News Day – AWS, Cerner, Transparency, and Mayo’s Moves
Episode 16610th December 2019 • This Week Health: Conference • This Week Health
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 Welcome to this Weekend in 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 and creator of this Weekend Health. it a set of podcasts and videos dedicated to developing the next generation of health leaders.

It's Tuesday News Day. We have a lot to talk about, but first an explanation. This is our new studio, at least for the next three months. This is our new studio. My wife and I are . Uh, living out a bucket list item. We sold the last studio we sold our last home. The studio before was my home office. And, uh, for three months we're gonna be living in an ocean front home, uh, which is a great opportunity.

It's off season and we get to, uh, live in this place. Uh, for the holidays again. Bucket list item. Looking forward to having the family home for the holidays. Uh, for those of you in the Midwest and Northeast, I just came back from New York. I know how cold it is. Don't hate me. But we're gonna do this for three months, see how it, how it goes, and then in three months we'll move to another part of the country.

So anyway, it's Tuesday. Let's get to this, get to the news Tuesday. Newsday a lot to talk about. Uh, two Mayo Clinic stories. Halamka gets hired. Uh, John Halamka, former guest of the show and, uh, future guest of the show as well. Um, and also, uh, Chris Ross went into why Mayo Clinic chose Google Cloud as its provider.

And a couple of other items there. Uh, there's four AWS stories. I apologize for that. But AWS uh, reinvent was last week, and so you have a bunch of 'em. They actually overlap a little bit. There's really two, three-ish main themes. So we'll cover, cover them as a group and uh, and take a look at the, uh, main themes from the Reinvent Conference.

Uh, hospital groups. Sue to block tri price transparency rule in the Wall Street Journal. And another one that, uh, another story on transparency that goes into a little bit more detail. Again, we'll cover those two, uh, together. Uh, Satya nad CEO for Microsoft and how Microsoft is preparing for quantum and edge computing.

Uh, pretty interesting, uh, story, actually, it's a very short story. It's just his answer, uh, from AQ and a session, uh, the most remote emergency room, life and death in rural America. This is a Washington Post story and, uh, I cover this because. Um, there's gonna be a lot of talk in the community these days about what's going on and how healthcare is evolving, especially in an election year.

And Washington's post stories and uh, Newsweek stories, they get a lot of, uh, a lot of airtime with, uh, with our constituents. And I wanna cover that. So that's interesting. It's really about telehealth. And then the final story, best Buy is healthcare strategy. Uh, somebody grabbed a slide, went into more detail, and I want to cover this a little bit.

Uh, and that one of the key points is they're gonna get insurance to pay. So, uh, great story. Look forward to, uh, getting into those. Uh, we wanna thank our founding channel sponsors who make this content possible, health Lyrics and VMware. If you wanna be a part of our mission to develop health leaders, please go to this week, for more information.

This episode is sponsored by Health Lyrics. And, uh, when, you know, when I became A-C-I-O-I was really overwhelmed at first. And one of the things I did is I went out and I hired ACIO coach, uh, to walk with me through the journey. Um, this was someone who had wisdom that can only be gained through years of experience, and it was invaluable to me in my success in the role.

I now coach CIOs through health lyrics. And if you wanna learn more, visit health or drop me a note Bill at this week in health We are back on our normal schedule. Just wanna make you aware of that Tuesday Newsday and Friday interviews. Um, I hope you have time to catch up on some of the great interviews we've done, uh, in the month of November.

undred thousand downloads for:

Uh, quick shout out to Drex to Ford's News Service, three X Directs, uh, where you get three news stories. Text it to you three days a week, Monday, Wednesday, Friday. Uh, to sign up, just text direct to 4 8 4 8 4 8. I use it for my research and it is extremely helpful. Alright, ready for the news. Uh, as you know, we're going to do this a little different.

