. F this or the definition of things that we can't even define within our health system without nuance and other things the federal government's gonna define for us.

I, I, I don't think we really want that to happen. We, we do want a, a, a standard way of reporting, a standard, uh, set of definitions for certain, uh, reports. And for that, I think, I hope that the state and the federal, uh, government can come together Question. A question that often comes up is, do we federalize this?

Right? Do we allow the states to continue to do the collection, which is, I think as it should be, but we, we provide them a lot more guidance, not only around the, uh, data and the terminology, the ontology, but also the, the technology that's gonna be used and, and how effective it needs to be. Just, uh, in interesting story that was out there, I just use it as a backdrop to talk about how ready are the states for this information.

This is interesting to me. Let me tell you a little bit about it from the article. I. Components of the program include Google's Health, APIX Accelerator, which offers prebuilt templates and best practices and other implementations to help app developers and others create new, create new build Fire, and API based tools.

The Google Cloud Healthcare API, meanwhile offers methods for ingesting, transforming, harmonizing, and storing your data. In the latest fire formats, as well as HL seven V two and dicom, and serves as a secondary longitudinal data store to streamline data sharing, application development, and analytics with BigQuery, according to the company and the Cross Cloud Apogee API management platform helps with security and governance for delivery and management of scalable APIs and enables more robust API analytics for faster digital rollouts.

It's, I. I asked the question, and is your, uh, are you banking on the EHR provider or someone like Google to do this? I will tell you that Google probably runs circles around your EHR provider. Google is making some huge strides in this, in this space, in the life sciences space, in the pharma space, they are starting to really hit their stride and is someone to keep an eye on.

As we've talked about on the show before, just this whole idea of ingesting, transforming, harmonizing, and storing your data to the latest fire formats. That's a huge deal. And that's, uh, that was the ascension deal and everyone's got a little skittish because Ascension took some, uh, flack on that for what they're doing.

But if you got a chance to look at some of the, the interface that they were able to create on top of the harmonized data across . Many EHRs, right? So this is in a single EHR and they harmonized the data. It made a, a new user interface for it. This is a lot of different EHRs. They pulled that data in and they, uh, created a new front end.

Uh, I'm gonna see if I can reach out to somebody from Ascension, get them on to talk about that a little bit. 'cause uh, I think the dust has settled, settled on that, and they've probably made a fair amount of progress on that. I think it's an interesting model. For, if you don't wanna spend two and a half, three, $4 billion on an EHR modernization project, it's a way to modernize, uh, the user experience, user interface.

Without doing that. So I think that's interesting. Uh, I think Google's somebody to keep an eye on. I, this is, uh, the other thing is I think the aggregation and consolidation of that data, if you're banking on the EHR to do it, just understand that we never have a, a single environment, right? So it's never across your entire

Health system. It's never all epic. It's usually multiple instances of E Epic. It's, and if you have, uh, a clinically integrated network or partnerships, you're usually dealing with multiple EHRs. Now, if you have A-A-A-C-I-N and you're trying to create reports, now you have to pull in disparate data and create something.

So you still have to solve this problem, even if you're like, Hey, we're all on Epic. You're still gonna have to solve this problem one way, shape, or form your EHR providers. One way to go. It's not the direction that I would go, but just, just something to consider. All right. CMS launches unprecedented hospital at home strategy to manage latest c Ovid 19 surge.

I like this. This is really interesting to me. Uh, and I ask is this is the future. So if, uh, they've announced these flexibilities, let's take a look at at some of this stuff. So from the article, where's this article from? Actually, I. Let's see, home health home healthcare news.com. The first time I'm quoting this one or that source.

So, under the program, participating hospitals will be required to implement screening protocols prior to delivering care in the home. Participants will need to screen for both medical and non-medical factors, including working utilities, assessment, physical barriers, and screening for domestic violence concerns.

So social determinants, uh, data as well, I would assume. Uh, I mean that is some, some of the social determinants data. Uh, it makes perfect sense. Participating hospitals will also need to provide in-person physician evaluation before starting care in the home. Also makes sense. Additionally, a registered nurse is required to perform evaluation on each patient in person or remotely daily.

