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  Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former Healthcare CIO for a 16 hospital system and creator of this week in Health IT at channel dedicated to keeping Health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology who are our news day show sponsors for investing in our mission to develop the next generation of health IT leaders.

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If you subscribe, you'll be notified when they go live. We produce, produce those clips just for you, the busy health IT professionals. So go ahead and check that out. Uh, we also launched today in Health It a weekday daily show that is on today in health it.com. We look at one story each day and try to keep it to about 10 minutes or less.

So it's really digestible. This is a great way for you to stay current. It's a great way for your team to stay current. In fact, if I were ACIO today, uh, I would have all my staff listening to today in health it so we could discuss it, agree with the content, disagree with the content. It is still a great way to get the conversation started, so check that out as well.

Now onto today's show, I. All right. It's Newsday and we have Che with us today. Sue, welcome back to the show. Thanks. Good to see you, bill. Good to see you. You're, uh, moving pretty quick. How's, how's the search going at, at Boston? It's going well. In fact, we are at the point of deciding on who we're bringing in for first round interviews, so we reviewed a very

Good strong slates of candidates and I'm confident that we've got someone there and, uh, we're gonna move this along. Fantastic. So for people who dunno, you are currently the interim CIO for Boston Children's in, in, in addition to your role as a principal at Starbridge Advisors, which is not a small job either.

You guys have a lot of people that, that work with you at Starbridge. Advisors at this point don't. We do, we have about 40 plus advisors who have served in senior leadership roles in health IT, that are working on, uh, engagements available for interim and advisory work. Yep. Good team. Right. So you're, you're pretty much not paying attention to your dogs and your, your husband at this point.

'cause you're, you have all that other stuff going on. Well, you know what the, the advantage of this particular interim, both given the proximity to where I live as well as the . Virtual world that we're living in still at this point is that I am home all week. I am not. Oh, wow. Traveling Monday morning, coming home Thursday night or Friday and in a hotel every night.

So yeah. I see my husband and my dogs every day. Wow. That, that's, that's fantastic. What's the major projects? I, you're working on the EHR or you're working on, uh, what other things are you working on that really is the priority? At this point, the business case around the EHR path to the future and what we're gonna do.

So, uh, we're circling in on that and along with all the other projects going on in day to day. But that's where I'm spending most of my focus with the team. Oh, we have some fun stories. This week we we're gonna look at telehealth and telehealth, cybersecurity. I've gotten emails where people are, you talk telehealth and cybersecurity.

The number one and number two things that CIOs are talking about, is that just me dreaming here or, I think it's the conversation. I, I would agree with you. The other is the people side and the virtual and the return to the office. That is, that's a big topic to be figuring out right now how that's gonna work.

Yeah. So I'm gonna tee up the, uh, the first story comes from Dr. Joseph DER's keynote address to the American Telemedicine Association. He was a guest on the show. Uh, you're very familiar with him having worked up there in Boston with him. So let me give you some of the things that he talks about. So he said last year at this time, telehealth was on the top of the mountain.

83% of patients reported overall high quality visits. 78% said the virtual care visits were with their regular provider, and he comes back to that theme later, and over 75% said they would continue using telehealth for chronic disease management. What's gonna be the driver, if you think about this, what's gonna be the driver moving forward?

Do you, do you think it is gonna be patients asking for it? Do you think it's gonna be, uh, systems transitioning as the payment models adjust to telehealth visits? It's just more, uh, it's a more efficient way of doing some visits. I mean, what's, where does the conversation lead us? What, what drives it moving?

I think the first one about patient asking and convenience is probably the biggest. So many people figured out that it works. That they can have their, have their visits with their, with their physicians from home. I, I, I just, there is some, this is the article that has some stratification by age groups, right?

Or is that the other article that we're gonna talk about in terms of Yeah, no, it is. The other article talks about this stratification with the younger population is absolutely asking for it. The older population is sort of looking at it going. I, I wanna go back to where we were before. And when you think about that older generation, they're, in some cases they're isolated and lonely.

