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My name is Bill Russell Healthcare, CIO, coach 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. This episode and every episode since we started the C Ovid 19 series sponsored by Sirius Healthcare and we really appreciate it.

Special thanks to Sirius for supporting the show's efforts during the crisis and beyond. If you haven't signed up for three X Drex yet, you're missing out. Drex to Ford came up with this three texts a week that he vets stories and selects the ones that are most important to people who are in health it.

If you wanna be a part of that text Drex, DREX, to 4 8 4 8 4 8 and receive three texts a week, uh, from to Ford. Great way to stay, uh, current, and it helps me to prepare for the show. All right, onto the news before we get going, a few stories I shared on LinkedIn. Let's start with, and I always start with a question.

I, I just like doing that and some of the questions is the Epic EHR falling behind who's ahead in digital tools, race payers or providers? And do you need a development arm? So let's hit a couple of these real quick. LinkedIn, here's a good one. Does your health IT shop need a need development capabilities?

You know what? This was interesting. Uh, I was actually sent a story from Mark Weissman, who has been on the show a couple times. He's the, the author of the CMIO podcast author, is that the right word? Anyway, he does the CMIO podcast, a good friend of the show, and he sent me a Jamie, a Jamie, a publication from.

And the results were exactly what you think they are. The participants, uh, completed more recommended care, recommended tasks per minute over longer sessions. The keystrokes per task were lower, and the participants expressed a desire for a reliable presentation of information that matches how they

Think and how they operate as clinicians. And uh, one of the things I said towards the end of this is the organizations that master the EHR with Standard Space Technology frameworks will begin to differentiate themselves in the modern, in the modern era of the EHR. And the reason I say that is, and we've talked about this a lot on the show.

there is going to be the need for speed, the need for agility to, to address problems that your EHR provider, when they put it on the roadmap and say, we'll have it for you in a year, that's not gonna be quick enough. And Smart On Fire is a great framework, open source framework for delivering the information directly into the clinician workflow.

But in order to utilize that, you have to stand it up. You also have to have some development capabilities, not heavy coders and that kind of stuff, but some development capabilities in order to tap into it. And I just asked the question, does your health IT shop need have any development capabilities?

And did they need development capabilities? So that's where that came from. Great article, by the way, if you get a chance to take a look at that article, it's worth, uh, taking a look at who's ahead in using digital care for, uh, the care of communities, providers, or payers. And this came from a story. Blue Shield of California created a dashboard for a advanced public health.

To increase the, uh, transparency around community health and to help address health disparities. It's a really cool dashboard. It, uh, has been used in California to give people a picture of what's going on in the community. Health outcomes, preventative healthcare utilization, access, health behaviors, social risk factors, environment, economic health.

The tool's free to the public. The hope is that the community and organizations, health advocates, hospitals, physicians, and others will utilize it. To improve the, uh, overall health of the community. And I just, I threw out this thing who's really incentive to use technology for the benefit and health of the community.

I know we anticipate that there's altruistic organizations, there are even faith-based organizations, but a lot of these organizations today are, are just functioning off of financial incentives. And, and it's hard not to, especially after Covid I and the shock to the system that was from a financial standpoint.

And, but the reality is when the ORs and ERs are empty, hospital financials implode. However, when they are empty, the payers do just fine. That's what we saw through covid. So the, the payers are incentive to keep people out of the hospitals, to keep them healthy. And I think it's one of the reasons that you might see more innovation around

The community health from the payers than the providers. At this point, I, again, I'm not overly excited about that concept. I just, uh. I thought I'd throw the, the question out there. Let me, let me hit the one on, is Epic falling behind? 'cause this one got got the most traction a lot of people, uh, commented on.

I made the statement that the Epic EHR is falling behind, but now give it, consider it has a huge lead and it's losing ground gradually. As I look at it and my case, my point here is that I think they need to re-platform in the next 24 months. And to date, their competitors have tried to compete head on with Epic and they're just losing.

Epic is a very customer centric organization. They listen to their provider partners very closely and they, uh, provide them exactly what they're looking for. So if you're gonna compete, you have to stake out new ground. You have to identify where things are going. And stake that ground, ground out before they get there.

