2021 Highlights from the Team at This Week In Health IT

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Kristin Myers: What we have learnt in the pandemic is it doesn't matter where you work. I think that our employees have choices. They could apply for jobs in Texas and still live in New York if they wanted. So we have to be competitive with that and while I want to hybrid work environment and I definitely see the value of meeting people in person. We need to be flexible because there are some employees who do you not want to come [00:00:30] back to the office. So we'll have to have that flexibility to be competitive.

Bill Russell: Welcome to This Week in Health IT. This is one of our end of the year episodes. I hope you enjoy. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged.

The second is you're going to get to meet the team and they're going to come on and talk about things. So this is one of those episodes. Before we get there though I want to remind you that for next year, we have some changes to This Week in Health IT. We're gonna have four channels. Four distinct channels on iTunes next year. We're going to have this week [00:01:30] health academy, this week health community, this week health conference and this week health news. So, if you are already subscribed to the Today show that will become the this week health news show, and you're gonna have the today show and the newsday show in there.

We're gonna have a show called insights in there where we take the highlights from the last four years and we break them down into 10 minute episodes. They're going to air three times a week. I would use this show to mentor people, to talk about what the various leaders in the industry have said over the last four years and how it relates to what you're doing at your health system. I'd also use it to bring people up to speed. If you hire somebody new into healthcare this is a great channel for that. And in this week health community is the channel where we're going to have guest hosts who [00:02:30] are going to tap into their network.

And we have CIOs. We have CMIOs. We have clinical informatics. We have data scientists who I've tapped on the shoulder and asked them if they would essentially interview people within their networks about topics that are a little closer to what you're doing on a daily basis. And we're excited about airing those channels. Again four new channels.

And you can subscribe that way. And we would love to have you be a part of the community again next year. Now onto our show.

Tracey Miller: Welcome. Hi.

Bill Russell: All right. So, yeah, this is going to be fun. I get comments from this group all year about my mannerisms. How I play with my ring. My hands flying around on the camera and all those things. And I really appreciate the comments. It makes me feel better. It makes me self-conscious about what I'm doing while I'm on camera.

So I did, I did the marketing, I did social media. I did the production, I did all that stuff. And it gave me an appreciation for the things that you do today. I appreciate. It's just the sheer volume of the work and and the quality that you guys turnout every day. But today we're going to turn it around a [00:04:30] little bit and have some fun with it.

So we're going to start with a, with an intro question because the guests, the listeners may not, know you. So here's the intro question. Just share your name, your role at This Week in Health IT. Your experience with US healthcare. Brief experience with SU health care. And I'm going to put you on the spot and ask you to name your favorite guests that you have listened to so far on the show. And we're going to go in order of seniority. So we will start with Tess.

Bill Russell: [00:05:30] Fantastic. Holly, you don't get seniority, even though you've been with the company twice in your history. Tracey, you get seniority because you have the longest running outside of tests. So, Tracey share those things with the audience.

I really loved John Brownstein. He's an epidemiologist. And Professor of medicine at Harvard. He's also the chief innovation officer at Boston Children's Hospital and just his insight on COVID and the pandemic are fascinating. I also really like Angelique Russell, who's a data scientist, so I think I'm into that whole data world.

Bill Russell: Yeah, absolutely. And so clearly you have an accent of sorts, so you're more familiar with healthcare from Australia. I would assume. Yes. Yes. Okay. Holly your name, role experience with US healthcare and favorite guests thus far.

I've seen a lot of the inner workings by living with someone who works in healthcare and seeing all that fun stuff. So, my favorite guests you'll see for my clips too. I picked Sarah Richardson. She [00:07:30] definitely edged out because I've met her before and we connected and bonded over makeup. But also I just kind of look up to her as a female CIO and she does a lot, she does a lot of work and she does some really good work for the entire industry so.

So people are going to hear that wonderful accent next year on the Insights show when we launch that. Here's what we're going to do. Most of your perspectives are as patients, right. As consumers of healthcare for the most part. And I love that. It gives us, you know, I think it's one of the things that when you become an insider, you start to see things and talk and insider ease, and you guys are gonna give us that that great outside perspective that we constantly need to be [00:08:30] reminded of. Here's what we're going to do.

Each of you submitted a few stories. Your favorite moments from the show this year, and what I'm going to do is I'm going to intro them. I'm going to actually play them. And then I'm gonna want the person who nominated the story to talk about, you know, why they, why they put that story out there.

