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 Welcome to this Weekend Health IT News, where we look at as many stories as we can in 23 minutes or less that will impact health it. My name is Bill Russell Healthcare, CIO Coach, creator of this weekend Health. It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

It is Tuesday Newsday, and here are just some of the stories we're gonna talk about. Uh, 10 predictions on health AI from a friend of the show, Dr. Anthony Chang. Uh, we're gonna go back to Epic. Talk a little bit about that. We're gonna talk about, uh, let's see, what else are we gonna talk about? We will talk about some of the challenges that are going on right now.

Um, practice Fusion and other things that are going on. We'll talk about that a little bit and what health it's response might be for that, and we'll go from there. This episode is sponsored by Health Lyrics. I coach health leaders in all things health. It coaching was instrumental in my success and is the focus of my work at Health Lyrics.

Uh, so I'm, this is gonna be unfiltered and fast on these stories, so let's open the fire hose and, and see where we go. Oh, actually , can we talk about the Iowa caucuses for just one minute and we'll talk about it From a health IT standpoint, we try not to be political on the show, so, uh, you know, I am one of those people who talks loudly at my TV when I hear silly things and, uh, we actually have tons of family in town and we're watching the caucus results.

And then I hear. That the results are gonna be delayed because of an app. And I'm like, are you serious? Uh, how this is so cliche, I can't even believe it. Um, you know, the, the first thing they do is they blame the technology. They blame health it, not health it, but they blame the IT department, you know, the app's not working.

Um, and, and I started to think, you know, you know, how complex can this app be really? I mean, dual form authentication, submit your results. End. That's it. I mean it, you know, anyway, the night goes on. I start to think I, you know, I wish some people from my, uh, EHR go live team were, were there on the ground in Iowa.

They would've had this solved, uh, probably within minutes, but definitely within, within an hour. Um, then I hear they can't get the results back 'cause the phone lines are flooded with Trump supporters. And again, I'm like, seriously? Do, do the phones not work in both directions in Iowa? I, I just didn't get it.

Um, uh, you know. The, uh. The easy way to solve that problem is, I think phones in Iowa still work in both directions. So if they knew the precinct captain's phone numbers, they could call them and, uh, you know, get the results. Um, you know, I was, I was really appalled at it, taking the fall, uh, for this and really the overall lack of troubleshooting skills from everyone involved.

So anyway, just wanted to get that off my chest. And I told you this was gonna be unfiltered and raw, so I apologize. Uh, here's, let's, let's go to the Epic stuff first. So here's your . Uh, epic ONC battle update for the week. Christina Farr from CNBC followed through on her promise to publish the hospitals, which signed the epic letter and, uh, which goes, uh, to what I said on the show, which is, uh, this is not gonna be one of those battle or one of those things that gets done in secret behind the curtain.

This is gonna be something that gets brought, uh, to your communities. Um, let's see. Couple of quotes from this. Uh, one doctor who signed says he shared Epic's privacy concerns as a number of . Proposed medical apps skyrockets. Uh, there are tens of thousands of healthcare apps. Said Neil Coleman, md Chairman of the Family Medicine at Mount Sinai in New York, and president of the Institute for Family Health.

In an interview I. Getting these big computer systems to communicate in a predictable and secure way took a decade, and now people are writing these apps in all different languages. There's no possible way a system that has been developed for decades now could all interface with all these apps and keep information secure.

This needs a lot more thought and more structure and regulation. He is just wrong, but we'll c we'll come back to that later. Um, clearly does not have a health IT background seems to have more of a medical background. We'll explain why this is, this is not rocket science. We can do this. And, um, and that's really the essence of what I'm gonna talk about in, in my take on this.

Uh, some health IT experts note that the letter has not been signed by some of the largest health systems in the Epic ecosystem. And they say that's significant and it is. Their absence represents a thundering silence at David Brailer. The first national Health Information Technology coordinator appointed by George W.

