This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

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

Your response to CliffNotes has been incredible, and why wouldn't it be you helped create it? CliffNotes is an email we send out 24 hours after each episode airs, and it has a summary of what we talked about, bullet points of the key moments in the show and for video clips. So you can just click on those and watch different segments that our team pulls out that we think really captures the essence of the conversation.

It's simple to sign up. You just go to this week, health.com, click on subscribe. It's a great way for you to stay current. It's a great way for your team to stay current and a great foundation for you and your team to have conversations. So go ahead and get signed up today. It's Newsday and we have a full slate.

In fact, I don't know, we have like 10 stories. I have a very conscientious guest, ed Ricks from Sirius Healthcare who has sent me a couple articles, which includes . Some really interesting stuff around HIEs I think is interesting in the state licensure for telehealth. Ed, this is gonna be a fun conversation.

Thanks for coming on the show. Yeah, thanks for inviting me, bill. I'm looking forward to it. I always learn from you, so it's kind of fun for me too. Uh, absolutely. Well, I, I learned from you as well. I see your office has gotten a little messier. You've got the guitars behind you, you've got stuff on the ground, and so the travel schedule's kicked up again.

Yeah, definitely traveling more, which again, I've missed that I was just mentioning, but. There's good and bad there, right? So you don't get to take care of things the way you probably should. Well, people, most people are gonna listen to this on the podcast, so they're, they're not gonna be able to see what, what I'm looking at.

But clearly you play the guitar. I think you have. I. Actually, I can't tell what kind of guitar that is. Uh, well, a you're not allowed to figure out how much I spent on 'em, nor are you allowed to tell my wife how many there are. So, luckily my office is my safe armor, so . Yeah, I probably, that's the good, well, I'm, I'm getting on a plane right after we record this and I'm going up to Pennsylvania for my father-in-law's, uh, celebration of life.

He died in December. We weren't able to. Do a funeral. In fact, the funeral requirements were in Pennsylvania. I think we could only have 15 people at the funeral or something like that. So we did the burial back in December and now we're gonna do a celebration of life and we have so many really cool videos of him playing his Martin guitar.

He loved his Martin guitar. He took it with him. When he joined the military, he joined the Air Force. He took this Martin guitar with him there. He's had it ever since. We have videos of him playing to the grandkids. To our kids and and stuff. And it's kind of interesting to watch the evolution. And one of the last videos, it was him playing the Martin guitar and my son on piano going along.

And it, you go from when they're a baby and he's playing the guitar to them, to, they're actually playing along with them. It's, it's actually a really, it's a really neat montage of how he brought music into the life. That is very cool to me. And I know this is off topic, but that has been probably one of the saddest.

Things from the pandemic last year were those who did pass away, and whether you could celebrate with your family and friends appropriately, because my father also passed away last summer and same thing, Michigan. That's where he lived and we were unable to really do anything traditional, which honestly, he didn't want that.

But we're all getting back together in mid-August, so we're doing something very similar. We'll just make it more of a fun remembrance and move on from there. It's amazing to me how many people I have on the show that have guitars or some aspect if, if we put together the this Weekend Health IT band, we'll, uh, we'll give you a call.

Yeah, I mean, I've got a lot of hobbies that I'm really bad at. That's just one . There, there's a lot of stories. Gartner reported increase in the spending in it. Uh, Walmart's push into 36 states to support their telehealth initiative is interesting. McKinsey has a telehealth update. Amazon jumps into data lakes.

Telehealth within the hospital I think would be an interesting conversation. Amazon has an attribution problem. UnitedHealthcare, man, there's just truda. And then you send along the HIE story of the state licensure. Telehealth. Let's see, what should the lead be? Let's start. Let's start with the Garner report.

So you're traveling around again, you're with Sirius, so you talked to a lot of different health systems. Whatcha hearing with regard to spending? I, I was kind of surprised that this report talks about an increase in spending. It doesn't surprise me that we're spending more in certain areas in, in cybersecurity.

