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 Today, on this week Health, if you take a step back and, and think about the progress that we've made and the ability to do a lot of things remote, and you couple that with the great resignation that's going on right now, where folks are, are walking and taking other jobs, I think if you don't offer that flexibility, you're probably dead in the water.

It's Newsday. My name's Bill Russell. I'm a former CIO for a 16 hospital system. And creator of this Week Health, A channel dedicated to Keeping Health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, Meditech, Cedar-Sinai Accelerator, Talkdesk, and Doctor First, who are our News Day show sponsors for investing in our mission to develop the next generation of health leaders.

Alright, it's Newsday and today Colin Banis joins me from Dr. First. Colin, welcome to the show. Thank you, bill. I'm so happy to be here. This is gonna be fun. We were just talking about what we were gonna talk about and we just threw up our hands and said, there's so many things to talk about. We're just gonna, we're gonna hit the news stories and see what's there.

You're a physician. Well, first of all, tell me about Doctor First. It's interesting 'cause somebody said, tell me what Doctor First does. And after I got done, they're like, bill, that was not as succinct as I would've liked to hear from you. , I don't have the succinct story. What is it that Dr. First does?

So a lot of our solutions center around making sure patients get on therapy, stay on therapy, can afford their therapy, as well as improving things like medication reconciliation. Using some pretty. Pretty interesting and patented technologies. If I were to say that, does that encompass all the things you do or, or have you branched off beyond that?

We continue to branch off, and I think that's probably what makes it difficult at times to describe. But within the last five years, we've also developed a care collaboration platform. We call it backline, and of course, . With the explosion of telehealth because of the pandemic, we had a lot of success in that as well.

And so there's a myriad of solutions if you look at the, the entire portfolio, but I still consider medication management to be the, the core of the business, core of what you do. I. Cool. And your role is? C-M-I-O-C-M-O. Chief Medical Officer. Chief Medical Officer. All right, so let's start with this. This is right in your wheelhouse.

Physicians in the same health system make vastly different choices for identical patients. This is from health exec.com. And let me give you a couple excerpts real quick. Physician practices in the same geographic area, vastly different levels of care during identical clinical situations, including some concerning variations.

According to new analysis, clinical and policy experts assess care strategies used by more than 8,500 doctors across five municipal areas in the us. Key in on whether they utilize, well-established evidence-based guidelines. They found significant differences between physicians, including some working in the same specialty and even the same hospital.

In some of the cases we looked at physicians who made the most clinically appropriate decisions were five to 10 times more likely to use the recommended standard of care than peers in the same specialties. And cities whose decisions tended to be the least appropriate. Uh. Lead Author, Z-I-R-U-I, song MD PhD, associate Professor of Healthcare Policy and general internist at Massachusetts General Hospital said in a statement, the difference we found is a cause for concern.

They go on. Additionally, doctors were separated into five groups on how likely they were to abide and use guidelines, and patients with similar clinical and demographic traits were included. They, they did this based on information they collected. They also looked at claims data and a couple other things, clinical variation.

This is a, this is a challenge for a lot of health systems. Why is it a challenge and where are we seeing progress in this area? I mean, does this, this doesn't surprise you, does it? Not at all. In. Prior to joining Dr. First, I was the CMIO for a large academic health system, and one of the core things that I helped oversee was.

The entire program devoted to reducing unwanted clinical variation. My health system was VCU. So if you know anything about Virginia Commonwealth, their mascot is the Rams. And our program was called RamCare because we were looking to reduce unwanted variation through, uh, reliable, appropriate, and measurable care.

And the idea was to get clinical consensus for some of these high variation. Conditions, whether it's surgeries, whether it's types of admissions, and then, and this is the key and this is, this is where I think there's still hope hardwire that into every facet of the care, specifically into the EMR. And so I think coming from A-C-M-I-O role, we know that the EMR is is a constant, it is.

It is the predictable thing that touches every patient. More or less. And so there are things that we can do within the EMR to hardwire appropriate behavior or reduce the likelihood of unwanted variation. But don't you struggle with, don't tell me how to practice medicine. I've sat in those meetings and I've seen doctors look at each other and they're like, that's what you do.

