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News Day - Will Security Scale? RPM, ML, AI and other fun
Episode 3126th October 2020 • This Week Health: Conference • This Week Health
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 Alright, before we get started, your response to CliffNotes has been incredible. We now have close to 500 people receiving these emails since we started the launch probably about two months ago. Why is that? Because you know what, we, we looked at it and we thought, you're busy. You may not have time to listen to every episode, but you want to stay up to date on what we're discussing on the show.

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Welcome to this week in Health it. It's Tuesday News Day where we look at the news which will impact health it. Today we're gonna go back to my newsfeed. We're also gonna go to our LinkedIn. I. Back and forth that we've been doing, and we have a lot of different things to talk about. Some AI things, some VMware announcements, uh, some exciting stuff.

So, uh, we're gonna get to that in just a minute. My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in health. It a set of podcast videos and collaboration events dedicated to developing the next generation. Of health leaders. See how that changed. It's very subtle, but it, it changed and that was a part of your feedback, which we received, uh, over the last couple of weeks on the form that we gave out.

Great feedback. Keep it coming. And stay tuned for more fun adjustments, especially as we go into next year. We're gonna do some really interesting things based on, uh, the feedback we got. I wanna thank Sirius Healthcare for supporting the, our mission of developing the next generation of health leaders.

Their weekly support of the show this year has allowed us to expand and develop our services to the community. I. Three x Drex is a service of Drex to Ford, frequent contributor of the show. In fact, Drex is gonna be here next week to discuss the news. I'm looking forward to that. He sends out three texts three times a week with three stories vetted by him to help you stay current.

To receive those texts, just text Drex, DREX to 4 8 4 8 4 8. All right. As I said before, we have two parts of the show. We're gonna check in on our LinkedIn conversations and see what you guys are saying about the stories that I posted out there. And, but this week we're gonna start with my newsfeed, because there's a lot in it.

Let's start with, let's start with a friend of the show. We'll go down here implementing Enterprise RPM, key tip, key takeaways. Where did I get this story? Current health, current health.com. Dr. Brett Oliver, CMIO, for Baptist Health, Kentucky. And Indiana was on a webinar and he was sharing about their, their remote patient monitoring work and what they had been doing.

atient monitoring RPM in late:

I. Which we heard about and saw a lot. I like this 'cause he, he goes into some of the lessons they've learned. Let's start with, uh, quick lessons. Focus on the workflow first, technology second. Yes, the technology must be great, but having aligned operational workflows is a key to success. To help with this, choose the RPM platform that integrates with your EHR for things such as ordering and alerting.

Having a flexible platform makes it easy to create consistent workflows across teams, especially as more service lines look to incorporate RPM into their strategy. At Baptist Health, the combination of a single clinical dashboard paired with flexible configurations allow the team to align on shared goals and build integrated workflows, and he really drives home this flexibility, and flexibility being the key to the tool.

Let's see. Here's a story. Uh, part of it is at Baptist Health. Once the care team understood that the . What normal deterioration looked like for covid 19 patients. They could relax some of the alarm thresholds to reduce false positives. Things like the ability to set up alarms involving multiple vital signs and adjust for individual patients were key to helping their team know when to act on an alarm.

He also talks a little bit about buy-in, focus on the patients and physician buy-in will come. Wow, that's just an interesting phrase in and of itself. Focus on the patient. And physician buy-in will come. I hope that's the case. And it might be the case at Baptist Health. Uh, you're gonna have to gauge your culture for whether that's true or not.

The enrollment process sets the tone for their experience. That's absolutely true. So hear that the enrollment process, so how do people experience the enrollment process? That's gonna set the tone for the overall experience and adherence to the program. Outside of the basic training, it's important to explain what outcomes you're looking for.

At the individual patient level, satisfied patients will help to grow provider buy-in for virtual care solutions such as RPM for Baptist Health. Patient demand for virtual care options has made it difficult for them to imagine going back. I. I love it. They have a little quote here from the patient. For our, for one patient, after about six weeks of continuous monitoring, I felt like we had to pry the device off of her.