It doesn't surprise me we're spending more in that area, or data and analytics or even digital front door. Those kinds of areas don't surprise me that we're spending more money, but just the whole aspect of spending more money given the, uh, loss in revenue last year. Kind of surprised me. I would think that budgets would be flat.

If anything. What's the sense you're getting at? And I think we're hearing both things, right? People are still saying we have to do more for less, which I get that. I think everyone should always sort of have that as the plan, but they still gotta invest to move forward. And I. I think what we found over the last year through the pandemic was we haven't really figured out in healthcare.

I don't think, I mean, some people do a great job of this, but I would say overall, like how to really improve that patient and clinician experience, and that's got to be a focus. And so the telehealth things came into play. While I think the budgets are going up maybe in it, I don't know if that's coming out of other areas in healthcare and whether that's good or bad.

'cause something's gotta give. You can't take away, but you've got to be able to invest to move forward. You can't let infrastructure fall apart. I think you're seeing people shift away from traditional infrastructure and it does probably take some effort and and money to make that happen, but that's probably an investment in the future and how you're able to build the resiliency in the way you do.

Couple of the CIOs I've talked to about cybersecurity, they have said they are taking their three year plans and. People swinging as much as a million dollars in the direction of, of cybersecurity in the next six months to shore things up so that they don't become one of our future stories. Are you hearing that same thing?

Are you seeing a lot of money flow in the cybersecurity direction? We are. A million dollars is nothing right for some of these initiatives, right? Right. Absolutely. What, what? To me, what's cool to see is probably how we should have been thinking maybe a little differently for the last 15 years is. Not looking at cybersecurity as a technology problem and what do we invest in, but looking at it as a risk management problem and how do we invest to not become one of your future stories?

And if we can't learn from things that have happened to some of our friends, you know what I mean? I think that we have to, and most people are really good about, I. Both sharing what happened and why, and maybe how they could help prevent it to some degree or mitigated it. And then learning from that with everyone else.

Well, that, that's an interesting comment. Uh, it's not a cybersecurity problem, but a risk management problem because in our organization, it actually reported up through the risk management organization and people were like, you're kidding me? Security didn't report up. No, it was, it had nothing to do with it.

It was risk management. The chief security officer was a peer of mine. And we had, we had to work closely together. But it really came down through risk and compliance is where it reported up into. And for the most part, I would say we, we had to do all the controls and the, and the software and, and those kinds of things.

But the agenda was really driven by a team of people. And it was really board directed as well. I mean, 'cause we were talking about the various risks. They would determine what the, the highest risk was, or we would make recommendations on the risk. They would chime in and then we'd come out and we'd develop budgets out those conversations.

And I, I think Carl West, who's also was serious, we've had some conversations. He talk about the same concept of having a comprehensive. Mitigation strategy as opposed to just plugging holes. Right. No, I totally agree with that. And that's the way we try to handle it all. So as the CISO did report to me directly, but I, I didn't necessarily even want that.

Right. So work came in hand with our compliance officer and risk management was the piece and reported through the audit committee, the board going to the board for everything. Because I, I agree. I don't think cybersecurity is necessarily a technology issue. It is managing risk, and we have a hundreds of other risks in the healthcare organization.

So you gotta balance that. And where do you make the investments? Takes technology and probably education, you know, to really improve a lot of the, the risk that you have in cybersecurity. But I don't think that you should drive it from, from a technology perspective either. All right. We're gonna go to the first of one of the two stories that you sent me.

This is an interesting one. This is about state licensure for telehealth. There was a Wall Street Journal, Op-Ed on July 20th, Joseph Bernstein, MD and Shirley Ney PhD. Shared insights on state licensing laws and why they believe the regulations are restricting virtual care practices, which they do. They absolutely do.

Dr. Ney is economics professor at Cal State Northridge. Referred to the current state licensing laws, a barrier to interstate commerce. Okay. Why not to find the location of telemedicine treatment via the, via an act of Congress as the doctor's location, as she wrote, seeking care from out-of-State physicians via telemedicine would be treated as no different from.