They that visit to the doctor. When I talk to my parents, they're like, oh, we're going to the doctor today. That's an event for them. And they, they enjoy that event. I know. And maybe you're the one who has said, or someone else has said their mother in particular, maybe not so much their father. Elder dresses up.

It's a big thing to go to the doctor if, if you're, if you're younger, you're working, you got commitments at home. It's like, okay, what time's my telehealth visit today? I gotta just squeeze it in amongst everything else. So clearly convenience, I think for not just young people, but many generations. And obviously the reimbursement.

He's got something in there about the original legislation that still needs to pass. Relative to reimbursement. So that's gotta go hand in hand with it. And he also talks about, now I'm gonna confuse the two stories, the brick and mortar story, but I think Dr. Evader and this one also talks about physicians falling into their old ways.

Yeah. Just come back into the office. That's the . Yep. And, and that's actually one of his big, big themes. So he goes on to talk about the numbers have come back, Commonwealth. The another survey by Fair Health Telehealth Tracker found that claims have dipped from 7% in January 21 to 5.9% in February, and he, he says, this is about really the hybrid model sort of kicking in and all the normal return to what is common to us, what is familiar to and

dermatologist. Do the first visit for caring for acne via telehealth. They're more prone to do the second visit as a follow-up as a telehealth visit. But if the first, if the first visit happens to be an in-person visit, they're more likely to just schedule another visit for that person to, to come back.

So there's, there's sort of this magnetic pool. So that's one aspect. Uh, the other is reimbursements and says provider organizations. I hear common themes. To an in-person, dominant care model themes such as filling beds and charging facility fees come up repeatedly, not to mention the threat of lower reimbursement for telehealth visits compared to in-person.

This payment, and this is one of the things that A, the ATA is really heavily focused on this and making sure that you can practice telehealth across.

That's the sticking point. What do you think providers want it to look like going forward? I mean, is it truly reimbursement at parity? I would think it's reimbursement at parity, and I would think that provider organizations want to work with their patients over the full spectrum or continuum of care.

So let's just go back to the bed point. Filling beds. I mean, who's thinking that in outpatient, in-person visit? An ambulatory in-person visit versus a telehealth visit is gonna make a difference on filling beds. I mean, does that make sense? No, EI mean, an ED visit would fill a bed, but not an ambulatory visit.

Yeah. But ed visits are happening. You're not doing, um, right. I agree. You're not scheduling a telehealth. visit instead of an ED visit, right? So what's the right balance to really have patient focused care over in, in, in the right care setting? So I, I see provider organizations as long as there is the right reimbursement model, continuing to encourage and figure out how to support.

Virtual care and individual physicians working that into their, their cadence and their schedule. It's interesting as I look at this, because there's almost, there's a call later on in this and he says, providers must resist the strong magnetic forces that draws them back to in-person, brick and mortar world, and find the right balance of in-person and virtual care, which I agree with.

We need that balance. Everything's going to virtual care because everything can't be done in virtual care. It's gonna be some balance thereof. Uh, but then he says, healthcare systems must, and I love when I hear that you must you. But anyway, healthcare systems must embrace value-based care rather than fee for service model that brings people into facilities.

This is difficult after experiencing a period of significant financial loss. It's interesting when we look at healthcare systems and we say, Hey, you must do this. It's not in your financial best interest. It's not in your normal practice, so you're gonna have to change a lot of things. You're gonna have to invest in the future and do other things.

You must do these things even though financially it's not in your best interest. While these other players are standing, these, these new entrants are standing these things up. Yeah. In the overall infrastructure, uh, to move forward. I mean, when I hear that thing, if I was ACIO, if I just put my hat back on, I'm ACIO at St.

Joe's, and we were mission driven and we, we tried to do the right thing in all cases, but there was a certain reality, certain financial reality that we had to look at all the time. All we're gonna go to telehealth and we're gonna start losing, I don't know. $40 a visit, are we going to be able to make that work?

