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 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former healthcare CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our new state show sponsors for investing in our mission to develop the next generation of health IT leaders.

We set a goal for our show, and one of those goals for this year is to grow our YouTube followers. We have about 600 plus. Followers today on our YouTube channel. Why You might ask because not only do we produce this show in video format, but we also produce four short video clips from each show that we do.

If you subscribe, you'll be notified when they go live. We produce, produce those clips just for you, the busy health IT professionals. So go ahead and check that out. Uh, we also launched today in Health It a weekday daily show that is on today in health it.com. We look at one story each day and try to keep it to about 10 minutes or less.

So it's really digestible. This is a great way for you to stay current. It's a great way for your team to stay current. In fact, if I were ACIO today, uh, I would have all my staff listening to today in health it, so we could discuss it, you know, agree with the content, disagree with the content. It is still a great way to get the conversation started, so check that out as well.

Now onto today's show. All right, today we are joined by Ed Marks. Ed is a friend of the show. Been on many times. Welcome, welcome back to the show, ed. Thanks, bill. It's like really excited to be with you. I really appreciate the invite. Yeah, I'm looking forward to it. So you are launching a new podcast. You, you are competition, which I, I don't really care about.

I'm always about getting the best thinking out there and tell. Oh yeah. Oh man. There's no competition to Bill Russell when it comes to, uh, to podcasts. So it's, it's, it's, it's different. So it's called Digital Voices. It launches officially next week. We've actually recorded, I think the first five or six episodes, we'll just drop weekly.

And what it's meant to do is cross all of health and life sciences. So instead of just the payer, instead of just the provider or pharma, we're crossing all of it. So Digital Voices so includes . Like Chief Digital Officers and another interesting people of interest from all those different segments, including patients.

So actually our very first drop is the digital voice of a patient, and it was quite powerful. So I'm really looking forward to it, and it's really meant to just add to the discussion and try to break down the barriers between payer, provider, payer pharma, you know, the whole continuum. So that's what it's all about, and hopefully it'll be enjoyable.

Yeah. And, and we're gonna, we're gonna talk a little bit about that, that divide and, and things that exist, uh, today. So it should be interesting. So, focus, I mean the, the unifying principle is really around digital, right? Correct. So, you know, there's the emergence of the chief digital officer, as you've spoken about quite well.

And who is the voice right now for the Chief Digital Officer? And you've covered it really well in terms of some CIOs are capable of doing both. In many cases, CDOs have been brought from outside industries and CIOs are reporting to them, and it's really quite an emerging field. So it's really about capturing that field across again, the health continuum.

And really creating a forum for them to interact, to talk about issues that crossover all the way into the patient side of things. So that's why Digital Voices and, and why we created it. You know, I, it's, it's interesting Ed 'cause in the last 90 days, just the interviews in just the last 90 days. So Tressa Springman now has the CDO role.

Jason Joseph at Spectrum has the CDO o role. Craig Richard at SEL has ACDO, so a dual role, C-I-O-C-D-O role. So the, the more established CIOs who have been around a while are, are latching onto and as well as, as some others we know that have both the CIO and CDO role. It's, yeah, some are able to pull it off well and are well trained and kept up with the times and are easily able to operate.

And both, but unfortunately it's not the case for the majority. And so that's the other thing we're trying to do with Digital Voices is bring out outside industries. So one of our first guests, again, these pods don't start dropping until next week, but yesterday we had a guest from Telecom and how they've digitally transformed their particular telecom company and how it might help healthcare.

So there'll be a lot of external guests coming into our digital officers and what have you. From other companies, and the hope is that we can all learn from them so that we don't need them to come in and displace us, but we can learn from them and, and upskill and lead all things digital. Yeah. One of the podcasts I listen to is the Accenture podcast, and one of the reasons I do that is because their CIO has boldly gone to the cloud.

To the point where there is nothing but the cloud left at Accenture and they, they talk about the agility of that and being able to ramp things up and being able to write applications on top of a well architected cloud, uh, stack. And it's, you know, it's, it's really fascinating. I haven't seen the health system that boldly has said a hundred percent in the cloud yet.

Yeah, it's really tough to do as you know, just the legacy, the history, the culture, difficult to move with agility and velocity in healthcare. And it's sorely needed, right? It's one of those key tenets that have held us back, although, as you've pointed out and others. During Covid, remarkable job, remarkable leadership across the board.

So that, that gives me a lot of hope and I'm, I'm really hopeful that that will continue, you know, that it just wasn't a blip in the radar, but that's the new way of operating. I, I remember in our cloud journey, we were, I asked the question of like, can we move PACS into the cloud? And, and they're like, the operational pacs.

I'm like, yeah, can we move that into cloud? And they're like, no, you can't move that into the cloud. I'm like, okay, here's what I'd like for you to do for me. Tell me why I can't. And they're like, well, it's gonna be too slow. I'm like, the math. Well, it's, no one's ever done it. I'm like, that's a different, that's a different, uh, argument.