To the physician's office for care. Dr. Bernstein is an orthopedic surgeon. He makes the case that, Hey, I'm nationally certified, so why all a sudden would you break it down by state? He's a member of the American Board of Orthopedic Surgery and US Medical Licensing examination. You get the picture and then for these reasons, he said, let's be state opposition licensure.

Competition. So why did, why did you pick that story? What's your take on this? You know, I've always sort of had a question around the licensing, both from nurses, I mean all the licensed healthcare providers and physicians. Like if you think of it as a patient perspective, right? If you travel from one state to the next, I live 20 miles from a state borderline.

If I'm shopping 40 minutes away someplace and twist my ankle and go into urgent care, I have the same expectation of. Of care from the providers I would have at home. Right? What? Why would they need to be licensed in every state other than a control and. For the state to have some revenue stream from that?

Possibly. I, from the telehealth perspective, I don't know that I agree that it's to protect the local providers. I mean, I feel like the local system should do everything they can to be able to compete with their providers and that will protect their business because those non-local providers can still get licensed in the state.

I mean, you look at all the . The Nighthawk Imaging Services, all the American wells, things like that. They have providers license in multiple states that don't live there, so that already is happening, right? I think it's more about the state control around that, but if you look at it from the other perspective of the patient, why not make it as easy as possible to get care where you need, augment specialties if necessary, drive maybe the competition, I think in some areas around that.

Take on it. Yeah. I look this I, I would take three perspectives. One is the physician.

So from a patient standpoint, absolutely tear down the barriers, make it easier. Bring more competition into the space, create more access points, give you more choice, more options in terms of how much I'm gonna spend for the care. Absolutely. Now, clearly we want medical care to have oversight and we want it to be done well.

And so, but from a patient standpoint, I think it's a win to head it in this direction. Now there's two ways it can head in this direction. Obviously the Cal State North is in California, so you can get an idea of where the political leaning is. I've heard other people say, yeah, we're, we're doing this just differently.

And that is compacts between the different states to certified licensing across different states, and I think there's, it's up to about 30 to 35 states that have licensed together to say.

Sort of approach to this as a physician? The, I, I'm not sure I would be as concerned about it as a physician. I think physicians need to get more savvy with regard to technology. That's just the case all the time. Uh, and their practice needs to be more efficient. It needs to be able to handle some digital tools for scheduling and those kinds of things.

So those are additional burdens and additional costs for local practices. This is why a lot of practices and cybersecurity and other things, this is why a lot of practices are folding into IDNs because can't afford outlay. Now, the good news is I think there's a lot of cloud plays that make some of this stuff.

Cost and whatnot. But so the local, I'm not sure is it impacts the local provider as much as it does the health system from this perspective. Yeah, you're right. The Amwell, the MD lives the Teladocs, the Amazon Cares, the ME, md, Walmart thing. Those are companies at scale. They have a lot of money. They can come in here, they can get licensed in all those states.

And they have a lot of runway, so they can do those kinds of things. But what this really enables is smaller players. So if you and I decided, hey, this, this is an up and coming space, this is where healthcare is really gonna start in the future, and we want to get into this. We go raise $20 million. We haven't raised enough money.

We have to raise $90 million to get the runway we need build.

We could potentially do it on $20 million and stand up a pretty good practice, target a few handful of locations and those kind of things. So, I mean, I, I look at it from, from that perspective, I think there is some angst within health systems that if this barrier comes down, the competition will go up.

Now they'll frame this in quality of care and, and those kinds of things. And, but at the end of the day, it's, uh, somebody's gonna get in in between the, the health system and their patient and the consumer and starting to direct care. So I, this is a, this is a tough question. I'm not sure this is going anywhere to be honest with you.