Bush. Many health systems are quietly discussing how the data access and data fluidity actually benefit them in the long run. Here's the full list of health systems and it lists all the health systems and you know, there are some notable . Uh, epic clients that are missing from this list and some very large health systems that are missing from this list.

In fact, there's very few large health systems represented on this list. Uh, so here's, here's, you know, here's my take. We're not gonna go into this in depth. Well, actually, we might a little bit. Um, you know, I, I sit on the show. I wouldn't sign this letter, and I'm gonna stand by that. I wouldn't have signed this letter.

I, I spoke with people who chose to sign the letter and their, and their, their reasons, uh, they gave me their reasons to sign the letter. And I, I respect that and I respect the leaders who signed the letter. Uh, even though I, I really disagree with them signing the letter, uh, for those who didn't sign it for Fear of Epic, which is a, a comment that I heard.

I hope this isn't a real fear. I understand wanting to stand in solidarity with a vendor that, that you trust and stand in support of an issue that you see as problematic. Uh, that has to be solved. I, you know, but I don't understand fear that d doesn't really resonate with me. I may be naive, but I, I don't think that's a valid reason.

I don't think Epic operates in this way. At least I hope they don't retaliate against their customers. It's just silly and I think unfounded. Um, but I, I just wanna re reiterate my advice on this, which is to stay out of the fight. Um, and really, to be honest with you, the fight is over. The rule is going to go through.

So let's, let's talk about how to handle this moving forward. Um, you know, this, this show really is, is, uh, partially about staying up to date on what the news is and partially to give me an opportunity to, to talk about how I would respond to this if I were the CIO of a health system. And so that's what I'm gonna do here.

Um. How we would handle this moving forward? You know, the rule calls for a development ecosystem. Uh, you can wait on Epic, Cerner, or your EHR provider of choice to solve the problem for you, or you can try to get ahead of the curve. Um, there are platforms that have been in existence for well over five years that bring all of your healthcare data together and, um,

You know, and, and, and, and they're already out there. They're already out there. They, to work with your EHR, they already provide a, a security layer and, and a bunch of other things. Um, they're out there. I'll talk about those in a minute. Um, but here's what I'm gonna do. I'm gonna share a simple diagram that talks about serv, that service oriented design for healthcare data.

Um. It will be on the episode page for this, on this week, health.com. Just go to this episode's page. It's not gonna be hard to find. Uh, this is a simple diagram. There are more sophisticated ones out there. I saw one by Dale Sanders from Health Catalyst. Very sophisticated. Lot of detail. That's not what this is.

Um. This is, uh, you know, this is a, this is the purpose of this document is for communication. Uh, this is not about detail. I've given this to non-technical, this presentation, this deck to non-technical execs, uh, to help them understand, uh, what needs to happen to shared data effectively in healthcare. And they got it.

And, you know, I'm gonna, I'm gonna give it to you real quick in, uh, in two minutes or less. You know, you have the . The source data layer, that's all your source systems, and you need to think outside of the EHR. It's not just the EHR, there's a lot of other source systems. You have your ERP solution. You have your, uh, your HR solu, there's, you have solutions across the board, uh, your PAC systems, you name it.

Um, and, uh, you know, as you move up, you have an integration layer, which, uh, you know, every one of those systems will have distinct integration, uh, mechanisms for sharing that data. Then you're gonna have an aggregation layer layer. This is where you bring the data together. And in some cases you normalize it, but you, a lot of times you just bring that raw data up there and make it available.

Then you have an API layer. This is, uh, where you create the standard set of APIs that your developers, any developer that graduates from college next week is gonna know how to hit that. API later, uh, understand how to make a request, how to get the response from that request. And then you have the security layer on top of that to ensure, uh, that the rules are being followed that you want, uh, to be followed again.

Not the most complex. There are nuances to that and there's a lot of different, uh, details. But, um, from there you have a path to an internal developer, an external developer. I personally, uh, don't think you need both of those. I think you have the same development platform for both internal and external, but.