No one's ever done it. Gimme the math. Let's see if we can do it. And then we eventually did it. And I think to this day, if you walked in and said, can you run packs in the cloud? Most people would say, oh, you still, it's too transactional, whatever. I'm like, and if you architect it correctly, you can, you just have to get people to stop saying, you know, it can't be done and start.

Why can't, I mean, we could do a lot. And sometimes you just have to allow that person that has, that doesn't have the same confidence level to have the experience. And so one of the things that we did, I'll never forget this because, and I think it's cool to talk about who it was in the, in the organization 'cause it's a very positive story, but it was at the Cleveland Clinic, we're number one in the hearts right?

For 27, 28 years in a row. Global leader. So there was a lot of skepticism about moving to the cloud. So we, we got the . The lead of Cleveland Clinic, cardiovascular surgeon, top of the world, you know, the division lead to come out to our data center. Okay. So we still had a data center, which I was trying to get rid of and all those things, but at least gain some confidence that we could.

Do some of these packs and some of these other really intense imaging remotely. So that was like the first step to take it from the closet next door to the data center. That was a big, bold move before we moved to the cloud, just to show that could be done. Well, I. He spent, I left before he did. So we had an hour to do a tour and to talk about the data center, how it worked.

He stayed, he took pictures, selfies. I have selfies with him because he was so excited. 'cause it dawned on him that the data center or the cloud was like the cardiovascular system and how it worked and how you had a sort of a center the data and then you had arteries and how things flowed. And so we just started using that sort of vernacular in our explanation about

Why it's beneficial, you know, to move to the cloud and how it really works and you're still connected and you're still blood flowing through. And that was magical experience. And so sometimes you have to let your, the doubters, sort of, the doubting Thomas, you know, touch the wound or, or see the. See what the cloud is and kind of have more of experiential as opposed to philosophical discussion.

Yeah. And that, you know, and that gets us to our first story. And I'm just gonna, I'm gonna share this because I didn't share this with you ahead of time. So this is the Tru Veta announcement, and this is a post from Rod Hockman, president and CEO of Providence when Providence established our vision of for a better World Data.

Maintain and protect copious records serving as the custodians of vital health information. Some of this is obviously, uh, you know, grandiose words to announce a new, a new offering, but, uh, here's, here's why I wanna talk about it. When de-identified and securely aggregated data at scale can produce valuable insights and have the potential to revolutionize the way to prevent health.

Prevent, treat and cure disease. Toward that end, Providence has been working to build a coalition of the nation's major healthcare providers, with the goal of bringing our de-identified data together onto one secure platform. Today they are excited to announce 14 health systems. Advent Health Advocate Aurora Baptist Health in in, uh, Florida.

Common Spirit, Hawaii Pacific Herman Northwell Health, Providence. And Trinity Health. So that's no small, that's a, that's, that's a pretty data set. Tru is in the early stages. Person. Let's see. A former executive vice president of Microsoft has agreed to lead the charge in his 21 years at Microsoft oversaw Windows, Xbox Surface.

I would say that's.

They're essential for quick, quickly understanding new viruses and other diseases, and so they're gonna bring that together. The time is now for healthcare communities to step up and lead the way. Big tech companies and even foreign entities are vying for access to patient data. As healthcare providers, it's one of our highest duties to safeguard to personal health information or our patients entrust to us.

We can ensure that privacy is paramount, that health information is, is protected. It's okay. So couple things. I wanted to talk about this with someone and you're, you're here, so this is perfect. You know, we, we have epics, uh, cosmos, I think it is. We have, I think Mayo's putting something together like this.

This is clearly data we've.

The new oil, I guess as they say it, it specifically with regard to healthcare, if we could bring that data together, we can create, uh, more, uh, precise, I don't know, determinations of what people have more, we can prescribe things more accurately. We can identify things more earlier, faster, as we just saw, with, with, so that's promise of this whole thing.

They, the trust in here about a million times. So clearly they believe that that is gonna be the cornerstone and, and it should be after the ascension misstep, let's call it a misstep. Earlier last year with Google, you know, they took a lot of heat because their people didn't know that what they were doing.

What are your first thought? I mean, that's one of my first thoughts on this is do the patients know that their data just went into this de-identified in my datas in there. I didn't any email. I guess they think because it's going in de-identified, I, I'm okay with it. So I, that's the first thought I have.

What, what are your thoughts? Well, generally, from an altruistic point of view, I think it's great that we start looking at larger data sets, try to take out some of the bias that are in some data sets and. You know, it enables some great opportunities for research and into doing really a lot of public good.

But it does come with a lot of, uh, big red flags. You talked about a few of them, and probably the primary one is, you know, did I agree? Is there some form that I already signed? That said, yes, uh, you can share all my information as long as it's de-identified, and that's something that we need to talk a lot more about and to make sure that this appropriate safeguards are in place.

Because many will argue that there's no such thing as de-identified data. Yes. So there's a way to break it back the other direction. I've, I've heard that. I've had data scientists sit, sit with me and data.