I've talked to influential doctors that support the state licensure, and the most interesting one to me was Dr. Joseph, who's the head of telemedicine. Association and he supports it. He supports state licensure. So while I hear people saying, Hey, let's nationalize it, I hear some very influential people in positions that you would think would say, Hey, let's, let's, you know, make it easier.

And he's saying, no, no, they're the state licensing boards, uh, oversee quality at a closer level to where care is happening. If you did it on a federal level, how much oversight would you really have over. How care provide. He, he made a case around it on the show and I was kind of surprised that he made that case.

I asked the question to sort of have that clip going forward where he would say, yeah, this needs to go forward. And he, he just absolutely surprised me. Well, I mean, you, in our case here where I used to be the CIO at, when we brought in amwell, not only did all the providers have to be licensed and we're South Carolina, but they also had to be credentialed on our medical staff, uh, because we were integrating them into our own

Primary care providers or urgent caress and things like that. So that is even another level of complexity. Again, it is another good way to sort of get your arms around the local quality and things like that, but definitely makes it more complex. There's a bunch of telehealth stories. The Walmart story's pretty straightforward.

They're getting licensed in 37 states because of the MD acquisition. And which I, I don't think it's gone through regulatory yet, but it's heading in that direction. So Walmart's getting into the telehealth space. We have Amazon care getting into the telehealth space, obviously. And there was an article here, Amazon Care, Intermountain Ascension Launch Hospital at Home Healthcare Alliance.

That's interesting, isn't it? Yeah. That is really cool. So now you see traditional. Intermountain Ascension partnering with New Entrant. So lemme give you a little on this one. Intermountain Healthcare Ascension Care are founding members of a new healthcare coalition aimed at expanding homebased clinical care.

The group dubbed Moving Health Home will support and update healthcare policy changes to designate home as a site of clinical service according to a news release. So this, this was from a little while ago. I, I, I bring this up as sort of a, there are opportunities not to just look at these players as competitors, but there's really opportunities to look at 'em as potential partners.

I think if you don't, you're gonna carry yourself out of the future to some degree. And then definitely in different communities, that's gonna be the case. 'cause those companies understand distribution at scale and how to reach out to customers and certainly how to focus on . That patient experience. I'm sure there will be speed bumps along the way, but it makes more sense to partner and, and again, you've seen some of that even with smaller people.

Again, I'll go back to my system we partnered with in this geography, Publix is a big grocery store chain, just to partner with them to get urgent care centers within the grocery stores, you know, so we had a telehealth center in there. They would provide the tech and if needed and we had the equipment and then telehealth in it.

And I think it makes sense 'cause it's just a way to reach out to other customers and other patients. Well this is an interesting article 'cause this is a little different take on telehealth and this, this becomes a definition problem. The headline is, in hospital telehealth is not an oxymoron and here's why.

And I think one of the problems people have is telehealth. Direct to consumer, consumer, patient, we're setting up a, a connection. But the reality is we use telehealth all over the place. Telehealth, we use it for, uh, consults. We use it for telestroke care across different venues where you don't have the, the, the funding to set up, uh, stroke care.

So we did stroke care out one of our hospitals was the telestroke. In, in some cases rural type location. It was our telestroke program. So it was all done via technologies, via video visits, via shared monitoring of the patient. That was a really effective way of getting people that that kind of care in places that normally wouldn't be able to afford it.

So in hospital telehealth, talk about that a little bit. What areas. Have we seen that or where is it growing or how has it been used? I would assume Covid-19 revealed a lot of use cases here. Yeah. I mean, literally you, the telehealth provider could be across, uh, on the other side of the wall and just didn't want it gown up and off and on and all that stuff.

And it's almost. Which, this is gonna sound really counterintuitive, but it's almost more personal than walking into a room with a mask on, a face shield, a gown, and all that stuff, when you can actually be in your office and communicate with a patient more frequently and easier, I think. So that definitely saw a spike like the EICU stuff that's been around for 20 years now.

