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Welcome to this Weekend Health. It's Tuesday News Day where we look at the news which will impact health. It actually, it's Friday before a holiday weekend, and I wanted to give my team the weekend off so we are recording early. Today, uh, we're gonna take a look at a bunch of things. We're gonna look at the Becker's headlines, and then I'm gonna talk to you about end of life equipment.

There are so few stories that are gonna reveal this challenge though, so I thought I would just throw it out there and discuss it at the end of the episode. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

This episode and every episode since we started the Covid to 19 series has been sponsored by Sirius Healthcare. Now we are exiting the series, and Sirius has stepped up to be a weekly sponsor of the show through the end of the year. Special thanks to Sirius for supporting the show's efforts during the crisis and beyond.

If you haven't signed up for three X Drex yet, you are missing out. Text Drex, DREX to 4 8 4 8 4 8 and receive three texts every week with stories that will help you to stay current. It helps me to prepare for this show. This is a service of Drex to four, a frequent contributor of the show. First things first, this is episode 300.

That's right. If you are new to the show and just found us, you have a lot of catching up to do. Uh, the first year we did roughly. 50 episodes and got about 25,000 downloads. The second year we did about a hundred, so we doubled our output and we did a hundred thousand downloads. And this year we've done about 150 episodes year to date and, which is really amazing and hard to believe.

But, and we're continuing to grow. We've done close to 175,000 downloads. Year to date. The show was born out of my experience as ACIO and, and CDO for a health system with 23,000 staff. And an even larger community that was looking at me to make sense of the advances in technology and digital transformation in healthcare, uh, I couldn't possibly speak enough or send everyone to conferences.

It was an extremely challenging problem. And when I left as the CIO, I chatted with a few of my peers and told them about the idea of starting a podcast for this very reason. And they were extremely supportive. Each of them has come on the show and several have come on the show multiple times. We strive to find the best thinking and to bring it to you and your team in a way that is understandable and fosters discussion.

There are new options on the market. Absolutely. covid has made everyone a podcaster and as a podcast consumer, I'm extremely excited about this development. The Chime podcasts are good. Becker's. The CMO Podcast is one of my favorites, the Redox podcast. And, uh, hit like A Girl are on my playlist. The host of Hit Like A Girl are actually coming on to record a show shortly, and I'm looking forward to that.

Quite frankly, there are a ton of options and I find value in each of them. If this is your first episode, let me tell you what makes this show distinct. . First off, we do three shows a week. We cover the news, we do solutions. So we'll dive deep into, uh, a solution and, uh, we do an influencer show. So we'll talk to somebody who's influencing the industry, who's, uh, dealing with some of the challenges firsthand.

And the second thing I think is we have sponsors, but I choose the content and what we talk about. Even on the episodes that are paid for sponsorship, there's no guarantee that they will air. We've turned down shows because, uh, people couldn't produce a client that will appear with them on the show with them.

Uh, we retain full editorial control. So you know, you're gonna hear what we think about the industry, what's going on. Third thing I would say is we listen to you. We did clips early on, but it was really a burdensome process for us. Uh, I, we didn't have a staff at the time, and uh, so we stopped doing it for the better part of a year.

You asked for them to come back and we brought 'em back. You asked us to have certain people on the show, and we've done, we've done that cover certain topics, we've done that. You've asked us to extend the duration of the show, and obviously we've just done that. We take your feedback very seriously. In fact, we've set up a form.

For you to give us some feedback, uh, this week, health.com/ 300. If you go to that URL, you're going to be, uh, given a form to fill out a survey. It's five questions. It's real simple and it's a great way for you to provide us some feedback. And if you want to, you can even enter your name and email address at the bottom.

It's optional. But if you do, you're gonna be entered in a drawing to win one of 10 moleskin this week. In health. It notebooks, they're black notebooks. The, the logo's really, actually even hard to see. So, you know, it's a really nice notebook. I use 'em all the time, and I think you'll like 'em. Uh, I give 'em to a lot of our, uh, guests on the show.

The fourth thing about the show is we make it easy for you to use the content. Some of you use it to get the conversation started, and some of you use it as a foundation for some training. . We've developed clip notes around making you and your teams more effective and to share that content a lot easier.