De-identify it pretty, it depends how much, what data element you give them, but they're like, I'm pretty sure I can de-identify any data set you give. Yeah. As opposed to the alternative approach, although it's a little bit more challenging and has its own. But that is why not ask someone like, I would freely give my data if I knew that it was going to help the common good, so they would get my data so that people could avoid having cancer as an example.

I would freely give that data and so, you know, it's, it's one of those things where I think the more transparent . You can be with the patient, the better. 'cause it's the patient data. You've made that argument pretty clear in your podcasts, uh, previously, and I believe that's to be the same. So I think you need to ask them straight out.

I. I, yeah, I have made this before. Hey, one of the things you're gonna learn in the podcast is you repeat yourself, and one of the reasons you repeat yourself is no one has listened to all three 80 of my episodes. So you're like, okay, you have new, you have new listeners coming on all the time who are like, this is one of my biggest arguments against the national patient identifier, and I understand, I get it.

A good effort, right? We're gonna bring all that data together long. Why it's important and it helps us at a time of a mass vaccination and whatnot. I, I understand the argument for it, so I, I don't want the angry emails. I, I'm willing to have the, the conversation, but one of the primary reasons I'm against it is it changes the focus.

The focus, if you're going with the national patient identifier, is that the information is the, is the property of the health system, and that's where you need to bring it all together and. I don't want to be brought together at the health system. I want it be brought together at me. I am the locus of information.

I wanna bring it to me. And so when all these guys say, Hey, I'm gonna, we're put all this information in, I. Here's what I want you to do. I want you to pass it through the, the patient first. Give it all these health systems should give it to the patient in some app that I can look at and then say, alright, do you wanna participate or not?

Yes. Yeah. Yeah. I I agree completely. That's what I was trying to articulate. And you did it much, uh, with a much better, uh, more clearer example. But yeah, at the end, at the beginning and the end, it's gotta be all about the patients. It's gotta be patient centric and allow them to see, oh, what information are you passing along?

Okay. Yes, I consent to. Do that. And I think there's gonna be more opting in than organizations think. And, and plus, it's, it's just the absolute right thing to do. Yeah. I, I think they're afraid that I'm not gonna give it to my health system. I'm gonna give it to Amazon or somebody else. And we already are, we're giving it to Apple.

Right. I mean, a bunch of us are. It's interesting. You know what I, I wanna talk a little bit about Optum. So you teed up a story from, from Becker. Why don't.

Because I just think when, when I think about digital transformation and from a provider centric point of view and from a hospital point of view, when I read announcements about how big Optum, it's not just Optum, it's all the payers, how large they're getting in terms of primary care, they, they now represent the largest primary care base in this country.

So Optum specifically has about 55,000 providers gonna add another 10,000 by the end of the year. So it used to be the way the ecosystem works, right, is you have a hospital and they attract a medical staff, and that medical staff is largely PCPs who then refer to their specialists, who then bring patients to the hospital.

So what does that mean for the hospitals and their future to sort of control patient flow? And I. And it's not being done in secret. And then if you take it to the next step, so what the payers are also doing is they're doing virtual health. So the lead commercial in the Dallas Fort Worth market from the Blues is telemedicine.

So I'm thinking to myself, hmm, if I'm a provider in Dallas Fort Worth, and this is all over the country. Wow. They have more PCPs than I do, and they're doing telehealth visits. That means those patients aren't coming to my practice or to my docs that are affiliated with my hospital and they're doing remote patient monitoring and they're starting to do hospital at home.

What's left for me and ? I don't know that I've seen a lot of reaction yet by providers, and so that's really why I thought it was a good item for discussion. And what does it mean from a health IT perspective if you're ACIO or ACDO at one of these health systems or hospitals and your primary care base is being taken away, and how do you, why are, is that happening?

And what can you do to stop that flow? That's a, that, that's, that's a great question. And it's, it's not only Optum and those numbers did surprise me when you shared 'em, uh, 50, 55,000 and 10,000 more physicians this year. You know, we're gonna, we're gonna see the same thing from Walmart. I've talked about that a bunch of times.

CVS is, is the next one. And, you know, Walmart for their part is getting into insurance. C vs. Bought in into insurance. I guess I'm not sure if Aetna's the controlling entity or if CVS is a controlling entity. It's, it's, it, the two very large companies coming together. Everybody's trying to disintermediate the patient from the health system and that's gonna be a significant financial problem coming up for the health systems.

So if I, if you and I, so let's assume we just. What would we do here? You know, I, I, I think the first thing is, look, we already have a base, a, a significant base of doctors in our market. How do we get them out in the community? How do we make sure we shore up our primary care physicians and make them as convenient as possible to access, not in the old, uh, medical office buildings, but in, uh, locations where they're very accessible, including the, the, the digital routes, right?

It's accessibility, it's convenience. It's, it's after hours access. We have a majority of that information. We have the up still, probably still today. We still. If we, if we start to make moves, if you're the CEO, what, what are some things you're doing? Yeah, so I, I think it does come down to two broad areas.