And worked well. And I think that you're seeing that just the same way as a stroke. You'll have the center of excellence and then all the other folks who are the hubs on that would connect to it. But then I, as the EICU, you're starting to see that now. So places have some of the capabilities in a more rural environment yet need that intensivist that could be always available.

When needed this tied directly to what's going on. So you're seeing that. We saw a lot of workflows. We didn't have an opportunity while I was still with the system to implement some of them, but we certainly did. We had some rural clinics and even just orthopedic visits and things like that you could do through telehealth.

Maybe the non-traditional. A lot of people think of just the urgent care. Telehealth is, I agree, there are so many workflows no different than a provider to provider picking up the phone 20 years ago just to call a colleague to ask for some advice on it. Yep. We did, uh, Telep Psychiatry was one of the things we did within the hospital.

After hours when people come into our emergency department and a certain percentage of the cases we had to do psych evals. And it, it didn't make sense given the volume to have a clinical psychiatrist or psychologist in each one of those locations. And so we had a one or two on call and it was all telehealth to even some of our larger locations and, and they would have a pretty full slate through the night.

But if they were at any one location. They would've had almost nothing to do. Very inefficient. But you know, it's interesting in that article, I think it broke down like the different disciplines and what percent of visits were telehealth visits. And the number one is behavioral health. And even not, not just on the acute side, but I think on the clinic side.

And so I was trying to figure out why. Why that is a, you can reach more people, obviously. Right. But I then I wonder, is there like a stigma to people in an outpatient setting to go into an office or versus being able to just sit at home? I, I would've thought 10 years ago that behavioral health would be like the last place adopted for telehealth.

but I guess I'm thinking of more acute cases, but when you look at what's really happening, it is, it's really driving the market a little bit. Yeah. It's interesting I gave you so many articles. I think you just confused to the articles, the McKinsey article. Oh, probably . Yeah. The McKinsey article has a bunch of where telehealth happened, and it was very, very interesting.

Psychiatry was the largest area far and away substance and use disorder treatment was. Endocrinology, rheumatology, gastro neurology. And then it goes down from there. But lemme go back to in hospital. Mm-Hmm. Telehealth because one of the biggest problems, let's see, I was in the hospital once. My father-in-law before he passed away was in, uh, several times.

And one of the biggest challenges is the doctor's gonna be in to see you today. Well, nothing more frustrating than that statement today. Today is 24 hours. When am I gonna see the doctor? And the reality is we're not real tight with regard to those, that kind of scheduling. And we wanna give the flexibility to the doctor to make rounds when they're gonna make rounds and those kinds of things, we can really tighten that up with, with telehealth.

In my case specifically, I would not have minded if on the tv the doctor popped up and we had a conversation. He could share some of the findings and that kind of stuff. My father-in-Law may have been a little miffed if the doctor didn't show up in person and showed up on a tv. But we can determine that stuff upon admission.

And to be honest, the level of frustration my to Father-in-Law, my wife and I felt, you know, the doctor will see him today and then at the end of the day, well, the doctor wasn't able to make it in. And you're like. I mean, literally he died in December. So I mean, it would not be out of the ordinary to say, Hey, he's dying, right?

The doctor can't see him today. The doctor can't get in. I mean, can't we be more efficient around this? And I would think that doing some sort of rounds or integrating this into the rounds in some way would make clinicians more efficient across that aspect. I'm.

Smoking something here or is that a, a valid, uh, assertion? Right. I mean, it makes sense to me, right? I, and it's clearly more efficient, uh, if nothing else, through the pandemic. We saw that of the adoption of some of these telehealth. Processes are clearly more efficient and hopefully that'll what'll give us the momentum to keep moving forward.

So I totally agree with you and it is frustrating. And then you wait all day and you don't see the doctor and maybe the PA or something will show up and certainly just as probably capable, but it doesn't feel the same to your father-in-Law. It may feel the same to me, but maybe not to him. And so I get it, and if you can integrate that seamlessly into the workflows.