And does that work for increasing access, improving quality, and those kind things. So we have to put a, we have to put metrics around those things to make sure that what we're doing is not impacting the quality of care, obviously. Right. And it's increasing access. There's no question that it, it does increase access.

In fact, there's an article I covered on today in Health it last week, which said, in fact, it is driving over utilization. People are, once they realize how convenient it's, they're more prone to call in. But this shouldn't be a bad thing, right?

You know, people calling in saying, Hey, I've got this. We wanna avoid ED visits and whatnot. This is, and he even says it in here, this is sort of tricky. What's the hybrid? What's the balance? Do you have a comment there? In terms of the balance? I, again, I'm gonna bleed into the other article that we shared on bricks and mortar.

I think that's where there was the example of a mother who has had 60, what'd you say, over a period of time, 60 specialist visits for her. Child who's got significant medical issues and how often does she have to drag her? How often does she have to move, go in physically with her child for those visits versus the telehealth?

So I just go back to convenience. and, and finding the right balance. And the other thing is have you, as I'm sure you've seen in metropolitan areas that you're in, I can say it here in, in New England and specifically around Boston, a push to. Build out new ambulatory centers in the surrounding towns and suburbs so that you're not driving in to the heart of Boston and all the traffic hassle.

So you take that one step further, you're making care accessible there. One step further, what can be Telehealth visit instead of coming even into one of those satellite centers? Yeah, and it's interesting to me because United Healthcare did this retroactive look at. They were gonna deny claims based on, on the criticality of the nature of the care.

But the reality is some people have been trained to go to the ed and, and I think it was New York Presbyterian, in fact, I'm sure it was New York Presbyterian. Daniel Barce talked about this on the talk and he said they actually created a pilot where they had, uh, one door went to the ed and then the other door went to a a, a telehealth visit, essentially.

So they could get triaged before, or they could even be sent from the ED over to that saying, Hey, look, you could, you could do this over here. It's just a lot better experience and I don't remember all the details, but the cost on one side was almost like seven to 10 times the amount as the cost on the other side.

I never really understood that's in the same building. It's because you're seeing your care doctor. An emergency visit kicks off a lot of, a lot of things, and there's a lot of infrastructure to support that. I, I get the, I, I get that from that perspective, but that's why we need more ambulatory surgery centers.

It's also why we need a very clear message, I think, to our communities that says, look, start your visit here unless you're bleeding and, and those kind of things. Start it here. Start a conversation with this doctor via telehealth. My insurance carrier, I don't have it in front of me now, but my insurance carrier sent me a, a thing that said, start all your engagements with your healthcare system through, through Teladoc offered through my insurance carrier.

It's really not a bad model 'cause you don't want me self diagnosing. I can't diagnose myself. I, and it's great to have a trained, uh, medical professional on the other line of the phone who could potentially do what, 20, 25, 30 visits an hour. Really, if, depending on how long the, the calls go. So, so I'm curious, so in that plan, is that through Teladoc?

Is the provider you're actually talking to, part of the health system that you would ultimately go to, that your PCP is connected? No, I actually, I don't think they would be. Okay. All right. So this is where I'm, I'm not familiar with, with how all these telehealth. Companies are, are working from a model perspective, but provider organizations want you in their system, right?

And they want you to enter in their system. So if there's the partnership between those telehealth companies and the provider system, the health system, so that they, it's a smooth transition, maybe a front end triage, right through a provider, and then you get to someone in your system. Yeah. Is that the way it works?

Yep. Uh, well, yeah. I mean, when you think about it, UnitedHealthcare, which happens to be my, the plan that I'm on, they're, we're essentially paying them so much per month. So that's what they're on, on the hook for. And they've done the analysis from a financial standpoint, maybe not even an access or quality of care standpoint, but they've done from a financial standpoint to say, look, reduce provider.