Uh, I'm going to introduce 10 stories quickly give you my take, and then we're gonna circle back. Uh, if there's time and, uh, take a look at, uh, the stories in a little more detail. Okay, so where are we at? Actually, here's, here's where we're at. If you like the format, please let me know. Bill it this week in health

Right now we're at a hundred percent approval rating of the new format, so I'm gonna continue to do it until, uh, until something else happens here. So, uh, let's take a look. First story, Halamka looks to scale digital health globally for Mayo Clinic. This was in the health data management, uh, piece. Uh, there was actually a bunch of pieces done on this.

nt to be a digital company by:

And it's gonna be one that we're gonna follow very closely, as you do normally in this space. Mayo is a leader, uh, but they're also a leader in the digital space. And, um, you know, you, you factor into that hiring great people, uh, like John Halamka and, uh. You know, this is, this is really gonna be the health system to watch in the next, uh, three to five years if they're able to make that transition to a digital company and really use their brand, uh, to launch things forward.

You know, I worry about the farm and the animals and, uh, and John's health, to be honest with you, the amount of travel and the amount of things that he does. Uh, the last time I interviewed him, he had flown from . Uh, we, we met up in Salt Lake City, but he had flown from Boston, but he had not crossed paths Chicago yet.

In other words, he had flown in the other direction around the world to get to Salt Lake City. Um, you know, that's a hard pace to continue and, uh, and uh, if anyone could do it, John could do it, and I am looking forward to great things out of there. Um, story number two, why Mayo Clinic chose Google as its cloud provider according to their check.

Uh, their technology chief. This is Chris Ross, their c Chris Ross, their CIO. The so what for this is, it's a simple answer. He gave superior technology and uh, I'm sure they looked at it in depth. He's saying it's superior technology. It's some something to consider. Um, you know, he also, there's a lot of talk in this article about, uh, protecting your data and um, and how they protected their data.

And it can only be used at the discretion of Mayo Clinic in certain ways. So, uh, I think they're trying to get out in front of the people are now starting to say, including myself. You know, why did a, why did the world come down so hard on Ascension, but not Mayo who just announced recently a, a deal with, with Google?

Um, and, uh, and I think Mayo's getting out in front of that and telling people, here's the kind of contract we signed and here's how we protected our data. Something to look at, something to consider as you sign these cloud deals. Uh, Cerner expands AWS relationship with new Machine learning initiative. Um, again, lots of stories from, uh, the reinvent.

Uh, Amazon transcribed medical and the expansion of the use of machine learning and AI to prevent readmissions primarily on the Cerner platform. And this is a result of the, uh, the Cerner announcement of them really partnering closely with Amazon and the AWS Plat platform. Um, you know, when this first came out, I said this was a story.

he most important stories for:

And, uh, it's gonna be interesting to watch and we're gonna keep an eye on it. Uh, the next story, I think it's fascinating 'cause it's a Newsweek story, so it'll get, um, uh, broad, uh, you know, broad distribution amongst, uh, end users, amongst patients, among consumers. And it's, do you trust Jeff? Do you trust Jeff Bezos with your life?

Tech giants are getting into the healthcare business. Obviously the, the Google announcement and ascension went all the way up to the Wall Street Journal and, uh, propagated at that level. . And now people are seeing, uh, some of the announcements with Cerner and Amazon and others, and they're starting to piece this together.

And you're gonna see more pieces like this out there. Uh, the so what for this is can Amazon, uh, you know, can Amazon question mark and do you trust Amazon, question mark to do to healthcare what they did to retail? And that is to aggregate the supply chain, create a digital experience, and drive out waste and improve the user, the consumer experience.

That is to design the whole thing around the consumer experience. The question is, can Amazon do it or are there enough regulatory and other roadblocks? And do you trust Amazon to do it, which is another thrust of this story. Um, you know, that's the, so what. Can they and do you trust them to do it? I think there's a lot of different opinions about that.

