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 Thanks for joining us on this week in Health It Influence. My name is Bill Russell, former Healthcare, CIO for 16 hospital system and creator of this week in Health. It I. A channel dedicated to keeping Health IT staff current and engaged. Today we're joined by Joey Smy, the Chief Information Officer at Texas Health Resources.

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You can also go to today in health it.com. And now onto today's show. Today we're joined by Joey, the Chief Information Officer at Texas.

Me appreciate it. I.

New conversations. Tell us, let's start with, tell us a little bit about Texas Health Resources, which I'm abbreviate we'll let you. We are an integrated delivery network in the Dallas Fort Worth area. Covering a pretty wide geographical swath of the metroplex. In fact, I think I've heard it said, if you go from our furthest east to our furthest southwest facility, it's a geography that's actually a little bigger than the state of Rhode Island, although technically.

We're considered just the Dallas Fort Fort Worth metroplex, I would say we're your, your prototypical in integrated delivery network. In terms of assets, we've got, uh, a wide range of hospitals from acute care to short stay to rehab. We've got, uh, a physician group that has. 250, 275, 280. So office locations.

We've started dabbling our toes in urgent care. We've got outpatient imaging facilities. We've got a partnership with a, a health plan through Texas Health Aetna. And so we've been in the market for a long time. We were the byproduct like. Many health systems, uh, of a merger in the late nineties between, uh, two companies here in the Dallas and Fort Worth area.

And really, honestly, just a, a wonderful, wonderful place to work. We were recently named number seven on Fortune's best Places to work in the us so it was a tremendous honor. That's exceptional. THR has a warm place in my heart. 'cause when I first came into healthcare, my first job was as CIO for a 16 hospital system.

So I'm, I'm out of my depth. I'm really anyone who will take my phone call, I'm calling 'em to say, Hey, help me to understand the, the nuances of being a healthcare CI versus a from another industry. And Ed March was the CI at the time at at at HR. And he, he, he was very helpful. And not only that, I said, we have this specific problem and he got some of, uh, the team members from down there to get on the phone with some of my staff members and just brainstorm around some ideas that you guys had had implemented.

And that's, I think that's the thing I liked the most about healthcare is that we, we are to share with each other best practices.

It really helped me out early on in, in my career, and I just wanna do that. Shout out if, if you don't mind. Yeah, no, thank you. And not to go off on our first little tangent, but I agree with your sentiment about healthcare and when you said that it triggered me, but the amount of collaboration we do in our healthcare IT industry I think is really special.

And there's a lot of organizations like Hims and Chime and others that have worked hard over the years to bring us together and help us to get to know each other. And we offer help. We ask for help. I think we're definitely all in this together. I don't wanna use the, uh, the phrase Misery Loves company, but we definitely know where to reach out to and that we're all seeing common challenges and, um, trying to figure it out together.

Let's find a place to start here. So what's top of mind? At THR right now at the CIO desk, what's top of mind with regards to technology in in health? It, lemme start with THR in general. I, I think we, like many other healthcare systems across the country, are really trying hard to make that pivot from viewing everything from a patient-centric lens to more of a, a consumer-centric lens and really.

Relationships start perhaps even before our first encounter with an individual. And so as everything in healthcare does, that translates down into technology. And so a, a lot of what we're focusing on, I would say that's sort of in the new space. And really what's top of line for us is how do we help advance that change?

How do we help healthcare? Look more like other industries who sort of have to take that consumer-centric focus or perish. So from our perspective, that's really what dominates the top of mind in terms of the new, and then of course, top of mind in terms of. The old adage, keeping the lights on are, are all the basic blocking and tackling things we have to do.

You mentioned security in our little previous discussion, and obviously that's something that's at the forefront of all of our minds, but looking out one year, two year, three year, five years down the road, we're really trying to make this pivot and quite frankly, it's a fundamental shift in healthcare.