Where did you learn to practice? Me? I mean, yep. Yep. It's like herding cats. You said, why is this difficult? Is it is exactly that. Strong personalities and, and maybe even a little bit of ego. I'll tell you the, the RamCare initiative was successful not because of the technology, and I you hear this all the time, but it was a commitment from the chair of whatever department that condition was applied to, and that that chair was.

Heading up the committee and then holding all of his doctors or the care team accountable, uh, to the things that we were measuring. And that's the other part, right? And, and where EMRs and, and big data come in, you can't manage what you can't measure. And so the, the fact that we have the ability to measure these things leads itself to an iterative improvement cycle.

And so I, I do still think there's hope, but that, that article was pretty surprising. Well, not surprising, but pretty damning if you will. Yeah. What's interesting to me is I, I was in the Southern California market. Our health system saw a third of all patients in Orange County, California. I. The other system that saw a third of all patients in Southern California was Kaiser.

And when Kaiser first came into our market, their, their quality scores were far lower than ours. And we sort of scoffed at 'em. Like, if you want really good care, you come to us. If you don't, you go to, you go to Kaiser. But over time, Kaiser's quality scores kept going up and up and up. And what they attributed to is a very prescriptive way of practicing medicine.

If you work at Kaiser, it was. Evidence-based care guidelines, this is what you do. The EHR told you what to do at, at every step, and, and you were expected to follow that. And what was scoffed at initially became a very powerful, uh, mechanism for turning something into a very high quality system. Yeah, this always, uh, gets into an interesting conversation about clinical decision support or, or CDS.

And there are certain things, uh, so in, in my opinion, and. I think good CDS is like the lines on a highway. Keep me in the lines. Help me go to the right place and do the right thing. But if I need to as a clinician in the moment, if I need to deviate because of some particular reason, I'm not hard bound by those lines.

I can cross over them and select I. Instances. And so that's where you see a lot of pushback against things like interruptive alerts or hard stops. And you get more success with what I call the passive CDS, whether it's suggestions or visualizations or dashboards. And, uh, the idea of dashboards goes all the way back to that.

Iterative measurement process in terms of leading to improvement. And we're hearing that same thing around ai. I mean, AI is obviously a component of CDS when we talk about it, read all the notes, go through them, look for the patterns, let me know the patterns because I'm gonna be examining this patient and you know what?

I have to examine 12 other patients this hour. So just bring the things I need to know to the forefront and let me practice is essentially what we hear a lot and. When you hear this, a practice of medicine is an art or a practice of medicine is a science. The answer is yes, isn't it? I mean, it, it, it really, it really is both.

And when I go to a doctor, I, I, I trust them to not just go, well, I'm just following this. I go A, B, C, D. But to look at it and go, you know, I'm doing A, B, C, D, but based on my experience, my knowledge, my training, the, the reading I did last week from an article, I'd like to do something a little different with you.

Yep. I think AI is wonderful at pattern recognition. I think that's a lot of the advances we've seen in a, in AI really lend themselves to things like, uh, radiology, interpretations, pathology, the dermatology, because it's pattern recognition and I think that's where AI is shown the most promise thus far.

Although you cover pretty much on a daily basis, the explosion of AI is. It's on the upward curve for sure. We'll get back to our show in just a minute. I'd love to have you join us for our next webinar titled Owning Cloud in your organization, understanding, implementing, and Designing Your Hybrid Cloud Strategy.

We're gonna have experts from Sirius Healthcare, cone Health, St. Luke's University Health Network, and they're gonna walk us through the lessons they've learned in moving to the cloud and adopting a hybrid cloud strategy. But specifically, we're gonna talk a lot about moving your EHR. Into Azure, which both of these health systems have done.

Join us Thursday, February 24th. You can register now at go dot this week, health.com/cloud webinar, or by clicking on the registration link in the description below. Now back to our show. Let's do this one. CIOs plan big investments in EHR optimization and pop health. It again, this is not shocking to anyone.

