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 All right. Before we get started, I want to apologize because what you're gonna hear on this show is what happens when you don't have a good DR plan in place? I have work being done on my house and they have been flipping on and off electrical switches throughout the day, and just prior to the episodes, they had flipped off the power to my mic.

So even though I had it right here in front of me. It was picking up the audio from the, uh, computer because the mic was not powered on. It will sound a little echoey it. Again, great conversation. Drex is awesome as always, and we, we discuss a lot of, uh, interesting topics today. Uh, I want to take this a moment to just remind you about CliffNotes.

CliffNotes is growing rapidly and the reason for that is it's a great resource. It's a great resource because we're busy, right? We have lots of projects going on. Uh, we're not going to conferences as much anymore. Our training budgets have gotten cut. We just don't have time for things. And what we've done is we've taken these, uh, conversations with industry influencers and these conversations about the news, and we've boiled them down to a single email that you'll receive.

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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, Drex de Ford is in the house and we're gonna talk Haven, Blackbaud, antitrust. We're gonna talk, uh, commercial payers pulling back some funding. For telehealth and what the impact of that's gonna be.

A lot of, uh, fun conversations. 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 podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders. I want to thank Sirius Healthcare for supporting our mission to develop the next generation of health leaders.

Their weekly support of the show this year has allowed us to expand and develop new services for you and the community. Special thanks again to Sirius Healthcare. If you haven't signed up for three X Drex yet, it's a service of Drex to Ford our, our co-host today for the news. And what Drex does is he vets news stories for you and he, he will text you three times a week with three stories that he believes are relevant and as you listen to him.

That his perspective is phenomenal and he picks out only the best stories and the stories that you need to know as a health IT professional To get signed up, text Drex to 4 8 4 8 4 8. Now let's get to the show. Drex to Ford is in the house to discuss the news. Good morning, Drex. Welcome back. Hey, thanks.

Glad to be here always. Uh, good time to be. Had you dressed in black today, is there a reason you're dressed in. Not really, but if there was a reason to be dressed in black, it would be, uh, the passing of Eddie Van Halen, one of the great rock and roll guitarists that people of our age grew up with.

Awesome. Just to ha had all of his flaws in all the issues that all of us do, and especially rock and rollers do. But man, you can't say anything about the way the . The guy played guitar. Sad to see him go. Absolutely. I, I don't know where to go on that because to, to be honest with you, you're one of the cool kids.

Everyone knows that who's listens to this show? You're one of the cool kids. So you're , Eddie Van Halen and AC or you know, whatever. I, I, of course, was listening to Broadway music and, uh, Barry Manalow and, hey, this is really good music. So we, we may not be, have run in the same, okay, maybe not, maybe not. So, oh man, I, I should rerecord that.

Make, just take that out. I don't even doing it. Um, I'm excited. We've got a lot of news today is, you know, we're gonna revisit a conversation we had almost two years ago about, yeah, that's the, the Berkshire, Amazon, uh, JP Morgan venture, and we, we'll, we'll come around to that. Because a lot of health systems have been, uh, impacted by this.

We may talk a little antitrust since uh, the report came out. The majority staff report with recommendations on competition, and it has some implications in healthcare. So that's gonna be, uh, gonna be good. But since last time you were on the show, we, we introduced this whole concept of LinkedIn conversations where every weekday morning I go out and I share a news story and I put a little commentary on it.

And we, we get some feedback from the, uh, community, which is great. And just start the conversation there. I do my best not to comment on every one , and I try not to lead the witness. I try not to lead the witness. I, I appreciate that. What, so let's start, we'll start with the LinkedIn conversations and let's see which one.

Should we start with, let's talk about the, the pullback in funding. I think that's a big story.

Yesterday I posted the pullback in funding from telehealth. Will that cause a pullback in the use of telehealth? And here's essentially the story is that two of the largest health insurers, Anthem and UnitedHealthcare, are no longer waiving co-payments and deductibles for some customers beginning on October 1st.

And it says, uh, while a virtual visit is likely to be much cheaper than going to an emergency room, uh, you could end up paying anywhere from 55 to $92. Of a lengthy telemedicine visit within your plans and network and, and, and likely the pullback of funds will cause a change in the, the use of telehealth.

You know what, what are your thoughts on this? It's, it's interesting to me that we're still telling people, Hey, uh, be cautious. Do social distancing, wear masks, do the quarantine after travel. We're telling people to do that and, and now these, these major, uh, payers are pulling back the funding and saying, yeah, but in this case, go ahead and sit in the waiting room and go see a doctor.