I know that clients like to have both for, um, for, uh, for reasons. Um, and then there's presentation layers. There's the app layer and things that go on. Now that might even sound complex to you. I'll share the diagram. It's not complex at all. A lot of systems have been designed with this. Um, you know, the, uh, you can wait for the eh r providers.

They're gonna have to do this per the 21st Century Cures Act. And they will do it. It's not as complex as what, uh, people have made it sound. Uh, and quite frankly, if one of the EHR providers wants to buy, uh, a company, they probably could. As I said, there are vendors who've been doing this for about five years.

Hart Health Catalyst, M-P-H-R-X, bad name, good product, uh, redox MuleSoft among others. Um, you know. Yeah, this rule is going through. You can do it securely and adhere to the specifications. This isn't rocket science. I would say get moving on this. Get ahead of this. This is something, uh, we can do. We've done much more complex things than this, for sure.

And these are so spot on. This is from Dr. Anthony Chang, who is a former guest on the show. And I, I'm just gonna, I'm gonna run through 'em real quick. Got about, uh, 13 minutes left. So we'll just, uh, to hit these, and here they are. Top 10 from Anthony Chang. The era of cognition, neuroscience, and AI will begin this year.

So he's saying, Hey, this is, this is really going to, uh, this is really gonna take a step forward this year. Number two, data from wearables devices will demand an AI strategy. This is absolutely true. Um. When I hear people say, Hey, we have too much data coming in. We need to make sense of it. We can't give it all to the doctors.

That is absolutely true. You cannot, you can't throw all this data in front of the doctors. You have to make sense of it before you put it in front of the doctors. They don't want data. They want, uh, insight. And there's a whole bunch of data that they are willing to allow you to, to put through filters, through AI filters, and bring that forward.

And so the data from wearables is gonna require an AI strategy. Uh, generative methodologies such as, uh, generative, adversarial, adversarial networks, scans will help. Neutralize the problem of inadequate healthcare data. A major issue is lack of healthcare data, including access for AI projects. But the deficiency can partly be neutralized by generative AI methods that will create synthetic data, although heterogeneity of the data may be an issue.

That's interesting. That's, I, I, I'm gonna reach out to, uh, Dr. Chang, talk to him about that. Essentially what he's saying is, we don't have enough data. We're going to, we're gonna generate some synthetic data. There could be issues in doing that. But he sees that as a, a next movement. Uh, the next one we've talked about on the show, and I firmly believe AI in the form of robotic process automation will become more appreciated and useful as a tool in healthcare administration.

I think this is already happening and will continue to happen. This was one of my predictions for the year. Uh, number, uh, the next one. Conversational AI will be increasingly more common and sophisticated in healthcare. Absolutely. We're seeing that, and we've talked about that a bunch on the show. Uh, there will be less hype about deep learning and its ability to predict with superior results, the more and more focus on patient outcome and behavior.

I think that's true too. You're gonna see this . Uh, really applied to the patient and impacting their behavior. 'cause when you think about it, if you can't keep somebody from eating McDonald's every day, it's gonna be hard to keep 'em healthy. And, uh, so there's a whole bunch of places that AI can be applied that is not as, uh, intrusive.

And, um, uh, have as many barriers to it. Next one, there will be more application of AI in altered reality, virtual reality, augmented reality, and mixed reality. I'd love to talk to him about that some more and understand that, uh, certain sur surgical and procedure-based subspecialties will incorporate image interpretation and deep learning more during procedures.

also fascinating, important issues in AI, in medicine such as bias in, uh, inequity and particularly data privacy will be even more in the forefront. Absolutely. We're gonna end up talking about privacy and security a bunch this year. I have a feeling and regulatory policies regarding ai, technology and medicine and healthcare will start to reflect the exponential rise of AI capabilities.

All right, so here's my take. , if you're a leader in health it get in front of this. Get your people trained. Be the most knowledgeable person in the room on this topic. Get in front of the eth ethics issues. Set up governance if you are large enough with enough adoption. This is, this is a, you know, a top of mind conversation.

