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 Today, on this week in health it, if you ask 10 providers the same question, you may get 10 answers. And that's just the nature of the B. So when you talk about data collection and how it is that we capture the data in order to leverage artificial intelligence and other things to help deliver better outcomes from a functional perspective, we're not leveraging

The data the way we should.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT at 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.

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For more information on our other channels and where you can subscribe, visit us at this week, health.com/shows, S-H-O-W-S. Now onto the show. It's Newsday and we've got a lot of interesting stories. We're gonna talk about interoperability, we'll talk about the nursing shortage, we'll talk about some telehealth fraud and some other things.

Today we have a, a new guest on the show. We have Tony Thornton. He's the principal advisor for Federal Healthcare for Worldwide Technology, and we're excited to have Mon Tony, welcome to the show. Hey, thank you, bill. It's awesome to be here a week before Thanksgiving. I know we're thinking about Turkey stuff and things, but it's always good to do this stuff.

I'd forgotten that. I, I've been so busy. I, I went to the health conference, the Chime conference. I went to another conference as well. I've been at three conferences and so busy. You forget that those things are coming up. It's, and, and the worst of it is, I assume you're done with all your Christmas shopping.

Well, it's funny you say that, and I was by some friends just last night and they have five Christmas trees up. Oh God. And so they're well into it. And unfortunately, fortunately my family, we kinda have a general agreement that I will get one gift each, and I'm the guy that will use some sort of virtual catalog or whatever it is.

I probably shouldn't say that out loud, but it's the truth. , if you're like me, the the family doesn't listen to these kinds of podcasts. They're like my, my wife for years is like, what does your husband do? It's like technology. He does something with technology and now it's even harder for her. She's like, what does he do?

I don't know. He is in his, he's he's in that studio over there talking to people all over the country and recording things. So your wife and my wife may be cousins then . So yeah, she's like, you're always doing something. What do you do? And all. So I sit there, but it's worse are my kids again, now that everything is virtual, the entertainment in the house is mocking dad in his virtual conferences.

So it's a three, four letter soup where all the different acronyms and different people and other executives. So quite entertaining. So we absolutely could probably put on a show in my house. There's some, i I, it was great to be with people at the conferences again, to like be with them and. You know, shake hands and talk to 'em.

But there, there's something about this, this zoom thing. Uh, I mean, I got to meet people's dogs, their kids, their spouses and other things because they're in the meeting and all of a sudden somebody's walking behind them or the dog jumps up on their lap and that kind of stuff. It, it really did open up maybe a little different window into some of the people that I've.

Interacted with for years. It was, uh, that aspect of it, I, I really did enjoy, well, it was, what's cool about it, again, because of Covid and the pandemic, probably it's been about two years, folks traveling kind of went, you know, to a strategic pause. So there are people that I've met over the past two years and just in the six months have finally gotten to meet them in person.

And so it's pretty cool. So while production went up because of it. The interpersonal things that you're used to, like you said, the conferences and just the basic blocking and tackling of getting to know people, going to restaurants, conferences and things of that nature, that's all changed. So it'd be interesting again, as we look forward, what's gonna be that middle ground going forward.

But again, I think the days of the full blown like hims where you have a gazillion people there doing things, I, I think we're still a little bit ways from that. Well, just to level set, because people aren't familiar with with you on the show, what does the principal advisor for Federal Healthcare do for worldwide technology?

Well, exactly that. In the title I advise, I'm an expert within the federal healthcare public space. Uh, again, I'm a retired naval officer, 30 years hospital administrator technologist. I was CIO of, uh, several entities in military medicine that include the President's Hospital, Walter e Bethesda. I was CIO of the United States Navy Healthcare Enterprise, and also in Defense Health Agency.

I was chief infrastructure operations zoned all the it. What does that mean? That means within the healthcare realm around technology stuff and things, I'm the guy that kind of knows it at the C-suite. So what I do is, is . Help at the client executive level, help our teams understand what's coming down pike strategically, and how is it that we align our capabilities within the worldwide technology portfolio?

How is it that we align those things to ensure that we are meeting the needs of the customers? And certainly because of the pandemic, because of this evolution that, that we're seeing right now where consumerism. In the brink of this digital divide and other things that are happening, you know what I mean?

Companies like technology. We have the benefit of a complex portfolio of stuff and things that we get to leverage and help our customers, in this case, healthcare delivery, do the right thing by them. So it's a cool place to be in, but I basically advise, I have to know where the puck is, so to speak, before we we get to some of the stories.