Yeah, it feels like it's diametrically opposed to the, the thing that we're actually asking people to do and what we want. So there's an unintended consequence. Clearly that will happen to at least some patients where they will either go and infect somebody or they will be infected by somebody else who's in the same room with them, and they could have done a telehealth visit.

It may cause, uh, telehealth visits to drop. We've seen a little drop off. Surprisingly, some of the metrics that I've seen have shown like inpatient visits coming back, but telehealth visits holding steady or maybe only dropping off a little bit, still multiples over what they were at the beginning of the pandemic.

So telehealth has definitely taken hold. I think the thing that worries me more. Long term is how are they gonna deal with cross state licensure and are they gonna put those other things in place that help keep telemedicine

Running right or, or being allowed, not being obstructed by some obscure or weird regulation about needing to place your hands on the patient before you can bill for us a service. There, there was really three things, right? So that the money was the biggest thing. You, CMS lead away and then you, the private payer.

So money being the.

In place right now, essentially overriding

h We are not a, a federal, federal run, uh, type of entity. So.

The third was just, just the, the, uh, adoption rates, right? So the technology has always been there. I think almost every health system I've worked with had some aspect of technology and some is better than others. But at the end of the day, there was a technology foundation in place. There really was adoption.

Could we get our physicians or physician networks and

the.

Cultural and adoption of users. Of patients. That's the part which I believe, to be honest with you, I believe is primarily driven by doctors saying, Hey, I'm gonna see you a telehealth. If the doctor says to me, Hey, I'd rather see you a telehealth visit, I'm gonna do that. Indicate they're the biggest driver of.

They found it to really work effectively and they start telling their patients to use it, but to to sustain and to sustain it. I think the funding that we'll have, the funding for Medicare, I don't think the Medicare funding will pull back completely. Uh, but if the commercial payers pull back, I, I, I don't like the message that sends and I.

A two tier of insurance kind of plan. There's gonna be one that's designed for the digital future that's literally a digital health plan. Mm-Hmm. . Where it's like, Hey, wear this sensor. Put these things in your home, step on a scale. Every day a nurse will be tracking this kind of stuff, and we want you to do televisit first.

All that stuff that's gonna drive cost out of the system. I think there will be digital health plans. And there won't continue to be traditional plans. I dunno. I'm just pontificating it. No, I think it's an interesting idea. Right? Would you pay less for a digital health plan because of all of the, at least in theory, all of the, uh, administrative and wait time and other things that you're beating out of the system, it should cost less so you should pay less, right?

Yeah, absolutely. Yeah. I agree. Along that same vein here, so AML expands their partnership with, uh, Tito Care to extend healthcare at the home, and I. I highlight this, I, I, I hesitate to carry somebody else's water when it comes to marketing, but I found this one to be interesting, uh, because TE Care, handheld examination device, they have a lot of different things that they do on it.

Uh, they can track heart, lungs, abdomen, skin, throat, ears, heart rate, body temperature. They can, they can track a lot of different things. And you, when you partner that with telehealth, interesting opportunity, don't you think? Yeah, I do. I. This kind of, again, gets back to this, is there a digital package or something that you could put together, send you, sign up, send this, this thing to the patient's home, and a lot of the stuff that you would need to do in-person visits for now, you're able to do remotely.

And it's not just looking at a screen, obviously it's a lot of other stuff that now you could . You could diagnose and, and treat remotely. So are we turning like the parents or potentially just myself as I'm doing my own care into the nurse assistant in this case? Is that what we're doing? Yeah, maybe. I think in some ways you, and, and it has a couple of different.

Possible side effects, right? Unintended consequences. Again, one of those is that the more you use that kind of a device and the more that you understand how it works and what's going on with it, the more informed you are about whatever that problem might be, and so you're more likely to be able to pay attention to it and actually take care of it.

So maybe there's a, there are good other good upsides to this other than driving out costs and saving people time. There unintended consequences of, Hey, now that I have this device, I might use it and not call the doctor. Is that really a, a negative? I don't know. I, I don't, I don't know enough about how the device works, but I'm assuming that it's, uh, a.

Gather data and transmit it sort of device, not something that in your hand, it's not a Star Trek, you know, tricorder kind of thing that you could point it at your knee and then it diagnoses you in place. So, I don't know. I'm not, I'm not sure about that. I think it's probably just it gathers information or gathers enough of the right kind of information to be able to transmit it to your doctor to then get

Some kind of feedback. I, I still want the Tri-quarter. Every time I watch Trek, I'll, you know, I'll pull up an old episode, even some of the new ones and they just wave it over and everybody goes, looks like he has a laceration. It's like, are you kidding me? Detail, just by waving this thing over people, it's, and there's, there's lots of, uh, stuff going on outright on out there right now in an experimentation phase that certainly have elements of that Tri-quarter in it.