We're, we're gonna optimize the EHR. Uh, isn't the EHR optimized at this point? Some of these implementations? I'm, I'm looking at this list of CIOs. South Shore Health, you have, Providence is in here. BJ Moore's in here, Ohio Health, I mean, these are established systems. Some of these have been on their EHR for decade.

Ascensions on here. That that's a different case. They've a lot of different EHR. Pen medicine's on here. So again, not a massive health system, probably on a single EHR we're still optimizing the EHRI don't wanna keep starting this with, does that surprise you? It's, it sort of surprises me if after a decade we're still optimizing the EHR, that would lead me to believe that we have inflexible software that we can't, or, or we have inflexible processes that we can't take.

Out of, am I not looking at this right? I think Well, you are, but I think you can develop a lot of bad habits in a. In fact, it doesn't surprise me that the older implementations struggle. I think if you go back a decade, it was all about, so, so this is like cleaning out my closet? Yes. You're, you're saying, I just, I just keep throwing things at this and the order sets gets messed up and the, this gets messed up.

I know there's governance around these things, but just over time it's like, Hey, it's, it's time to clean this thing up. It's, it's just got to be a mess. Well, and back to my comment about the chairs. Heading up certain RamCare initiatives. You can have governance and then you can have good governance. And a lot of times people fold to the new specialist who demands a new care set or or order set or a very specific form of, uh, a rule or alert for certain situations.

And I would say over the course of a decade, like you mentioned, you can really accumulate some, some junk. In fact, especially if your EMR is highly configurable, you can almost paint yourself into a corner where you start to get into trouble with your ability to take new functionality or take upgrades from your core vendor.

And I think what you saw from the larger vendors more recently is a push towards, and call it whatever you will model content or core content where it, it's almost frowned upon, if not impossible to deviate from certain. Uh, functionalities within the MR to some extent. The newer implementations have a up in terms of.

Standardization and lessons learned. It's interesting, I, and again, I'm not gonna talk about specific EHR, although everyone's gonna know who I'm talking about here. But when the EHR provider is prescriptive, that's almost a backstop for me and my governance, right? So I can say, look, our EHR provider won't do that.

They won't allow us to do that. There's a build that becomes the floor for how we can do certain things. I've often thought. That, that's really prescriptive and I'm, I'm not sure I like it from ACIO perspective, but I can see why I would like it. 'cause I don't have to, I have somebody else who's saying no, it's not always me in the governance process saying that we really shouldn't do that.

I. I, I couldn't agree more actually. There's technological cover in terms of we can't do that or the technology won't allow it. And then there's also regulatory cover. I know you don't wanna do med rec, but it, it, it's probably a bad example 'cause med rec is, uh, highly important and saves lives, but I.

It's a regulatory mandate that we need to do this and we're being measured on it. So I'm sorry that you don't think it applies, but it is not up to me. This is coming from a higher power. So you do get a little bit of cover in your CIO or CMIO role for things like that. So I do agree that it's not fun to use that as an excuse, but it, it is welcome sometimes.

What, what's the best governance you've seen? You can choose any area. I mean, it can be around a specific thing. It can be around an EHR implementation or whatever. I'm, I'm gonna tell you what mine was and you're gonna scoff at me, but I'm curious what one that you've seen that you said, Hey, that governance that worked and, and what were the elements of that?

So we had an entire governance structure around. Ed Diversion. So our health system was super busy and going on. Diversion of course is not only financially bad, , for lack of a better word, but it we also can't treat our population. We can't, we can't serve our mission. And so this was a top down governance.

The CMO showed up at every meeting. And got commitment from every single department within the health system, all the way down to the folks that helped turn the beds over and, and transport. Because every single piece, uh, of the, uh, care continuum had an element that they could control and that they could improve and that we could turn that ED diversion time around.

And it took years. It was consistent, it was dogged. And back to my earlier comment, it was measured, it was measured at every level, at every department, all the way down to the individual or individual shift. But it started with our CMO and he was a, he was a charismatic guy and we could all get behind him, executive buy-in, we hear that word executive buy-in all the time.

But when, when you have governance meetings that. Don't have activity, don't have action, don't have value. The executives, they, they scatter 'cause they have other work to do. There's just a lot of, there's a lot of important things to do in, in healthcare and some of, some of the best governance I've seen is where it is just five people, three people.