In the middle and there, there is a fee associated with it. And yes, from a, from a patient standpoint, there is gonna be a continuity of care. That's right. I think lost in, in that model. Right. Yeah. I, I'm smiling because the whole interoperability, continuity of care is something that my husband and I have experienced very personally.

In the recent period after a couple ED visits and hospital admissions and hospitals not part of the system that we are connected to, so trying to get the right people talking to each other and the records over and what tests were done and what were the results. It's like . I could write a whole blog on on this at some point.

Once. Now there's a lot of ways we can address the continuity of care between, uh, uh, telehealth or between a Teladoc and an Amwell and gonna the local provider. If, if, if they are fire enabled and we have decent systems on both sides, we should be able to move those records and the notes back and forth.

Mm-Hmm. , uh, pretty, pretty easily, I would think. But the other way to do it is to have local healthcare providers. Hybrid model, hybrid model that works for their community. And I think it's gonna be different, right? It'll be different depending on what market you live in. Yeah. Yeah. Well, and you're not always gonna be, this was our case.

You're not always gonna be in your market when you need that care. At least if it's, if it's a ED kind of visit. So. We'll see. Yes. My mother is looking forward to going back to her doctor, and that's, that's one of the, one of the things this, uh, brick and mortar story talks about. Patients are looking to go back to brick and mortar post pandemic, and they cite a HIM study.

So the study said essentially that 60% of patients want to return to the pre pandemic experience. By the way, I think part of that is we wanna return to our pre pandemic experiences just in general. Exactly. I, I don't know that it's 60% really wanna go back to sitting in traffic and trying to get to a, a doctor's appointment.

But these are the, the healthy or the young Invincibles, I think was the. The people that don't need healthcare all that often. Yeah. They're saying, look, when I do, it's usually not chronic care. It's usually not. I just, I just wanna talk to a doctor about, fill in the blank. Yeah, yeah. I go back to the balance.

How do they characterize the, okay. The silent generation, the baby boomers. Okay. We're baby boomers. I. Not the silent generation, but you know, my husband's got a series of appointments scheduled with specialists subspecialists, and we're just looking at what's the right balance. When does he need to be seen and touched by them with some associated monitoring and tests and when can it be?

Uh, hey, we're gonna call, we're gonna review the results on the phone and we're gonna decide what's next. So what's that balance? You know, I think this segue is pretty good into our next story, because. The hospital Room of Future five innovative, uh, innovation execs outline what to expect in the next five years, and there's some great content.

Toola at uc Irvine, Nick Patel at Prisma and Columbia. Albert Chan at Sutter. Daniel Durand at LifeBridge In. Who has been on the show before at Title Health Systems and the over, we're gonna go into this in a little more detail, but the overarching theme is we're moving into the home. Yeah. I think almost three or four of 'em said, Hey, the, the hospital room of the future is gonna look dramatically different in the, in the building itself, but they are very much thinking about what does the hospital room of the future look like?

In your home? Well, if we can get to high levels of acuity in the home, I would assume we could do some of that monitoring and some of those other things that we were talking about and telehealth visits to sort of augment those things. Healthcare could look very different in the next five to 10 years in terms of, of sending people home with certain monitors or maybe even they have bought devices that have, you know, that are FDA certified to monitor some things.

And we're doing, we're getting more, we're getting more signal back from them on an ongoing basis where it's not as required for them to come into the office and we can see them via telehealth. Mm-Hmm. . So it, it'll be interesting. I, I think what you're, you're what you described that the experience for your husband will be different in hopefully in five years, but, but definitely in 10 years.

Yeah. When I teed this article up with you and sent it to you in advance, it is what you're saying in terms of what is that balance, what's that spectrum, what a hospital room's gonna look like, what are we gonna do in the home? And there's still new hospital buildings happening. We've got one opening up at Boston Children's Hospital next summer.