I'm with you. I'm excited about the day that that comes. All right. So look, I I, I had a post out here where I said Can health it, uh, security scale, and I talked about it on last week's episode, uh, a little bit talking about the VMware announcement. Uh, their, their have some free trials and some other things out there.

But what I wanna talk to you, I come back to question can health it security scale, you're one of the. But let's start with Blackbaud. How serious is this? If you are talking to a health system that's been compromised at this point? How serious of a uh, issue is this? Yeah, I'm just looking. We know that 38 organizations, healthcare organizations, have potentially been breached in healthcare.

Uh, they discovered it in in May. They sent out notifications in July that said . We, we had some of our data has been, may have been, uh, compromised and then at the beginning of the month, or right at the end of the last month, they actually sent in another notification and said, these social security numbers, these kinds of things actually are now on the dark webs.

You need to notify patients and families. It's interesting if you go to the Blackbaud site and read their spin on this breach, their spin on this breach is that they stopped a breach. I. In some ways I can totally see that they stopped a breach from being a really bad, horrendous breach and completely taking down all of Blackbaud.

But realistically, there was some data that was exfiltrated and they've admitted to actually paying the ransom to make sure that the bad guys destroyed that data and received some kind of a certification from the bad guys that they destroyed that data . But these are cyber criminals. How much do you trust them?

And at the same time, there are other interesting things happening, right? They, if you, if you pay the ransom, and I think most cyber pros would say, don't pay the ransom. But if you pay the ransom, obviously that's going to create more cyber crime. You're just funding a bunch of thugs who are gonna do bad stuff to healthcare it.

Healthcare and healthcare. It. The other part of this is that you're a known payer now, so we're going, we will be back. You're we're, you're, you're gonna be a return customer. Yeah. You're, yeah. You're like an ATM for, yeah. And the third thing that's really interesting is the think late last week, the Treasury Department issued some

Notices or advisories. That said, if you pay ransomware, we're probably gonna come and have a conversation with you because we may very well need to find you because you are supporting cyber criminal activity.

There's a, there's a lot of stuff going on. I, I think it's a big deal. I think as with a lot of these breaches, the breach happens. They figure out what's going on. They bring in forensic investigators, the FBI, others, they dig and dig and dig, and the more they dig, the more they find like, oh, wait a minute.

This isn't what we thought. There was more information than we thought. And then there are these updates that . Happened last week and so we may even see more of those out of this breach. Alright, let me fine tune it then. I'm ACIO, I had Blackbaud, we used it for donor management, essentially. There wasn't a lot of patient information.

There was more donor list and you know, , credit card numbers and maybe social security numbers. And in some cases systems do what? How, how should I be viewing this at this point? This is an excellent opportunity for you to talk to your board about how you manage third parties and how critical that, uh, vendor risk management program is that you may or may not have in place.

You probably have something in place to do vendor risk management. You have inventoried all of your third party vendors. Maybe you have a database that sort of describes all the data that is exchanged and how it's exchanged and what you know qualifies as PHI and what doesn't may. You may be monitoring those network and traffic activities through your SOC or through a partner soc.

There's just, we're in such a weird world today that directors and managers who have a credit card have the opportunity now to go out and buy services without you knowing it. And maybe in the procurement of those services, they're actually sending PHI may may not have signed a business associate agreement.

And the bottom line for this too, for I think for CIOs is that . Even when you sign a business associate agreement and it's an airtight super good risk transfer, BAA, it's written into your contract and everything else that clearly it doesn't completely transfer risk because in Blackbaud's situation, I.

These health systems are still having to go to HHS. They gotta go out and notify donors in the middle of a pandemic. Where donations are incredibly critical to keep many health systems running, you've gotta go out and tell them that we partnered with an organization that may have compromised your data.

If I'm a big donor. I'm probably gonna have to rethink my whole donation strategy if I get that email. Let me, so let me ask you this. So when I became A-C-I-O-I, I walked in and, and security obviously was, uh, in fact, I think it was six days into my being named interim, CIO. mm-Hmm. We reached Mm-Hmm.

I was at fault 'cause I was at fault. I was six days in. Maybe I should have, you know, completed the audit before then and whatnot. But, uh, just get the contract done was more than six days. Yeah. And then I started looking at security almost immediately. And then we had, we had well over 30 applications doing all sorts of different.