And essentially they're bringing the things in. They're making a decision. It always has to be an odd number, by the way. It can't, it cannot be an even number, otherwise you're gonna, you're gonna get to an impasse. But there's sort of a, an agreed on decision making process. You're trying to let the organization make the decisions, but the governance is there to make sure that the guidelines are in place and then you, you keep progress.

And I've seen it a couple places and at first I thought when somebody told me, Hey, this, this is what we've done. I thought, I. Man, that's, that's not replicable. And then I've heard it in a couple other places and I thought, that's interesting that that seems to be a, a model that works. 'cause I've been in meetings, governance meetings that had 16 people at a table going, should we move forward with this project?

Everyone? And, and I go, man, 16 people think we should move forward with that project. I find that hard to believe. And I'm walking out and I say to somebody, why'd you vote for that project? It's like, 'cause I'm bringing my project next week. Yeah. I'm like, oh man, that's the, I have definitely experienced that it, it often presented itself just like in like your example in terms of IT roadmap.

If you're not very specific about your 12 month runout in terms of what you can and can accomplish, you'll keep adding things to the roadmap. You'll dilute the, the effort. And of course none of them will get done. And so we, we eventually got to a point where we said, okay, if we're gonna introduce something new, this group is gonna tell us what we're gonna take back off because we can't, we can't continue to do it all.

So I think it's a, a, a perfect example. So. So the, the next thing they talk about is big investments in EHR optimization and population health. It, population health is, is always been one of my favorite terms because if I went into a health system and told them, you're gonna have a pop quiz today, and it's gonna be on pop health, and it's gonna be a one question quiz, and if everybody gets the same answer.

We're gonna deem this as a success, and we're gonna say, what is the definition of population health within the health system? Unless it's very focused, the answer to that is gonna be all over the board. And I used to love that because they'd come to me as an IT person and say, put these foundational elements in for population health.

And every time you sort of pushed on it, it got a little squishy. So, yeah, we need analytics and we need analytics beyond just the EHR. We need analytics on the community, and yeah, we need interoperability, but we need interoperability beyond the clinically integrated network. We need interoperability to these other entities who are delivering social services and other care services and other things to that effect.

And it seemed like it didn't have. Population health didn't have like four walls to it. It seemed like it was, it was nebulous and from an IT standpoint that always concerned me. 'cause it was a project, there was always another project waiting to happen within it with not a lot of definition. Do you have a great definition for population health?

No. I, I think, I think you're spot on that it, it can be incredibly squishy. I think successful pop health programs do it in, in the cadence of people process. Then technology and aligning those people around a common problem that, that they wanna solve. And so for an academic health system, for example, it could be the chronic folks who are getting readmitted, who are indigent, and so we're on the hook for them no matter what.

Then identifying that population and then putting the resources and eventually the technology around it to tightly manage that population to a, to a, a predetermined goal, which is, in this case, reducing readmissions. And then secondary benefits of things like demonstrating improvements in blood pressure, hemoglobin A one C cholesterol, things like that.

And so I think, and you, you've said it a thousand times, people rush to the technology very, very early when really that probably should be the last thing. You should be evaluating when trying to stand up a pop health program. You know, at Doctor First, the piece of the pie that that we have in, in pop health is around medication adherence.

And so that is a piece of the puzzle that we try to bring in. And I think you said it beautifully in terms of outside of your core EMR, outside of your clinically integrated network, where am I getting additional data? That I can bring in these insights, that I can then empower that clinical team to make interventions to get patients back on therapy.

And so that's the piece of the puzzle that we're really proud to own and that we're trying to push really hard in this year upcoming. What I've seen more often than not is that population health programs support the value-based initiatives, right? So if a health system is a payer provider, which we're seeing more and more, you'll see a lot more focus on population health.

Initiatives, and it depends what umbrella it comes under, but essentially the, the model to support it is the value-based care model or where you're taking on risk for a population. And in, in that population we've moved from sick care to, to WellCare. Love to see that happen more and more. Love to see us take response.