She just loved the comfort and security of knowing that somebody was keeping an eye on her 24 7. Yeah, and I think that's really true for chronic patients. I think C Ovid 19 has created this concept of care at a distance, and this is an area to keep an eye on that is really going to be moving. That's my so what.

My, so what technologies like RPM will get a significant move, uh, out of COD and it's one of the silver linings is that it was moving slow and languishing and now I think we're gonna see it accelerate as we move forward. I'm gonna do a couple AI stories and then I'm gonna come back to the VM world stuff 'cause VM World has some exciting announcements around this.

Let's see, and actually I get these next three stories all come from healthcare IT News, I think. Yeah, healthcare IT News. So they sent out a, an email. With use cases, and that's what I'm focusing in on today, is use cases I like. I like sharing with you what other health systems are doing. So, uh, university of Minnesota Epic build, uh, new AI tool to detect c Ovid 19 and X-rays.

So researchers at the University of Minnesota, and by the way, this is gonna be available for free, I believe. Yeah, we will find out in a minute. Researchers at the University of Minnesota working with Epic say they validated an artificial intelligence algorithm that can assess checks, chest X-rays for potential cases of C Ovid 19.

The tool which was developed in collaboration with M Health Fairview is already deployed at 12 hospitals and will be made available through Epic to other providers. The new algorithm is able to evaluate x-rays as soon as the image is taken. Says . University of Minnesota Medical School researchers in just seconds.

The tool looks for patients associated with C Ovid 19. If it recognizes them. The clinicians can see within Epic system that the patient likely has the virus. They said to train the AI diagnose c Ovid 19. Specifically, the researchers used a hundred thousand X-rays of the patients who did not have the virus and 18,000 X-Ray X-rays of patients who did once the algorithms WA was validated.

Dr. Genevieve Melton. Oh, Genevieve Melton Mu Chief Analytics and Care Information Officer for M Health. Fairview worked with Epic and her fair, Fairview colleagues to build an infrastructure around it. Integrating the electronic health records software to enable easier access for care Teams, U of M and Fairview Team, U of M and Fairview Teams will now make the AI tool available for free in the Epic App Orchard.

So this is available to you. And which is fantastic if you are an Epic client. It's available through App Orchard and these kinds of use cases are really fascinating to me, and this isn't the only one. We're gonna talk about another one as well, and this really sets up some of the so what around ai, the use of ai, the use of data, and I'm probably gonna bundle all this.

So what together, let's take a look at the next one. Next one is uc, San Diego uses AWS Cloud to deploy homegrown AI algorithms for c Ovid 19. again. Uh, uc. San Diego Health engineered a new machine learning method to help diagnose pneumonia earlier. A cont a condition associated with severe C Ovid 19 cases.

This detection allows doctors to quickly triage patients to appropriate levels of care even before the c Ovid 19 diagnosis is confirmed. Results. uc, San Diego Health has been able to run roughly 10,000 chest x-rays through its algorithm. Thus far and identified several patients with covid to 19 pneumonia on chest X-rays, who otherwise may not have been diagnosed.

And again, that's healthcare IT news, ano. Excuse me. Another case where we are starting to use AI and machine learning, specifically machine learning, is when the machine actually learns, right? So we're pumping a lot of data through. It looks at results, and it looks at the conditions, and it determines that these conditions match these results.

More often than not, it learn. It teaches itself over time as it's processing more and more information. In order to do that, it needs clean data, and in order to do that, it needs significant processing power. . So those are two of the things that it needs. And I'm, I'm, I'm not minimizing those things. Those are significant things, uh, especially the clean data aspect of it.

But that's machine learning. AI is actually the application, creating intelligence from that where machines appear to act intelligently. Really what they're doing is just processing a series of algorithms that are looking at, looking at the data, looking at the outcome of some pretty advanced technologies.

But at the end of the day, it's algorithms written by . Programmers and individuals that are making decisions or making it look like machines are making decisions and actually getting smarter. Okay. That might be an, as I, as I listen to myself say that I'm minimizing what AI actually is. But anyway, regardless, AI is a, a suite of, uh, different technologies, AI powered.