Monitoring. So our security portfolio was pretty large. We had way too many interfaces. Somebody went into this and some, there was an interface for this, and identity was a different thing than this and whatever. And, uh, it generated way too many alerts. One of the first excuses I got was, uh, we, we can't respond to all these alerts.

It, I mean, I think it depends on the organization that you're in, but in a lot of places we've not progressed much. We, I think, and, and this is a really broad generalization, so if you're offended by this as ACIO or CISO, please don't be. In your heart that this is true in many places. We, we love to buy technology that we think is a silver bullet and so it's gonna solve a problem in this area.

And so, um, in security, in a lot of organizations, we've bought a lot of tools. We've bought a lot of preventative measure kind of stuff, and we put it in place and those things are great, but . Very often, they're designed to send those alerts to somebody, right? Hey, look at this. Look at this. Look at this.

That doesn't look right. I'm not sure we should be talking to these guys. Shouldn't this be blocked? I don't know if this is a thing. Should these two things in the network be talking to each other and you gotta do something about that. And there are security operations center organizations who are.

Built, I don't, I don't know if you want me to say one, but there's security organizations that are built that actually . Take that burden off your shoulder and take those feeds. And then because of the way that they have created the, the analysis data on the backend, they can actually sort through it so that a thousand alerts become like three alerts and then they have expert sort of analysts to be able to go through that stuff and tell you when we think this one is actually a problem.

And so we need to research this with you. Uh, those are . I think we've, we've gotta get better and better and better at this because it's not, the tools are important, but it's not about the tools. If you buy the tools and then you don't do anything with them, in a lot of ways what you've done is just created exposure , um, for your organization right here.

Oh, you knew all of that. Now that we go back and do the forensics after your, after your hack, all that information was available to you and you chose to do nothing about it. Great. That's definitely not something I want. The, the HHS . Inspection team to know about my organization. Think carefully about how you build that security program and associated Tech.

So here's the, I'll, I'll start this com comment by saying I did exactly what you just said. I did, I did outsource to a, uh, company that took our alert.

You know, and they did a much better job and they were able to triage very quickly and they were able to raise alerts almost on a daily basis. So our team just, there's just collective sigh of relief. Yeah. Not that, hey, we're not responsible for security anymore, but just. Somebody's gonna tell us, these are the ones you need to focus on today.

And we didn't have to figure that out. Right? And I get to go back and do the job that I was actually hired for, which is what I wanna do. And part of the reason that I came here, I love the healthcare mission. I wanna work on networks. I don't wanna spend half my day talking to Chatty Kathy technology that tells me that

There's a squirrel over there. Now there's a squirrel over there. But here's the thing, I, I don't think that that's gonna scale. And, and, and this might be Bill still searching for the technology solution. I think this is the number one place that AI and ML can really, really, and security monitoring because, and infiltration attack typically, they don't look different from, it takes a while for them to develop something new.

They're using the same things over and over again. We know what they look like. We know what the patterns are. We should be able to see those. Uh, on the virtual machine, we should be able to see those on the network. We should be able to see those in a lot of different ways. And I'm looking for the complete fabric that is going to be monitoring for those events and identifying those events and potentially shutting down, yeah, uh, workloads so that they, they don't get exposed or they don't get, uh, locked in a, uh.

In some sort of malware attack or, or lockout attack. Yeah, no, that's the, that's the key to the operation, right? You can take these feeds, you feed it into some sort of an ML machine that sees these patterns, and I think it is scalable because for the, the companies who do . You know, security operations as a service.

The more customers they have, the more stuff they see, the more they're able to correlate attacks on hospitals, several hospitals at the same time, see what they those are, and then they're able to actually contact the client about what to do next. This is happening, or in some cases, if the client would will, it will allow it.

They can actually go out and say, we're gonna kill that printer, or we're gonna kill that pc, or we're just gonna turn off that part of the network until we resolve this issue. I. That's tricky in healthcare, right? Because sometimes if you kill a part of a network or you kill a device and you don't know what it is, it could be an MRI machine or an X-ray machine or an IV pump, and you don't wanna do that.

So it's very sensitive. You have to be very careful about how you work your way through this, but. The tech and the services exist today and I think it's scalable because the more hospitals, the more healthcare organizations that are on that service, the better opportunity they have to put out the kitchen.

Fire affording, golfs the entire house. Exactly. Yeah. And so last, last story, I.