You know, you talk about med adherence and those kind of things. Number of prescriptions that go unfilled. Do you know the percentage off the top of your head? It's 25%. Of new prescriptions. Go abandoned. Go abandoned. And we don't really have the number of, because we, we just don't know if people take the medications and how much ends up in the medicine cabinet.

I don't know. Are our technology's getting better at that? I think there's, there's certain things that we can do. You think about all the different places where adherence can go wrong. One of the things that, that we strive to do at Doctor First is patient engagement. Immediately after the prescription has gone out into the ether, the abandonment rate is 25%, really boils down to three big friction points, one cost, right?

So we know that if the. Copay is $50 or more, the likelihood to abandon goes way up. Number two, uh, lack of understanding or education or misunderstanding about side effects. And then the third one is people just forget, I know, I forget. I rely on reminders either from the, the EMR, from the, the pharmacy dispense to let me know.

And so we have technologies that engage the patient immediately after prescriptions go out the door via text. We're not gonna rely on the portal, we're not gonna rely on a new login or, uh, a new app for them to go get. We're gonna do it via text because the, the research shows. Over 93% of texts are, are looked at and responded to.

And then we deliver an app-like experience, and we serve up coupons or copay assist when, when we've gone out into the, into the ether and, and matched it up. And we also provide videos and educational content and even give the ability to schedule reminders, uh, within your smartphone. So that's just one piece of it, right?

Because now you got home and to your point, the, the prescriptions into the medicine cabinet. How do I know you're taking it? And that's where you've seen other technologies, smart caps on pill bottles, reminders, smart assistance in the form of your Alexa to remind you to take your medication. Sorry, I didn't, so Alexa, Alexa is listening to us right now.

Yeah. So, uh, and all the way to refills. How can I make sure that you get your refills on time? How can I engage you either with a chat bot or with a pharmacist or someone from the clinical side to check in to make sure you're, you're staying adherent. So there's all different touch points that, that I. We can conceive.

And again, uh, I think it takes a village in terms of technology in order to, to achieve that perfect adherence. Uh, I, I start thinking about ubiquitous technologies, ubiquitous interfaces and texting is probably the most ubiquitous interface. Everyone does it. My mom does it. My dad. Well, my dad does it on his iPad, but he does it.

It's like passing notes in grade school, right? I mean, everybody knows how to respond to one and how to, whatever. I mean, the other is the web. Everybody knows how to get on the web now, even if it's to check sports scores or in my father-in-Law's case to check the obituaries. 'cause he wanted to see if any of his friends died.

I mean, the number of times he got on the internet, it, it wasn't often, but that's, that's what he did. But he knew how to get around. He'd click on things and whatever. Those are ubiquitous. Technologies, but you know, the sisters, I was at a Catholic health system, and the sisters used to always challenge me to think about the underserved.

And I would say, well, everybody, everybody can respond to texts. And they'd say, not everybody has a phone. And we just learned through the, uh, pandemic that not everybody has, has a, uh, a computer because we're in the, we're in the tech world. You know, how do we solve that problem? I mean, is do we solve that problem just by.

Uh, continuing to support programs that get tech into people's hands. Yeah, I think, I think that's the role for the social services, those pushes to get broadband into underserved areas. We saw a lot of legislation trying to promote that when the pandemic hit. And then there's even new technologies like starlink.

That kind of satellite based technologies, uh, addressing the latency problem. I think that's why we haven't seen it rolled out across the board yet. They're still trying to work out the latency, but man, if they could ever work out that latency, we, we now could cover the globe with, uh, pretty cost effective internet.

That would be pretty interesting. Yeah, and I, I think that's the vision. And I, and I think to your earlier comment, I, I think smartphone access is becoming . More and more ubiquitous. Yes, there are definitely folks who who don't have or cannot afford, but the price points keep coming down. The technology keeps getting better, and you can do a whole lot from your mobile device.

In this day and age. I wanna talk return to work. The reason I wanna talk return to work is we had a very dynamic conversation with 13 CIOs that I was meeting with this past weekend around return to work, the ideas and the concepts. Are the same around certain aspects. Like we know that people want flexibility.