And the last story I wanted to touch on. Healthcare IT news again. AI powered patient communication tools help one orthopedic practice save $405,000. And I, the reason I I highlight this story and the other two is AI and machine learning is going to be where it's at over the next, I don't know, next five years.

And we're gonna see all sorts of these things pop up. Some of it is gonna be . Essentially AI washing. We're gonna say, Hey, look, this is ai. When in, in reality, it's just some pretty simple algorithms, other things are going to be actually, uh, classified as AI in terms of the machine actually processing information, learning from it with each new piece of data that it receives, it actually get smarter and becomes more intuitive as we move forward.

The other reason I, I highlight this one is free. . One, I'm not sure that it's free, but they're just pounding their chest saying, Hey, look what we did. This one is widely available. A lot of health systems have done this, but it's available to smaller health systems as well, and even uh, smaller practices.

Patient communication tools help one orthopedic practice save $405,000. Direct orthopedic care reduced no shows by 45% and slashed outbound manual calls by 72%. Here's how its virtual assistant. Holly helped out and it goes through that. Uh, the practice had only very basic one-Way patient reminder system, which was not having a substantial impact.

They implemented this and essentially it became more intuitive. It, uh, responded to people in ways that they, uh, were more prone to get back to them. And, and I'll give you some of the results in a minute. Uh, but I'm not focusing on this one vendor. There's a lot of vendors out there that do this. Luma Health, nimbler,

Uh, revenue, Salesforce solution, reach, weave Web pt. There's an awful lot of 'em that do it. The results though, are pretty astounding. And this is a orthopedic practice. We did this across our health system, or at least across our medical group, and this had significant savings and optimization of time and other things.

So here are some of the things. Reduced. No-shows increased revenue by 45% overall. Uh, reduction in outbound manual calls alone cut 72%. Uh, noticeable reduction in inbound calls. 81% of patient engagement rate with Holly, which is that system. 78% of patients that cancel take action through Holly rescheduling or leaving feedback via text.

Uh, patient recovery, no-shows bumps and reschedules. 24% of lost patient no-show recovered. 2,700 patients recovered by Holly in the first 18 months. $150 per appointment equals more than $405,000. And those are similar to the kinds of things we saw at at uh St. Joe's when we did that project. All right, I bring all this back.

VM World happened this week and it's crazy 'cause you know, we, these major conferences, because they're all virtual and online, there's some benefits to it and there's some downsides. The downsides is some of these things happen. And there's a whole, the number of conferences going on right now is staggering to me and online options and things.

I'm gonna try to cover as much as I can there. There's just too many of 'em there and they're starting to overlap. It's crazy. We've got VM World just happened. Becker's is coming up. Health conferences coming up. Health Impact is going on and, and part of it is really saturating My normal people I normally interview, they're just, they're being tapped by so many different resources, which has really challenged me.

To go outside the normal group of, uh, people that you see at the conferences. It's been fun. I'm, I'm, I'm tapping into, uh, a little deeper into my network. And getting some interesting perspective from, from people that you don't normally hear from. So I'm looking forward to doing that a little bit more.

And then when things slow down a little bit, I'll get back to some of the CIOs that you love to hear on the show and whatnot. But anyway, VMworld happened. 136,000 attendees. That's the huge benefit of a virtual conference, by the way. Uh, you don't have to travel, you don't have to get the expenses approved.

You just sign up. In between your meetings and things that are going on, you're able to attend, hit, hit the keynotes, see what's going on, and that kind of stuff. So attendance is way up on these things. Uh, that's what I'm hearing across the board. Here are some of the highlights and uh, I'm almost gonna start with a, so what?

I don't think security is gonna scale. I don't think security in healthcare, I don't think security in general is gonna scale. I think it has to start being built into the infrastructure and VMware is leading the way on this, which I think is really exciting. So, um, pat Geisinger, CEO said VMware is disrupting the security industry by building security controls intrinsically into the infrastructure.

And they had a lot of announcements around this. Let me pull up the VMware announcement summary. Wow, there's too many, so I'm not gonna cover 'em all. But the, the security stuff is really interesting. They, the infrastructure is, uh, progressing cloud access service broker, uh, secure web gateway and remote browser isolation via our new collaboration with Menlo Security.