Just it. Um, as to how we view individuals in the market and really their role as a consumer. That's an interesting place to start. We used to have patients, and I remember the first time I called it a consumer in a meeting and I got, I got blasted . Yeah. Probably by a position, right? Uh, yeah. It was, they are not consumers.

They're they're patients. And I'm like, okay. And I learned my lesson, but I think as time has gone, we are starting to see them be. Really treated as consumers or looked at as consumers. You just have so many consumer oriented things going at them. Right now. You have Walmart just bought a telehealth provider.

You have Boost Mobile, just adding, you know, telehealth to their plan. Like you get mobile, you get web access, and you get telehealth and obviously C vs. Amazon Care and all these people starting to. Look at markets, and you're right in competition Central in Dallas. I mean, everybody I just mentioned is probably in that market and we had the same thing in Southern California.

I mean, everybody and their brother was trying out their consumer oriented. In our market and what that looked like for us was just a lot of really slick new tools were coming into the market and it, it takes time for patients to become consumers, but once they do, they start asking you for things. I, I remember when this shift happened and they started saying, Hey, we want our portal to do this and we want our portal to do this.

And I'm like. Oh gosh. I mean, they're starting to act like consumers. I mean, is that just a, the nature of being in a market like Dallas, that there's so many ways that they've been treated like consumers and they start to want that choice and flexibility. I, I, I think that's a fair correlation to draw, not just Dallas, you mentioned, um, Southern California and markets that have.

A plethora of choice in whatever it is. And when you are competing in a plethora of choice, whether you're in healthcare or retail or food services, right, you're trying to differentiate yourself. And so, you know, I I don't think it would be some sort of. Secret. I would be sharing if, if you made the leap that some of the larger urban slash suburban areas that are a little more advanced in terms of size of population corporations that are there, they're probably a little quicker to demand, um, really new tools and technology.

So I, I think that's fair. Back to your comment about, 'cause we, we went through that consumer versus patient and I don't know that we'll ever solve it. My perspective is. They're really both. And an individual on any given day can vacillate in between one role or another. If you're laying in your bed in our hospital, you're probably viewing yourself as a patient.

If you're shopping for services and comparing, or to your point, you're even after service, you're looking for expectations of post-service capabilities. You're functioning more as a consumer, and I think that's important. And, and probably for those who have struggled with the leap from patient to consumer, good to hear.

Because at the end of the day, if you're, again, in one of our facilities, at its core, you are our patient, we are treating you. And so, you know, I I I don't think it's a Boolean yes, no kind of situation. I, I, I think everybody I know, at least me personally, I, I consider myself to. Sort of weave in and out of both those states.

And the good news is a lot of the solutions we do or are thinking about in terms of consumer, they really serve both those states of mind from an individual's perspective. And we ended up with so many new terms, a patient journey, care journey, patient experience. How are those things changing And maybe as result.

How are those things changing? The expectations of the patient experience, the expectation of the care journey as, as a whole? Yeah. I, I think from the, the individual's perspective and I'm, I keep using individuals so I don't fall on the patient or consumer side of the coin. They're so inundated in other industries with efficiency and ease and.

What they need at their fingertips within a few clicks that it's become an expectation. And you pointed out we've really adapted to this word journey in healthcare. I I, I think we probably view that as a journey more than the individual. I still think individuals, when it comes to healthcare, tend to think episodically minus those who are chronic.

Right. And who are. Truly having to interact with the health system, um, on a frequent basis. But, but I think it has to start changing because we have to prepare the steps along that journey, whether it's at the very beginning when they're considering who to choose, or it's at the very end when they're sort of evaluating how we perform, even if they don't see it as a contiguous journey, we need to, because we need to be sure that we're.

Bringing solutions across that entire continuum that service the expectations they have for any given industry. I said individual in the beginning. 'cause I think what's interesting is from a Texas health perspective, we've really changed in the last couple years how we think about and start mapping out whatever any given initiative is.