We talked a lot about security there, but I think it's . Yeah, we did. Sorry. It's, it's very relevant right now. The last one is, what would a health system look like if they actually committed to customer service? And, uh, Dale Sanders, who's been on the show a couple times, and he, he shared a post based on an experience that he had and he, he pulled up this story and.

Around customer service, and I'll just rattle off some for you. Relentlessly advocate or relentlessly advocate for the customers. Trust our customers and rely on associates to use good judgment, anticipate customer needs, and treat their time and attention as sacred. Deliver personalized, peculiar experiences that customers love.

Make it simple to detect and systematically, uh, sy Yeah. Systematically escalate problems and eliminate customer's effort through this sequential and systematic approach. Defect elimination, self-service automation and support from an expert associate. Uh, and I just, I wanted to know, these are Amazon's customer service principles, and I just wanted know, is this even possible in healthcare?

And what are some examples of where this has happened? I know we used Ritz Car. Gosh, we were in Southern California. Oh yeah. We used Ritz Carlton and Disney Mm-Hmm. programs at different hospitals. So we didn't, we didn't really mandate as a system what to do, and so our hospitals did Disney, so did Ritz Carlton, and I'll be honest, those programs were pretty impressive and had a profound impact on the, uh, culture and, and delivery of care in those.

Uh, in those, uh, environments. So I, I have seen some of this being done and being done well, but I, I, I'm wondering, is it even possible to take like these six principles and say, this is what we're gonna be about it, or does that create like a. A revolt where people go, okay, I'm gonna advocate for the customers.

Hey, you shouldn't do this procedure, you should do this. You shouldn't be in this hospital. You should over there, and I'm not gonna use this gauze because it's gonna cost you 20 bucks. I'm gonna use this one because it's gonna cost you five bucks. Do we, it would be interesting to see if we put these six things and said, all right, hospital act this way for one week.

What kind of individual activities would happen as a result of it? Yeah. I've written about this and we've talked about it before. Habits are very, very difficult to change the way people work. Very, very difficult to change an organization. Culture is just incredibly difficult to change. So bringing in Disney or bringing in Ritz Carlton, I've been in organizations where that's happened before.

Seems like a really great idea. Six weeks out. A lot of it is faded away. Six months out. The, the two people who are still trying to do something like that are considered, maybe they've addicted. They're they've addicted, they've become addicted to the gimmick of the Disney thing, and a year later it's all over with.

So the, the. Important part of this, I think, is that if you wanna make these kinds of changes in your healthcare organization, it can't just be a one-time hit. You have to go back again and again and again. And you've gotta look at everything through the lens of whatever your customer service tenants are going to be.

And it starts with things like you hear people say, patient first, patient first. It's always about the patient. The patient is in the center of the target. I called up my provider three days ago and. I went into the call tree and the first thing in the call tree was, if you're a provider, press one. If you're a patient, here's your six options.

It was still very provider oriented and healthcare has been built that way and is built that way, and I don't, again, I paint with a very broad brush. I know there are a lot of places that have made progress, but . This is not something you do overnight. It's not something that you send out in an email and say, start acting this way.

It is one of those things that takes grit and you've gotta just stick with it, and there's gonna be a lot of those hard places that you're gonna make your way through that. Like how do you advocate for the customer? What does that really mean? That takes a lot more than the, the four words in that sentence.

It's, it's requires a lot of exploration and testing and change. So let's talk about one of the organizations talking about pushing through and getting to the other side. So even Amazon, Berkshire. Oh yeah. Um, huge Promise two.

Improve primary care access, simplify insurance benefits, make drugs more affordable, at least for their organizations first and then potentially for the market. Mm-Hmm. . They're gonna leverage data and technology to drive better incentives, lower costs, and better system overall. That's what was the promise of Haven when it came out.

They went out and hired and we were all like, Hey, this a positive, uh.

Yep. And it's, and then they go on to say, still unclear. And by the way, I'm reading from a, an advisory board. Yeah, yeah, yeah. I saw it. Yep. Came out. So they, they announced gowane, he has since, uh, stepped down to, to stepped down as the CEO, but still is, uh, on the board, on the board chair of the board fact.

So what that tells me is that the daily operations of the thing were too much for his. Schedule or that his interests were more around what was going on with Covid and he's, Hey, I free me up this, this operations day to day thing is, is a little too much. So chair of the board is more strategic. He's able to still guide the direction of it.

And let me, I'm just hit, hit a couple more of these points here. Uh, while gwane shouldn't be held, hold the entire burden of getting haven off the ground. His step down from the CEO was a major blow to the firm. While as a skilled surgeon and thought leader, Gwane likely struggled with trying to handle day-to-day operations.