One is the patient experience that you're alluding to, and the other is the clinician experience. So what I'm understanding from some of my friends that are in this PCP mix with companies like Optum is their lifestyles much better. So they are given, you know, the equivalent salary with, you know, now they're part of a for-profit company and incentives that come with that and their lifestyle's better.

So they're given finite hours in which they work as opposed to just kind of an open-ended expectation. So I would do everything I can to ensure a great quality of life for my clinicians that they would want to be part of the hospital and the health system. That they would have this affiliate affinity for working together to serving the community.

So that would be number one. So like I said, it, it could be lifestyle related, like work hours. I. It could be having the right digital tools so they don't have to go in seven different systems, that there's one platform that they might work with. So that's one thing. And then the other one, like you were talking about Bill, is the whole patient experience.

So we are going to have office hours in the evening. I remember how hard it was. I know you, you're a, a longtime CIO as well. Having those discussions with medical staff's like, no, we don't work. You know, Wednesday evenings, well, there's a way to do it and still have quality of life, right? It doesn't mean that they're working all day Wednesday and Wednesday evening.

Right? You have shifts and things like that. So there's a lot of things that that you can do to make it a better experience for the patient, because you're right. You've got retail coming in, you got the payers we just talked about, you got retail. It's very convenient. You just walk in. Or a lot of them with their apps, you know, for telehealth, they can press a button and talk to someone right away.

And I don't think we're there yet on the provider side and the hospital side making it that convenient. So that's what I would stress out. CEO, I'd make, make sure my clinicians were all happy, had a good lifestyle, had all the digital tools they required. And then of course, all about the patient experience and patient engagement.

Yeah. 'cause the patients really do follow the physician. If the physician goes from one group to the next. They'll figure out a way to go to that physician, won't they? Yeah, absolutely. That, that's the key relationship. That's the trusted relationship. You know, trust has eroded in so many different verticals.

You know, you've seen the reports, especially politicians probably at the bottom, and the one that has been maintained as nurses and doctors have always had this high trust, and so I would just leverage that trust and, and really just . Make sure that my clinicians felt like their job had meaning, their work had meaning that they had ability to influence the organization and that they had the digital tools, like we mentioned, to ensure, you know, quality of life.

You know, so you and I are gonna close this with three stories, which are related, and we're gonna talk telehealth.

You shared an interesting story about the next generation of physicians and their training. Why, why don't you tee that one up for us? Yeah. This has been really interesting for me. So my wife, who you might see her pictures in, in the background, uh, she's getting our DNP, so her doctor of nurse practitioner, she's been a long time nurse.

She's been a nurse like. If I told you how many years, she might be mad at me, but she'd been a nurse for like 30 years and she's really digitally capable. In fact, she led epic implementations at her particular hospital in a big health system. So she went from bedside nursing to. Into tech for about five years.

LED epic implementation represented, you know, basically the, that hospital, she was like the liaison to it, uh, for, for multiple years and then went back to bedside nursing. And then the last couple years she's really been focused on getting her master's and her DNP. So I'm always asking, 'cause I'm always curious like, what are you learning?

What are you learning? And so there's some, there's some journal articles now that are out there about . Uh, what they are learning and, and it's kind of scary maybe 'cause it just takes many, many years. But for modern digital practice to be folded into the clinician training. So this is clinician training for both doctors and nurses.

And you would think right, that they're learning all the digital tools. That they're learning, remote patient monitoring, that they're learning about virtual care, but they're not, you know? And so, and when my wife was picking her dissertation, I was like, pick virtual care. Pick pick digital medicine because that is the future and you'll be set, you know, you'll be the expert with your doctorate.

And her advisors kind of poo-pooed the idea. And I think one of the reasons why is 'cause they didn't know anything about it. Right. So. So anyways, I think it's becoming going to become more mainstream in our education. It just takes a many, many years, almost like healthcare bench to bedside. Similarly, I guess, in the educational side.

Yeah. You know, it, it, the, the abstract says, you know, the, the, this is a perspective piece seeks to highlight areas of concern. The digital health environment and provide potential educational pathways to prepare students. And the, the two of the things that they highlight is rapid technology development and a generational shift that's going on the rapid technology development.

And so I was pointing to my phone for those people who aren't watching the, but the generational shift is something that I thought was very interesting because they, they say this in the abstract, the digital natives are upon us. Although this article postulates, these students who may be starting postdoctoral curriculums, uh, or other health sciences, are inclined to be digital natives in accepting the use of technology in their lives.

They are not necessarily well versed on how to use it. The expectation for this generation to anticipate the use of technology may be beyond what their professors can envision in patient care. So you have that aspect of their, their professors. Can't really envision what's gonna be next, but, but they also slide this little slight in on that generation saying, yeah, they've used it since they were born, but they, they don't really, they, they don't have the vision for what it can do either.

They're, they're just users of the technology. That's an interesting perspective. I don't know if I agree. Yeah. Yeah. It it, it's interesting too because I had this opportunity to help write the first te, I think it's the first textbook that's really aimed at this problem for medical school, and it's probably gonna be released sometime this year, I imagine.