And, and a lot of that begins these days with. Kind of the old school, what you think of consultative patient map or a patient journey on a page where we're flowing them through all these steps. And that's not necessarily how we used to do things. And for me, it's a welcome change because it. Especially in it, it backs us way up into the process where we may not have thought to operate or think in the past.

So that's a good shift we've had as a company too, and been forced to take. Thinking about that holistic journey, do you guys involve the patient at all in, in that process, understanding? Uh, do you have a way of gathering the voice of the patient? We do. And that again, so let me back up for context. It's probably been three years.

We did a pretty big reorg and, and part of that reorg was we created a consumer experience group. The journey process I just talked to you about was born through that group. Um, the other piece that you were just alluding to is connecting with the voice of the consumer. And so we've done focus groups on certain things.

I don't wanna call 'em studies 'cause that starts to think of, uh, some type of medical. Trial, but um, smaller groups that continue, don't just participate one time to give us ongoing feedback. We test things with these focus groups. What the reception is. And, and again, that's been a new muscle for us to develop some memory on and, um, it's been a welcome change and, and a, and a fun journey to go on.

Key learning, key learning that health it is gonna take outta this time in our history. I mean, from my perspective, it, it's undoubtedly that care is not just inside the walls of our physical assets anymore. I know all health systems we're at a, a varying point in their journey to do, let's say, virtual care or probably less.

We're doing some level of home monitoring. But to me, that pivot we had to make. I'll talk a little bit on how it, it actually helped us get over some cultural barriers around it, but that's the future pandemic or not. It may slow down a little bit, the desire or the need for those virtual type capabilities or outside the care wall capabilities, but it's not gonna dip all the way down to pre pandemic levels if there's a silver lining, I guess.

Not that you can have a silver lining in a pandemic, but what came out of that is it forced both. Patient, consumer and health system to have to deploy some of those capabilities. And I think in the future, as that continues to mature, that's in non pandemic times only gonna give us the ability to treat people more effectively and efficiently and in the comfort of, of wherever their comfort location may be.

Yeah. Is there anything about the way you operated? Clearly, we're not completely outta this, although you're in Texas. If any state's acting like we're completely outta it, it would be Texas and my state of Florida would be the second. Florida's not far away, right? Yeah, exactly. But is there anything from the way that health, it has acted during the pandemic that you want to remain in the culture, remain in, in the way that you operate moving out of the pandemic?

I'm, I'm gonna answer that from a Texas health perspective, not just it, because I think one of the things we learned is. We had to do a pretty fast pivot on several areas of care delivery and, and one of the things we learned as a health system is with focus and appropriate prioritization, we can move mountains a lot faster than we thought we historically could.

The hidden piece of that is, and I kind of teased on this earlier, we cut through some cultural norms. And how we deliver services that without the pandemic may have taken us a much longer time to get over. Virtual care is, is a good example. There's always been a sort of a mixed feeling about virtual care, even within the provider world.

Some are all for it. Some really crave that physical interaction and, and weren't quite sure about the future. So, you know, I think not just for health it, but, but in general, . The fact that if we prioritize appropriately and you get organizational commitment to the level we all had across the country during the pandemic.

You can achieve big movements in small amounts of time. Now, whether we can stick to that discipline as an industry when times go back to normal, yeah. Is TBD. Um, but I know we've shifted even how we do some of our prioritization and thinking about things as a company because of what we learned in the pandemic when we talk about prioritizing projects.

I, I'm, I'm almost a little jealous. And again, silver linings, I think is the right word. I'm a little jealous of pandemic era CIOs from this perspective. We had such focus, such, I mean the priorities were very clear and one of the challenges, I mean to just rewind, just pre pandemic by a couple of months, was we used to joke that there wasn't a project that our healthcare leadership team didn't wanna consider at any given time.

We were doing I projects sometimes it.