Mm-Hmm. , uh, haven is unlikely to make much short-term progress without strong CEO leading the way. Haven's challenges go far beyond turnover, though, and likely stem from several issues, including it. Here's the five issues they give, announcing the venture too early, seemingly without any immediate strategy or products of its own.

So it was a little premature. Yeah. Attempting to disrupt the status quo for employer health costs by relying heavily on entrenched players and services, trying to fix too many big industry problems at once. Navigating the bureaucracies of three major companies that operate across different industries, and establishing a non-profit culture from those same three companies that happen to be heavily focused on making profit for share shareholders.

Yeah. All right, so I think I captured this. What, what they're, they're saying about this. Uh, let's, let's go to the challenges. Yeah. Should we go to the challenges or their expectations? Well, where do you expect this to go? Will they be able to overcome these challenges? I think that's the question.

And I think you gave me grief for this. I think at some point I said that when they finally changed the name from the 10, you know, word name, that they had to haven, it turns out that may be the biggest thing they accomplished with Haven so far. And I still believe that. And, and I think when it, when it comes to, to a towane.

Again, this is a, this is a guy who's a great strategist. He's a big thinker. He understands healthcare problems in a big way, but when it comes to you and I have been there, if you're an operator, if you're, if you're in the trenches in healthcare, it's hard and it's super complicated. And to quote the president, who knew it could be this difficult healthcare is really, really.

Challenging and there are a lot of moving parts. And so when you get into this and you are basically a employer organization and you say, we're gonna go in and change healthcare, a lot of people were really excited about it. But what we saw, I think ultimately is these guys got into it and. Everything they grabbed onto was really slippery and difficult to, to understand and to get ahold of, and, and maybe they didn't come from a healthcare background, and so they, they've really struggled.

I hope they don't go away. Ultimately, it, I think they have good resources and good thinking and they have a lot of good engineering capability and they, they've, they've, they've got a place, they just have to find it. There's a niche for them. To make healthcare better, but it's not solving world hunger.

It's a niche and they just haven't found their place yet. That's my sort of thinking about where they will wind up is . They'll find something they can actually get a grip on and they'll make it better. And if they don't, you still have Amazon out there with pill pack and doing all the things that they're doing to try to make healthcare better.

But they've taken a very different approach to it individually as a company. They're finding little tiny things where they can make it 2% better or. 6% better, and maybe over time they develop enough experience that they can put it all together and make a bigger impact. But yeah, it's, it's interesting.

At the time, I think we both liked the hire of Tuwana into the, into the role. I, I've really soured on that, to be honest with you. I. I, I think we're gonna see more happen in this space from Amazon by themselves. In fact, you have seen Amazon do a bunch of stuff in their local market in terms of the clinics and the care and Sure.

Here in Seattle. Yeah. Yeah. They're, they're doing a ton of stuff and I, and it's interesting. I think they've accomplished more in the last two years than Haven can, even remotely, and part of that is. Uh, no fault of, uh, Gawande's is his lens. His perspective is from healthcare. So he approaches it like a healthcare person that says, Hey, these things are immovable objects.

We have to function in this way. Whereas whoever does this needs to have a strong understanding of healthcare, but they need to be more entrepreneurial and bent to say, all right, we're gonna do something. Different. We're not gonna partner with Cigna and Aetna and create a plan for 60,000 employees.

That's more based on wellness than, than sickcare. We're, we're going to, we are gonna fundamentally upset the apple cart here. Yeah. Figure out a way to keep our employees healthy. And, and by doing that we're gonna drive down, I I, with some healthcare background rather. A physician, somebody from a physician perspective, from established healthcare.

And again, I was really, I thought that was a great hire when ahead. Mm-Hmm? . Mm-Hmm. . I just, I just saw, no, I think we both, I think we both agreed at the time. That's good. This guy, he's got, he's got big vision. He, he can sees the field. He's gonna bring something to that conglomeration that they don't have right now.

And yeah, you're, you're right. Some of this too is just. When you work in healthcare after a while, I think you do get to the point where it's, I can't. We can't do anything until everybody agrees that's the right thing to do. And that whole delay of game process that winds up being beaten into us over time as healthcare people, we have to collaborate.

We have to make sure everybody's read in on this before we do something. Yeah. It, it, it doesn't work in the, I think the kind of venture they were trying to create. Yeah. Also, keep in mind, one of the things we liked about him is he was a, he's a, uh, he's a researcher guy. He, so he was going to, to, he was gonna approach this from a data-driven perspective, which I think was a good thing.