People want a choice. Now, it used to be we could tell them, Hey, you're coming into the office. In fact, somebody shared a story that, uh, health system in in New Jersey went full on. Everybody's coming back to the office a hundred percent and they immediately lost 10% of their IT staff because people want flexibility.

And so people are trying to juggle this return to work. One health system sold. $50 million worth of real estate. That was their IT building. And they said, we are now a hundred percent remote. And then they had the challenge of some people still wanted to go somewhere and so they're, they're solving that specific problem and other health systems are just now starting to say, okay.

Pandemic's starting to wane. Omicron has either inoculated or gotten a majority to get vaccinated and we're ready to come back into the office and they're trying to do this hybrid thing of two days and not even saying two days a week, we're all gonna be here Tuesday, Thursday. But just saying two days a week, you pick the day.

There's a lot of flexibility involved there. What are you seeing and, and what do you think would work as a a former leader in a health system? Well, it's, so, it's interesting. I'm in the minority. I miss the office terribly. Something about the energy of, of others and the sort of the random interactions and the chance for, I just, I just miss people.

And so I'm hopeful for some semblance of, of getting back into the office. But what you just laid out rings true. Even for our own company. We got rid of a whole bunch of our office space, and in fact, the, the remainder of the space is converted into that. Shared space. Lots of table, hardly any more cubicles, hardly any individual offices, A couple if you need to make private phone calls and things like that.

But a lot of shared space, a lot of whiteboards, I'm a little different one from a clinical perspective, the clinicians really didn't have a choice. They were right, suiting up, going in every day. And as a former CMIO, it is there to support the enterprise and, and to support the clinical enterprise. And to that extent there, there really does need to be an in-person presence, at least of, of some skeleton crew at a health system, whether wires and fibers and things like that.

But you know, if you take a step back and, and think about the progress that we've made and the ability to do a lot of things remote and you couple that with the great resignation that's going on right now where folks are, are walking and taking other jobs, I think if you don't offer that flexibility, and in fact I've heard you talk about companies that are making sure that they can recruit across all 50 states now, because if they can't, they're not gonna be able to staff up.

So. I, I think if you don't offer that flexibility, you're probably dead in the water. One of the CIOs I was talking to, 48 state hiring strategy and he said the return to work is gonna be the biggest boom to his recruiting that he is doing. 'cause he is like, look, if, if every health system across the country loses 10% of their people as they try to bring 'em back into the office.

That means there's a bunch of 'em looking for jobs. A lot of 'em are gonna have experience in the EHR that, uh, he was on, or the analytics platform that they're on. They're gonna have migration experience. They're gonna have, he goes, so a lot of, a lot of good people are gonna say, uh, I, I like the. The autonomy, I guess, and the flexibility.

I'm, I'm with you by the way. I, I do miss people a fair amount. Of course. I, I have my own business, so I made my own bed. I'm lying in it, which is, if you're not gonna work for a large company, that interaction is not gonna be there anyway. One of the things I did throw out to them was around culture and getting people committed to the organization and the mission of the organization.

And, and as I think about this, let's assume you work for me. I'm talking to you and I feel like things are good and that kind of stuff, and then you hang up this, this Zoom call, and the next call you have is with a recruiter who says, Colin, doesn't this feel a little stale to you talking to me over this thing?

Wouldn't you rather be at an organization that blah blah, fill in the blank. I'm like, aren't, aren't you concerned as CIOs that your people literally. Could start working tomorrow for a different company and just a different Microsoft teams meeting or a Zoom meeting, and they're doing the same work that they were doing before and they are concerned about it.

It is a concern they've spent a lot of time working with their managers to help their managers to understand that their relationship, their one-on-one teams meetings or Zoom meetings are really important at this point. Just because you've been on, uh, group calls with these people all day doesn't mean you've made that connection that you need to make with each individual in your group to ensure that they understand their career path.

They understand the mission, they're connected to the mission, they're happy with things. They're still happy with working at home. Somebody might have moved. Gosh, the stories are just amazing to me. The number of people who moved during the pandemic and didn't let anyone know is, is kind of, kind of interesting.