It's the Hale Family Building. It's been in the planning for over 10 years. It's 11 story, 700,000 square foot building. And we, we will, once we have those inpatient rooms open, there will be some retrofitting of rooms now in the current building that are double rooms into private rooms. I think that's a, a common trend when you see new inpatient facilities opening up.

It's nearly impossible. Right. So how do organizations and CIOs plan for the future with the technology evolving as fast as it is, right. , right? Yeah. And, and, and you have these trade-offs. I had a conversation with ACIO that's, that's a part of building a new building. And we were talking Kat six Cat, six E wireless, and you sit there and go, well, there's the, there's the limitations of what's.

There's the demands that don't exist today, but you know, are gonna exist right around the corner. And so, and then there's budget, right? Yeah, yeah, yeah. And so there's, there's a lot of trade offs you have to make in terms of, yeah, we know it's going in this direction, but this is all we can do today. This is all we can afford today.

This is all we can do today. You wanna make sure that the physical, whatever's physical in the walls, in the building can handle as much as it possibly can, because. Right, right. Deja vu here. When we were planning that building back in, uh, two thousands, we, we had an issue as the, as the wiring was advancing cat, which I, I think it was cat five then, and we had to make a decision.

This is, this is what we can do right now. We know what's coming, but it's too late to make that switch given the stage of the building. So those are just some of the challenges you have to deal with technology. But let's talk about some of what's. So Tom has some good stuff in here. He said, switching gears to the traditional hospital setting.

So this is the room in the building. We're seeing significant opportunity for improvement for both medical professionals and patients. For patients. We're seeing creating better experiences in their stage through personalization of the room, amenities and services, tiny home concepts to better accommodate families and solutions using IoT AI and wearables that make the room more quiet, safe, and even.

That's one of the things I think I would, I would love, I've, I've been in the hospital room I think twice in the last year. They're still loud. There's still a lot of beeping and buzzing and, and that kind of stuff. Oh yeah. Oh yeah. And you would think we'd be past that by now. 'cause no one's listening to it except for me, the patient.

I mean, I know they're watching it somewhere else, but Yeah. You wanna sleep while you. That was exactly the experience a couple weeks ago. Small room, double room with another patient. A lot of beeping, a lot of monitoring. There was the ability to order room service on your schedule, food service, the restricted diet.

I think we should be past that. You're absolutely right. When I think about hospital rooms though, the importance of the amenities and the service, the accommodating families. I do think going forward hospital beds are going to be more and more and more the really seriously ill ICU beds and some of those amenities and services really don't make a difference, right?

It's, it's. How is that room fitted out to best take care of that patient? But I think we need to be accounting for the convenience, the services, the amenities. At the same time, you know, I like, I like his perspective. 'cause he then goes on to talk about the, the care professionals and he said, you know, technology will offer more intelligent realtime delivery of data to where they are and not confined.

To example a. Voice assistant wear, wearable based alerts will be used to monitor for sounds that indicate a patient safety issue or immediate, uh, alert for the care team. Mobility and miniaturization will also allow for more services to happen in the room, allowing for shorter cycle times and reduce risks.

And finally, if we can figure out the great balancing act around augmented intelligence making. For the patient at the right time while having better predictive capability to minimize adverse events. And that, that's one of the promises of data, right? So that we're gonna be able to look at, uh, the data over a, a larger population and be able to say, look, we, we anticipate a code blue event before it actually happens.

Yeah. And we anticipate a, a fall before it actually happens. We've, we've been advancing those technologies for years in, in, in healthcare and in the. And, but the promise is that we have more data, we have access to more data, and we're building out more AI models that we might be more predictive and be able to deliver that.

But then there's the other aspect where he talks about delivering it to where the physician's at. So the physician no longer has to be at a certain location to receive the alerts. A timely fashion. These are challenging things for CIOs, aren't they? They absolutely are. Scroll Daniel Durand from LifeBridge.