These offerings will be sold and supported by VMware NSX Stateful Layer seven Firewall, zero Trust, network access, uh, edge Network Intelligence, VMware Workspace Security, VDI, VMware, workspace Security Remote, VMware, carbon, black Cloud Workload. All those things are starting to get built into the infrastructure.

So it's gonna be native to the infrastructure. And I think that's the, that's the real takeaway from this conference is somebody is finally recognizing that it's not gonna scale. You can't keep throwing tools at this. It has to be intrinsically built into all the different layers that are going on. And you're gonna want a, a much more simple tool set to be able to monitor that.

And that's gonna be the so what? And that's, I, I think that's the exciting thing about what VMware's doing. In the space is that they are recognizing the need to, uh, secure it from container down to the, the wan down to at all layers. And that's their potential to really disrupt the market, which is what Pac Eisinger is saying.

And I agree with them. I think security is the area much what VMware did in the data center, . Uh, with virtualization and really change how we view it. I think they're gonna do insecurity. I think they're gonna change how we view security, and that is going to be, it's gonna be built in at the component level with a very, with an interface that we all understand and can, can have access to.

Yeah. And another part of that is that VMware is going to offer a six month unlimited free trial of VMware carbon Black workload essentials to all current customers with VMware 6.5 and above, as well as VMware Cloud Foundation 4.0. That is a great, uh, offer that they are putting out there. I think the other, the only other one, gosh, there's, there's too many announcements to go through here.

They've been busy. But the only other one I'm gonna touch on because of the stories we covered earlier around machine learning and AI is the NVIDIA and VMware partnership. And so what, what VMware's doing is Nvidia, if you're not familiar with GPUs, they are essentially what Intel was to, to the data center, Nvidia, is to machine learning and ai.

They are the intel of machine learning and ai. They're building the chips that allow us to do processing at a different level, at a different scale, and they power machine learning and ai. What VMware's doing is overlaying the VMware tool set on top of Nvidia, and so it gives you access to that power and in tools that we already know and understand, and we can, uh, build out clusters.

We can, we can automate things, we can . We can, uh, segment things. We can align resources to specific workloads. All the things that we know how to do in VMware we can now do for machine learning and AI with Nvidia. I think that's also an exciting analogy. There's just a, a ton of information out on the internet if you wanna read that stuff.

And to be honest with you, I, somebody's gonna say, Hey, you're just covering that 'cause you're VMware's a sponsor. And, uh, to be honest with you, I'm excited about these things. I'm not just covering that because VMware's a sponsor. I'm covering it because I think security is not gonna scale. And I'm looking for somebody who's gonna recognize that and build it in, and they're doing that.

And the other thing is, how do you give us access? To these new advanced tools of machine learning and AI with interfaces that we already know and understand, and they've recognized that. And so they, they are a leader and they continue to be a leader and that's why I'm excited about that announcement.

Alright, let's get to LinkedIn. Let's see, let's see what we've posted since the last time we were out here and what you guys are saying.

Why isn't big tech fixing healthcare was the last one we talked about. Okay. We got a lot of feedback on that one. Then we you, one of the big stories this week obviously was UHS hospitals hit by reported countrywide Rauch, RY UK ransomware attack. I'm sorry if I get that pronunciation wrong, but one of the things I shared in this post was

something somebody shared at a conference I was at once and they said, if a foreign power parked a carrier off the US coast, would we expect the federal government to protect us to do something? So if a carrier's off the coast of the East Coast or the west coast and they're attacking or getting ready to attack, would we expect the federal government to protect us?

And the answer is absolutely we would. And I just posed the question of hasn't that already happened? Uh, with regard to the internet and these cyber attacks, they're just happening. All the time. They're just happening, uh, everywhere. And, uh, Cindy McDowell points out, I don't necessarily believe the federal help should be, uh, the expectation, more time focused.

exceeded the total number in:

Uh, I'm gonna lose a thousand out of a thousand times. So I think there is some support that the federal government, uh, needs to give us. Jake Dorst, CIO, for, uh, Tahoe Forest Hospital. Uh, friend, I've had him on the show. Bill Russell State funded attackers compromise our systems and our healthcare finds the organizations that get compromised.