And how people found out is also kind of interesting. People just assumed, Hey, I, I don't have to go into the office. We're on a Zoom call. I could do this from anywhere. You wanna riff on any of that stuff I just threw out there. I have direct reports that I've still never met in person. Two years of working together.

Of course, we see each other every day. We try to turn the cameras on. I think that's important at a minimum, but I think you're right. Nothing beats the in-person experience and the comradery. I really miss the comradery. We've had two holiday parties now that were were Zoom parties. I. As opposed to that, that predictable time where the entire company was together.

And I miss that. But you know, times have changed. And if you're not offering that flexibility that you, uh, referred to earlier, people are voting with their feet and you're spot on. If you do not develop a good culture, good comradery. One-on-one touch points with these folks. That you were getting previously in the office.

Yeah. Those are the folks that are likely to be lured away, and right now it's it's dog eat dog out there. In terms of recruiting and retaining talent, it really is. We're gonna do one story and then I'm gonna ask you your plans for HIMSS and Vibe, because I wanna get the read on this two weeks before the actual conference.

The last story I wanna cover is Senator's intro, bipartisan effort towards modernizing health privacy laws. This is a long time coming, isn't it? Yeah, this one was interesting. They're trying to stand up a commission to make recommendations, essentially revamping HIPAA from what I can tell. And uh, yes, it is a long time coming.

Of course. Interesting aside, one of my favorite . Twitter that I follow is bad. HIPAA takes, I don't know if you've ever uh, looked at that bill, but No, that would be fun. There's a lot of people out there who are misinterpreting hipaa, and when this guy gets ahold of him, he puts it on Twitter and it's, it's a laugh riot.

But I'm interested in, in your take on, on what we read excited about. As I think about it, I think Waterfall versus Agile. Right. So one of the things that happened with HIPAA is it needed to be updated like on a every six month basis. And instead it became sort of a, it's the law, it's bedrock and that kinda stuff.

And then people implemented it and the world changed since HIPAA was pa. When was HIPAA passed? It was like it was in the nineties. The world . The world's changed in the last 20 plus years. And the things that. Marketers do today in terms of tracking you and all that other stuff and whatnot are completely different.

The movement of this data into Apple Health, into other things, the world has changed. So I, I'm glad they took this up. I think this is a long time coming. I, but I would like something that sort of gives them the ability to monitor it, change it, continue to adapt it. If, if the smartest people in the world puts something in place today, it's in this tech world that we live in, in this mobile world we live in, in this data hungry world we live in, that that whole thing's gonna change in six months.

Yeah. One of the comments on, on the article, and it it stuck with me, is the focus of any new legislation around this topic really needs to be on. Consent and control, and I like that. So the, the patient's ability to consent to the sharing of their data, even anonymized, which was another topic that this, this article took up.

And then the ability to control where that data goes all the way back to the individual patient level. It's a fine balance though, because there's a lot of . Insights, medical breakthroughs, pharmaceutical breakthroughs that have occurred from the, uh, mining of anonymized clinical data. I agree with that. I like the consent aspect of it.

I've talked about truda and other things. IBM has a bunch of my data. Truda has a bunch of my data, and I, I never consented to that data being used. Now I know it's being used. I, let me rephrase this. I believe it's being used well for the good of mankind. I would've liked to have that choice. And I don't think, if you gave me the choice that healthcare would be at a loss for research data, because if you said to me, Hey, bill, you wanna give your data to doing heart research studies around the world?

Absolutely. Number of people in my family have died from heart related issues. I, I would absolutely love to. Provide my data for that, and I'll do that for free. Somebody else might come to me and say, Hey, we wanna do studies around this and we'll give you a free hotdog. And I'm like, yeah, for a hotdog I'll give you, I'll give you my access to my data.

That kind of stuff. Some stuff I'll give away for free. Some stuff you might have to incent me. Hot dogs probably not gonna do it, but you get the idea. I mean, there are people that are like, look, if there's value in my medical record, I want that value to accrue to me. I wanna be able to to sell it. If, if somebody finds value in it, I wanna be able to sell it.