But I just wrote one of the chapters. And so I had to do a lot of empirical research. So this wasn't sort of my opinion, but you know what? The research shows out there and we, they really are lagging quite a bit, which then impacts us from a health IT leadership point of view. Because even your digital natives that are coming to on your medical staff now, they finished residency.

they're not necessarily super adept at all the medical tools. They are at the consumer tools, but at the medical tools, because they're professors, there's just a lag. Uh, that's, that's the only way to describe it. So I think it's still gonna take another five, 10 years before it all becomes mainstream. And they're actually having courses, right?

Their coursework should be, should be on digital tool with digital tools. And, you know, you know how long it took the EMR to get ? Studied it took it a long time to get studied in, in medical school. So I think we're seeing the same sort of lag, but there, there's hope. Uh, it, it's changing. It just takes a little while.

But people, the point is people should just be aware of the fact that just because it's a digital native and generation of, of a different generation, they're not necessarily gonna come in ready to practice with digital tools. All right, so we we're, we're, we're getting into your wheelhouse here, and that is remote patient monitoring.

And so one of the articles is remote patient monitoring goes mainstream and healthcare transformation follows the the next one visits.

Covid, this is actually about Canadian healthcare, but still those, those are generally the numbers we heard in this, in the states as well. It, it jumped, uh, dramatically and then I highlighted a, a report that shows vast improvement in state telehealth reimbursement policies. And there, there's just a ton of information in that.

Let's start with remote patient monitoring. So it highlights the, the, the tailwinds that are lifting the plane and it, it, it identifies some of the headwinds. Talk a little bit about what we're seeing in remote patient monitoring these days. Yeah, and I think Bill, all these topics again that we're gonna cover here pretty rapidly are really important for healthcare IT professionals to really understand because we have to lead.

It goes back to what we talked about earlier with the CDO and CIOs. We have to lead, and I know you've written some art, there's been some articles out there about . CIOs becoming key leaders, not just operational leaders, but more strategic, which is something we've always desired. Some have done it most haven't.

And here's really an opportunity to lead and lead the strategy in the organization, obviously along with your clinician counterparts. So yeah, with RRP M, so we saw, we did see the big bump in telemed. I think it's come down depending on who you study, you know, at about 20%. Or so, some are still higher, some are a little bit lower, but I think 20% is obviously an empirical number that's been researched and you know, RPM has has taken off as well, not as much because the use cases aren't quite as strong yet for RPM, but it's something definitely to keep your eye on RPM, meaning remote patient monitoring.

So especially with covid. So instead of filling up all your beds with covid patients, many progressive institutions. Found if you were pretty low risk, they could send you home with an RPM kit. Maybe it's a pulse ox temperature reading, and they would review it on a, on a daily basis and make sure you were okay.

Very popular simple use case, but I even better use cases are for acute care conditions, like maybe, uh, CHF and uh, congestive heart failure. But anyways, those sort of acute care conditions are, are really . Prime. But I really think that what you're gonna see this shift, that's just the beginning. So while the penetration wasn't, isn't the same as it is with a tele visit, a visual visit, it's going to start creeping up and essentially, I believe, go past that because a hospital home, and one thing is you've seen with the government recently announced, you know, they're, they're allowing certain organizations that met certain criteria.

To experiment and get paid for it in hospital at home. So they're testing the waters right now, and we've seen this before with CMS. They test the waters, they make some adjustments, and then pretty soon it goes mainstream. And I think that's really mainstream. I think one of the articles that we, we talked about was out of, uh, was it outta Denver, Humana, maybe in in Denver or maybe some other markets, Lewisville, where they are really offering this type of service.

So it is . Hospital at home. It's daily visits, it's daily encounters, but with the appropriate technology. And so far the early results are that the patients and families are happier 'cause no one wants to be in a hospital. The financials on it can be, uh, up to 50% less cost. And the clinical outcomes appear to be the same or better.

Takes advantage of this because I believe that in the future that hospital care, as we know it will be only for the very, very, uh, sick high, high acuity surgical patients, high acuity patients that need an ICU. But other than that, people, patients will convalesce at home. I. Yeah, my gosh. He gives, he gave me so many directions.

We, we have overhyped this in the past. We are guilty of overhyping this in the past, uh, of just, you know, remote patient monitoring hospital at home. And we, we got out over our skis and said it was gonna be there. But now what you have is, it feels to me like a race for the home. Like, you know, more services, more things going on, and it's being led by, it really is being led by whoever's taking risk.

Right. So you mentioned Humana. Going after that and, and, and, and there are health systems that have risk-based contracts, and they'll do this because it is a lower cost of care to do it out of the home than it's to do it in the, in the facility. And so if you get good at this, you can, you can actually drive some costs out of the system and, and still get reimbursed at at rates.

That, that, that makes sense. There's a lot of other, they talk about the tailwinds patient habits changed during covid. Changed during Covid. MR integration is a, is way down the road for, for a lot of health systems. I, I realize I, I shouldn't speak so broadly there, there's still some health systems that are implementing their EMRs and, and whatnot, but workflows are there, reimbursement is starting to catch up, and then the technology's there, right?