And I think the, the last thing I would highlight is the, the thing which makes our show show unique is me. And I feel weird saying that, but so many people have said it to me that they appreciate the perspective of a former healthcare, CIO, uh, who is sharing my journey with you, and, uh, also bringing you along as I try to stay current on what's going on.

And as I'm keeping up with my peers and, and you get to eavesdrop on our conversations, uh, and even participate in them from time to time. That's all about that. We don't celebrate the show all that much. We really don't talk about the show all that much. We're probably gonna do this again when we get to episode 400.

So if you think this is too much time spent promoting our accomplishments or talking about the show, you may want to skip episode 400 when it comes out. As always, we appreciate all the support that you've given us, and if you continue, if you really want to continue to support the show, the best way to do that is to share it with a peer sign up for clip notes, forward it on to someone and say, Hey, thi this has been great for me.

Sign up for CliffNotes or listen to this podcast. Uh, I get a lot out of it. All right, so let's get to the news. I'm gonna do this quick. So I'm, I'm just gonna look at the Becker's September issue is out, which is great. It gives me some stories to look at. Let's see. They have the 10 most and least concentrated hospital markets.

I'm gonna skip that. Not too much in the way of health it. Hospital margins could sink to a negative 7% this year. And they talk about that a little bit. I, you're gonna hear that a lot. There's financial pressures on health systems. It creates opportunity for some and challenges for others. Let's see some other things.

Seven hospitals buying land for expansions. As we've talked about on the show, there's a handful of good reasons to buy land and expand, but there's a lot of bad reasons to buy land and not pursue an asset light strategy. But regardless, hospitals overbuild, Medicare, $1 billion by Upcoding Claims Inspector General Fines, that's going to continue to, to, uh, be a problem , especially as we start to take a look at these claims around telehealth and whatnot.

And hopefully they're, uh, coded as well as they can be. Uh, Walmart Health expands in Florida and Illinois. Let's see, 10 best healthcare companies for women to advance. Uh, again, uh, I'm just reading the headlines at this point, I haven't found one that I really wanna dive into. Pandemic speeds Up Mayo's Digital Transformation by 10 years.

Dr. John Halamka. We'll have to have John on. I wanna do a platform episode. A lot of people are using the word platform and not necessarily, I think using it. I think John uses it real well. I think he understands that a platform brings together consumers and producers, the obvious ones that we are all familiar with.

iTunes, Uber, those kind of things, right? You have producers, you have consumers, and the platform makes those transactions easier. And the sharing of data and all the things associated with that sophistication of the transactions and those kind of things, that is, that's probably an article worth taking a look at and delving into.

Let's see. Anything else exciting? Wow. Just not a lot of exciting things going on. I guess it's a holiday weekend, you know, a lot of stuff on Covid obviously, and, uh, we just don't cover that. If technology doesn't solve the problem, we don't really go into it. Advent Health, CEO, amid Florida c Ovid 19 Surge says I wouldn't hesitate to go to Disney, which is great 'cause I would love to go to Disney at this point.

That would be a, a welcome respite and I hope people are going. Let's see. Anything else? No. Wow. There's just, quite frankly, a little slow time. Let me go over to my newsfeed here. Let's see if I have anything else. All right. Amazon Fresh opens up a, their first set of Amazon grocery stores outside of the, so they, they had Amazon Go Now they have fresh grocery stores and they are introducing smart shopping carts with Alexa guides.

I'll tell you why this is important. This is essentially a. Implementation of IoT and it will give Amazon, again, a really good picture into our health. If you shop predominantly at a fresh grocery store at an Amazon go. Market. Amazon will have the, essentially a list of all things that you're purchasing at your grocery store and be able to cross-reference that with a lot of other data sets to determine if you are eating healthy, if you're, if you're living in a certain place that could potentially is a food desert, those kind of things.

So I, there's a lot of things to, uh, to really delve into here and if you're a health system or even a payer, potential partnerships with grocery stores I think has made sense for a long time. And continues to make sense. And even becoming a technology partner with some of the grocery stores, I think might be interesting.

Ah, let's see. Any other stories? I, I wanna do a little bit more on this, navigating the RPA landscape, but this is interesting. I, I think RPA is huge. and if you're not looking at RPA or haven't looked at RPA, it's worth looking at and David Chow puts something out there, navigating the RPA landscape in healthcare.