So I, I love that construct. The, the other thing people talked about, by the way, is, let's see, Teladoc, IBM, epic, and Athena Health, all, all signed on to support the proposed legislation. And the more cynical of us said, isn't that special like. Some of the biggest names in potentially profiting off of big data is Yeah, that specific.

Yeah. Yeah. They wanna be pretty close to this as it sort of winds through is. That's what the cynical people are saying. But where I sit, if I were the CEO of Epic, IBM who has a large data store, Teladoc, who's heavily invested or athenahealth, I would absolutely. First of all, I'd absolutely support this.

'cause the ambiguity makes their role in healthcare harder. I would also wanna be close to it because it's something you need to understand and each of these companies handles healthcare data. All right? Conferences are, are you going to vi Uh, I am going to vi I will be in Miami. Are are you going to him?

Yep. a, a week later I'm turning around, coming right back to Orlando. We might be some of the few who are going to both. I will be going to both. What are you hoping to get out of each conference? Well, this will be the first year for Vibe, obviously. I found, uh, that when I've attended Health or HLTH, uh, and, and Chime in the past, it's more about curating and developing potential partnerships.

Between other companies, where are the synergies? How could we partner up and solve some of these problems that we've been talking about for the last hour? When I go to hims, I inevitably run into a lot of colleagues, whether they are CMIOs from my former life, CIOs that I've interacted with previously.

And then of course there's also the bigger touch points in terms of. Back in my former days, making time to go see my core EMR vendor and do a touch base there. It's certainly interesting now that I'm on a quote unquote, this side of the fence in terms of how I view these conferences now, I definitely have a, a different appreciation now having lived in both, both sets of shoes.

Yeah. Some of the people I've talked to are kind of miffed. They're like, I can't believe they're doing back-to-back conferences. I can't believe that. And I'm like, well, you know, they're, they're competitors. And who do you want to back down? I mean, who do you want to say, oh no, you can have this time slot.

It's actually a great time slot. It's, there's a reason that HIMSS has been at this time slot every year. It, it's at the beginning of the year so you can connect with all your vendors and whatnot. That's what I used to use hims for. I mean, for me. It was one trip and I got to talk to I, I got to explore new vendors and I got to talk to my existing vendors, and because HIMSS and Chime were connected, I also got to see all my peers and get some new thinking, some new ideas, brainstorm around things and and develop my network.

I sort of liked how that worked. I think that's the vision for VI is that you'll still have that. I think they would like to, you know, see HIMSS go away, is I think their goal and hope and HIMSS is just trying to continue to be hymns. Do you think non CHIME members will still choose to go to HIMSS non CHIME member?

I think so. I wonder if the play and the expectation is, Hey C-suite, you're gonna want to come to VI and. Hey IT team and maybe not quite the CIO level, we're gonna bring you into himss. It'll be interesting how it plays out. I also think attendance will probably be down for both, just based on. The current state of events, even if the pandemic is flaming out.

I still think a lot of my colleagues and companies have pretty severe restrictions on travel. So it will be interesting to say the least. Yes. Well, and that's the other thing. As a physician, I was looking at their health policies and the health policies are interesting 'cause in the state of Florida, they can't require

Vaccine mandate as a requirement for admission. So they have policies that essentially say, look, show us you're vaccinated and gain admission. But the alternative is show us a daily test and you gain admission. Yep. And so there's, there's different ways you can get in. I, I think the combination of things though, if, if I were a betting man, the attendance at these things.

Are gonna be less than 10,000, which that's a, that's a bold prediction for himss. It's not so much a bold prediction for a new conference. I think the Vive conference will come out of this looking better than the HIMSS conference, 'cause HIMMS numbers will be down significantly from previous years. The Vive Conference will look like a fairly good start, if you will.

It is still not gonna be a big conference. It'll be three to 4,000 person conference, which is enough to have a conference if, if you have good content, good presenters, and I think both are doing digital content as well, so. Yep. We'll, we'll, we'll have to see how it plays out. Colin, I want to thank you for your time.

I love this. Anytime you need me, bill, I'm here and I'm looking forward to seeing you in person, so we'll, we'll both of us will get our fix of people at the conferences that are coming up, so looking forward to that. Thank you so much for having me. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions, I.

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