I think he had some good points here where he talks about clinical and he's the chief clinical officer. He is a physician at LifeBridge Health In Baltimore, clinical innovations will involve gathering over more signals from the patient, infrared sound, electrophysiology, pulse facial expression, to be sifted in real time through machine learning algorithms that will help physicians refine their understanding of diagnosis and prognosis in ways we can only imagine today.

I think that's critical and. I'm just gonna take it back. I feel like I'm always taking it back to some practical experience. I watched the video this morning and I'm gonna share it on social media today. It's a video that's now available on the hail building that we're opening up next year at Children's Hospital.

The two leaders featured in are the Chief Nursing Officer and the Chief, the the EVP. Well, the EVP for patient care family services. EVP for health affairs. The EVP for health Affairs. Dr. Peter Lawson talks about the space when he is walking through in this video and how the space is designed. He talks about being in the OR and I have what I need here, right?

So that the space works for me, and I'm thinking to myself, okay, CIO, we've gotta make sure that technology works for him and all his colleagues as well. So that as he says in the video, the space works. I can do my job. I can focus on doing my job. So we need space and technology designed so that the clinicians can do their job.

And what Daniel Duran here is talking about in terms of

more, more information at the bedside for the clinician to, to use in caring for the patient is, is also part of the future. And so kind of a whole different. Work stream, if you will. Then the amenities, the services, how do we make it convenient for the patient and the families? It's interesting as I think through that, there's a challenge here, right?

Are we, we just going to wait for those capabilities to show up in our EHR, which is our EHR providers are going to build out some of those capabilities for sure, and, and they have a, a vast data store, not only from our health system, but also from other health systems. When you think about some of, some of the data they can pull together.

Are we gonna look to a third party, uh, health Catalyst or someone like that who also has a fair amount of data and has, it really has built out a, a, a secondary type system that can collect information not only from the EHR, but from other ancillary systems. Mm-Hmm, . And are we gonna have to look at those systems, especially when we start thinking about social of.

Our R third party don't public, don't great things government.

They have a lot of table stakes and basics to work on. You're right. The public health infrastructure, so, so we're not gonna see it there. But you know, one of the things that just strikes me is we're gonna have to become, health systems are gonna have to become, this is gonna sound silly because it's so obvious and it was obvious 10 years ago, but we're gonna have to become data ninjas.

I mean, we're gonna have to be so good at data that bringing it.

Essentially making that data usable, identifying the, the places where we have to clean the data up and whatnot, and then feeding that into these models and understanding the ramifications of feeding that into the models. Yep. And, and the, the bias that exists and all those things. So we're gonna have to be really, really good at, at, at data.

Is that something we're build out internally or? We're more and more gonna have to rely on, on external third parties to help us with. I think it's a combination, and that's a great question. One of the things that I'm starting to think in the, in the past, you'd think build versus buy. I think it's John Halamka who talks about build buy partner.

Yep. I think at Boston Children's Hospital, we're looking at it that way by build or partner, whatever, or you wanna put it in, but . Why should we be building it? If there is some new, um, entrant in the market that's already doing it and that we can partner with that, we then can hopefully integrate well with our core platforms.

Yeah, that's gonna be the interesting balancing act, I think moving forward. I think the battle for talent is just starting to be honest with you. I think it's gonna heat up. and get harder and harder. Mm-Hmm. , uh, especially as funding keeps coming into digital health. I mean, the, the offers outside of healthcare are somewhat more lucrative than they're within healthcare.

You mean within private industry Yeah. Technology firms than, than within a health system. Yep. I, I mean, I get people asking me about, we. To hire a doctor, hire for hire, you know, this role within this new startup or private equity back or whatever. And some of 'em don't pay as well. I mean, doctors generally have done pretty well in this, in this space, but others do pay pretty well.

And there's, there's, there's gonna be battle for talent, I think. Let's hit, let's hit the last two stories, HHS allocate.

And the OC for health. It has established 80 million program to strengthen US public health, informatics, and data by diversifying the health IT workforce. They said on June 17th, and let's see here, this is from their actual health IT gov gov website. A four year cooperative agreement, A-P-H-I-T Workforce Development Program.