No, that's interesting. In addition to building new capacity, CM S'S program is also a. Also a means to support established hospital at home programs, which have mostly had to rely on payment mechanisms outside of the Medicare fee for service world. CMS believes that with proper monitoring and treatment, acute conditions such as asthma, congestive heart failure, pneumonia, and COPD can be treated in the home setting.

And I just noted that this seems like the future to me, right. So this is a, a great way to not expose people to unduly, to, uh, to potential viruses and other things which are more pre prevalent at a aggregation point, like a hospital or a. Emergency room or a waiting room and, uh, getting this kind of care outta the home is, is pretty interesting.

It's a great way to expand the number of beds in the community. And we've seen this a lot with covid. I mean, we've seen this in a lot of different markets. I've talked to CIOs who are doing this at least on a trial basis, a handful of, a handful of potential. Maybe a hundred or or 200. We're not seeing massive, uh, uptake of it, but we're seeing pe-people or organizations start to, uh, go in this direction.

All right. Next story. States can make a difference in long-term telehealth policies. I read this report and I thought it was really interesting. And it's the National Governor's Association, and it's really, it's for the governors. It's to inform them on what's going on around telehealth, and they talk about the, uh, considerations that can help governors and their teams assess the potential implications of different policies.

And they have 1, 2, 3, 4, 5, 6, 7, 7 areas to, uh, consider licensure policies, uh, can be used to facilitate interstate practices. We know that's a huge issue. Our huge opportunity coverage of service services provided via telehealth may be narrowly or broadly defined to allow providers flexibility. . That has also helped during covid pairing payment policies and incentives to move towards more value-based models.

That is also being, uh, done during, uh, the pandemic as well as fee-for-service models, for that matter establishing policy. But I think those fee-for-service models will start to get, uh, contract post covid, and I think you'll see. This, uh, idea of moving to value-based models make a ton of sense with integrating, uh, telehealth, establishing, uh, policies that narrow the digital divide will increase accessibility to those who may have difficulty engaging in services via telehealth.

So, and they talk about those people that struggle to get around, struggle with. Visibility with you all. All the things, um, around accessibility, encouraging interoperable telehealth platforms, streamlined processes that improve information sharing, ensuring policies, account for appropriate privacy protections without limiting access to care and engaging stakeholders can be an important process to inform telehealth policy development.

Telehealth isn't going anywhere. It has, it has made a major leap during Covid. A lot of talk around how much it is receded, and we almost expect, expect it to recede. If we have another surge, uh, which we are having, we're in the middle of another surge. I think we'll see telehealth go back up again. Uh, and again, not, not to the m.

May, April, may levels, but it'll go back up again because people will be, uh, stay in place and those kind of things. But the reality is it, it has, it has entered into the mainstream, right? It's the mainstream of what we expect as patients. It's the mainstream of what we can deliver now as health systems, and it's a matter of baking those things in to our normal everyday processes and procedures.

I find that people are overwhelmed. They're overwhelmed with the number of alerts, they're overwhelmed with the number of tools, and when you're overwhelmed in defense, it just creates opportunities for the attack. Invado is around, uh, identity and. And fair warnings really around privacy, using AI tools to really look at the behavior of people that are utilizing the data.

So I think identity and behavior seems like a really good match. I like this. I like this merger. No acquisition. I like this acquisition. I like this partnership. I like these two organizations coming together. I think this is a . Uh, really good opportunity if you're an Imprivata user and, uh, aren't using fair warning, I think it's a good match to bring the second in.

And if you're a fair warning client and aren't using Imprivata for, for identity, then uh, I think that's a good match as well. I think this is a really good partnership for healthcare. All right, let's see. Let's go back, see what other stories are out there. Again, to participate in the conversation. Follow me at Bill j Russell on LinkedIn.

Actually, I didn't go to the comments. I apologize. Moving a little fast this morning. We're gonna get back to the news in just a second. I, I just wanna remind you that we're in the middle of our CliffNotes referral program. We've had, gosh, we've had close to a hundred people sign up for CliffNotes since we've started this.