The other thing is there's a benefit as they get larger, it's harder and harder for them to make a shift to re-platform. They have so many modules now, they have so much, uh, going on that there are times they actually head in the other direction that they're trying to solidify people's, uh, need and really push hardware to the, to the edge that they possibly can.

And so I make the case that we need an an inter internet-based, uh, web-based EHR. That's, uh, that, that's truly re-platformed that's truly written from the ground up and went to, or Cerner went to, uh, AWS and they're running in the cloud. And, and the first glance, you look at that and they go, oh. Great.

They're running in the cloud. But the reality is you can run Epic in the cloud, you can run Meditech in the cloud, you can run Athena in the cloud. It's not hard to run these systems in the cloud. The question is, which one is actually gonna re-platform and become an in on internet architecture. So accessible APIs, scalable, ubiquitous access, those kinds of things that are the nature of web applications.

Some of you're just gonna say, look, . My EHR runs just fine. I don't need anything else, but I make make the case that your operational, your operational data store, your analytics data store, your document data store, they're all growing and they're growing rapidly. I've been keeping an eye on that, and poor architecture runs outta headroom Eventually, I.

And then the other thing I, I make the case of these, these monolithic platforms were not designed for innovation. They actually stifle and slow down innovation, not by design, but they by design, they end up slowing down innovation. So until they re-platform, they are going to continue to move slower and slower.

They have more clients, they have more baggage, if you will. As they move, some of these other players are gonna be more nimble and able to. . To move. Now again, I think the clock is ticking. I think you could see, uh, significant advantages to whoever does replatform first in this space. So those are just a couple of the stories that I share.

If you are, uh, following me on LinkedIn, I'm gonna drop a single story every morning, every weekday morning and just open it up with a question and let's see if we can get the, uh, dialogue going out there. All right, some stories for today. HHS . Focuses on, let's Open This up, focuses on telehealth and tech innovations in the rural action plan.

Okay. The plan lays out a four point strategy intended to address the hurdles providing. Two, providing rural healthcare, including building a substantial health model for rural communities, preventing disease and mortality, increasing rural access to care, and leveraging technology and innovation. The latter initiative includes broader support for telehealth and funding for the development of technol technological.

Solutions to chronic conditions. It also acknowledges broadband access as a continuing concern, making the use of health. It's interesting, uh, don't expect big dollars coming out of HHS to fund, uh, rural broadband. It's just not gonna happen. Plus, I think it'd probably be, would be a mistake at this point.

We are so close to a, to a terrestrial kind of internet. You have, uh, starlink. You have a SpaceX launch launching starlink. You have other providers out there are starting to create that constellation of, of access points, for lack of a better term, satellites, but their access points to the internet for these rural locations.

So it'll be interesting to see, uh, what speeds those, those satellite communications come down at. And, uh, if they're able to keep up with the, with the demand for the rural. So anyway, I'm just, my, my, so what on this is don't expect a lot of, uh, money for rural broadband, but expect them to focus in on that, the first parts of the, of that, that strategy, which is I.

Building a sustainable health model for rural communities. This is one of those things that we have not really spent enough time on. I, I feel like Mayo's starting to head in this direction with their, uh, care, care in the home kind of thing. If you do care at the home, you could eventually do rural communities extremely well.

By just taking that technology and leveraging it across a different, different set of modalities and, and care delivery networks. There's an awful lot of stuff that can be done here. I, I highlight this story. I. Mostly because I think people think this is a technology story and it's, I, I don't think it is, to be honest with you.

I think, uh, once a health system with the reach academic medical center, that really starts to understand their ability to leverage rural communities and to bring those rural communities into their care plans and into their, into their insurance products and into their hospitals, quite frankly, 'cause rural communities, they need

That higher level of care that is only offered in the cities. And if you're tied into them delivering care at the, out of their home or out of remote facilities through technology, uh, and through other means, you're gonna have access to those communities. So anyway, HHS right thing to, uh, look at that. And I think the care models is the most important thing of that story.