I think with the Cerner relationship, uh, they have their, they have their foot in the door. I mean, no matter how you look at it, someone said to me, why is that a big deal? 'cause Cerner, you know, is losing market share. Epic's gonna own the whole thing. I'm like, well, except the numbers don't say that. I mean, I know that Epic has won a lot of contracts and they're now the predominant, uh, EHR in the market, but you're still looking at Cerner, which is

I, I don't know the exact number right now, but I know it's in the twenties, maybe even the thirties percent range in terms of the EHR. So, um, you know, Cerner, Meditech, epic, uh, Allscripts, Athena, you know, the, anytime those players do something and, and Athena a little bit less, but, you know, people think Meditech's not a player, but Meditech's a player.

They have a significant amount of market share, uh, especially in smaller health systems. So, um, just something to keep an eye on . You know, can't Amazon do it? And, uh, we'll come back to that story actually. Uh, Cerner, Cerner, AWS team to tackle readmissions. Uh, the, so up for this, this is just this one more example of rapid innovation around the Cerner AWS platform.

And, uh, I'll jump off of those stories. So the next story is hospitals, hospital groups. Sue to block price transparency rule for the Wall Street Journal, uh, from the Wall Street Journal. The so what for this is, the optics of this are horrible for healthcare going into an election year, essentially. Uh, you know, it seems like what we're saying is, you know, we're fine with surprise bills and opaque billing.

We're really fine with it. In fact, we wanna protect it by suing to protect it. Now. I, and it's an awful place to be, especially during an election year. It's, it seems like we're saying patience be damned. We're gonna protect our business now. . That's not actually what this is about. What this is really about, I hope what this is really about and what I think it's really about is no companies should be compelled to disclose every aspect of their pricing.

There's no other industry that's, you're required to disclose all of your costs for the development of whatever services that you're delivering. I think that's what this should be about. The article though. To be honest with you, give some really lame excuses for why healthcare can't do this. And we almost seem incompetent if you read the article, 'cause it talks about all these lines of you'd have to build this massive spreadsheet, which would corrupt and, and, and, and, you know, destroy computers.

It would absolutely bring the internet to its knees. And I'm reading this thing going, you know, a lawyer wrote this, but man they should have consulted with somebody who knew something about technology. 'cause it is the, the lamest piece of crap I've ever read. Um, you know, we can't do our pricing because it can't fit into a spreadsheet, okay?

We don't use spreadsheets for heaven's sake. Anyway, uh, just the whole thing was just ridiculous. And then they said, well, you can't do it on an inner, uh, website because, you know, it would be too big for a website. Well, you wouldn't, that's, anyway, it, it's just, it's anyone who's technical, who's listening to this podcast knows that that is the most insane argument ever.

But because it's in that article, when I see it posted on LinkedIn and uh, and Twitter, you know, people's comments back are, are you kidding? Healthcare? Is this lame? We're not this lame. I just want people to know we're not this lame. We could do this. Technically we're choosing not to do this. And, and what I'm saying is the, so what is the optics of it are very bad.

So we just have to keep an eye on that. Um, Satya Nadal, how Microsoft is preparing for quantum and edge computing. So the so what for this is Satya's answer, uh, to the question is essentially we architected for edge and quantum computing. And the, so what is, uh, architecture matters. So they designed in such a way that they can do edge computing because they have so many data centers across the country and, uh, they're able to push that even.

Further out beyond, uh, their data centers to, uh, to remote locations. And then Quantum is designed in, uh, in that you can use different platforms within their cloud environment. Uh, next story, the most remote emergency room, life and depth. And by the way, when I talk about architecture, it's amazing to me that just gets in, in the, when I'm talking to healthcare it, they tend to say, oh, yeah, yeah, yeah, whatever, whatever.

Our CTO has that. No, no, no. Everything gets architected. Every application that gets, uh, uh, that gets purchased, that gets developed. Every workflow, every uh, data element, every architecture matters. And when people don't keep an eye on architecture, eventually the, uh. The infrastructure will get frail and fragile, and it will eventually, uh, it'll eventually show up in failures or the inability to, uh, to create new workflows or to handle new business models or to, uh, support the clinically integrated network Architecture matters.