And that just gives you the magnitude of how do you get focused when you're doing a hundred to a. And we were actually really good at prioritizing. We had a very set strategy for setting a a five-year roadmap, reevaluating that roadmap on a ongoing basis. But still, it was hard. Prioritize. How do you set your priorities?

How will you set your priorities moving forward for what projects get done? Do you guys have that same kind of structured strategy framework that helps you to set the priorities and then reevaluate them as time goes on? We do, and there's really two layers to it, and I, I, I kind of mentioned that organizational layer coming out of Covid.

Or where we're at in Covid, I'll say that as an organization, we have shifted again from those learnings we had about fast movement and focus and, and we're actually setting organizational priorities on a quarterly basis Now. There's a roadmap behind that. That's obviously much longer term, but what we're doing on a quarterly basis is sort of making sure we're putting focus on the right things.

So if you think from an IT perspective, and by the way, we've got some voice in that conversation because there's so much of that priority that touches technology. But so you've sort of got this, this layer down of prioritization. And then of course, in any IT world, you've got to do some capacity management.

So you've gotta layer up with. The things that just have to be done. And we pretty tightly track kind of what our capacity is for project work versus operational normalness. And within that space of what we have for operational normalness, we evaluate really on a, I would say 12 to 36 months. Kind of lead time.

What we need to do on the in, I'll call it the infrastructure side, but I'm even including some of the base applications that are, I mean the reality is at this point ERP and and the EHR are kind of base tools that are more, look like the normal infrastructure than some of these new and advanced digital tools we're bringing out.

So, so we kind of try to marry from the bottom up what we know we need to do on a 12 to 36 month timeline versus. What the organization's seeing both in their 12 to 36 month and then again on those quarterly priorities. It's a constant dance. The music never stops and new opportunities present themselves.

And like you said, uh, there's a lot of projects people like, and they're all worthy and, and we just need to make sure we're working closely with. Some of our other executive decision makers to, to know that we're focusing on the right ones. Yep, absolutely. So I'm gonna ask you a vague question, but I'm asking it vaguely for a reason, and that is, what's the coolest thing you're doing at THR with regard to data, data analytics, that kind stuff.

Yeah, so what's interesting is that organization change, I mentioned a little bit ago, one of the things we did is we really didn't have an enterprise data warehouse team. Our, our largest gathering of data warehousing type was really coming out of our clinical side. And when we did this reorg as a company, we actually created, we sort of took parts and then created, um, an enterprise data warehouse and team that, that sits outside of it and exists in our transformation office.

And, and that transformation office is the group that's responsible to. For the execution of sort of the overall strategies we're laying down at THR and, and trying to, to operationalize. And so this journey's ongoing and, and one of the coolest things they're doing is it's not just ingesting data from our normal transactional systems, but we're starting to bring in and utilize data that's coming from outside sources related to consumer.

Whether that's how our consumers feel about us in terms of how they're, you know, scoring us, whether that's how we're building out our customer relationship management system and those consumer preferences. And that journey's really early. And I don't own it, but I'd love for you to ask me that question again in two years to see how they're gonna meld all that together because.

I think historically in healthcare it, it's a piece of data we haven't really thought about, and when you layer it on top of all this other transactional data we have and know and use appropriately about a patient or a group of patients, I think it's gonna tell a pretty powerful story. But work in progress.

We start on a process where we called it the whole patient profile. And it was every aspect of the person, right? Because at the end of the day, if you can't get me to stop eating a McDonald's Big Mac, and I don't want a lawsuit from McDonald's, but you know, if I eat those on a daily basis, I'm not gonna be healthy about that

Yeah, there, there was. And it's true. I mean, if I wanna eat Big Max and ice cream every day, I might as well get a room at the local hospital because that's, I'm extended. If we're gonna start to take on wellness and keeping people healthy in our communities, somehow we've, we've gotta see more of them, see more of the picture of who they are in order to impact the decisions that they're making around their health.