At some point those people fail to get things started. It's what I've do something. Yeah, yeah, yeah. It's get something done. Anything done sometimes is, is better than, uh, sitting back now. This is, this is absolutely, somebody's gonna say, Hey, you're armchair quarterbacking. And I will, I will totally, absolutely are.

That's. But hindsight, I would say, and even today, I would say go find somebody with an entrepreneurial bent. We will, uh, and I think we'll see some things. Uh, uh, we are, we, we've gone over a little bit. I'm gonna go ahead and hit this last story only 'cause I, because I, I think it's timely and it's the antitrust stuff.

And so the report came out. Now here's just a couple of excerpts from the report. They, they've looked at all the evidence of how these big tech companies use their platforms to squash competition for the most part. And their stories, you know, it's like Google. Uh, there was a, a, a gentleman who had celebrity net worth, so he had the net worth of, you know, 10,000 or so.

25,000 celebrities. He had a staff of 12 people. He collected this information. Their website organically was one of the biggest websites for that kind of information out there. Actually, it was the biggest website for that kind of information out there. Google sent them a thing saying, Hey, we would like to tap into your information for our Google answers.

And, uh, they said, no, no thanks. And so essentially what what they say happened after that is their search rank went down. Google started to assimilate that information and start to use that information for Google answers. And as now, when you type in a question for Google, there's, there's an answer at the top.

So if you ask for the net worth of Taylor Swift, likely you're gonna get that from Google. You're never gonna go to another website. And to which completely decimated this, this, uh, the whole business model. Another one, Google as well. Same thing around song lyrics and Google's defense. There was essentially that.

Hey, the song lyrics weren't owned by the company that aggregated 'em. They're owned by the, the authors and, and, and the, uh, music companies. Therefore, they just went there, gathered the lyrics, and now they make those lyrics available. It's, it's interesting and it's the same kind of stuff for Apple.

There's stories about Apple. It's a 450 page report. I appreciate Sherry Val actually. Commentary on it and the links to the pages to find the, the appropriate stories. Apple with their app store, there's a bunch of stories in there of people signing away their lives to be on the app store, the app store, and part of the agreement, quite frankly, says, Hey.

We, we, we will, we, we have the ability to compete with you and you have no ability to come back at us. Yeah. And they, they under, but when you're, when you're doing it through the app store, they know who your customers are, how much they paid for your app, where they're located, how much they're using their, your app.

They, they end up with a wealth of information to compete with you on, uh, on, on those things. There's, there's some more. Google stories in here, and then there's also some Amazon stories and how much information Amazon is, is really gleaning not only from their, from their platform in terms of resale and whatnot, but also their, the, uh, echo platform and the the, uh, yeah.

The intel that they can gather. Yeah, it's amazing. So my question to you is healthcare.

You know, the, the, the, if I wanna write an app, I, I, I probably needed to work on Epic and I needed to sort, right? Yeah, yeah. No, I think that there's the clearly two or three players that really dominate the market. Epic, Cerner, and probably Meditech. We know that when the apple orchard, we've heard people complain about what you have to sign as an agreement to be able to get an app into the app, into the App Orchard.

Is there, is there really an equivalent today? It's, it's hard to say, but I definitely feel like Epic is very dominant and they have. Put together a lot of structure that says if you're going to work with Epic, you're gonna have to do it our way. Uh, you know, what's listening to you right now? Because I feel the same way.

It's, I, I've read the agreements. You've read the agreements. They're onerous. Yeah. But our, our livelihoods depend on Epic clients not going, Hey, I'm not gonna work with Drex or Bill because they said this and, but I'll come, I'll just come out and say it. I've talked to these guys. And they're saying, look, read this agreement.

I read the agreement. I go, I wouldn't sign that agreement. Yeah, but if I don't, I don't get access to 50% of the market through Apple. Yes, exactly. I'm like, really? You have to sign that in order to do that, that doesn't make sense to me. You essentially have to say, yeah, epic can compete with me. Epic takes no liability.

Epics, APIs may change and may break your stuff. And , sorry. Yeah, no, you're, you're. You know, I just had a friend of mine send me the Epic API agreement and just was, he basically did exactly what he said. He sent me the Epic API agreement and he was like, would you sign this? I'm, I don't know what's going on here.

And there was a lot of stuff in there. And the kind of nutshell of it version for me was. You know, we're gonna publish APIs and you can use them. And if it turns out that something goes wrong, we are completely off the hook. And once the data goes through the API out to you or somebody else and something happens with that data, we're completely off the hook.