He talks about examples of ARPA in use, R p's, you know, being used for, uh, really rev cycle. It's being used around hr. It really can be used anywhere where you want to automate a process where the machines can talk to each other. You can take information from one machine process, put it through some logic, and then apply it to another machine process.

That's essentially what robotic process automation is all about, and you could see it in rev cycle if you just go and sit in your rev cycle. Area for a while, and you watch the number of screens and, and the things they're flipping through, and they're pulling information from one website and putting it into another website.

That's the kind of stuff that RPA just hits the ball outta the park with. So, something that it is something to, um, consider and take a look at. Uh, also as, as you're looking at RPA solutions, uh, keep in mind that not all RPA solutions are the same. Some have some digital vision. I'm not sure what the terminology is, but essentially computer vision, the ability for the, for the RPA process to actually see your screen in the same way you see your screen and to identify things.

So sometimes when you're doing screen scraping and those kind of things, uh, the processes can be a little fragile. That kind of, uh, digital vision en enables the RPA solutions to be a little bit more, uh, robust, if you will. We've done some episodes on RPA and I I suspect we'll do more. . Because that's going to be, continue to be something that advances pretty significantly.

Let's see. Anything else? Wow. It really is a slow week. Epic's decision to put its voice assistant. This is healthcare. Healthcare it. Today, Epic's decision to put its voice assistant front and center could have a big impact on . Healthcare. Okay. As some of you may know, voice assistant technology is becoming one of the hottest new applications to hit the healthcare IT world to be sure.

Many institutions are still trailing the trialing, trialing the use of voice assistance in clinical settings. But also, but this also points up that we're still in the early phase of adoption, and we are in the, it might feel like voices showing up everywhere, or it's being talked about everywhere, but don't be deceived.

It's essentially . It's essentially at the early stages. We've been doing, uh, voice for a long time with nuance, primarily with nuance. I'm not even sure who the other player m modal some other players out there, but for the most part we've been doing dictation and those kind of things. We're actually getting to the point where we might see navigation of the EHR become much more prevalent.

Again, keep in mind the, the limitations of that and the limitations are in order to do voice navigation, you have to speak. And there has to be, you have the challenge of, you have to have the right place to speak, you have to have privacy considerations. There's a lot of limitations in the hospital itself in terms of how you're gonna navigate that EHR doesn't mean it's not a great technology in the right direction.

It absolutely is a great technology in the right direction, but there is going to be a lot of stuff to navigate. And then the question becomes, do you wait for Epic? To come out with it. Do you integrate with nuance? Nuance is also looking at navigating the EHR as well, and a lot of us have significant nuance implementations and whatnot.

There's, uh, a lot of things to look at with regard to voice, and I haven't even touched on how voice is being used for the consumer. within healthcare. 'cause we've actually talked about that, uh, a little bit here and there. I'm gonna make a, it, it's a holiday weekend. You're coming back, it'll be Tuesday before you hear this episode.

So you're coming back. You probably wanna get to work and, uh, get moving. So I'm gonna hit the last topic that I wanted to talk about. And as I said it, it doesn't show up in any news story, but I, I wanna talk about it and it's end of life equipment. And when I became the CIO, I don't remember the numbers exactly, but

The equipment in our data center was about 80%, or I'm sorry, about 60% end of life. So 60% of our equipment in our data center was end of life. And the equipment on the desktop, the across the clinical setting in the nonclinical setting, uh, was a higher percentage than that. Okay? So those were staggering numbers.

End of life in most cases means that the manufacturer no longer provides support for the equipment. and it is sold that, uh, again, a lot of times it will no longer be patched, which means that it becomes a security issue. Uh, at a certain, actually, it absolutely becomes a security issue, and most of the equipment, it really can't be upgraded.

It can't be upgraded to the latest operating system, and again, it just becomes a significant security issue. We definitely have that in biomed, in spades. If you're confronted with this problem, you have to address really two aspects of it. You have to address the emergency that's been created. So you have a crisis that's been created, and you have to address the problem, right, the source of the problem.

How did we get here? The emergency is that you have a serious gap that has been created for whatever reason, but it represents a significant security and business continuity risk. The problem is that you got here because of really a maintenance budget that has been starved. . That has to be addressed in some way, shape, or form.