This is the, uh, this is probably one of the top conversations over the next five years, top of agenda. Um, it's, uh, this. Is going to be one of the forefront conversations for the foreseeable FU future. And so my comment on this is get ahead of the curve as much as you possibly can get ahead of the curve.

Uh, I'm gonna bring three stories together here. This is so electronic health records vendor to pay 145 million to resolve criminal and civil, uh, investigations. This is, uh, details around the practice fusion, $145 million DOJ settlement. Uh, and uh. And, uh, electronic health records create a new era of healthcare fraud.

This is Kaiser Healthcare News. Uh, one of 'em, I think I'm pulling from his talk and another I'm pulling from. I dunno. Uh, all right, so lemme give you some of the details. Department of Justice announced details about the previously announced $145 million settlement by Allscripts own practice. Fusion Practice Fusion admits in the settlement that it solicited and, and received a million dollar kickback from an opioid manufacturer.

Patient data exported. Oh my gosh, 145 million is not enough. Now, unfortunately, they've already been sold to Allscripts, so I don't think Allscripts should take the brunt of, uh, get hammered for this. But this is egregious. Allow providers to falsely claim Medicare and Medicaid. EHR incentive payments when its product did not incorporate standardized vocabularies as HHS required.

A deferred prosecution agreement requires practice fusion to make compliance changes. Obtain independent oversight, report any evidence of kickback violations by other EHR vendors, and to make details of the company's unlawful conduct available to the public on . a website. The oversight organization must also approve any sponsored CDS rules before they are implemented.

Uh, the Northern California US Attorney said an announcement prescription decisions should be based on accurate data regarding a patient's medical needs, untainted by corrupt schemes and illegal kickbacks in deciding what is best for patients, electronic health records software is an important tool for care providers.

It is critically important that technology companies do not cheat. When certifying the software, uh, the $145 million settlement was announced by Allscripts as a tentative agreement in August. But, uh, specific details were not provided Allscripts said in its Q two earnings call. So, I, a lot of this is from the his Talk article.

Um, so a couple things. My take on this. Um, we had practice Fusion at the health system where I was at. Actually, we did not, if I, I need to say this correctly. Uh, we were a Meditech shop. We had Allscripts, uh, touchworks as our, um, within our foundation now within our clinically integrated network. We had all sorts.

'cause we, we didn't control those EHRs. We had . Uh, and non exaggeration. We had close to a hundred different EHRs. Practice Fusion was one of those, and they were very challenging to, uh, to, to deal with. So, uh, you know, here's my take on this. This is really, uh, a black eye in the industry and it impacts all of our credibility.

Uh, don't, don't mistake the fact that your system didn't use Practice Fusion as you go unscathed by this. Consider yourself scathed. You're in a bucket of behind the curtain practices that the public doesn't understand. And when they get a chance to look behind the curtain, they, they see these unseemly things pop out.

So let me think about this. So here's how I can be constructive on this topic, and it is this. Tell your story to the patients. If, if you don't tell your story, they're gonna make one up and they're gonna take these stories, knit 'em together, and come up with their own stories. Uh, we need to be intentional to tell our story both internally and externally.

This is one of the things I talk to my clients about at Health. It I. Leaders about all the time is how are you telling your story constructively, internally, have you developed a story? What is your story? What is your point of view? What is your, uh, what is your health IT organization doing for the organization?

If you can't tell that in a, in a way, I. That is, um, that is encouraging, that is, uh, hopeful. That is exciting. Uh, then don't expect people to be excited about the things that you're doing. You have to tell the story. Um, not just the health system story, but the health it story. What is the health it story doing for the community?

And it's doing a lot of great things. It's, it's, uh, you know, it, it is, it's fulfilling the triple aim. Over time. Now we clearly have a long way to go, but you should be talking about those, those steps every year that you make in that direction. We need to be intentional about telling the story. Health IT strategy is, uh, is health system strategy these days.