Recipients will be a part of a consortium that will develop a program curriculum, recruit and train participants, develop internship opportunities, and assist in career placement at public health agencies, public health focused nonprofits for public health focus, private sector or clinical settings.

Again, talking about the talent, they identify that this four. And that organizations can apply for this. Lemme see that. Would I wanna be real clear here?

Yeah. There's a, there's a, there's an application process for the program is to train more than 4,000 people over four years through an interdisciplinary approach, own co award, up to 75 million, two cooperative agreements recipients. And use the remaining 5 million to support the program's administration.

So there, there's a process to getting access to that money, but the, the real goal here is 4,000 people within minority or underserved communities being trained in the area of public health and data, specifically data and informatics to support public health. So, interesting initiative. Curious, I mean, you, you brought this story to me, what your thought.

Well, twofold. One, we need to be investing in the public health infrastructure, and this is a drop in the bucket of what is probably from the federal government going into the public health infrastructure at this point in time. I don't know what that number is, but it's good that as part of the current administration's plans, in terms of.

Healthcare nationally, that there will be more money in public health infrastructure. The second part of the the good or the win-win is recognizing that we have to grow our health IT workforce and we need to have more diversity. And a program such as this to train and make opportunities available to people of color is a positive thing in my opinion.

So it will help with talent overall and it helps with . Broadening opportunities for communities that maybe didn't have 'em in the past. Yeah. It was interesting to hear the seven previous ONC coordinators at the CHIME conference talking about this and how historically underfunded public health it's been and all of them agreed.

It's like we all brought it up. We all made 'em aware and, but the problem is we invested.

$40 billion has gone into the medical record, and they said one of the things that happened during the pandemic is all of a sudden we had this really robust, we don't think of it as robust, but.

Architecture over here on the provider side and the public health side was com completely underfunded. So we, we turned this and said, all right, we're gonna give you this data. And he said it was like, it was like taking a fire hose and pointing it at this, this cup and saying, trying to fill the cup. And the, the public health infrastructure just, just buckled under that need.

And so there, there's a, I think, uniform recognition that money has to go in that direction. If, if we have a unified vision for what, what that should look like. I think Mm-Hmm mm-Hmm. . Yeah. Well, you, you, 'cause you have both federal and state, right. When it comes to public health and, and states can vary widely, I know it's not in this story, but I think one of the tragedies, there's so many dimensions and tragedies to the pandemic, but one of 'em was how many public health leaders came under fire?

And decided to leave their positions. So there's just a lot of need in the public health space. Yeah, I think you have to take everything with . I, I recently did a, a review of Sky Lakes Medical Center and their response to the ransomware attack, and I, I give them a lot of leeway because, you know, quite frankly, they're, it's a small organization.

That has all the same regulatory requirements that you would have at a very large organization with a lot of staff and a lot of budget. And I know how that goes. They just carve off what they can towards cyber security. Yeah. And they do what they can every year. And, and the same thing with public health.

I mean, you could put those people under scrutiny, but it's not like they haven't been asking for more money for decades. Right, right. So, um. It's a good segue to the last story on cyber, right? Yeah, yeah. Cyber, I think cyber's getting the attention it needs, it'll get a lot more money and a lot more funding.

Senators introduced bipartisan bill to fight cyber crime. This goes along with the story we covered where, uh, president Biden has really, uh, put together the executive order, which is moving this forward. A lot of focus on this from.

Military, I mean, bipartisan. Just say it, bill. It's bipartisan. Oh, it's it's bi, it's, it's just beyond bipartisan. At this point. We're looking at this good. They could shut down our pipelines. They could shut down our hospitals. They can shut down our meat factories. They could shut, I mean, at this point, we're, I think we're all afraid they, they could shut, they could just shut down our power in our sections of, of the, of the country.

So there a bill.