Oddly enough, a bunch of people don't put in a referral name, so a lot of those people who have signed up don't have somebody as that. They have referred them. Even though the form, the fourth line is who referred you where they can put your name in. Some have not done that. And to be honest with you, the, this is really widespread in terms of the people who have gotten referrals.

Nobody has a significant lead like . But an awful lot of people have referred their friends, and for that we are incredibly, uh, appreciative. Don't forget, you can win some great prizes. We have a work from home kit that we're gonna draw a, we're gonna draw a, we're gonna have a drawing January 1st. And we will draw somebody who's gonna receive that work from Home Kit.

If you get up to 10 referrals, you get the Black Moleskin Notebook from this week in Health it. And, uh, for whoever gets the most, we have an opportunity. We're not gonna force you to come on. But if you'd like to come on and discuss the news with me, you're gonna have the opportunity to do that. And all you have to do is be the one who refers, uh, the most people to the Clip Notes program.

I'll tell you, we really believe in this content. We believe in, uh, what we're doing over here. We're excited about it. And your emails and your. Comments to me on LinkedIn and on Twitter, tell me that we are meeting a need within the industry. We wanna get this content into as many hands as possible. I, I wish I had this content when I was A-C-I-O-I, I just, I, I, I would've had my entire team listened to it so that we could have been.

Talking about it, not necessarily that I'm right, but that I'm starting the conversation and then you could have much deeper and better conversations within your health system. And so that's, that's why we want to get it out there. That's why we're doing the referral program. Thanks to everybody who participated and we really appreciate it.

Alright, let's take a look at the headlines. as when I get to the second section, I really just look at the headline itself. I don't dig too much into the story unless it's something I really wanna pull out. But the first thing I wanna talk about is vaccines. So there's uh, oh my gosh, there's so many vaccine stories at this point.

It's, they're everywhere. Alright, so we are pretty close to the, the Pfizer and Moderna. Vaccines showing up at health systems, right? So it's gonna be limited quantities in December. It will grow a little bit in January, probably full supply chain and everything by February. So we are looking at some, some interesting decisions to make in December.

Like who gets it right? Who gets the. Uh, who gets the vaccine. Now, the, the instructions from from the c, d, C is somebody referred to me as vague. I don't think it's overly vague. I just think it's, there's a lot of room to maneuver within the, within the recommendations. And so obviously frontline workers, hospital workers.

So you have to decide who's going to get it. I know a lot of health systems right now are doing surveys of their frontline workers, of their healthcare workers to determine who wants the vaccine. And this is a highly politicized thing. It's, I'm hearing everything from people are lining up to. Not even all the people who are donning and doffing their PPE every day want to get the vaccine.

So interesting challenge right now around this. First of all, uh, I think the survey makes sense. Figure out who wants to get it. Second of all, you have to determine who's going to get it. You have to determine who's paying for it, right? I think in some cases it's mandated that you can't pay for it. In other cases, you may need to pay.

Charge insurance or something for it. I think those questions need to be answered. The logistics of this are pretty interesting as well, just in terms of the two having to do to administer two doses of the vaccine for full. For full, I don't know, efficacy for full. That's not the right word either. Anyway, struggling with my words this morning.

But for the full potency of it, you know, creates a challenge. 'cause you're gonna give the first one and then you have to determine, you have to ensure that they're gonna come back for the second one. So there's gonna be a follow-up mechanism. At some point, you're gonna have to determine, are you going to have walk-ins, are you gonna have a scheduling?

Situation. Are you going to integrate the scheduling into your digital platform in order for people to just go in there, see schedule to get the vaccine, make the scheduled appointment? Are you gonna deliver that in the home? Are people actually gonna go out to the home to deliver that? Uh, is that a safer way?

Are you gonna bring 'em into the clinic? Are you do drive-through? There's an awful lot of logistics to be done around this vaccine, and, and it, it, it's come at us pretty fast and furious, but we knew it was coming. And I hope we have that, those plans in place. And then the other thing I'm talking to CIOs about is, is marketing.