So we didn't even hit on the fact that, my gosh, you, you can't open, you can't open social media or something.

Somebody's funding and, and you know, and we saw the Livongo deal and how much they, you know, were, were able to sell for and whatnot. So there's, there's a race of money minds and talent running after the technology to really perfect this. And then you're starting to see some things sort of coalesce around this, not.

Is one areas competitors see as the opportunity to get in between. Right. If I can go right into the home, either through televisits or physical visits and then direct the care, I've now again dis the health system. Yeah, and this goes back to our earlier part of our conversation. If, if you don't take action, and I know, I know there's always that sort of fear or governor that we don't wanna get too far out ahead, but if we don't do something and take some risks, we are gonna stop one day and look and say, where are our patients?

Where we don't, we're gonna keep, you know, what we're gonna keep doing is budget cuts. Yeah, we're gonna keep, okay, take another 10% out. Take another 20% out. Why? 'cause the volumes are way down. Revenue is way down because the care is now being done by the, the payers. It's now being done by retail. And you know, the other categories, there's bunch other categories, but other categories.

Digital first companies, digital only companies that do some of these, uh, things, you know, and, and concierge medicine. And pretty soon there's not. God could be anything left. So that's why. Even if you, even if it's an experiment or a demonstration project as CMS would call it, I would get something going in my health system and, and start working it and seeing what happens.

Because otherwise you're gonna be caught flat-footed and I don't know that there's gonna be time to pivot and catch up. Alright, ed, let's get a little free consulting here from The Health Next, whatever your title is. I'm not sure what your title is. Let's call, how does A Into rrp. Everybody has a little bit of this going, don't.

Yeah, so I, my official title, I'm Chief Digital Officer for Tech Mahindra Health Well Life Sciences. And in the United States, a lot of people would know us more as, uh, HCI group, but we're part of Tech Mahindra Health and Life Sciences. So here's what's going on with, with most health systems is Israel interested in RPM, but I would say only 10 to 15% are actually doing RPM.

So there's high levels of interest. So because of covid and the. Amazing televideo response that happened. And as you know, for some organizations it went as high as 80% of all visits were virtual. There for a while sunk back, as we mentioned, to 20%. Now they saw the success of that and now, now they're thinking, oh, we should probably move into RPM.

And again, they're, they're smart leaders out there and they're reading things and seeing what competitors are doing or planning on doing. And so their initial foray is usually pretty low risk. And Covid is a really good example 'cause it's, it doesn't require a huge amount of technology and it's, it's pretty simple from a, from an end user or patient point of view on how to operate these things.

So that's what I would recommend. Start with something. It could be covid. It could be a small demonstration project maybe for CHF patients. You know, when, when I was at the clinic, we had to, uh, develop for our areas sort of a vision statement or, you know, a broad, you know, some people call 'em BHAGs, big hairy, audacious goals and for, for it.

And I led digital and it, it was, uh. 50% of our visits would be virtual outpatient visits would be virtual. And as a regular thing, not a covid thing. This was pre covid and 25% of our inpatient days were at home. So that's what we were shooting for. So you gotta put up some sort of goal and objective. And so for us that was pretty, a big, hairy, audacious goal.

Think about that 25%. Apples to apples comparison, you would start treating those patients at home. So that would mean early discharge for some, and it would be no admissions for others, and that's what we were working towards. So you have to start someplace. You get the vision. Then you take a demonstration project or two, find your clinicians that are really progressive and there's those sort of clinicians everywhere.

In fact, they're usually waiting on it and they get frustrated and go out and do their own thing. So find them, partner with them and start doing things and then collect the metrics. So it's really important, I believe, to be metric driven. So . Collect the metrics. Did you, uh, reduce length of stay? Did you reduce cost?

What was the patient satisfaction like? So the more you can measure, the better evidence you have and the better you can make your arguments for, for additional funding. Then you start getting funding saying, look, we, we need to move this direction. And we have a very progressive unit here and we're willing to do.

And that's what I've done pretty much my whole career. And I know you're the same way if you wait. It's too late. You've gotta take risks, you've gotta push the envelope. People may laugh. People laughed at me. You know, bill, I don't know if it was 15 years ago, 'cause I was a big work from home person and I took a lot of grief from hr, took a lot of grief from a lot of people about how work from home doesn't work.

They ultimately, I. Let us do it. And then we were hit one time with a major blizzard, and then we were hit another time with a major oil spill outside our corporate headquarters. Just like a typical disaster scenario you make up. We actually had one of those happen, and, and lo and behold, you know, pretty soon the rest of the organization started working from home as well.

So you just gotta push the envelope a little bit and I think you'll find people out there, clinicians out there that'll push with you. So that's some of the things I, if I can recap really quick. Is, you know, you gotta have the vision. You find collaborators, you push the envelope, you measure, then you go back and ask for permission.