I'm, I'm curious, so. When we talk consumers, well actually let's step back. Federal healthcare, I assume that's, that's va It is. It's the hospital systems within the federal government, but it's, there's also some other aspects to that as well. What areas does that actually oversee? I. So federal healthcare includes HHS and its subsidiaries that include certainly Indian Health, but also F-D-A-C-D-C-N-I-H, national Library.

So that's one thing. And then of course, VA and all of those subsidiary hospitals and then defense health. And so the combination of the three are where I lean in most, but certainly we, we look to our commercial partners because again, some people think, uh, military healthcare is antiquated. I mean, you read a lot of things, but the truth is, is a doctor that on the commercial side, they go to the same colleges and get educated the same.

The training and whatnot are all the same on the federal side. The divide is not as great as people think, but it's really, really cool because military health defense, certainly the va we're, we're basically nonprofit. And what I mean by that is we can do things because we want to do them because most, in most instances, we're taking care of the men and women that worn the cloth of this nation.

So the people that are in our hearts, the kind of the backbone, so the war fighters and other folks. So it's a different type of healthcare because again, I mean when I say nonprofit, mark. Tax dollars, drive the delivery. And so, uh, it's a pretty cool system to be in because again, we get to do things because we want to and have to.

So it's a different culture, so to speak when you talk about healthcare delivery. I, I, I'll tell you, Tony, it's that aspect. It's the taxpayer dollars. I, I'm on record as saying I would, I, I would never want to lead an EHR implementation for a public entity like that because I did one for a 16 hospital system and I know the number of things that went wrong, right?

How challenging it was. But when you're doing it with. Taxpayer dollars, that whole thing gets adjudicated in front of Congress, in front of the media, in front of everybody. And I'm thinking, oh man, that, that, if, if my implementation at that 16 hospital system had been adjudicated that way, it would've been, it's, it's much, it's much easier when you get the doctors and everybody in a room.

You talk through it, you figure out what you need to do, and, and you move on. As opposed to, yeah, you're right. We, we just read so much about what's going on. It's a hard job. It is a hard job, again, as a former CIO, um, and certainly have relationships with the standing CIOs. It's difficult because again, culturally it's more about change management and the human adaptation around information and the technology you've talked about on the show, the EHRs are getting better, but they're not perfect.

When we talk about clinical workflows and how it is, it will delivered. Again, military and federal healthcare are very, very similar. But again, the challenge are there are some challenges around infrastructure. There are other challenges because we're remote. Again, it's not like we have this little quarantine health system, but we're global.

We're all over the place. So again, when you're talking about delivery, . Those challenges make it difficult or more difficult than what you would have in a commercial health entity. But again, at the same time, it's, it's one of the best health systems in the world. There are people who would challenge me and say, well, what about this stuff?

And what about these things? But the cool thing is, is our doctors and nurses, paraprofessionals are resilient, and at the end of the day, they want to do the right thing. And so that humanistic aspect when it comes to healthcare delivery is always critical. To, uh, the delivery of care. Fantastic. All right, let's get into the stories.

According to the blog post published by the Deputy National Coordinator, Steve Pozak, the agency received more than 700 submissions in response over the course of the next few months. As Pozak explained, the agency analyzed each statement and looked for trends, groupings, combinations, and other affinities.

The resulting theme statements ran the gamut from shifts in individual and care delivery experiences to changes at health systems. So let me just jump over. So that's, that's what they did. That was the process. And I went over to the ONC site. Here's some of those statements that he was talking about, and they're grouped into two things.

They're grouped into health system statements and they're grouped into individual statements from an individual standpoint. Here's some of the statements. Individuals will have. Internet based access to their past, present, and future electronic health information from clinical and administrative sources.

So that's the first one. Second, individuals will be able to seek and receive care telehealth specialty without needing to gather and provide their health information themselves. Next one, prior to administering care, an individual care team will have ready access to updated electronic health information that reflects the latest changes in health and care.

And it goes on. And a lot of it's the same thing. Individuals and health professionals will be able to discover and compare online the costs of healthcare services, procedures, or drugs before it is ordered and prescribed. And there was a lot of those kinds of things. It's about the experience. It's about having access to our information.

It's about, I would say, . The, the friction that we have all along the way, being asked seven times, can you give us this information? And you're just shaking your head like, oh my gosh, this is a seven. I mean, for a chronic condition, you may have given this information 15 times and here you are giving it again.

And, and they ask you, do you have your medical record? And you can't get access to it. And so the vision here is a vision where people have access to their medical record. The providers have access to their medical record. Individuals and providers have access to, uh, pricing and procedure costs, and we are informed and we are communicating.