We just, yesterday we had three former presidents. I think it was three, maybe four. I. No, I think it's three former presidents said that they were gonna take the, uh, the vaccine right up front, and I think we need more moves like that. The reality is the most trusted source of health information in the community is not CNN or Fox.

It is the local hospitals and the doctors in those hospitals and your primary care physician. So I think our marketing groups are going to have to flex some new muscles to really lead the charge in changing the perception of the vaccine and, uh, driving those numbers up. If, if we, if we have a vaccine and can only get 30, 40% of the people, uh, to take the vaccine, we're gonna be fighting this thing for a long, long time.

We have to, uh, figure out how to get . A majority, how to get 60 some odd, 70% of the people to take the vaccine, as well as those that have developed antibodies around it. So a lot of vaccine news, a lot of stuff going on out there. Hopefully you guys have a plan in place. Hopefully you're talking through this with your incident command centers and and whatnot.

So let's see. There's still a lot of talk about Amazon Pharmacy, how it's gonna disrupt healthcare. So we talked about it a couple weeks ago. and worth just keeping an eye on Amazon is bringing Mac OSS to the cloud in a boost to Apple app developers. I think that's great. I don't know how applicable it is to healthcare, but we did a lot of development on cloud platforms because you could stand 'em up, uh, you can instantiate the platform and break 'em down pretty easily, having the Mac oss

I don't know. Interesting to create some native apps, potentially some iPad apps and those kind of things. So I think that's, I, I think that's a good move and could, uh, save us some money, move something into operating that used to be capital. So interesting, interesting play right there. I. Let's see.

Patients at Vermont Hospital are left in the dark after cyber attack. This is a New York Times article. This was shared with me by David Mutts, who's been on the show. This is actually a really good article and one that's worth reading it. It's really about the human side of these cyber attacks and how it impacted specifically the oncology patients.

It's kind of heart wrenching. I, it, it also reminds me of how often they drop political statements in here that are irrelevant to the overall story. And I just wish they would not do that, but they do. So it. I would, uh, just encourage you to get past the political statements that are irrelevant and really focus in on the human side of this so that I think these are great stories to have when you are talking about your cybersecurity budget and what you're gonna be putting together.

These are great stories that you cut out and you send to your board members. Uh, so that they understand the, uh, human aspect of the cybersecurity budget and how you're spending the money. So I, if I were ACIO right now, I would take this story, I'd forward it to, uh, I'd put it in the next board packet and share with them a handful of things.

One is the, the number of attacks that you are fending off on an, uh, a pretty regular basis. The fact that . The University of Vermont and some of these other health systems were all targeted, but it wasn't isolated. They targeted upwards of about three to 400 hospitals across the country. And so this is an opportunity to say, Hey look, we are defending against these, these, uh, ransomware attacks and.

Vigilance is key, but we are, at least for now, staying ahead of this. But we've gotta remain vigilant. So anyway, that's how I would use one of these stories. I also, it's good to remind me of the, we talk a lot about technology, we talk a lot about cybersecurity, and those are kind of disinfected terms. And when you read about people that are having to delay life-saving treatments over weeks that they're counting on, it is, it really brings it home.

New York Times and the title is, patients of a Vermont Hospital are left in the dark after cyber attacks. So worth thinking a look at. There's a couple other things in here. Nothing exciting, and I'm gonna be talking to Drex next week on the show where we're gonna do our last, uh, Tuesday News Day of the year.

And we're gonna do, I don't know, we'll, we'll call it our holiday show. We'll figure out a way to make it a little more festive, maybe. Uh, we'll both wear . Some hats or something. We'll see. We'll see what we do. So I'm gonna leave some of these stories for next week, Forex and I to talk about. That's all for this week.

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Please check back. Through the end of the year, we're gonna be dropping our best of shows at the, the last two weeks of the year. So looking forward to that as well. So st stay tuned, uh, for some of those. Thanks for listening. That's all for now.