That's the so what the care models matter in that a VA report identifies HIE barriers to improving care coordination. This is one of those that you just scratch your head and go, uh, okay. And I was reading this story. Let's see. The OIG noted that facilities challenges for sharing information include the need for additional training and increase in community partners and an understanding of how to use the program.

In addition, facilities reported technology challenges to viewing community health information through VA exchange, including the dual sign-on requirements for VHA providers to sign into the electronic health record and then sign . Into the joint legacy viewer, JLV, to access community partner patient information.

The JLV data quality was not ideal. Information Naming and access was not user-friendly and facilities reported a cumbersome process. One of the reasons I pointed this out is 'cause I, I believe this is a case, a good case study of we know that they're rolling out a millennium and power chart, uh, millennium power chart across the entire va.

And as they do that, some of these things, some of these challenges are going to just, they're gonna dissipate, uh, because if they get onto a single EHR and that EHR is sharing the information effectively, so some of those problems are gonna dissipate, then you have the sharing the information with the community.

That's just, that's a matter of getting the ontology right, getting the, uh, dataset correct and getting them shared into the appropriate HIEs. In those communities. But to be honest with you, if you're in a Cerner environment and you can get Cerner, epic, Allscripts, and Meditech to talk, you've, you've covered

I don't know, 80% of the market. And so to a certain extent, I, I love the HIE work. I think it had its day, uh, and I think it's gonna diminish. And I know that, I know that there are programs that are heading in this direction and really bolstering the HIE, but to be honest with you, I'm not seeing it. I'm not understanding.

Uh, the need for it at the community level. I think they are underfunded. I think their technology is sporadic. I think some of it is phenomenal. And, and you go to Massachusetts, go to New York, go to other places. They're, the HIE are, were well funded and well thought out and well implemented. And other areas.

And some of the areas that I was responsible for, uh, the HIEs were fragile. They were severely underfunded, funded by the health systems and not really by the state. And represented a, a significant challenge to the sharing of data. The sharing of data is not a problem of standing up. The technology in between these things and getting the information to move back and forth.

It's a, a competition challenge. Not for the va, but for others, uh, putting their information in there and accessing those HIEs is a body of work that, uh, a bunch of people haven't really stood up as a priority to get to that data and to share that data. Now, if you have a large VA facility by you, I'm sure you would, uh, prioritize that work and do that work, but if you don't, you're probably not prioritizing that work anyway.

The reason I highlight this story, the so what of this is sometimes you spend the money, focus on it and run after the problem. But when you can see the finish line for, uh, addressing 70 or 80% of the problem head on. With, with a large project, like the implementation of an EHR system-wide across the va, that has a, uh, good data structure that you're defining as you go, that you can share that data.

Uh, sometimes it feels like you're spinning your wheels a little bit to, to run around on this. Now, I, people are gonna disagree. I disagree with me on this. I get it. I understand, but I use it as a case in point. We had several of these things where you just had to grin and bear what you had. Because you knew that something good was gonna come in the next year or two.

Consumers are increasingly willing to tell their doctors when they disagree with them, are using tools to get information on costs and health issues are tracking their health conditions and using that data to make decisions and accessing and using their medical record data. That's interesting and probably the first time I've really heard that the patients are that actively engaged.

I'd, I'd want to dive into this study a little bit more and understand who they surveyed, uh, what pop actually has the populations down here. Let's just go down. Wow. And it looks like. Interesting. Most consumers are comfortable telling their doctors when they disagree with them, and that looks like it's pretty standard across the board with seniors being a little higher than Gen Z, although they're all pretty close to 50% or higher.

Let's see. Somewhat likely you get the picture extremely likely is, uh, 50% or higher, which means somewhat likely is 30 to 25%, and, uh, slightly or not at all. So we're becoming more according to this, we are, we are facing . And we are becoming consumers of healthcare. We're starting to, uh, demand certain things.

Interesting. We have to get our finger on the pulse of what the consumers are saying. And I, we've talked about this before. One of the, so what's on this is gonna be, do you have a mechanism to collect the users or the consumer's, uh, viewpoint on the tools that you're providing and the services you're providing and, uh, the quality that you're providing?