So that's from the individual side. I'm, I'm curious, as you hear some of those things, does that resonate with you in terms of where we. Want to go and where we could go from an interoperability standpoint, from a patient side. So it's, it's more than a one. It's an absolute need. We have to go there. I tell this story often, uh, within close friends, close circles.

My, my wife and I built a home a couple years ago. I. Right before we go into closing, there was an error in the closing, and I coincidentally was on the golf course when the wife said, you shouldn't be golfing this day 'cause we're gonna have the closing. You never know what's gonna happen. And of course something happened, but the cool thing was to my phone, I was able to get a.

packet, if you would, where I was able to digitally sign and keep everything going. So we closed that day. The wife was not upset at me and all was well in healthcare. You could have two healthcare entities right next to each other and not be able to share information, and that just doesn't make sense.

And so I, I clowned around within the circle of friends. That we're probably about 10 years behind. On the financial side, you can see, I mean, with your ATM card or your phone, you can access your financial information anywhere in the world, but yet in healthcare, we can't do that. And why is that? So is a technology problem.

The answer is no. Functionally. Again, when we talk about consumerism, and you mentioned it in your opening statement, the two core people or entities are the patients themselves and then the providers. The providers. And when I say providers, I'm talking, I. Doctors, nurses, paraprofessionals, and ensuring that the right information is in the right place at the right time.

And to your point, even the need of filling out applications or or capturing your health information, why does it make sense that you have to do it sometimes multiple times when in fact you should be able to do it just once? So the statements that you read are true. Certainly the technology companies are looking at, not from a technology perspective alone, but from a functional.

Perspective in terms of delivery. How is it that we provide that interoperability, uh, change management? How is it from a clinical flow perspective? How is it that, again, we use that thing that we call a phone, which is truly a digital platform, so to speak. It happens to have a phone app. How is it that we leverage that?

I have a 22 year old daughter who during the pandemic, has probably been tested. I, I cannot tell you the number of times, and she has the greatest expectation that the results. Her information are gonna be where it is, where she needs it, when she needs it. She certainly has been very, very cautious, but she looks at me as a healthcare guy, like, dad, this has to get better.

It's pretty cool, but here are the things we need. And so again, this next generation I think are going to drive us toward that. And like I said, there are other interested industries comparable to healthcare that are doing the very same thing. So we have to, it's a must in order for us to improve outcomes from a clinical delivery perspective, but also just the demand, the demand signal from the patients themselves.

They're wanting it now. I will add this and, and people argue this point, people are most interested in their healthcare. I mean, putting the pandemic aside. When you're younger, you're a baby, and when you're older, so typically those middle year people are kind of like, eh, unless you have some chronic disease or something like that, you're not concerned.

I think the pandemic has become a forcing function to kind of drive our interests. Or, or improve our interest, if you would, around quality care delivery and those sort of things. So that's a longwinded answer, but hopefully get the gist of where I'm going at with that. I agree with you. I, I didn't really care about my, my health all that much for a number of years, and I'm finding now that as I get to a certain age, a lot more of the conversations I have with people and my friends.

At some point we used to talk about work and, and other things. Now, at some point we get to aches, pains, medications, procedures, , and I'm like, man, that just, I guess once you turn about 50 years old, your friends are around that age, you, you start having different conversations and there really is a lot of truth to that.

You start to become very aware of the health system once again. But, but between those ages of what? 20 and 20 and 50. I mean, God willing, there you're. You really don't have a lot of need, hopefully for a health system. So you sort of check out, let, lemme give you a couple more of these statements. So those were the individual statements.

The individuals want their information and they want transparency and they don't want to keep filling out these forms. Here's the statements that they put together for health systems. The health system will enable evidence-based precision care that accounts for the social and health conditions of each patient, including links between health and human services.

So this gets to. Uh, whole Person Care, right? So we're not just caring for the individual ailment of a population. We're, we're actually getting down to this, this n of one, this individual type of care, precision type of care. Uh, the next thing is the health systems will more quickly identify high risk conditions, chronic diseases.

Disparities in health equity. Next one, the data used for clinical and administrative processes will be electronically integrated to support decisions about payment eligibility and benefits, and it goes on and talks about public health, public health response and preparedness. We'll be driven by real-time data that allow public health agencies to quickly identify when and where infectious disease breaks out and maintain insights about health system capacity, and they have reporting and those kinds of things.

The interoperability, it's interesting. We're starting to see a lot of really cool. Tools and they're amazing in what they can do. With machine learning, with AI and really analyzing large amounts of data, the challenge still becomes getting that data to move and the quality of that data once it moved. A lot of that data is still not as clean, I guess, as some of these AI systems and machine learning systems would like in order to to, to benefit us.