And, uh, you know, from the user perspective, uh, you know, I had a firm. that helped me create videos and presentations from the first day I became ACIO. You are public figures, CIOs, CTOs. If you have C in front of your name, you're a public figure. You're either a public figure within the health system. Uh, representing health IT and, and the technology within the health system.

Or in some cases you might be a, a public figure outside of the health system talking about what you are doing for the community. You're an ambassador for health IT and the health system. Most health system marketing teams, quite frankly, uh, are understaffed. And, uh, they may not be experienced in this level of communication.

That's why I brought a firm in almost on the first day. You don't have to, uh, you don't have to have 'em on retainer, and you don't have to have 'em on contract. You just have to have somebody that, uh, really understands how to get the message out. You need to use social media, uh, promote your health system, the content that they put out there.

Tell your story. I've heard someone talk about CIOs before. They say there's two types of CIOs. There's the ones that actually get work done and the ones that are, you know, socially out there in the, in the media. And what I would say is the role has changed. Um, it really, you can't say that there's two CIOs.

There is a role, part of the role of the CIO o is to be visible, to be visible within the health system. And one way you do that is through social media because there are gonna be people that you don't get to talk to. That you're gonna be able to reach through social media. Uh, maybe not Twitter, LinkedIn, whatever, but some aspect you are figuring out what the best mechanism is to communicate with, with your internal staff, and then communicate with the community if you have something exciting you're doing through, uh, through a portal or, or to, uh, to make, uh, going into your clinic's easier to, or telehealth or whatnot.

Um, you know, mark, uh, some marketing teams do a great job. I, I was in New York City. I saw things plastered on the side of a bus. I saw things on, uh, billboards and, and that's, that's exciting work. But part of that gets augmented and supported by, uh, the words that you take out into the community. I. . So, uh, so I think it's important to recognize that role within the organization and to embrace that role and to get out there.

And, you know, one of the ways you could do that if you, if you have AC in front of your title, is to shoot me an email and tell me what we could talk about that you're excited about within your health system. What's the best practices, what's, what are things you've done for the community? I'm more than happy to do that, and I'm not doing that from a, I'm not saying this whole thing from a self-serving standpoint.

I firmly believe this. I set this up within my organization. We actually had a team of, uh, that was sort of a spinoff of marketing. We had a three person team that, uh, was the front end for all of our projects that we did within the health system because they helped us to communicate better, uh, throughout the entire organization and, uh, in uniformly across the projects.

Right. If you rely on each project team to put together their communication strategy, uh, they're all gonna be different. And then it's gonna appear that health, it is disjointed to the organization. So we had a filter that that went through and it really helped the project managers to focus in on the things they needed to focus in on, and to have a team with expertise to, uh, create the training materials and the documents and any kind of communication and, uh, interaction with the field.

They, uh, they, they handled anyway. Um. Couple more stories. Wow. I'm out of time. Well, I, you know, next week I'm gonna talk, I'm gonna get back to my top 10 format if I can. That would be great. Uh, at, at Davos the tech leaders called for AI regulation. I thought that was interesting. Uh, tech Giant's new appeal to, uh, governments.

Please regulate us. Uh, wall Street Journal article. I think it's fascinating as well. Uh, why successful digital officers don't always have digital in their title. This is a he and it struggles. Um. White paper. I, I think it's fa safe to say it's a white paper. Uh, interesting read and worth, uh, looking at.

We'll, we'll get to that story next week actually. We'll get to all these stories, uh, next week. Uh, and, uh. And we will dive into 'em in some detail. So that's all for this week. Special thanks to our sponsors, VMware Starbridge Advisors, Galin Healthcare Health lyrics and Pro talent advisors for choosing to invest in developing the next generation of health leaders.

This shows the production of this week in Health It. For more great content, you check out our website this week, health.com, or the YouTube channel. If you wanna support the show, best way to do it, share it with the peer, send an email, let them know that you get value from the show. And uh, . You know, just keep expanding, uh, the, uh, expanding the conversation.

Uh, we'll be back again on Friday with another interview with an industry influencer. And Tuesday Newsday next week. Thanks for listening. That's all for now.