It would make sense just like we're starting to integrate telehealth visits into clinic, office visits. It can be right on the schedule. It's just your next patient is telehealth. It's not somebody sitting in the lobby. And so if you can make that seamless, it makes sense to me. And how do we make that seamless to the physician who got caught up in surgery longer or whatever specialty is if things happen throughout the course of their day to keep them from visiting in the hospital.

But there's got to be a way to make that. I think technology is gonna be the answer. Somewhere around that. Probably cultural is the other component. You gotta jump over. I wanna get to both of your stories. I think they're two really good stories. Uh, unified data. The key to HIE success, actually, I'm not gonna go into this story too much because it's gonna sound like I'm being critical.

It, it is an ad piece by the way. It's written by somebody who's a solution director for an organization. It's on healthcare IT today. They make the case for essentially master data management. Across HIEs in order to do this. And, and part of my problem with it is I, I read some of these things with human guided ML for data mastering.

ML does the heavy lifting to consolidate, cleanse, and categorize data, enabling healthcare teams to drive better outcomes faster. This approach can also vastly improve patient analytics, allowing for targeted care geographic.

It's just so whitewash is how hard this is, right? I mean, it's just like, oh yeah, just plug in a cloud native master data management, and all of a sudden the machine learning is gonna take care of all the problems that you have. The reality is there, there's a couple problems with HIE, A couple of challenges, but the problem is at the point of entry of the data.

We have different definitions of data. We have different standards for our data entry clerks, otherwise known as c clinicians. Uh, we have, uh, clinicians that we don't have agreement across our individual hospital how we're going to enter data in certain cases. And now all of a sudden you're saying, Hey, the HIE serves the region and if you think we're gonna be able to control or get closer.

By just plugging some technology on top of this for a region like Southern California where my clinicians can't agree with the clinicians within our own health system, how are we gonna do that across a region? What's the state of HIEs today? And where do you think this is going? And that's sort of why I landed on article because.

I again, while some of this sounds really cool, I don't necessarily agree that HIEs have solved a lot for us in healthcare. From the broader concept, it has brought a lot more data and information to be available to providers, but is it when they need it and where they need it and something they trust, and all those things people talk about for 10 years now, I think that the plan.

The long-term concept is if you've got one sort of unified medical record, but none of that helps unless it's fully integrated into the workflow of what the physician's doing. So the example I think I mentioned earlier is, has it really kept people from ordering unnecessary cts, whatever. If you're the ER physician, someone presents, and that's sort of in the care plan that's gonna happen for you.

Is it integrated real time that someone across town from a different system actually just got a CT last night? It may be available to you, but it may not in your EHR, which is probably different from theirs while you're ordering that as you go through, I don't know if that happens and just like a lot of the other information that's out there, it just becomes information overload.

How important is all of that? What's distilled down to drive insights while you're delivering care? and every, just as you said, everyone thinks of everything different. They used to crack me up, so a hundred years ago, before I became ACIO, I was a software developer and we did sort of EHRs before they were very clinical, right?

But it was a lot of it was billing and things that we did at the time, and I love the fact that our actual billing forms were the ubs, whatever they were at the time, UB 80 twos, whatever they were. And UV was uniform billing. Well, yes. Everyone used the same piece of paper, which later became the same electronic form.

And while it was called uniform billing, every organization, including all the payers, treated each one of those fields differently. So while they were printed out, they looked the same when they were printed. But the information on 'EM neck something different to every organization. It's no different electronically today with the clinical information in this area.

I really like the work. OC is doing. I like the work. I like how Mic Pathy is continuing in the work. I think some of the most important work that is, uh, uh, untalked about within our industry is the work in the, uh, us CDI It is around the core data set that that is being developed and what people don't.

That the federal government is sort of the floor. They're looking at it saying, all right, we need to have at least this core data set. Right? Right. So they're putting that together. What they hope will happen is that healthcare as an industry or even as a region, will self-organize. Come together and say, we're gonna design a core data set around, fill in the blank, uh, what, whatever the area is.