And, and so that concept you just described of the consumer data as well as the clinical data and, and there's probably other data as well that just gives you a better picture of who this person is. That the same thing we might do for this person and the person who lives right next door to them could be two different things based on who they're we're.

We're getting closer and closer to really personalizing our approach to nudging people to healthier behaviors. Yeah. I think if you think about what we've done historically in terms of data on patients, we know your body because that's the medical piece of it. What we haven't really known is your mind.

In terms of what your preferences are and how you react to certain things, and that's such a key component to the holistic picture of a person and how they want or need to be treated. Not that we're developing some mind reading technology, but if we gather the context clues, whether it's in our CRM and and what your preferences are or or how you're evaluating us post visit.

We can build a, a bit more of a story than just what we know about how the inner workings of your body functions from a medical perspective. Yep. Absolutely. Journeys to the cloud. Do you, are, are you guys doing anything in the cloud at this point? Not a ton. Little side story here, so, gosh, it's probably been five years ago, like many health systems, our, our data centers were

In the basement of two of our hospitals. So we said we've gotta do something to, um, improve on this and which is it? Another story. As an aside, within my first five years in this role, we've done a data center migration, an ERP rollout, and a revenue cycle system rollout. So that I, I won't say I had hair five years ago, 'cause that would be a lie, but if I did, I would still look like this.

At the end of the journey. We did take a look at it, kind of a really aggressive cloud strategy at that point. Candidly, our EHR vendor wasn't ready at that point for us to do some kind of private hosting arrangement, or it was cost prohibitive 'cause it was so new. And so we decided to in invest in a longer term co-location agreement with, with a couple data centers, two in the market, and then a tertiary outside the market.

And once we made that decision. We really put on the back burner any work to pursue some type of holistic cloud migration strategy. So. What's happened in the interim is I think we're selective, right? If, if an opportunity comes up on a particular application to, to move to their private hosted cloud, we consider it a little more than we did historically.

We don't do a ton of development, although now that we're moving in more into the consumer space, we're starting to see that pick up, and so we're taking advantage of some cloud offerings there. But as a holistic strategy, we, we kind of anchored ourselves for a decent amount of time to the data center we're in.

So we're being a little bit more, a little bit more strategic about and surgical about cloud decisions. Talk to me a little bit about tech debt. How do you maintain, I was talking to ACIO major system and we were sort of joking. I don't know if this got on the air or not. We were sort of joking about the fact that I had a 25 year old PBX that.

And I mean, just the, the thought of that still makes me cringe that, and we sort of be like the two old sitting on the thing. Oh really? You think 25 years old. And what is strategy? Maintain current hardware at the clinical workstation, at the router level. How do you keep all that stuff current? Do you have a model for doing that?

We do, but it would be disingenuous to say it's some type of genius IT effort. I think the reality of IT is in in IT at Texas Health, we've been blessed that. Long before me, Texas Health really understood information technology and understood the hygiene that comes with it. I mean, the bottom line is if your organization isn't gonna stay financially committed to that, and, and that's a back and forth dialogue about what your tolerance is for how often you do that, right?

Right. But if your organization isn't gonna stay committed to that, there's no plan ACIO can come up with to stay fresh. That will work. And so. While we do our part, and we have a wonderful team who does appropriate planning, and we start, we think out several years in terms of the technology. We're also blessed that we've got an organization that's that's committed to supporting that and understands the value.

Heck, even just from a security perspective of staying current, and we honor that, we don't personally, and, and so my department kind of takes this on. We don't chase a lot of shiny coins. We don't wanna be on the bleeding edge of a lot of technology, right? We'd like to settle in sort of that leading edge space or well adopted space.

And that helps, right? Because we know we're moving into something, we can make work. We're honoring the investment that the organization is putting into it. But to your point about, you think that's old I, I mentioned the ERP conversion and the revenue cycle conversion, both of those. Were to get off of a mainframe based application, one of which was 30 years old

And so that took a lot of work when we were trying to keep that up and modernized and, and the decision to stay on that was far more about how we had liked what we had customized, and it was an unwillingness to invest in new technology. You know, the reality is mainframes were, were solid. When you had a system that had been running for multiple years, they generally, they ran and they were, they're just solid.