And that's just the nature of the beast. So when you talk about data collection and how it is that we capture the data in order to leverage, as you suggest artificial intelligence and other things to help deliver better outcomes. Again, from a functional perspective, we're not leveraging the data the way we should.

The technology is there to assist, to be able to drive better outcomes. We have to get better data, clean data, and the truth is, is that's not gonna happen overnight and that's gonna be driven by again, continue to standardize how it is. We capture that information so that we can utilize it in a way to drive better outcomes.

None of this will be true. If in fact we don't have full interoperability from the clinical perspective, from the providers to ensure that they have the right data, healthcare is becoming more specialized. That's just the truth. I mean, before you, you had a hand doctor, now it's gonna be an index finger doctor, so there's gonna be more and more, more data.

So imagine a time where we're leveraging artificial intelligence and other tools. To flag when in fact there's a, an error or a challenge in terms of healthcare delivery. We, we have case management, which typically are humans that again, act if you would, as a kind of stop guards, uh, safety likes around the data.

But what if we have a time again, around interoperability, where you are leveraging the tools to do just that? So the statements you read are spot on. It is a must. Because we're becoming more specialized because there's gonna be more data. The chances for us to have adverse effects will be increased. So we have to use technology and other innovations to be able to reduce the possibility of having those negative.

One of the things I wanna talk to you about is this nursing shortage. One of the stories we have here is the CHS community health system. 80 OD hospitals across country is looking to put programs together for nurse recruiting and training. I've talked to, uh, a bunch of health systems over the last couple of weeks.

And this nurse shortage is, is top of mind. It's a very serious issue. And as we're talking through that, one of the things that struck me is we're gonna have to figure out a way to make nurses much more productive than they are today. And one of the reasons they're not productive is they spend an awful lot of time in front of this computer that you and I are talking through, typing in notes and those kind of things.

And it struck me as you were talking, we almost need AI and, and smart systems. Uh, on the front end, right? So part of the problem, you said 10 different clinicians. Ask them a, a question. You're gonna get 10 different answers. And the same thing's true with data entry. In a lot of cases, 10 different people input the same medication five different ways.

Let's just say this tablet, this many times versus this tablet this many times, it, it gets kind of convoluted in the health system because they didn't get into medicine to be data entry clerks. And that's what we've turned them into. And it strikes me that there are smart systems right around the corner.

One of the ones I was looking at was a, a clinical automation tool. And all it is is a camera and they address the whole idea of privacy and whatnot. They essentially blur out the person who's doing the work, but that camera's there to watch. Certain things that happen in the room and it never turns off.

It's always there and it watches for fall risk. It watches for hand washing, it watches, it, watches for other things like turns in the bed for pressure wounds and those kinds of things. And it's all those things are things that the nurse used to have to think about and made them less productive. And in fact, the, the turns they've actually integrated into the EHR and it actually.

Will put the information in the EHR for them so that that act of, okay, this happened and they type it into the EHR. We're taking that stuff away from them. I mean, this, this nursing shortage is top of mind and I think technology's gonna play a big role. In terms of how we support the nurses that remain, how we train and bring new nurses up to speed moving forward, are you hearing the same challenge that this nursing shortage is top of mind or is something that is something that we can address?

Somewhat with technology. Clearly we need more nurses, but uh, we can support it with technology. Yeah. Bill, so you're absolutely right. I think that the healthcare industry staffing shortages across the board, but there are under other industries as well that are challenge. And so again, with this problem becomes opportunity.

How is it to your point? We certainly have seen over the past 18 months, two years virtual care. Telehealth increase exponentially. But to your point, we have to figure out how was it that we crack the nut on, whether it be automation, robotics, or other tools that will never necessarily replace. The, the functional care, the care that you get from nursing, but the ability to capture the information or to do the things, the due diligence that nursing nurses provide.

Again, my dear friends are providers and I, and I tell them this and some of them wanna strangle me. I. I tell them, I say, while doctors are everything in healthcare, the truth is the nurses are the glue. They truly are what makes hospitals run. My nursing friends are probably the ones that watch this.

They'll smile, but they're the ones that that make it happen, the nurses and the paraprofessionals. And so the, the nursing shortage is real. It's going to continue, especially, I'm not gonna say it's, uh, a mass exodus. But because of, uh, COVID and the pandemic, you're starting to see people leave the cities, which means healthcare.

The healthcare footprint has to expand. So again, we're in this evolution where it's not like all of a sudden we're gonna have this bolus or increase of people overnight to address those shortages. So we have to get creative. And certainly the folks that I work with from a technology perspective, we have clinical professionals on staff, nursing professionals on staff.