And it's not just the job of CTO, although that is a key component of it. Uh, next story. The most remote emergency room, life and death in rural America. This is the Washington Post story. Again, I'm covering these stories because, uh, for the next year anyway, uh, there's gonna be a lot of stories out in the mainstream media about healthcare, and you need to know what they're saying.

Washington Post Post did this story, and they're talking about how these, uh, rural healthcare systems are struggling. They are, uh, . Really having the inability to keep these emergency rooms open, and they're now starting to lean on telehealth as an enabling platform for rural medicine. It's actually, you know, they could have done a different, uh, title, but it wouldn't have got as many clicks.

But, uh, really what the story is about is telehealth as an enabling platform, which means that there's a business opportunity to support rural healthcare for . Those in urban centers with a significant number of physicians and that don't have a physician hiring situation. Um, and there's probably some other business models that I'm not thinking about that are going to present themselves.

And the final story is Best Buy is healthcare strategy. Get insurers to pay. Um, and uh, I'm gonna go to the story actually. The, so what is Best Buy is one of the most relevant healthcare companies for seniors in the country right now. And let's go ahead and start there. Let me see if I can find that story real quick.

Here it is. And there's a great slide here. Coordinating care across every everyday needs of seniors is vital, and we have begun to address this imperative. This is a Best Buy slide. Okay. Coordinating care across everyday needs for seniors is vital, and we have begun to address this imperative. Uh, here's some of the key bullet points.

By the way. They have a really cool diagram. It has, uh, most of the things that, uh, seniors are . Uh, being or trying to address isolation, anxiety, medication management, chronic disease, physician follow up. Um, gosh, access to care, transportation needs. It's really small print, sorry. Uh, and they have three main bullet boards.

Coordinating care across these social determinants of health is growing needs that CST supports and Anthem Centena Molina already offer one of these services as a plan benefit, and we charge insurers a per senior monthly recurring fee. . To provide these services. In the past year, best Buy has spent $1 billion on acquisitions to expand its healthcare services.

senior seniors by fiscal year:

Today. Most of the seniors we serve are utilizing easy to use mobile phone products and connected devices that are tailored for seniors and come with a range of relevant services. I think that is gonna transition in the next probably three years to voice enabled and conversational technologies. But again, relevant, my, um, you know, 87 year old father-in-Law, who's now almost famous on this show.

Uh, is interacting with Alexa pretty regularly at this point. Um, Ms. Barry, uh, CEO, uh, shed light on how Best Buy plans to expand its healthcare business. She said The company plans to scale its five star service that connects seniors with caregivers, dispatchers, emergency personnel, and more. We also expect to advance our commercial business where the services we provide for seniors are paid for by insurance providers.

This includes services such as remote monitoring. . Based solutions that provide meaningful insights to improve timely care and reduce the cost of two frail seniors. Um, you know, I go deeper into that story because it continues to fascinate. Me Best Buy is having a relatively weak Christmas holiday season, but their stock continues to rise and I think their stock continues to rise because people now see them as a healthcare company.

And, uh, it's just something to keep an eye on something. Uh, potential partnership in your marketplace, uh, potential competitor in your marketplace. Don't know which it's gonna be. Um, the emergency room, remote care. I'm not gonna go into that Washington Post story worth taking a look at Satya Nadal, I won't go back into that story.

It's really about architecture. Let's go back into this hospital Sues story. I covered a bunch of it, but. Okay, let's see. The burden of compliance with the rule is enormous and the, so this is Hospital group sues to block price transparency Rule, wall Street Journal. The burden of compliance with the rule is enormous and the way out and, and way out of line with any projected benefits associated to the rule, according to the suit, which by the way, I don't think is true either.