That's a great point. We have these attacks from foreign countries, we, we get compromised and then we get fined. And he says, I would much rather see financial aid and guidance from our government rather than penalties that just make it harder for small organizations with limited resources to protect themselves.

And those are excellent points by Jake. Uh, appreciate that. How is a small health system supposed to protect themselves? I don't really know. All right, so the next, the next one I, I just highlighted, uh, Scott Norland from Banner Health offered, uh, a bunch of different ways that Covid has really changed how we, uh, approach care and view care in, in terms of reducing touchpoints.

Uh, we now have digital waiting rooms, digital check-in remote therapeutics, uh, discharge instructions are coming digitally more. Technology will enable smoother management of provider delays. Combine in-person and virtual encounters to maximize local capacity. Consumers will increasingly find providers and schedule care online, and I think all those things are true.

I, and that's why I highlighted this some really good points. Laura Marquez says, excellent article. I believe the importance of a smooth patient digital experience will continue to drive great technology solutions and organize, uh, organizations should be focusing. On their digital strategy, but we need to meet the patient where they are at.

We need to get creative and meet the needs of our underserved communities and patients. Those who don't have mobile access or internet connections to reach the patient portal may become more at risk. We need to consider all the social determinants and how IT solutions may further the disparity gap.

What ideas do you have as you would imagine? , somebody makes that. I posted three different things. , I say, first thing I say is digital is a foundation for our society and life. What hub is to housing the FCC should be in terms of access to mobile technology and bandwidth. I believe that's true, and I think there should be government programs around that.

And so I agree. The the next thing is social determinants to me is a leadership problem. It's a, the challenge with social determinants is we're not really at the starting gate yet. We don't know who owns it. Is it the health system? Is it the government? Is it faith-based institutions? Not really sure. The question is who's gonna lead?

Who's gonna fund it? Uh, once someone steps into that gap of leadership, we can explore the technology solutions. But until then, it's really hard if you don't know where the money's coming from. We could talk about it all we want, but somebody needs an air conditioner for better health. Who buys that? Who helps them to afford that.

And, uh, I also make the point that remote care through IoT devices will lead to better care, uh, for chronic and underserved patients. And I believe that the cost of those things are, uh, coming down already low and coming down even further. So there's some, there's some exciting things going on there. The next thing you know, does your health system have algorithm inventory?

and this is from a JAMA article that was put out there about five years ago. Oh, this is algorithm. Inventory is really part of algorithm governance and I made the case that a, about five or six years ago now, I got in a room with a, with a couple people and we mapped out the, uh, current state of healthcare, future state.

We put fee for service pop health. Consumer driven healthcare and prescriptive care. And we put a timeline on that and then we, we looked at, okay, what are the characteristics of the workflows, the locus of care core electronic systems, point of electronic interaction with the patient and governance. And from a governance standpoint, one of the things that we found interesting is fee for service.

We were talking about it governance. Do we have, uh, project governance? Do we have, uh, intake governance for the projects that are coming in? Then we moved to pop health. And when pop health hit, all of a sudden, data governance was the rage. We had to figure out how we were going to take care of our data, how we were going to make sure we had clean data, uh, and how we were gonna be, uh, consistently reporting that data out.

So pop health was really about cleaning up the data and reporting out on the data. Consumer driven healthcare is really about app governance. You can't have 50,000 apps. Accessing the data within your, uh, health system, you had to come up with a way to manage how they were coming in, build experiences, the security of how these apps were coming in, the build experiences.

'cause you can't have disjointed experiences and if you have too many apps, you're gonna create that. And then the final one was, uh, prescriptive uh, care. And this is where we are actually predictively saying, Hey, you are at risk for this. You're at risk for this. Let's take care of you. And the case we made back then, and the case that this article's making is algorithm governance, right?