And if it turns out the API doesn't work, we're off the hook. And there was a lot of, and I, I'm, I'm sure I totally have that wrong, but there was a lot of stuff in that agreement that also . Said, and you have to sign this by Friday if you want access to the discounts for the APIs. Either were, I was just like, I, I don't know what to think about that.

Like where, where does, how, how, what do I do? I can't, like, we're gonna throw out Epic tomorrow and install Cerner. You're, you're, you're gotta do what you gotta do. Like you said, we've talked to a lot of Epic clients, a lot of friends who run Epic, who. Who run up against the same thing. And, and it's not just epic, it's, it's, once you've made an investment in these core critical clinical systems, you can't just change boats.

You can't just change horses in the middle of the river. You gotta keep going. And sometimes that's your detriment. Now, whether that's antitrust or I'm not a lawyer, so I don't know, but it definitely makes me feel uncomfortable as a customer that I'm, yeah. We have those same things in ERPs. Once I choose to go to Workday, EERP.

Exactly. Not, I'm not swapping that out any. Right. I, I've heard people say similar things about Salesforce. Uh, the reality is I, I look at Epic and I go, if I were in charge over there, would I write this agreement this way? Yeah, absolutely. I would. Sure. Why? If I could. If I could say, look, I'm gonna wipe my, if you are gonna take the data out, which by the way was their argument.

Yeah, yeah. No, you're right. No, they, they argued against this. Now they're just trying to protect themselves. I see both sides of the argument. If, if you stay, they wanna pon poll this thing. Right? I mean, and, and in fairness, Epic's saying, look, if you stay in our world, we will protect you. We will make sure that you are whatever.

And they've done a fairly good job of that. I agree. And now the federal government's coming in and said, Hey, open up the APIs. And they're like. Alright, we're gonna open up the APIs, but you know what? If you want, if you're gonna take data out, the minute you take that data out, not, I, I can't. It's on you.

Yeah. I can't do anything to forget. And if for some reason something doesn't work the way it's supposed to, that's on you. And if right on down the line I, I, I'm with you, bill. I see both sides of it. Right. They did make a very fierce argument. Whatever it was six or eight months ago, or however long ago it was that, you know, they didn't wanna do this.

And I think it's the, again, it comes back to the, if you're in the epic ecosystem, then data exchange works and you can talk to other epic sites and you can exchange data. And if you're using apps from the . Orchard, the data exchange works and it's supposed to work. And then when you say open it up to everybody else, this is where, this is where they get defensive about their business model.

Yeah, and, and direction. I talked, uh, I'm doing consulting work and I've talked to three Epic clients this week, and it's absolutely strategic to their application rationalization project. It's, you know, to just about everything they're doing. And they're willing to put up with a little bit here and there.

Uh, what they consider to be a little bit here and there for the benefits that they've received and we're, we're probably making, there's probably some people that are like, yeah, let's storm the gates of Verona, but before we storm the gates of Verona, just understand they've done a fair amount of really great things for healthcare and you don't have a lot of, a lot of their clients.

Are, let's, let's grab a pitch Forks and, and go storm the gates. They're, they're not Yeah. In camp in any way, shape or form. Yeah. We just had to go live here in Seattle. Seattle Children's went live with Epic, uh, Saturday, and the, the, the March continues, the conversion continues. People aren't going to Epic because they hate Epic.

That just isn't a, it just isn't a thing. Yeah. And we talked about customer service. Uh, they have phenomenal customer service. I, I, one of the CIOs I talked to last week said, yeah, Judy, we're doing a go live and Judy's been on the phone for three or four of the calls. And what other C-E-O-C-E-O self-made, bajillionaire is right, taken out on the go live calls.

Yeah. And I'm like, yeah. Point, point, well taken. It's just, it's, it's an unheard of level of customer service. Yeah. All right. That's all for this week. Don't forget to sign up for clip notes. Don't forget to sign up for three XX two great services to keep you and your staff current. Uh, special thanks to our sponsors, VMware Servers advisors, Galen Healthcare Health lyrics, sir Healthcare Pro Talent Advisors Health Next and McAfee for choosing to invest in developing the next generation of health leaders.

If you find value in the show, check out our YouTube channel, share it with a peer. We would really appreciate it. Uh, don't forget to check back every Tuesday, Wednesday, and Friday for shows except for tomorrow. My parents are in town. I'm not doing a show tomorrow, so, all right. Don't tune in tomorrow. I'm gonna be hanging out with them.

I don't know what we're gonna be doing. It'll be fun. Drex, thanks for coming on the show as always a great conversation. Thank you. Thanks for listening, everybody. That's all for now.