I know we measure quality in a lot of different ways. What about the quality of the experience? And then consider also that your populations experience healthcare very differently. There are chronic conditions. There are the young Invincibles. They all have a little different picture of what healthcare should be and how they access it.

So as you're starting to define these, you're gonna have to create those personas. Around that. And I know some of you have said, I'm getting tired of doing these, these personas. I'm getting tired of doing experience maps until you get 'em right. It's like your architecture diagram for your network , until you get 'em right, you gotta do 'em.

Hey, don't just sit back and go, I don't like 'em. Experience maps are there for a reason. Personas are there for a reason. It's hard to design a set of tools without understanding the consumers that you're working with. Uh, their second point, consumers are using virtual visits more than ever before and plan to continue using them.

It really depends. Uh, yeah. They were doing this essentially during covid. Yes, I would agree with this. People got experience with it. People liked it. I would like to use it more. And when it comes time for me to see a doctor, I will pursue a virtual visit first. So that makes sense to me. I think we have changed behavior somewhat more.

Consumers. Their third point, more consumers are using technology for health monitoring and are willing to share their data. I would say almost everyone's willing to share their data. Once you strap something on like an Apple Watch or a, I guess the new Amazon. Uh, device or whatever. Once you strap one of those on, you have to know that you're being monitored and followed.

The whole idea of privacy goes out the window when you strap it on. You know that they are tracking you via GPS so that they can give you a really cool map when you're done, your jog or your bike ride or whatever you're doing. I think people are less concerned about privacy, especially that group that are using health monitoring tools.

As health systems, technology companies, and others rollout virtual services, it is imperative to provide the same. . Personal experience as during an in-person visit. This is particularly true for organizations that are developing tools or services for those with chronic conditions as they are most likely to value a sustained relationship.

The so what on this is know your consumer and you know what the gen, if you see these national things. The, they're great. They give you a perspective, but know your consumer. 'cause the consumer in Lubbock, Texas is different than the consumer in Southern California is different than the consumer in Northern California.

And those were three markets that I operated in when I was the CIO. And so you have to really know those entities and you just can't take the generic, everybody wants a digital experience. Well, everybody may or may not want a digital experience based on . Uh, their relationship with their existing doctor and, and the community they live in and how they function.

Alright, next story. OCR updates the HIPAA resources for M health apps and cloud computing. And for this one, I, I'm gonna give you the link's too long. So the, uh, link I give you is this week, health.com/mhealth apps, APS mHealth apps. So if you go there, it'll take you to the OCR update. Website and it has a bunch of the things that the OCR is doing.

So the Department of Health and Human Services Office of Civil Rights updated and renamed. Its formerly former health app developer portal as HIPAA resources page for mobile health apps, APIs and cloud computing designed to support covered entities and mobile health developers. There's a couple things in this, uh, story, and I got the story from Health IT Security that I thought were interesting.

Then that app may not be covered under HIPAA because they're not, they may not be a covered entity and you may not be, oh, so I'll just keep going here. Once protected health information has been shared with the third party app as directed by the individual, so me, the consumer directed the app to get my information, the HIPAA covered entity will not be liable under HIPAA for subsequent use or disclosure of electronic protected health information.

Provided the app develop developer is not itself a business associate of a covered entity or other business associate officials explained at the time. Further HIPAA liability is directed, uh, directly determined by the covered entity and their relationship to the health app. If the patient decides to send their health information to a provider using an app that doesn't fall under hipaa, the patient health data is not subject to HIPAA regulations.

As the US continues to push to adopt contact tracing apps that may fall outside of hipaa, industry stakeholders have stressed, patient privacy may be at risk. I thought all those things were interesting. I didn't realize that it was that clear. To be honest with you, and that is actually a great thing for providers.

I, I know that there was a lot of concern about if, if the patient accesses their data via this app, am I responsible for it? But the reality is, if the patient uses a third party app and they request the data that you are not going to be, uh, liable for fines, that doesn't necessarily mean that we don't worry about the privacy of our patient data.