I want to ask you about the EHR market. Where does the EHR market go from here? Do we end up with like three players, four players running the entire operations of [00:09:30] every hospital system in the country. Or do you think we're going to see something different emerge? Is there going to be something that breaks out of the pack?

Glen Tullman: Well, first of all, I would be remiss if I didn't say thank you. You were an early client of ours at Allscripts. You were great in terms of not just being a client but you helped us make the system better. And so thank you for that. There was a lot of innovation that occurred with us working together and we appreciate that.

We had a 20 plus billion dollar [00:10:30] stimulus courtesy of the government. That allowed us to really accelerate adoption, which was critcial. We had to get that information, like trying to take the next steps. But then the industry kind of stagnated. You saw a lot of leaders, the most innovative people in the industry leave.

There's no other software in almost any other industry that's so hard to use that we [00:11:30] need somebody else to sit next to the terminal and use it. And so one, we didn't fix the front end and make it really easy for doctors to use and really valuable. And on the backend, we surely haven't used data science to say to doctors, here's three things about this patient to discuss with her, discuss with him. And here's the recommended treatments. You still use your judgment, but we haven't served that. So most doctors think of the electronic [00:12:00] health record today as a necessary evil, as opposed to a valuable tool. Like when we did e-prescribing at Allscripts eventually doctors understood, you should never write a prescription without drug to drug drug to pregnancy, all the interaction data and knowing whether it's on formulary and you could send it electronically to be filled. So there were no handwriting errors. Doctors grew to love that it was challenging early [00:12:30] on to pry their script pads out of their hands. But when I left, we were doing a few hundred million electronic prescriptions and that we knew saved lives and we knew improved the processes. And so did the doctors. They never had that same feeling about electronic health records because they didn't make them better and smarter.

Bill Russell: So there you have [00:13:30] it. Glen Tulman talking about the EHR. Tracey, you picked this one and nothing like starting with a nice, controversial one. Why, why did you pick this one?

Tracey Miller: Well Glenn Tullman, he's such an inspirational figure in healthcare. First of all, I love the name of his new company, Transcarent. It's basically transparent care.

It's obviously a huge topic right now. He calls it a big dumb data repository that isn't easy to use. He says most doctors think of it as today as a necessary evil, as opposed to a valuable tool. So it just has to get better. So I love his viewpoint that, you know, he's spent a lot of time in Silicon valley and he's not saying that Epic [00:14:30] and Cerner are going to be replaced, but the innovation that's coming from the valley is going to compliment the current platforms. So yeah, I really, I really like his thoughts and ideas on that.

Bill Russell: So you guys have each experienced the EHR. None of you have used it, but each of you has experienced it in some way. I mean, what's your, and you've also heard a lot of episodes about the EHR and its use on the clinician side. What's your experience with the EHR?

But yeah, we talk about things such as the EHR and they're like, oh, let me tell you about my EHR. Like immediately, like the first thing they want to talk about. And it's fun because I actually can join the conversation now. But yeah. I, I personally have seen some of those things in like, the telehealth visits I've had and different things like that.

I've already given it to you. How many times? So when is it going to be accessible to each other? What's the point of giving you all this information if you're not going to have it?

Bill Russell: Right, right. And Tess, I'm sure you have similar stories.

And what we'll see with the clip that we have coming up that I chose is when we talk about the difficulties with the EHR, you're actually talking about two different consumer groups. You're talking about the user experience on the end of the patient. And the pain points. I have friends as well as soon as you start talking about healthcare, I just sit back.

Bill Russell: It's interesting cause you all give a patient perspective on it and I think that's, that's refreshing and important to the industry.

We still have a long way to go with regard to this. You know, we could rest on this one topic alone here. But we're going to move on to the next one. The next one, embracing the future of healthcare with CIO Sarah Richardson. And in this clip, what we ended up talking about is we created an awful lot of momentum in 2020.

What do you think the lasting impact of the pandemic is going to be on health IT?

Sarah Richardson: I love this question because I created like six questions from it. And that's only because not to be annoying and answer a question with a question but it really got me thinking about some of the things we need to be prepared for because you know how are we actually accelerating digital engagement and digital health?

We weren't very good about putting disruption in place, because you had to go through like 50 committees to do it. Some of the time you actually decided what you were going to do, it really wasn't disruptive. It was just like a relief to finally get it in place. You weren't even excited about some of the things that we're putting in place.

But I feel like we were able to ditch some of the bureaucracy around some of our decision making, but I think really it's how you make investments and changes in your IT workforce. And what does it look like over the next 24 months? [00:19:00] I've never met anybody in my company in person. Anybody. I interviewed on Zoom.