So, yeah, as it wasn't the mainframe, it was when all of our mainframe, or many of our mainframe team members came to us and started saying, Hey, I'm gonna retire soon. What gonna do? And then, you know, you start gonna the market, when you start getting those people coming and going, Hey, we're gonna to hire two more COBOL programmers, and you're like, oh my gosh, mean.

I, I don't know how many of those there are left to hire. Right. Yeah. And it's a tough recruiting pitch to go to a college grad and say, Hey, we're gonna train you up to be a COBOL programmer. And . Yeah. I would imagine, although you're in a pretty good spot to hire people, what's your pitch when you go talk to college students or whatever about coming to work at THR?

Yeah, I, I, I think. Not just it, but in general, our pitch at THR is is just look at the data. And I mentioned at the beginning we had moved up to number seven on Fortune's List and we've had great success in the past. And with Modern Healthcare, it starts with the company itself and our culture. When you consider an interview and tell people the tenure we have.

Across all our areas is very high and strong. It's because of the culture and that's living proof that people don't wanna leave THR. It's a great place to work. I think the other piece that relates to technology specifically is we're honest. I mentioned earlier we can't afford to be a leading edge company or a bleeding edge company, I should say.

Sorry. And most of healthcare really can't. I mean, there's a couple of, of the ones out there who. Really pumped into sort of that innovation arm, but they're few and far in between. And so if somebody's coming in that's young and and really looking to push the envelope, we're gonna tell 'em this probably isn't the place for them if they want to not necessarily be on the bleeding edge, but, but get the opportunity.

To transform the way people receive their healthcare in a big part through technology, then we're the place for 'em. And that challenge is more than just the technology, right? It's learning what we talked about earlier. What is that patient journey like? What do consumers seeing and wanting? And I think when you put all that together.

Um, but that's kind of our pitch and we've been blessed to be very successful. You're right, it's a competitive market. Dallas is, there's several other health systems or non-health system, healthcare opportunities people can fall into. And then of course when you get into the deep tech, you're competing against not just healthcare, but every industry, right?

Yep. So we, we really do our best to try to take care of our employees and, and make sure we're a place they wanna. Stay for the employment side, but also challenge them enough technologically that they feel like they're training some new muscles and learning some new things. How do you keep your staff current?

How do you keep them trained in skills, trained in a development to the next level of leadership and those kinds of things? Yeah, I, I'd be lying if I said we were really good at that. It's a challenge, and quite frankly, the last year has wrecked a ton of that, but it'd be disingenuous if I said it. Wasn't something we think about a lot and probably haven't mastered.

And a big part of that comes down to the nature of healthcare. Margins are tight. Budgets have to be managed. It's not a financial services type situation where. You maybe can get a little more investment. So we have to, we definitely have to get creative. We prioritize what we think is important. As we look at that 12 to 36 month roadmap I talked about if we've got a skilled efficiency, we'll kind of focus on that for those limited resources.

But it's a challenge and I suspect not just as I've talked to some of my peers, it's not just a challenge for us and. We've got some internal programs on the leadership and growth side. We try to offer everybody and to let them grow those skills and those capabilities, but it's definitely something we need to, we need to get better at because the next generation that's coming through is more acutely aware of it and desires it and wants it.

Versus some of us in sort of that next or next two generations up. The training was sort of as needed and you did it when it came about and when you needed it to be your next initiative. That's a generational change that's coming through. Yeah, it is interesting. Given the pandemic and, and those kind of things, has it been a challenge to fill those roles or, because I assume you, you always have open roles.

Has it been a challenge during the pandemic? I wouldn't say it's been. A noticeable enough difference from the areas where we traditionally have either filled a role fast or taken a little bit more of a lead time. I think the bigger challenge has been onboarding people in a, in a corporate virtual environment, especially when you're onboarding a new leader, whether that's a manager or a director, or above.