If we should be, to a certain extent, educating our patients, providing them a set of apps that work. . We shouldn't complain too much. When people utilize third party apps that aren't good or aren't certified or aren't authorized or those kind of things. We should be running after this pretty hard to make sure we fill the gaps with apps that are trusted, and maybe that's one of the things we provide.

Maybe we provide a directory of trusted applications for our, for our patients so that they can go to a website, see the trusted apps that we recommend. Not necessarily the only ones that we'll support, but the ones that we recommend that we can, uh, ensure their security and their privacy on. So that's my So what on that?

Uh, there's something to get ahead of there. Uh, there's a new, there's some new resources for you at the OCR website. And again, if you wanted to get to, to that through us, the easiest way this week, health.com/mhealth app, all one word. Easiest way to get there. All right. Interesting story. Let's see how far we're 27 minutes at Forbes.

Eliminate the many to many integration problem brings down the cost of spreading them over, continually increased number of users and unleash the virtuous cycle of further innovation. So this is, that is the promise of platforms. It's actually a pretty decently, uh, written article. We talk about platforms a fair amount and platforms to me.

Are really about creating that marketplace. You're gonna have consumers, you're gonna have producers, and, and that can be producers of data that get used by researchers, uh, that can be producers of health services that get consumed. You want to turn your health system into a platform. We talked about this last week, about Ohio State and how they're talking about their healthcare system as a platform, a healthcare platform.

But in, in addition to that, we should be thinking about the resources and a platform will provide . The ability to aggregate data to provide advanced analytics, uh, machine learning and AI on top of it. The ability to build applications, the ability to facilitate transactions, maybe financial transactions, but definitely data, transactions, moving that data around.

I think more and more we're gonna be looking at platforms and the EHR is a platform. It's a specific kind of platform, but it is, I wouldn't. Necessarily call it an open platform. And it's definitely not based on internet technologies. Uh, so the so what for that is there is an opportunity to use platforms.

You're gonna hear that word more and more from this side of the fence. But you're also gonna hear it more and more from the industry. And I think the EHRs are trying to become those platforms, but I think they're, uh, hampered by, as we talked about earlier, the legacy architecture that they've, that they've used and adopted.

What broke in the process, and one of the things they note is that so much money goes to the facilities that not enough money's going to care and too much is going to paying rent and paying for these massive facilities. And he called it, what do you call it, an edifice complex. Yeah, I can't find it right now.

It's a lot of hospitals have what I call an edifice complex. Left, says all they want to do is build buildings and, uh, we should be moving past that. Today we've made that low asset entry into new markets is the way to go. That is usually led by digital initiatives, uh, and then followed up by, again, smaller footprints, strategically located parking lots that you can get in and out of without

Massive signs and those kind of things. Uh, I made a note of this in one of the shows way back that in my hometown in Bethlehem, Pennsylvania, St. Luke's will have a building on all four corners of a major intersection. And you look at that and you scratch your head and it's like, why would St. Luke's have a building on all four?

That one's for ob and that one's for radiology, and that one's for fill in the blank, but they each have their own parking lot. When you park there, you know exactly what you're going in for. Um, and you don't have to navigate this massive, uh, system. Anyway, this goes on to talk about how not nearly enough money is going towards the actual care.

And if we really did focus in on that, one of the things we would realize is that a lot of the buildings and the campus and the setup that we have is really obsolete. And if we can drive care into the home, there's an opportunity for a a trillion dollar . Benefit in care, in the delivery of care and the quality of care.

And quite frankly, in the experience. 'cause people want to age in place, they want to be in their home, they want to be able to see their family and and those kind of things. Huge opportunity there. That story is worth taking a look at by, so what on that is, it just has to be really strongly. Consider any investments you're doing in facilities.

From this day forward and really look at scrutinize them, is that required for your community? Is there a reason that you're adding on to that tower or building a new tower? Uh, a lot of those are gonna be . Obsolete the day that they are built. We need to be thinking agile and nimble and, uh, low asset as we go forward and utilize the, the space we already have.

There's an awful lot of, uh, commercial real estate in the market that is available. That's an awful lot of. Other ways to go about this, but again, digital is the platform for a lot of the capabilities that are needed. We don't have to be within the four walls of facility to to have a secure network, to have data sharing and all the things that we need.