I work on Zoom. I have literally not met anyone face to face. And so how you can actually curate and build relationships. And how do you build trust when you've never met somebody in person? Like you don't get to break bread, you don't get to have a beverage. You don't get to go bowling yet. Do those things that you might do for team building.

Let's contract out this one piece of the puzzle or let's go pull this over here or [00:20:00] hey, we can be in 23 different States and be on the same team and get things accomplished and done because you're willing to go that extra mile sometimes because hey, so-and-so wants to go to their kid's soccer game and they live in Florida that's 2:00pm for me, 5:00pm for them, but they're willing to get back online at seven after the game is over before dinner. And it's like, you start to make these trade-offs because you're all trying to achieve the same thing, but you're getting to live your life at the same time.

Bill Russell: Holly, you chose this one and I guess it's because you haven't gone bowling with the entire team and that's what really resonated with you or is there something else?

And so I understand the fear for disruption but Healthcare has to grow and change. Society is growing and changing. I mean, you do talk to Sarah who literally hasn't met anyone on her team in person yet. That is completely different than it was two, three years ago. And so we have to change and be able to adapt to these systems in the society that we have.

Bill Russell: Yeah, we're going to talk about the changing work environment and work from home in a [00:22:30] later clip. So I'm going to leave that topic for later. Cause essentially on this call, we represent four different states. We've been together from time to time, but at the end of the day for the most part we've been apart. And this is a probably atypical Zoom call for health systems and health system leaders these days.

So, Holly, you've mentioned the experience a little bit and Tess you picked this clip out and I'm going to go ahead and play it real quick.

Human centered design advocate. What is human centered design? Why does it need an advocate and where does it come into play in healthcare?

And once you have poor usability baked in, it's really hard to recover from that. So that's why some of the usability is so bad there.

Bill Russell: Wow. That gets us right back to where we were before isn't it? On the EHR usability. Tess you chose this one, give us, give us a little rundown.

I work with people to make those things happen and thinking about how when it comes to tools, successful tools for humans are not happening in a silo, but iterating within teams and getting feedback. And I think it's a propensity, not just in healthcare, but in a lot of different industries to say, this is the way we've always done it.[00:25:30]

Bill Russell: You know, we, we talked a lot about experience this year. It came up over and over again because organizations are finally recognizing how important experience is. We always recognize how important it was on the campus.

Tess Kellogg: Yeah. And I think it's something that's been developed across all [00:27:00] industries. It's not something that just healthcare has struggled with. I mean, you're looking at sit down restaurants that started doing takeout over the past two years. They're not fast food restaurants. They never had, you know, Uber eats going out, but now they do. And so maybe they had those foundations in place that made that adoption quicker and easier. But maybe healthcare being behind the eight ball before COVID-19 is now playing catch up a bit more seriously.

Bill Russell: Yeah, well, Tracey, this next one kind of surprises me that you picked this. I'm gonna go ahead and play the clip.

Zafar Chaudry: Yeah because I think what people fail to do in the healthcare IT space is if you've got seven, eight, 900, a thousand applications, how often are you reviewing those applications for updates, upgrades, bringing it up to the right version?

You know technically I've got 788 systems that require some sort of upgrade every three to five years. If I don't do that, then they will age and they will cost me more and more to support. And in some cases could fall over and I can't support [00:28:30] them because the vendor isn't even providing support on that particular version.

So yes. I think you have to look at that. But going to a board and saying I need funding to refresh 700 plus systems isn't going to be viewed as at the top. Well, you know, it's important, especially for the clinical system, but at the same time that price tag is so astronomical that people tend to avoid that.

Bill Russell: Zafar Chaudry. Dr. Zafar Chaudry. So Tracey, I'm really proud that you selected a clip on tech debt, but why did [00:29:30] you select that?

Tracey Miller: Everything's so complicated these days in a digital world. And I think the healthcare industry, you know, having 900 applications in one health system is insane. How did the doctors and nurses keep on top of that? But I do think that healthcare is very reactionary so they don't often have time to delve into, okay which applications do we need? Which ones avoid? Obviously there's another whole thing about contracts.

Bill Russell: It is a significant number of applications and we've all personally experienced tech debt. Right? So at some point you're sitting there going, why can't I connect this phone to this computer and the phones [00:30:30] only what, four years old or whatever, or the cable doesn't work or that kind of stuff. Well, you multiply that out by a thousand applications across 16 hospitals and it becomes a very real problem when people are saying, Hey, look, I want my information to go from here to here.