Yep. You should. You should always have a bunch of tiny projects going, tiny bunch of projects going on, small projects. For sure. Something that you can almost fund outta your operating budget within it and, and just keep them going. I, I love the, I know I'm not gonna hit on the meat of what you just said.

I, I love the, the physician. There's a physician that wants to partner with you, but can't wait any longer. And they say, and I, I remember just, I just, these stories I remember of people coming into my office saying, you wouldn't believe what doctor, what, what's his name did? I'm like, well, what'd he do? It's like, oh my gosh.

He signed putting images.

I wanna have a meeting with him. It's like, oh, you're gonna, you're gonna slam him? I'm like, no, he's, that's perfect. Yeah. What he's trying to do is solve a problem and meet the needs of the, of the consumer. And you know what? We're gonna step in and we're gonna partner with him and we're gonna start doing that.

And they're like, but he is, he's not doing it right. I'm like, yeah, we're not helping him. Let's go help them. Let's do it. Right. Yeah. I, it reminds me too, we had a community at the clinic called Brain X. Had nothing to do with it. Are you kidding me? It would've squashed them. They were a bunch of smart physicians.

They met after hours and they were talking about AI machine learning, and they were actually getting data and they were building a AI machine and capabilities and like actually impacting positively the quality of care. And so I heard about 'em, so I showed up at one of their meetings and it was the same sort of thing.

It was like, oh my gosh, you know the CIO's here, he is gonna shut this thing down. I was like, no man. How do I ? Get officially, how do I officially become a member? And I did become a member. And the funny thing was, they, they all expected it need to be, you know, I was super smart. And, and so at these meetings, they would talk the most complex things.

Again, these are all highly trained clinicians who, for fun, do all this AI machine learning, uh, programming at night. And they would always turn to me after the pre, they'd have presentations every time that would just boggle your mind. And they'd turn to me and like, what do you think? And , I'm like, I, I just didn't have anything, any uh, pearls of wisdom for them other than say, that is awesome, you know?

But that was my role. Sometimes your role is just to encourage that sort of innovation, encourage that sort of leadership and partner with people, remove obstacles. I couldn't add any value from an intellectual point of view. They were way beyond me, but I could remove obstacles. And give them safe guardrails and allow them to do amazing things that would save people's lives.

Yeah. You know, LA last thing here was, and I, we're not gonna get to cover it, we're already beyond our time, but you know, it, it was a good article. I covered it in today in Health. It it's just the, the article on state reimbursement and you know, you mentioned earlier, and so I.

Via telehealth and 25, uh, percent of inpatient days at home. Is that right? Yeah. Yeah. Perfect. So that requires a business model change, right? And this is, this is the thing we, we keep talking about, about CIOs stepping into those business model changes. Most CIOs don't wanna wait in there. They're like, well, that's not the business model.

We're not, we're not ready to go there. Instead of saying, you know, I think this is the future. Let this conversation I technology.

You know, at what point do we start to see business models change and at what point are we a part of those conversations? And, and did you guys have those conversations? Yeah, absolutely. And then that's what we're talking about when we're talking about the CDO. Why are CDOs coming from other industries?

And it kind of may I, I'm glad 'cause we need to learn from other industries and the same time I'm like. Come on. Because if you wanna be the CDO, it's, they shouldn't have to get someone from outside 'cause you can do it. And so that's one of these areas where you have to lead, you have to be a business person, you have to be a clinical person.

So don't be afraid. Don't say, well, I'm just it, I'm, or operations, well then I wouldn't hire you as ACDO if that's the way you felt. So you gotta be bold and take risks, even if it means you lose your job. So what you'll get, you'll, if you're good, you'll get picked up somewhere else. So you, you gotta be bold.

That's the worst thing, right? I know this isn't what you asked, but the worst thing is someone who just becomes assimilated. Like they're bold, they get hired, they're so excited, and then they get pushed back, pushed back, pushed back, and they decide to play it safe. And that's why healthcare is so far behind.

'cause so many of us have played it safe over the years. So it's time for bold new leadership, whether it's outside or inside. So to answer your question, yes, of course. And so. We really had to work through it. So I let it, I pushed our way through it and we changed it. So what it was, I'll give you two really good examples.

One was how physicians were compensated. So I can't get into the specifics, you know, to reveal sort of the magic sauce of where I came from. But there was a definite way that physicians were compensated, you know, productivity. Was analyzed carefully. So suddenly you're doing telemedicine visits, which at the time were not on parody in terms of reimbursement with an in-person visit.

So how do you make that change? So what do you do? You get with the me chief of staff, you get with the CFO, you start laying out the arguments and why this is the future and why we have to go this way and why we have to make accommodations in that productivity formula. And that's what ended up happening.

They made accommodations and a productivity . Formula so that you were not penalized for doing a telemedicine visit. That was number one. The second one, which I was not successful with, but I bet if I had another run at it today, I I would be, and that is, why do we have urgent care? Why do we have urgent care clinics?