It's likely that the, the problem wasn't created overnight, and it's not gonna be solved overnight, although you are going to want to solve it as quickly as possible. and some might say, isn't it obvious we need to spend, just gimme $6 million. I'll upgrade all the servers. I'll upgrade all the workstations.

If you've ever had to make that request, you'll understand why. That's a hard request. Now, some health systems might do that. They might just say, all, yeah, we're gonna, we're we're gonna bite the bullet and we're gonna upgrade and we're gonna give you $6 million to upgrade it. I think that's a mistake, by the way, but that's one way to do it.

And, but that does get us to what we, where we should start. We, the starting line is what is the exposure you have to baseline the cost and the effort to remediate the risk. Our number was staggering. I forget what it was, but it was a lot bigger than the $6 million number, and you have to communicate the problem effectively, the, the problem and how we got here, how we're going to ensure that we don't get here again, and the options to address the problem.

Now for me. That conversation went, uh, pretty much all the way up to the board in some aspect up to the board. It went up to the board from a security standpoint, but for the most part it, it really stopped at the President's Council. But at the President's Council, which is the highest, uh, executives within our organization, we made it clear that we've got a problem.

We've got a problem in that we did not take care of our . Maintenance budget and we didn't take care of our equipment. And because of that, we're all driving around in Dotson's, Dotson B two tens. And some of you are, are too young to even know what that is. Those are really old, uh, cars from back in the day.

And it's bad if you've ever operated on a four or five year old computer and that you're not just operating with cloud apps and, and virtual environments. Uh, I'm doing that nuance just for you people who are gonna argue with me. But if you've ever operated on a four or five year old computer, you know what I'm talking about?

And especially if it's a clinical workstation, it's just, it's beyond its life. It's just barely keeping up. And so you, you've gotta address that. You might be saying, we're just coming out of Covid. Why are you talking about spending money? And the reason I'm talking about spending money is 'cause I believe that every dollar that we spend in healthcare, it should return some percentage of that money to the organization today and into the future.

Let me give you an example. Clinical desktops. Our clinical desktops were on a four year refresh cycle, except when we had a bad year financially, and then we would skip a year or two or whatever. I'm just keeping it real. So that's what happens in healthcare, right? We all say this is on a three year cycle.

This is on a four year cycle, but when we have a bad year financially, . The maintenance budget's on the table, and uh, sometimes it will get cut. We could buy a bunch, so there's a bunch of different options, right? We could buy a bunch of new clinical workstations and upgrade them in place and refresh them again in four years.

That's one option. The natural response was, you want how much money and you want to do it again in four years. That's the response you would get from an executive. They're like, I don't understand this. Why every four years do we have to pour out another $6 million or whatever the number is? that didn't really work for us.

We did look at that option. We looked at all, this is what we have today. We're gonna replace everything we have today. So we looked at that, we said, ah, that doesn't make sense and a lot of you are have already gone down this path and said it didn't make sense. So we presented a model to do VDI with app publishing across the entire organization.

Now, a lot of you stopped that publishing for the clinical workstations. We went full blown VDI and it for a couple of reasons. One is we get to the thin clients, it, it shifts our refresh cycles to 10 years, right. And it, it also gave us the infrastructure and the tools to upgrade all the machines without taking any downtime.

That's where VDI came in. For us, VDI was the next logical step. We were gonna do this massive upgrade. Anyway, let's get to a, a situation where we're taking very little downtime for upgrades. And the reason you could do that with VDI is, 'cause every time somebody logs out of AVDI workstation, it destroys the session and recreates it.

So the next time they log in, we may have patched that entire, that entire session. , we may have patched that entire server. So every time it's spawning a new session, they are getting an upgraded system. Okay. We, uh, there's a couple other benefits to this as well. We eliminated the parts rooms. Uh, every one of our hospitals had a parts room and you would go into it and it would look exactly what you think.

It would, it would have hard drives, it would have old machines. It would look like they were just ready to replace . Uh, elements in any machine that would potentially go bad. So we were able to return that real estate. We were able to get rid of the parts rooms because quite frankly, when a thin client goes bad, they make a call to the help desk.

They reset the session, uh, nine times outta actually 49 times outta 50. That does solve the problem. They one time outta 50, they might need a new thin client, in which case somebody could just roll one in, plug it in, and away they go. . Another thing we did is we reduced outages pretty significantly and we provided new cap capabilities in the process.