I think price transparency would go a long way into restoring the confidence of patients. Yeah, think about it. Patients walk into an emergency room, they get care, or they get care in some way in an operating room or whatever. Um, they are essentially, it's, it's like they're walking into Best Buy. Well just keep using that.

They walk into Best Buy. They buy a tv, they walk out with the tv, and then they receive a bill three months later. First they receive an explanation of the TV that they bought, and the potential cost is $10,000. And you're like, horrified. You call Best Buy. Am I gonna pay $10,000 for this tv? And they say, no, no, it's not tv.

Don't worry. Like somebody else is gonna pay a portion of that. You don't have to worry about it. And then three months later you receive the actual bill and it's $7,000. And you're like, I didn't want a $7,000 tv. I wanted a $500 tv. What just happened? I don't know. You understand how ludicrous that is, that we cannot tell people what it's gonna cost for their services.

I understand it's complex, but we're smart people. We can figure this out. I was just at a conference and I asked people what their innovations were and to be honest, we went around the room. The one I was most, uh, I was really most excited about was one health system said, we are gonna get to a single transparent bill for our clients.

And I was like, that's innovation. That's what we should be doing as health it anyway. Um, and that's what, that's what people want us to do. That is innovation. By the way. It doesn't require huge amounts of technology, just requires us to bring all the pieces together. Uh, the groups say that the disclosure under the rule would be, uh, compelled speech, uh, in violation of the First Amendment.

They're asking for an expedited decision saying hospitals could otherwise spend needless time and resources preparing for a rule that may inval be invalidated by the court. Um, by the way, that is true. I believe that is true. I, I think it's, uh, interesting that we're trying to compel them to disclose their costs.

Uh, just really compel us to disclose or disclose our costs. It's just not normal. Um, we should be trying to do it just to. Uh, just 'cause it's the right thing to do in some ways. Um, so anyway, uh, let's see. I wanna go more into this. So, hospital group says that the true cross is far higher. The rule requires hospitals to publicize their, their rates.

ed to take effect in January,:

And I think what people are gonna choose to do, if this goes through, they're just gonna choose to pay the fee. I don't think we're gonna see price transparency. I would like to see those fees a lot higher if you're gonna do it. Do it right. You know, make it so that people have to get there. Um, and then, anyway, some of the silly things I talked about before, you know, spreadsheets, websites, crashing and those kinds of things.

Uh, just wanna share those things with you. Um, I. You might get stopped at a holiday party where somebody says to you, you know, I can't believe you guys want to keep your pricing a secret and don't want to tell the, the patients. Um, and I, you should just be, uh, ready to talk about those things. So I have to go back to the Cerner stuff real quick.

Um. Cerner and AWS is a rocket ship. There's two main things they've done. Machine learning around readmissions is, uh, is one of the things they've done. They have a use case and it, it drove down readmissions significantly. If I can find it real quick, I will try to, uh, um, I'll try to get to the number, but it was a, it was a really compelling use case.

Uh, a large Cerner client. There it is. A large Cerner client asked for help predicting patients at risk for being readmitted. Uh, from a re re rehabilitation center back to the hospital by applying machine learning technology to historical data migrated from AWS cloud. Cerner built a model that helped the delivery system reach its lowest readmission rate in over a decade and sent more patients directly from re rehabilitation to their homes.

Um, and that just gives you an idea, and that's the tip of the iceberg. I mean, and we know that readmissions is not something new we have. . Uh, we have, uh, other algorithms around this already, but it's, I think it's the tip of the iceberg. They've latched themselves onto a, uh, a technology stack that is just loaded with opportunity.

And the other one we talked about was Amazon Transcribed medical, uh, and, uh, Cerner as soon as it came out, said that's gonna be a part of Cerner. Um, and you're looking at 2 cents a minute in transcription, uh, fees and a accuracy rate that is . Uh, through the roof, well, not through the roof. It's equivalent, if not better than, uh, nuance.