It doesn't have to be comprehensive. You're not trying to do this across the entire EHR. You can do it in just, in just oncology or just in just one area. If you can get a, a group of people in a region to sit around, they can start to just define some of those standards and that team will help you.

Establish how to put that stuff together. And if we do that on a regional basis, some of those regional standards can then essentially move a around the country that work at us. U-S-C-D-I is so important, but if we don't self-organize and we have very little propensity to self-organize, the federal government's just gonna keep.

Down the line, it's gonna take a lot longer, but they're gonna go down the line. They're gonna start with the, uh, core clinical dataset that they have now, and they're gonna start to move in into other areas. I hope we're smarter than that. I think some health systems are trying to lead the way in this, especially coming out of the pandemic and the needs that, uh, were unmet because of the quality of the data and how we were putting the data in there.

I hope to see this. Not require a federal mandate, but that we just recognize as an industry where we can, we can really address this problem with, with standards around, just sets different sets of data and then the transferring of that data obviously fires there and we have a different, about a couple different ways to, to move the data around.

So it's not the, that's not the hard part. The hard part is getting quality data in and available. And I think what people have to, there's gotta be incentive to do it, and I don't necessarily mean a financial incentive. So I, I feel like most organizations, probably all organizations, right, they wanna deliver quality care, they wanna improve, you know, the, uh, lives of the people in their communities and.

So that should be the incentive enough to do those things. And I think you're creating efficiencies though in your organization when you can do that. And you are going to definitely lower expense to deliver that care over time if you're measuring that quality and make an improvements based upon what you learn.

Uh, but there's something that's got an incentive that to happen for most people, I think. Alright, so Ed, let's, let's close this story as I said.

We will, we'll cut this one a little short. So Truda grows to more than 15% of US patient care with three new members. So Truda is this partnership that has formed, they've raised a hundred million dollars, giving it probably a billion dollar valuation. If I thought about it, I'm not entirely sure what it is.

Essentially they pulled data together, the initial health systems, advent Health Advocate, Aurora Baptist Health, south Florida, Baylor Scott, and White Bon Secours Health, common Spirit, Hawaii Pacific Health, Henry Ford Health System. MedStar Memorial Hermann. Northwell Novan, Providence, Sentara Tenet, Texas Health Resources, Trinity Health, and actually in three recently.

And those are Baylor Scott.

This is an awful lot of data. They have a hundred million dollars that has been invested in the organization and they're going to be bringing this together for the good of mankind. I mean, that's the whole premise around this, is we're gonna bring all this clinical data together, make it available to, for anonymized, of course, for.

Dataset. Mostly it's just making people aware that this is, this is growing and it's a growing trend that the aggregation of this data, how I view this is, this is all in all this is a good thing for healthcare and for patients in that hopefully this will take us closer to identifying cures and getting closer to personalized medicine and those kind of things.

As I look at this.

Interest to me. One is it, it appears to me to be more of a capital capitalist kind of thing than a for the good of mankind. I'm not questioning people's motives here. I think there's an awful lot of good value. I just said that around this, but it's a hundred million dollars has been raised. The valuation is a billion dollars and all these health systems are investors, and I think you're seeing more and more systems say.

It's a $4 trillion market. We're not only gonna make money as healthcare providers, we're gonna make money as providers to other healthcare systems, and we're gonna start leveraging the assets that we have to greater value. And one of the greatest assets they have is that medical record that they have amassed over the last decade or two.

And so I think they're just tapping into other value streams. Health system and really monetizing that, that value stream. I'm curious what your thoughts are on Truda and their direction. I mean, I think I pretty much agree with you. The concept is kind of cool, right? But it's all gonna be retrospective research.

You know, when it, maybe, someday, I guess this is probably the, the, the holy grail is can that help drive insights to deliver care to you when you're in the hospital? In real time and what does that mean? And that's, to me, a completely different story and what's gotta happen from a mechanism perspective.