And the thing I love about just having that as one of the is you know, I, I think people recognize when you go to a hospital that there's somethings amiss here in the back office. Like we're still doing things by fax and whatnot. Something's still amiss. And I think that kind of clip for those people who aren't in healthcare, they go, oh, okay.

Talk to me about adjusting maybe your management style or your team helping them to adjust their management style with work from home. This is very different meeting people in this format. Very different than meeting in a room and the energy that can get brainstorming ideas and meeting and going out to lunch and those kinds of things. So how did your team adjust from a management approach?

Bill Russell: It's interesting. I was just reading a study. Microsoft came out with their annual study on work and the work trend index for 2021. And it predicts that 41% of workers are considering leaving their current employers. When you hear those kinds of statistics does [00:33:00] that create concern for you or do you feel like you're on top of the retention aspect?

Kristin Myers: No I think that what we have learnt in the pandemic is it doesn't matter where you work really. And I think that our employees have choices. They could apply for jobs in Texas and still live in New York if they wanted Or move wherever they want to and work at any facility in the country.

Bill Russell: We're going to have to have that flexibility to be competitive. Talk about why you selected that one. [00:34:00] Holly.

Holly Russell: I think for me, it's just the idea that. I mean, once again, you have a CIO of a large health system in New York, and she talks about making herself available.

Even Sarah talked about it in her clip, like being able to have that flexibility just addresses the fact that humans are not robots. I am not a person who wakes up at six in the morning and works really well versus Bill, I know you work at 5:00am and it's great for you. So we're not both working at the same times, but remote work allows it so that when I wake up and get your emails, I'm able to respond and work at the time that I need. And that works so much better. I [00:35:30] think it brings the productivity to a higher level.

Bill Russell: So what's been the hardest thing. I throw this out to the three of you. What's the hardest thing of working remotely. I assume you've all worked in an office environment and now this is pretty much a remote environment where even if I had an office, we wouldn't, none of us would go to it.

Tess Kellogg: So my position before this, I was in a role where my boss joked about us being chained to our desks, because it was a role where if you were not sitting at your desk, you were not seen to be performing, correct, like being able to perform your role.

Bill Russell: It's interesting. I mean, you talked about the manager saying chained to the desk kind of thing. And you came from an old school industry just to be fair. But th e, the role of [00:37:30] the manager became so critical during the pandemic, the communication, the touch points that you talk about became so critical.

And then the culture changed pretty dramatically. Even in our organization. It was me by myself for about two years. You and I really doing this thing for about a year of just you and I going back and forth, constantly talking, texting all that. Then we added Tracey and it added a little bit different dynamic.

Anybody else want to comment on that? I tend to cut these things off in the interest of time, but you know, what else has been [00:38:30] really hard about working remotely do you think?

Tracey Miller: I think what you said, our team's good at, we kind of know what is going on in each other's lives, not to a really personal point, but you know, we know if we're going on vacation or your wedding anniversary is coming up.

So, you know, that in-person is invaluable, but I personally love working remotely. I do love the freedom, but I do miss that deep, deep connection that you get, even if you just wink at someone walking to get your coffee. It's yeah, it's an amazing experience.

You're not the first to talk about the relationship between the chief marketing officer with regard to digital. So talk a little bit more about how you organize. You have a steering committee or a governance group. Is this part of IT or did you keep it separate from IT? Is it highly integrated? What does it look like?

And so we created a steering committee. It's a digital services steering committee. Salesforce, for example, is a component of that steering committee. And then what we did is we looked at the different resources that we had in the company. And we brought all the resources together. The human resources and the budgets go along with that.

And then we filled that position with somebody from the outside to come in to lead that now newly merged team that's coming together. But when we look at the steering committee that we've put together, there's the person there that's for communication. There's a person there that runs marketing strategies [00:41:00] there.

Some of our operational groups are there, so it really is a very multi-disciplinary group coming together. All for the purposes of digital services.

Bill Russell: It's interesting cause this has come up a couple of times this year. Marketing has taken a more prominent role in healthcare and it's done so for a couple of reasons. One is we're interacting more directly with our consumers. And then the second is we had to figure out how to get information out there and get people in line to get a vaccine.

Tess Kellogg: Well, that's definitely a part of it, but to quote the John Halamka quote that rolls at the beginning of our YouTube channel, which all of us on this call have heard so many times. The role of the CIO has changed totally. We were software [00:42:00] developers. We could tell you how much Ram to use. Do you think any of that matters anymore?