Right. You know that, that you can't recreate that first 90 days in person where they get to, not just the team they have or their boss or whatever it may be, but some of those pure relationships they take a little bit longer, longer to develop. But the reality is the world was moving this way anyway.

It's kind of like. The virtual example I gave you and, and trying to find that silver lining. We were eventually gonna get to more of a remote work where you can, or even WeWork type scenarios. Heck, even gig type scenarios. We were gonna get there and so, uh, we've just had to adapt and learn a little faster.

But, but again, Dallas, we've been pretty fortunate. Growth has been . In the market in terms of population, even over the last 12 months. And so there really hasn't been a shortage of workers, a shortage of willing workers, and so. I would imagine in some other areas of the country or some areas that are a little bit more remote from a, a larger metroplex, the pandemic may have made it a little bit more challenging.

So this is not a question to end my interview with, but it, it's actually been pretty fruitful to ask it, so I'm gonna keep doing it. What's the one question or one area that you're surprised I didn't ask you about that you think the, the community of listeners might benefit from a conversation around?

Well, I'm always surprised when I do an interview and I don't get asked a ton about security, right? But that topic, there's plenty of podcast. Can I, can I tell you why I don't? Because I was ACIO and I had my internal auditor sit across from me and say, you are not to answer a question publicly to anyone about our security posture.

And so I, I try not

generally partner. I. Other people, because I just keep remembering that conversation. I don't wanna put you guys in that spot. That's, that's one of the reasons. Yeah, I, I think that's a fair position. And the reality is a lot of publications in our industry tend to lead with that anyway, so there's plenty out there.

So, oh, there's plenty to talk about. I mean, there's , there's been four or five hospitals that have been shut down by ransomware at this point, so Yeah, but you're right. I wouldn't touch that anyway, so, you know, one of the things I jotted down. Is, it's kind of topical, but, and it's very specific. But with all this new information blocking set of rules that have come out and really balancing that against the fairly dated HIPAA privacy and security laws, there's so many places where this concept of feed the consumer more and, and even the consumer conversation we talk about.

Is completely juxtaposed to what we learned. Gosh, I don't even know what it's been. 20 some years, thou shall not do x, right? In terms of of hipaa, there's a pretty big gap in the rulemaking, or I should say a crossover that contradicts itself in the rulemaking, and it's a bit of a challenge for us to try to figure out how to appropriately service both needs that seem to overlap each other in terms of instructions.

HIPAA is interesting to me because it was really about health insurance, portability. I mean, the High Tech Act is really about the security and and stuff around it. But in terms of portability, and this is the hardest thing to really get our arms around C-M-S-O-N-C, they're really what they're after is choice, access.

So if, if you give my data, there's a belief that I will be more empowered as a healthcare. I don't know the cons, uh, consumer's the wrong word here, but, but I'll, I'll be more empowered in my own healthcare and so I can do things like not only engage Texas Health resources, but I might engage a, uh, big tech company who happens to have doctors or is providing resources.

The, they're really, 'cause we've done a lot of interviews. We've interviewed head of the ONC Healthcare Group, Mickey Pathy, we interviewed the previous one. We interviewed an Denise Chopra around this topic. And, and generally it's interesting 'cause it's Democrat, it's republican, they're all saying the same thing, which is we want to get the healthcare record in the hands of the consumer because we believe it empower them to take more accountability of their care.

To get more engaged in their care, but it is a fine line. How much information do you give them? How much help do you give them when you give them that information because they may or may not understand it. How much are you required to be responsible for the protection of that data after it's left your four walls and, and been given to them?

Those are some challenges. I mean, that's.

The challenge is how do we do that effectively? That's an interesting spot to be. So you guys have just opened up the doors, you're letting people download directly out of your Epic platform at this point? That's right. If you just hit the internet now, it's all out there. No, I mean, we've, I, I'm not gonna lie, we struggled with interpretation, as is normal when new regulations come out.