Other tools used to commit cyber crime enhanced, which I can't believe we don't already have enhanced prosecutors' ability to shut down botnets and other digital infrastructure used for a wide range of illegal act, which is great. As we know, there's probably still a lot of computers across the country where the, the users of those computers don't realize they're a part of the illegal activity 'cause they've been compromised.

Create a new criminal violation for individuals who have knowingly targeted critical infrastructure such as dams, power plants, hospitals, and election infrastructure prohibit cyber criminals from selling across to botnets to carry out cyber attacks. And I, I saw an article this morning, the FBI Director is.

Strongly encouraging. I, the words were stronger than that. I forget what the words were, but essentially telling people, stop paying ransomware. Mm-Hmm, . But, but what's the alternative? I mean, I, I mean the, the alternative, now I, let me be clear here. Paying the ransom doesn't necessarily mean you're gonna get the information back.

Doesn't mean they're.

But when you're talking critical infrastructure, when you're talking about can I bring my hospital back online? How do I get my images back? How do I or the pipeline, how do you, how do you get things going? I mean, we've, we've seen cases recently where, uh, the pipeline, I, I forget the number, but I know it was, it was upwards of five, 5 million bucks was, was sent out and I think the, uh, meat packing situation was another 5 million that.

So I, I don't wanna put you in this spot of saying, what, what do you do? But it, it, it is a, it's a tough spot and I think this is a conversation you need to have before you're ransom. Exactly. And I think the series you've done, I may have listened to all of 'em. Maybe I'm a little behind on your podcast given my schedule, but.

You did a lot of good coverage on ransomware and cybersecurity and preparedness, and that's where the focus needs to be. How do you get ahead of it? How do you prepare? It caused me to revisit where we are with bots and children's and looked at some stuff and I'm, I'm relatively confident, can you ever be truly confident in terms of your preparations, but I think you've done a great service to the industry.

Lemme say that, bill, by highlighting this and educating everybody. . And focusing on the preparedness piece. Well, I, and I am very happy to see the, that it is getting more, let's say, coordinated national attention with this legislation potentially. I see that one of my senators, Sheldon Whitehouse, I live in Rhode Island, is one of the ones who introduced this bill with Senators Richard Blumenthal, Connecticut, and Lindsey Graham, South Carolina, the article after Scripps by their CEO.

Was excellent. I know you shared that with me. We, we don't have time to talk about it, but being willing to say it's gonna take a village, it's not one hospital that missed something and therefore they, they were subject to this, everybody's vulnerable to some extent, and how are we gonna combat this together?

Yeah. And uh, last week on this week in health, it, we had Carl West on, that was a great episode. And on Friday we had Mitch Parker. Both who are pretty active out on social media and I, I like where they, I, I just like the experience they bring and I like the, the fact that they, they believe that we can fight this with, with sharing, with knowledge, with getting, with helping each other down the road.

This is not an area of competition. This is an area where not at, not at all. We're trying to help each other. And that goes across industry lines as well. Yeah. And yeah, so thank you for flagging those. I haven't listened to them. I've been listening to the Today Snippets, but historically, and from being ACIO, it's not something you talk about publicly.

'cause you do not wanna show your organization's vulnerabilities if you have any. Right. And everybody does. We know that. So I think we have to figure out how's that crime sharing gonna happen? I. Across industry. So it does, and talk about what we can talk about with each other. Absolutely. Sue, thank you for taking some time to sit down with me.

I appreciate it. I know that you, you have a lot more time when you're not in these interim roles, but I also know that you love doing these roles and serving these great organizations so. I'm helping them. They're happy with what I'm doing. We're moving the ball along. We're gonna find the right next permanent person and uh, always happy to talk to you and share with others.

We have to learn together. Right? Absolutely. Absolutely. Alright, Sue, back to work. Yeah, . Thanks Bill. What a great discussion. If you know of someone that might benefit from our channel from these kinds of discussions, please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show.

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