And as you know, nuance partnered with, uh, Microsoft. Um, so I, I'm gonna try to get up to, uh, to, uh, Amazon and talk to some people up there, uh, early next year about the things they're doing. And I'm also gonna try to reach out to Cerner and have some conversations around that. I think it's something to take a, to keep an eye on.

It was interesting. I was at, again, I was at a meeting and somebody asked me, . You know, do you think these people who switch over to Epic will switch over to Cerner in, uh, three years or five years? I think the answer to that is no. Um, I think the best EHR is the one that you're on. Um, identify the limitations of the EHR you're on fi, fill those gaps and live with them for heaven's sake.

Don't spend another billion dollars going from one to the other or one to the other. If you have a planned migration from Cerner to Epic right now, I would halt it. I wouldn't spend the billion dollars, to be honest with you. Um, my recommendation, my, my coaching to every health system is if you have a majority of one system and you wanna get onto a single system, by all means do that.

But if you have a, if you're on a certain system right now and you're like, I wanna be on the one that everybody else is on, I, I think that's a huge mistake we have seen in technology stacks and other industries over the years that all of a sudden somebody takes a lead, everyone migrates to them, and then all of a sudden

Their, uh, innovation cycles get slower. They start to fall out of favor. They start to move a little slower, and then somebody else takes over. Well, you just can't keep popping back and fix your EHR. You're not gonna keep popping back and forth. Uh, so at some point you're gonna have to live with the limitations of what you have.

Uh, don't migrate off of what you have and, uh, you know, and, and, you know, get to as, uh, you know, as . Uh, you know, homogenous in an environment as you po possibly can. But, uh, again, the best EHR is the one that you're on, uh, Mayo Clinic. . Uh, Mayo is doing things right. Uh, Chris Ross in his article, talks about the superior technology, but he also talks about the importance of the contract, uh, the importance of the contract, and I would say the importance of communication.

You see, Chris, who doesn't normally get out there and do interviews is getting out there and doing interviews because communicating to the community, here's the, here's your data, here's how we're gonna use it, here's how it's gonna benefit you, is I think an important step, not required to do it. By hipaa, but it's an important step and they're doing that.

And then contractually, how are they able to use your data? Where can your data be used? People are worried that their data is gonna show up in search results. It's not. We know it's not. We know that you're not gonna sign an agreement that does that, but we're in the healthcare industry. People outside of the healthcare industry hear Google and they think search.

They don't think, you know Google, you know, artificial intelligence and. You know, they don't think Google Health, same thing with Amazon. They think Amazon, they think packages at my door. They don't think Amazon in terms of, you know, a comprehend and transcribed medical and those kind of things. So we have to do a better job of getting out there and explaining to the community our communities, we are doing these agreements, we are doing these agreements to your benefit and here's how we're going to use them.

This is actually a much harder way to do this show, if you're wondering, uh. So I think I am at the end. I did not clock this, but I'm pretty sure I'm over over. So that's all for this week. Remember, we're uh, back to our normal schedule Tuesday, uh, Tuesday's for news Friday's for interviews with influencers.

If you wanna support the fastest growing podcast in the health IT space, uh, here are for few ways you can do that. Share it with the peer sign up, uh, for insights and staff meeting on the website. These are designed to help you in your career, interact, uh, with our social media, contact on, on Twitter and YouTube and LinkedIn.

Post or repost our content and send me feedback Bill at this week in health Uh, your insights continue to help. I'm gonna be doing a survey at the end of this year, like we did last year, and I want as much feedback as you could possibly give me. Uh, I will probably publish that in the next week or so.

And don't forget, we do the best of shows towards the end of this year, and I love going back over what we learned this year and, and who we talked to. This shows a production of this week in Health It. For more great content, check out our website this week, or the YouTube channel. Special thanks to our sponsors, VMware and health lyrics for choosing to invest in developing the next generation of health leaders.

Thanks for listening. That's all for now.



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