But that's a lot of data. Normalizing that data. You've got all that work to do to make it all make sense, but you ought to be able to drive some insights from that kind of dataset. Yeah, and I think they're going more in the research direction than the realtime insights at the. Leave that the biggest, I guess both.

I, I see a big impact from a research, like you said, if we can help find cures for things that bring all this aggregated data together will drive that. It does make a lot of sense, right? Because it takes a lot. The more data, the better. There's no doubt about it. But when, when you talk about personalized medicine and how do we really impact each patient at the point of care, to me that's where

Someone's gotta make that happen. From that level of dataset, this whole data supply chain's getting really interesting to me, of which, which data is really good at the point of care, and how do we make sure that that data has a, a really good supply chain to get from its source. Inside the clinical workflow and then identifying what data is only mucking up the clinical workflow.

There's too much data in the clinical workflow today, and how do we take that data out and do the analysis we need to do, get the insights we need to get and just deliver those insights into that workflow And we'll, doctors trust that or do they need to see every aspect of how that data was derived before they will trust it.

And, uh, be able to, to take action on it. And there's, there's a lot of cases to be made. Uh, IBM Watson being the biggest, we've had a couple of missteps with regard to data in the clinical workflow, and we have a trust gap to really fill. And I think that's one of the reasons you take a, a startup like this and you focus it on research because you can.

You, there's a bunch of different ways that you can address any data gaps or data quality issues along the way if it's being used for research as opposed to realtime delivery of. No, I agree with that and I think ultimately physicians will trust, I mean, we've sort of landed on evidence-based order sets.

It took some effort to get away from 20 different specified order sets down to one or two or three perhaps, uh, as you go through medical staff. And so this to me, doesn't seem a lot different other than the fact that order set's gonna differ for patient A versus patient B versus patient C based upon what the evidence and the insights are driven from it.

Ed, I want to thank you for doing a whole show where we only margin cybersecurity,

cybersecurity. Risk management, cybersecurity. We had that short conversation earlier on, but it is such a top of mind topic. So many news stories out there right now around cybersecurity. We end up talking about those a lot. So it's super relevant for sure. So it's super, it's super relevant. Yeah. You'll come on a little later, maybe in, uh, a few more weeks.

What topics do you think are be hot over the next. We have HIMSS coming up and I was just gonna say, I'm sort of curious to see how HIMSS goes and what if we learn from an industry perspective much of anything through that other than it's hot in Vegas in August. I think we all know that going in, so that that part will get for sure.

But I think that'll be interesting. I am still curious to see how people are. We're actually gonna focus their spend over the next couple of years. And that's starting to sort of shape up. And we did address that, uh, most, a lot of cases. The one thing I left out was, I think it's, it's actually reducing complexity of what they've got in their environment and, but still being at a higher level of what they're get putting out at the end of the day.

And, and I think that you'll see that trend. Yes, I think that's true. That will be an interesting topic to see where we start to do budgets. Uh, some of the budgets will come in July 1st. A bunch of health systems is their fiscal year, so we'll start to have conversations with CIOs around where they're, they're placing Betts as a health system.

Some have September, end of fiscal years as well. Not as many have January 1st fiscal years anymore, just because closing the books is hard and you don't really wanna be doing it over the month. Well, and I think a lot of organizations line up with the CMS, the federal government year, which is October one.

So yeah, we did July, which is easier to get resources to work on the books and, and get all that stuff done. Always a pleasure to have you on the show. Thanks. Thanks for coming on. Talk to you soon. What a great discussion. If you know of someone that might benefit from our channel, from these kinds of discussions.

Please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show. It's it's conference level value every week. They can subscribe on our website this week, health.com, or they can go wherever you listen to podcasts.

Apple, Google. Overcast, which is what I use, uh, Spotify, Stitcher, you name it. We're out there. They can find us. Go ahead, subscribe today. Send a note to someone and have them subscribe as well. We wanna thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders.

Those are VMware, Hillrom, Starbridge advisors, Aruba and McAfee. Thanks for listening. That's all for now.