So computing systems make these decisions now, and these decisions process tons of information. And, and what they do is they present the most relevant information to either the clinicians or the patient. And the reality is those algorithms which are embedded in the systems, are written by programmers and they make decisions on what to process, what is relevant and, and what to actually present back.

And this whole idea of algorithm governance, I think is going to pick up some steam. We're gonna have to know what decisions are our systems making and how are they determining what information to present. And so anyway, that was one of the stories I put out there that didn't have enough time to fester to, uh, get the kind of comments I would, I would want to get on that, but I think that is going to, to take off.

There's a couple more out there. I, I share one or I'll share, I'll share one more and that is, can what ale's healthcare be solved by hiring someone from Disney, Amazon, or Apple? And, uh, you know, this is a growing trend in healthcare. We're seeing it. This is that chief digital Officer versus Chief Information Officer.

Uh, I actually love the spirit of this whole thing. I love the fact that we're going outside the industry. We're starting to look at different things that have worked for other industries and we're bringing 'em in. And actually, the part of the thing that this resonates with me is the reason I was hired as a healthcare CIO.

'cause my first job in all of healthcare was as ACIO for a . A $7 billion, 16 hospital system. And one of the reasons they gave was we wanted ideas and thinking from the outside. So I clearly, I'm a fan of this, I benefited from this, but I wanna, I wanna offer some things that I think are required for this to work and the the first is culture, right?

We need to recognize that Walt Disney, Steve Jobs, Jeff Bezos, they started their companies with an obsession on customer service. And that's not the foundation of most healthcare systems and culture. Work is hard and it takes time and it takes leadership, which gets us to the second point is leadership.

You didn't hire Walt Disney. You hired somebody who worked for the organization. And while the spirit of Walt lives through that organization over the years, cultural change and adoption requires strong and almost uniform leadership and executive support. . So don't expect, Hey, I hired this chief digital person from Disney and they're gonna change our organization.

That's not their job to change your organization. They bring new thinking. They will influence and start to impact the organization. But the, if you want this, I've often said the role of the CEO is now as a digital transformation leader. Because there's too many things that need to change in the organization to make it a customer centric, digitally enabled organization.

And so that requires the CEO. Don't expect to just hire somebody, plug 'em in, and, and magic happens. Expectations. A new person in any role takes time to impact the department of organization. Give that, give this time, uh, to support it. There's gonna be success stories, there's gonna be failures. Uh, the people who are against it are gonna easily point and say, see, it doesn't work.

People who are for it are gonna say, Hey, look, these things have happened. I would say, in any case, look a little closer. They may have hired somebody from Disney or Apple or whatever, and the success is not really a result of that person. And they may flame out horribly. And you might think, oh, see, that model doesn't work.

And it has nothing to do with the model. It has everything to do with the leadership and the underlying. Culture of the organization. I think that's all I'm gonna share for this week. Those are, those are probably enough stories. Uh, I do want to encourage you to be a part of the conversation. I'm gonna keep Monday through Friday.

I'm gonna go out there one story a day. Sometimes I'll post two if I'm, if I have a little time and I've read things that I, I just can't pick between two stores. I'll put two out there. Follow me on LinkedIn. Bill j Russell. . Out on LinkedIn and I will post that story. If you comment on those stories, I would love to, if we go back and forth, I'll probably share it on the show and that is gonna be our mechanism.

Again, we wanted to get feedback from you. We want you to start participating in the show to become contributors on the show, and this is one of the first ways that we have identified to do that. So please follow Bill j Russell out on LinkedIn. You can also follow the show this week in Health It. You'll get the clips, you'll get a bunch of other stuff.

So there's a lot of good things happening there. That's all for this week. Uh, little note, we are not gonna have a show next Wednesday. The reason for that is my parents are in town for two weeks and, and I'm gonna spend a little bit of time with them. We're still doing a Tuesday news show. We're still doing a Friday show 'cause those will be already recorded.

And we're good to go there. But next week, not tomorrow, but next week, we're not gonna have a Wednesday show. We'll have a Tuesday and a Friday show, and we'll, we will come back with our normal schedule after that. But I'm gonna take a little time with my parents and, uh, try to stay up on my, uh, consulting practice as well.

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