So we look at ways, how is it that you can leverage the technology to do just that, to fill in those gaps, because it's not like all of a sudden, overnight we're gonna have this surplus of people. And again, the challenges, the shorting, uh, staffing challenges permeate across all industries, not just healthcare.

So let's, let's talk about the technology. So there's a, a shortage for some reason. There's a shortage in health IT staff. I think there's just more competition for it. I've talked to, uh, a couple, I wouldn't call 'em rural, well, actually I would call 'em rural locations compared to some of the cities you're in St.

Louis. I mean, some of these. Cities are much smaller locations and what's happening is you have these, these big firms coming in, hiring the technologists who know various technologies. They don't have to move from that rural location. And they just got a 30% pay increase. And I was talking to somebody, their health system, uh, nurses, clinicians, and it combined has a 16% open rate right now.

Unfill rate, I mean that of positions that they need to fill. And there was almost, he goes, you know, that's 16% that are actually posted that we're looking for. He said, there's, there's still other positions that aren't even posted yet because we have to fill some positions before we get there. That's a significant amount.

And one of the articles was, uh, a conversation that happened at Health Evolution and what will it take to maintain the accelerated pace of innovation in healthcare Post pandemic. We're all excited. I mean, we made so much progress during the pandemic. From a digital standpoint, it is the silver lining is the amount of things that we were able to do from a digital perspective.

But now we have this potential shortage in the IT staff and we also I think have. That same appetite still remains for keeping up the pace of innovation. How are we gonna do that? I'm asking for some free consulting at this point. How? How are we gonna maintain that pace of innovation in healthcare with actually a little bit of few fewer staff?

Well, I tell you, it's not an easy fix. I think I've read a couple different articles in recent weeks, months that said the shortage, if all things being equal. And all of our health entities, facilities were fully staffed. We'd need additional 20,000 nurses is, uh, the number that I heard. So that's not an easy fix.

And to your point, the larger health systems that can afford to pay a premium for those technicians, clinical nursing staff, they're the ones that are benefiting. And unfortunately, the smaller health systems are the ones that are struggling even more 'cause of their bottom line. It's a lot slimmer. So they don't have the latitude, and so you're absolutely right.

What we need are our doctors and nurses to help drive those innovations to fill the gaps. We as technologists have to listen and better understand what that looks like. What are those requirements and how is it that we deliver the necessary capabilities? . To be able to solve those gaps. Again, it's not going to be an easy fix, but again, you see more often, or at least in recent years, you see doctors, nurses, paraprofessionals, becoming technology and informatics experts.

They're understanding the industry. . And so that compliment to people like myself, and again, I'm a hospital administrator, but the truth is, I mean, you don't want me drawing your blood or doing some things. And so we, we are gonna absolutely depend on those functional experts to kind of help shape and drive that.

And companies like Worldwide Technology, we have that expertise and so we leverage our functional folks. To kind of help shape where it is we're going with the technology. So Tony, to close this out, but we're getting close to the end of the year. We talked about Thanksgiving, we talked about the holidays at the end of the year.

So you are gonna see more and more of that virtual care, the better use of the technologies and even expansion of those technologies. Again, which are gonna drive interoperability. That's going to happen. I actually, while I am in St. Louis this week, I'm actually in Washington dc. I live right outside Washington, DC and you see from a business perspective, and we have a lot of wonderful buildings, and you seem vacant, so the whole workplace function thing is gonna change.

Now what that means and how is that tied to healthcare? We're still trying to figure that out because again, I don't think, it's not as easy as the easy button, so to speak, but the goal is just that we have to continue to innovate and be smart to be able to drive better outcomes. Again, as we talk about.

Patient-centered care or consumer-based care with the, with our doctors and of course the patients being in the middle. How is it that we drive better outcomes using technology? So I think across the board, everyone's looking at that and uh, it'd be pretty cool. There's also an undercurrent of security as you go virtual.

How is it that just cured the information? How is it that with the ransomware and some of these other things that are happening, how is. That we do it in a secure way and and manage the data. And so again, those challenges are going to exist, continue to exist, and we just have to get better. Yep, absolutely.

Tony, I wanna thank you for your time. It was wonderful to meet you and I appreciate your perspective. Maybe the next time you're on, we could talk about the progress on the VA's EHR implementation, but I didn't wanna put you on the spot on your first, on your first time on the show. No, not at all. Thank you very much for having me, bill.

Happy Thanksgiving to you and your family. Thank you. You too. 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. I know if I were ACIO today, I would have every one of my team members listening to this show.

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