Bill Russell: Yeah, Craig is a really innovative leader and I love the way that he has brought all those things together around digital services and and making all that work. So I want to keep going, cause I want to get to some of these clips. This is Angelique Russell.[00:43:30]

All right. I want to talk some data science concepts with you. Since I have you on the line, you wrote an article you said model drift, concept trips, historic time bias when working with healthcare data to train predictive models. It's always prudent to have an extra hold of recent data to make sure the accuracy is the same across time. Help us to understand those three concepts and what you're talking about about holding some data back.

And once you get into the treatment domain, this is very subjective data. Based on how you are being treated, you will have a different data set. So if we're talking about sepsis and it was pre 2011, I think it was there were others drugs that were on the market that were pulled from the market. Xigris I think, just fell out of my brain, but there was a big change [00:45:00] in treatment in 2011. So treatment decisions that might predict in your algorithm would no longer predict after that point in time. And that's just, that's one big decision, but treatment guidelines and order sets, which are how a health system or a hospital standardizes the treatment that patients receive these change all the time.

And we could see some of this in the COVID pandemic. So early in the pandemic, we believed we were having [00:46:00] a very bad flu year. And the very bad flu year myths continued long after we knew that we were in a pandemic because we didn't have testing available. If you recall, there was a real strict criteria for who could be tested for COVID.

Bill Russell: Man. I love that episode and I love that episode because it followed the other episode that we did with Paula Edwards and you know, Paula Edwards is a brilliant data scientists, and then you had Angelique Russell in back-to-back episodes. And I thought that was just great indication of what women are doing in healthcare.

Tracey Miller: Yeah, again, just data science fascinates me and the way that it can change dramatically in healthcare. With COVID obviously they didn't have the resources for testing or didn't know what the symptoms were. So it's obviously unraveling. But it's pretty [00:48:00] incredible once they finally do figure it out what it can detect what it can predict. So I just, I just find this topic fascinating. I don't completely understand it, but I'm learning.

Bill Russell: Yeah. I'm going to skip to the last one in the interest of time. It's John Brownstein.

Five years from now what will it look like if we take these lessons and apply them well? And you can talk about any of the different areas in terms of surveillance, in terms of public health or that kind of stuff. What will it look like in five years? If we learn the right lessons?

So hopefully some of the new supports that's coming in at the federal level will help to even the playing field. I think that, of course we need to strengthen our ability to respond to, to global threats. Over the last several years, we've had significant underfunding of efforts. I was part of a [00:49:30]project funded by USA ID to look for novel coronaviruses in populations. And that project was defunded last summer. So bad timing to defund a novel coronavirus surveillance project, right before a pandemic, but that happened. And so hopefully some of these larger efforts that are involved in sort of field-based surveillance, identify new viruses or efforts that are above strengthening global public health surveillance.

What is the outlook and how do we bring the discipline of disease surveillance and modeling and bring that to a federal level where we have full visibility on what is happening across the wide spectrum of pathogens. I mean, the likelihood that we're going to see another pandemic is significant.

Bill Russell: I have to appreciate [00:51:00] John Brownstein, if nothing else, for the Fauci pillow behind him, which is one of the more interesting backgrounds that we had this year. You know, final thoughts. You know, those are the clips that you guys selected. I appreciate you pulling those clips together. That's a great cross-section of some of the conversations, the diversity of the conversations we had And just the, the great experts that gave their time to the community. So I appreciate you selecting those. I'm just going to go around last, last comments. Any of you to, to close out the year.

Tess Kellogg: And I think 2021 was going to be a very telling year because 2020 forced us to innovate, to accommodate in ways we would not have thought ourselves ever needing to. But in 2021, we proved that not only are we not going to snap back, but we're going to have to continue to do innovation [00:52:00] to accommodate the continued pressure's on health systems. So I think going into 2022, we can expect only continued momentum instead of diminishing.

Bill Russell: Holly, anything to add?

Bill Russell: We did have a clip on tech debt. We didn't have interoperability. We did not have cybersecurity. So very interesting that no one pulled a clip on cybersecurity. Although we did cover it pretty in-depth on the news day. end of the year clips. I want to thank you [00:53:00] guys. We couldn't do this without you, and really appreciate all the work that you've done this year.

And looking forward to next year, we're going to do some really fun things with the new channels and look forward to sharing that with the community. Again, thank you. Thanks for doing this show. I know it's not in your comfort zone and I appreciate you coming out of that to share your thoughts with the industry. Thank you very much.