The next opportunity was non it. It really for us as nonclinical workstations and Covid has brought that opportunity front and center. Do we need thick clients for that type of work? The answer is probably likely not. And as people move to their homes, VDI and app publishing probably makes more sense.

Now, before you go down this path, you have to determine if you have the skills and capabilities to manage that environment. I've seen a lot of VDI environments, a lot of, uh, virtual delivery of application. Those kinds of environments just crumble under neglect. You have to keep those things maintained.

You can't make the same mistake. Once you, you implement an environment like that, you can't make the same mistake and not patch 'em, not fix 'em, and not invest in the maintenance you need on that infrastructure. 'cause they're running hundreds if not thousands of workstations. You've gotta keep those things current.

Alright, so let's get back to the framework, the emergency and the problem. The emergency is the situation where every problem has multiple solutions and some are better than others, and it depends on your lens. Okay, so let me break that down. . So the emergency is you still have a ton of end of life equipment.

You're not gonna get the full amount of money you ask for. What are you gonna do? Well, you have to look at every problem distinctly. Here's my, let me talk about the lens for a minute. If I know that I have a long-term solution in place in 12 months, if I know that I'm gonna solve that, I'm gonna upgrade every workstation in that environment in 12 months, then I only need really a stopgap solution.

that's all I need today. I need something to make sure that I don't have any extended downtime and no security breach. That opens up a, a plethora of opportunities as opposed to sitting there and, and taking a hard line and saying, no, we can't do anything until we get there. Because I have a solution coming.

I can do some short term stop gap kinds of things. If I won't have a long-term solution for several years, I'm gonna have, I'm gonna need something a little more substantial. The lens matters. I can serve my, i i, I can solve my server end of life problem by upgrading the server, or I can move it to a VM or I can move it to the cloud.

And there's multiple options in the cloud. You see, the beauty of the cloud is that it can be a temporary solution. It can also be a, a really, a long-term fix. I. It's very flexible in that way. You have a lot of options that weren't even available five years ago to solve an emergency situation in your data center with both capital and operating dollars.

The same holds true for your clinical workstation problem. You may upgrade a hospital at a time and when you do what? One of the things that happened for us is not all the machines that you replaced were end of life, and you could actually redeploy those machines into the other hospitals that you're not gonna get to maybe for 18 months or even two years.

You could turn, you could also turn some of those older machines into thin clients. There's a lot of options that are available to you if you have the right infrastructure in place and if generate that story and get that movement going. Let's talk about the problem though, right? The problem is you don't have a mechanism to identify and protect your maintenance budget.

Every organization needs a lifecycle plan for equipment, network, wireless desktops, thin clients, mobile devices, biomed, when you buy it. It. You have to give it a lifespan and the budget should be in place for when that event happens. So when something comes to an end of life, there should be a budget that automatically gets triggered to replace that, uh, piece of equipment on whatever cycle you determine, and I'm not even telling you what this cycle should be.

Some people will say, thin clients, 10 years, that's too long. Maybe it should be seven or eight. I don't care what it is. What I'm saying is the problem is you haven't identified it and you don't protect that budget. We had a maintenance budget that was separate from our operating budget in it, and it was untouchable in any annual budgeting process.

It was untouchable. It was taken out like building maintenance. It wasn't even on the table. We had a re refresh cycle and every hospital knew what year they were going to have their equipment upgraded. And that didn't change because the budget couldn't get touched. So we made a commitment to the organization.

That we were able to keep. 'cause we said, we're gonna upgrade this hospital and in, in three years we're gonna come back, or in four years we're gonna come back. Um, and they knew that we were gonna do that because they didn't touch that budget. You might be listening to this thinking, why are you spending so much time on this?

More than happy to discuss it with you a little off this week. In terms of, uh, just going through the news, I thought I'd throw a topic out. I, I, 'cause I thought about this topic. And there's not gonna be any news story that I would really talk about this topic per se. Just thought I'd share that with you.

That's all for this week. Don't forget to sign up for clip notes. Send an email, hit the website. Uh, we wanna make you and your system more productive. Special thanks to our sponsors, VMware Servers Advisors, Galen Healthcare Health lyrics, Sirius Healthcare Pro, talent Advisors Health. Next. And McAfee, we have a new channel sponsor, uh, who are choosing to invest in developing the next generation of health leaders.

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