Alright, last story. Chime advises ONC to help lift national patient identifier. , I'm not a fan of this. I'm not a fan of this for, uh, a bunch of reasons. One is I think it's the wrong approach. I think there is a, I think there's a commercial path to this. The other reason is I think there's a security issue with it.

The third reason is, uh, it just doesn't cover everybody. And Southern California, 15% of the people who came through one of our ERs didn't have social security numbers. , go figure. So what, what is this gonna do? Or are we gonna assign an MPI to these people? They don't wanna be tracked. They create IDs every time they come in.

Now we were able to use advanced algorithms, bring them, uh, together with a certain amount of, uh, certainty. Uh, we were able to link records and do that kinda stuff. But at the end of the day, if people don't wanna be tracked, they don't wanna be tracked. And the, the national identifier, while I applaud what they're trying to do, and they are trying to create a, a record, a, a single longitudinal record that gives you all the information you need at the point of care, but the reality is.

They don't review all the information at the point of care. There's so many holes in this, I understand, for research, but again, for research anyway, there's a lot of different ways to do this. But anyway, chime has taken, and by the way, a lot of you . A lot of CIOs and other individuals have said this is a good thing and we are encouraging Chime to pursue it.

In fact, I I've yet to run into too many people that agree with me on this, to be honest with you. Uh, so a lot of you're saying, Hey, push this forward. And they are, and this is exactly how I would push it forward if I were them. They not only got the champion, the legislation through and really educated the congressional leaders on this and got that, that moratorium pulled off, gosh, what was it?

Uh, the Foster Kelly Amendment. There it is. And they removed the bill that prohibits the federal funds for the adoption of MPI, which is exactly what we asked 'em to do. And now what they're doing is they're making recommendations to CMS on how this can be done and how it can be done effectively. They

They say that there's already mechanisms out there that they can utilize. They could utilize things like the post office or USPS. Yeah, post office data standards, so they can set up data standards to pull these records together. Multiple address standards, numerous birth standards. And again, they note, not all these, not all these are are perfect, but they will get us heading in the right direction.

Above all, chime continues to assert that the first policy obstacle that must be removed is Section five 10 of the Labor HHS appropriations bill that has been in place for two decades, concluded the organization. We continue to advocate strongly for Congress to remove this ban and open the pathway for a nationwide strategy to address patient identification while our members vary in their opinions on whether a unique number should be assigned to every patient.

What they can agree on is that a band is an enormous barrier to safe and interoperable care for patients. Maybe, clearly I fall on a different side of this, but at the end of the day, I think that Google's already figured out how to do this. I think they're doing it for Ascension. I think the ascension deal that everybody who's up in arms, uh, but I guarantee you they brought all that data in, they matched those patients just fine.

Quite frankly, I think that Apple can do this very easily and uh, probably already has done this pretty easily. . And I, I think a lot of this is a technology problem, not a lot of it. Two thirds of this is a technology thing that you can really address 90 some odd percent of the duplicates. The other is, quite frankly, there's a bunch of people without IDs, nor do they wanna be tracked.

So there's that aspect of it. My percentages are gonna go outta whack here real quick. And then there's, there's training. Quite frankly, there's training, and again, but a lot of this is technology. We can nudge people. So when people are checking in, you get that nudge that says, Hey, this person might already be in the system.

They find that person that's already in the system or even pop up potential people that this might be. So when I say my name's Bill Russell, I. It might show up as there's 15 Bill Russells in this health system. It might match based on birthday, might match based on my cell phone number, whatever the other things are.

But there's a lot of different things that, that can really address this, to bring this together. And then we still haven't figured out the structure of sharing this data across the board with, with researchers in an effective way. I guess we're starting to see that with Cosmos. We see that with some of the stuff that, um, Cerner's doing as well.

And there are others. Health Catalyst is doing this and I'm sure they are matching the patient records pretty effectively. Anyway, just wanted to make you aware of the fact that Chime is, is advocating for this and pushing it forward like we have asked them to do. That's all for this week. Don't forget to sign up for clip notes.

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