I mean, when meaningful use came out. If you think about all the. Different requirements and how people tried to interpret things. It took a while to groove that. Right. So we, we've made some changes we think are appropriate and in the spirit, and, and we've always, in terms of not just with the, the patient, but in terms of other groups that have need to know, we've always tried to, um, be pretty interoperable, obviously taking the appropriate steps to make sure all the.

Boxes are checked and the T's are crossed, but it is difficult. It's a great hypothesis that you said they've all shared. Whether it's true or not is probably for a different discussion. What's difficult is servicing that hypothesis to test it when there are existing and dated laws constraining how you can do or what you can do, or to your point, the extent.

To which you're responsible. I, I think there needs to be kind of a revisit of, of HIPAA from the privacy and security side with the new lens of this hypothesis that we want to put things in the consumer's hand. Now, if there's the given of trying to protect somebody's information from somebody who shouldn't have it.

But there's an area in between about who should have access to it. And yes, putting it in their hands puts them in control of it. But it's an interesting journey and it's just one of the next ones we face from a regulatory perspective. Yep, absolutely. And I, I'm a huge proponent of patient-centric interoperability.

We are getting really better at sharing it between health systems. I, I, I wanna write the app. That says, download my patient record to my phone, and then the other button on there will be, uh, report to ONC that my health system did not provide the information as per the information blocking rules, because generally that's their intention.

Their intention is that I would be able to, as a consumer, get that data and so.

I'm not writing that if,

but, but if that is, it's almost that.

Uh, because at that point it's like saying, Hey, we don't know if we should give you access to your bank records because somebody might steal 'em. Well, once you provide 'em to me, if I wanna share 'em on the internet, if I wanna leave my computer wide open, that's really on me. And so I think that's where the line has to be distinguished.

Did I appropriately share it in a secure way with the patient? Yes, I did. Okay. They have the information now I cannot control what they're gonna do with it. Right, right. I agree. I agree. And what, what's interesting, my hypothesis around information blocking was not that there's gonna be a surge, but coming with the, the rulemaking taking effect in April.

We were likely to see more requests we had to adjudicate on from partner, physician groups, vendor organizations that are providing some type of service or outsource service to a healthcare company. And, and quite frankly, not that it's been a huge deluge of this, but. That's what we're seeing, but it makes sense, right?

They're far more aware of what's happening in the regulatory space in healthcare. If I went and knocked on my neighbor's door and said, Hey, tell me how you feel about the new information blocking . Rulemaking, they're probably gonna ask me if I've seen my psychiatrist lately or if I'm on some type of drug.

So I think that's more of a reflection of knowledge and, and who's ahead. But hopefully as, as patients and consumers get more educated and informed about what they have access to in terms of their record, but kind of to your point, somebody, whether that's the health system or not, I don't know. Somebody also has to be there to educate and support them in terms of.

How you responsibly, how you responsibly absorb that. I'll close with this. It's like if you've ever done the one of the 23 and me or whatever, DNA testing, it's same scenario. They're giving you data on you, but they put huge disclaimers everywhere. Like, look, this is, you may learn some things that you don't wanna know.

Here's a number you can call if you wanna talk about it. I, I think we may have to get to the point in healthcare where that's supported as well, as opposed to just saying, here's your information. Best of luck. Yeah. Absolutely. Hey, hey Joey. It, it was great getting to know you. I love the map behind you and it was great to catch up.

So I look forward to hopefully the next time we'll see each other. We'll be at a conference. Are you gonna the, uh, chime conference in San Diego? Uh, not sure yet. Not sure yet. We're still working out when we're gonna travel again, so, yeah, that's I in November.

Who knows. Hey, thanks again for coming on the show. I really appreciate your time. Yeah, pleasure visiting with you. Thanks again. I appreciate it. 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.

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