When we have virtual care capabilities, why do people go to virtual care? Okay, you go to the ed ideally because your artery is wide open and you need life something quick, lifesaving. That is good. Virtual care not gonna help you very much there, but urgent care, why do you go to urgent care? 'cause it's less costly than ed care is usually less weight, a little bit more convenient, and there's more, more locations typically.

But that's exactly what virtual care's for. So I took that on Bill. I wasn't successful, but I took it on. I said, look, we want to go to 50% of outpatient visits being virtual, but yet we're advertising and pushing our urgent care centers. We don't need urgent care centers. It's brick and mortar. It costs a lot of money to run those brick and mortar centers, and we can do about probably 95%

Because the argument is you can do about 80, 85% of what happens in an ed. You can do it virtually or what happens in an outpatient setting. So in urgent care, it's probably like 90%. Okay, so let's argue you're a clinician. I'm not. Let's just say it's 80%. Okay? Whatever that number is, a high amount of the reasons you would go to urgent care can be done virtually.

So don't have urgent care centers. Let people go to the ED that need to go to the ed, handle everything else with virtual care. I did not win that one because why? Urgent care makes a lot of money. Yeah. Well, okay. Hey, let me let, let me close on. Let me close on this question, which is, you've done podcasts now for a while and this, so this is, this is consulting for Bill.

You're, uh, you're gonna gimme some free consulting here. What's the, what's the most challenging thing of doing a podcast? Well, I've only hosted six or seven. So are you asking as a host or as a attend? Well, no. You, you used to do that other series that you did as well? Yeah. Yeah. Okay. Is preparing.

Preparing it takes a lot. People don't realize it. I know you do. It takes a lot to prepare. My episodes are, are short, maybe 25 minutes, and it takes a lot of preparation to do it right, so anyone can sort of wing it. But if you want to have that professional level, quality, you know, giving out great information like you do.

It takes a lot of preparation, so it's hard to fit that in my regular job. You know, to add that in it takes, takes a little bit of effort. Yeah, I did, and I would say that's, that's the number one. People don't realize people are. And I, I have a whole thing of show notes right in front of me that I prepared, and it took me an hour and a half or so, plus you and I both read about six or seven articles to go along with that.

And so, even though it sounded like a spontaneous conversation that you, that's part of the gift, right? It's, it's figuring out how to make it feel like a spontaneous conversation, even though you prepared for. For, uh, for a conversation. Yeah. And, and that's why, and I hope you keep this in the show, that what I'm about to say, bill, that's why I'm so thankful for you.

And all the work that you do and you put into the show, I know you do it because you're, you're passionate about it. And I also know that, you know, obviously you make a, make a living for from it. But what you're really doing is investing in the next generation of leaders. I know that's part of your, your, your statement as well.

Your, your passion and what a gift to have someone else put in all that investment. And then to bring in the most important things and talk about it. And then you always have fascinating guests. Because, you know, it would be boring, right? As, as great as Bill is, or great as Ed or or Drex is, or Sue is. We get boring after a while, but you bring in these other guests with these different perspectives that are clinicians and digital people and all that kinda stuff, and it just adds so much value.

So if I were ACIO today, I'd almost make it mandatory that you're listening to all these things from, uh, health, health it, from Bill Russell, uh, because it makes you a better. Employee, it makes you a better leader. And so I am really thankful, and you know this because I've told you this privately, but you're the main thing on my runs.

I run a lot. Uh, I listen to podcasts. I, I keep up to date. Thanks to you. I don't have time to do it otherwise. And I really appreciate all that you do for the industry. Well, I, I appreciate that. I'm gonna start leaving like codes. Up on.

Yeah, digital Voices, it's spelled like DGTL. Try to be like hip DGTL voices and we're on everything, I imagine, Spotify and Apple Podcasts and, and whatnot. But yeah, thanks again for having me. Oh yeah, it's fantastic. And by the way, you were the number two runner up in, uh, referrals for the Cliffs program, which is why you're here.

Just so you know. Right. I'm gonna be number one next time because I, I did, I didn't blow it up as much as I, as I had intended to. But I, I have shared it with all of our leaders of our organization, and it's funny. I'll tell you one quick story. We have a new person that came from outside of healthcare, and that's the one thing I told him.

I said, listen, follow Bill Russell. You'll catch up on healthcare. And now if you were to meet him, he's only been in healthcare about six months, you would never, you, you would think he's been in healthcare for six years and a lot of that has to do with you because he is listened to all your stuff. Well, I, the, I, I appreciate your support, Frank Nyam, for those of you who are wondering who was the top, uh, referral?

It was Frank Nyam from VMware, and he has agreed to come on the Newsday show. I, we haven't scheduled it yet, but he has agreed to come on the Newsday show, so I'm looking forward to that. He's a great guy and, uh, appreciate his, uh, supports with vm.

Apple, Google, overcast, Spotify, Stitcher, probably some other places that I'm not even familiar with. Uh, we wanna thank our channel sponsors who are investing in our vision to develop the next generation of health IT leaders. VMware, Hillrom, Starbridge Advisors, Aruba Networks, and McAfee. Thanks for listening.

That's all for new.