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 Welcome to this Week in Health. It, it's Newsday. This is our last episode of the year. It's actually a, i, I would call it a top 10 countdown, but that's kind of self-serving to, these are the top 10 things that I, I said on the show. So let's just call it a recap. A recap of what happened this year. Uh, clearly

Covid was, uh, top of mind, but we have a bunch of clips from earlier, and this will give you an idea of some of the things we were talking about ahead of time, uh, and how things transpired as a result of that. This is gonna be one of three episodes that we do that do a countdown. We're gonna do this, we're gonna do a covid series, uh, which is the top 10 things that were shared during the, the three months that we did daily episodes with health systems, sharing their best practices.

It, as we get to the end of the year, I really wanna call out our channel sponsors and . Tho these are the people who have stepped up in, in a big way. VMware was our first channel sponsor and they took a risk on the show. At that point, we had no sponsors and they said, we really believe in your mission and, and

And we appreciate their support. They will be a sponsor again next year. So looking forward to that as well. Uh, Starbridge advisors, David mts, SU Shades, uh, company, and all the great work that they do do, and I appreciate them coming on the shows as well to, uh, share their wisdom. And Sue will be a, uh, contributor next year on, uh, every six weeks on the Newsday Show.

So looking forward to that as well. Gail, in healthcare. Doing great work around data and application consolidation. Health lyrics is my company, uh, Sirius Healthcare. We talk about Sirius a lot. They, they, uh, were, were huge this year just in terms of their commitment to stepping up during the Covid series.

They called me up and said, look, we believe in your show. We believe in what you're doing. How can we support the mission and what you're doing? And we created a, a unique sponsorship just for them. And then they have stepped up since then to be a channel sponsor. They're gonna sponsor again next year.

Really looking forward to having them on board. Pro talent advisors. Really exciting, uh, startup company that is doing staffing. . And, uh, some really interesting things contractually in supporting the, uh, organizations that, uh, really across the nation in terms of, uh, large healthcare, uh, projects, ERP implementations.

Just, just a bunch of different stuff. I love working with them. Health. Next I. Part of HCI, this is Ed Marks, uh, the work that Ed Marks is doing around a digital platform to support all of your digital initiatives. So instead of building silos, you're gonna bring it all into, uh, into a common platform so that you can orchestrate experiences across the entire health system.

McAfee and Hillrom were the latest people to latest companies to join us and to become a part of our mission. and we appreciate them. You're gonna be hearing a lot more about Hillrom. They have stepped up to be a sponsor again next year, and I'm looking forward to, uh, breaking some of the myths that you have about Hillrom.

They're not just a bed company, they are a digital company. They're doing a lot of really exciting stuff around communication. Uh, nurse call all the way through, uh, communication into the room and, and you name it, they're, they're doing some fun stuff and I'm looking forward to, uh, talking to them into the new year.

And, and none of this would be possible without them, and I really appreciate them. Alright, let's get to the news. So we have 10 clips that we've hand selected, that the team has hand selected that we are going to, uh, run through for the year. The first one's on ai and we were, I mean, it was being predicted at earlier in this year that this was gonna be the year that AI really had a breakout and

Some of these things that were predictions really were stifled by Covid, but, but this one was not. AI took a huge leap forward. You had the protein folding thing that just happened recently with a deep mind. That's a huge step forward solving a 50 year old problem. You also had just a ton of things happening around automation and

Using AI for automation. You also had AI in, uh, chatbots and other things that were utilized during the, uh, during the pandemic. So let's our first clip around ai. Here you go. That's one we've talked about on the show, and I firmly believe AI in the form of robotic process automation will become more appreciated and useful as a tool in healthcare administration.

I think this is already happening and will continue to happen. This was one of my predictions for the year. Number the next one. Conversational AI will be increasingly more common and sophisticated in healthcare. Absolutely. We're seeing that, and we've talked about that a bunch on the show. There will be less hype about deep learning and its ability to predict with superior results, the more and more focus on patient outcome and behavior.

I think that's true too. You're gonna see this. Really applied to the patient and impacting their behavior. 'cause when you think about it, if you can't keep somebody from eating McDonald's every day, it's gonna be hard to keep 'em healthy. And so there's a whole bunch of places that AI can be applied that is not as intrusive and.

I have as many barriers to it. Next one, there will be more application of AI in altered reality, virtual reality, augmented reality, and mixed reality. I'd love to talk to him about that some more and understand that, uh, certain s surgical and procedure-based subspecialties will incorporate image interpretation and deep learning more during procedures.

Also fascinating, important issues in AI, in medicine, such as bias in, uh, inequity and particularly data privacy will be even more in the forefront. Absolutely. We're gonna end up talking about privacy and security a bunch this year. I have a feeling and regulatory policies regarding AI technology in medicine and healthcare will start to reflect the exponential rise of AI capabilities.

All right, so here's my take. , if you're a leader in health it get in front of this. Get your people trained. Be the most knowledgeable person in the room on this topic. Get in front of the eth ethics issues. Set up governance if you are large enough with enough adoption. This is, this is a, a top of mind conversation.

This is the, this is probably one of the top conversations over the next five years. Top of agenda. It. This is going to be one of the forefront conversations for the Foreseeable FU future. And so my comment on this is get ahead of the curve as much as you possibly can get ahead of the curve. We have to go back to early in the year and, and look at some of the predictions that we're, that we're coming down.

And so our next clip is really . Uh, touches on some of those predictions. And, uh, again, some of them have really been, uh, accelerated as a result of the, uh, pandemic. Some of 'em have, uh, slowed down as a result of the pandemic. So, we'll, let's have a, a listen to this clip and, and we will. Decide for ourselves.

Now, some of these have a bent of. Of course somebody from the payer is going to say this, but I think this is really a, a real trend that is going to happen and, and really it's about time care is finally going out of the hospital itself. And I think we would all agree it's about time. It's very expensive and there's a certain amount of risk to it.

Clinics of all shapes and sizes are popping up across the landscape. Some are run by health systems, some are, uh. Actually some, they're, they're being run by a lot of different things. They're being run by employers, being run by venture backed groups. Some retailers, uh, Walmart obviously is, is getting into it.

Amazon Care, Amazon's running, that's an employer back employer program. It's a lower cost venue and it's really becoming the preferred choice of, of many. But I agree with him that this is just a stepping stone to some more bold moves in telehealth and home-based care. Models. Yeah, I, I think this one's going to accelerate a little bit.

You always have to look at the financial models and where it makes sense. 'cause that really will determine the speed at which something moves. But this is, uh, this is gaining some traction and it's a, uh, way for, uh, new entrant to compete. And so keep an eye on that. So a lot of predictions around telehealth, but quite frankly, we could go back to 20.

All right. This is the first of two clips. The. The next one. Which one is this? This is number, number seven. Actually. The number seven clip. There was, uh, a lot of talk about interoperability. Interoperability is still key. We can't do so many things because of interoperability. We're having trouble tracking the vaccine because of interoperability.

We're having trouble doing social determinants effectively in our communities 'cause of interoperability. We're having. The, the challenges are endless, and so 21st Century Cures decided to really address that, and we required a rule as a result of the 21st Century Cures Act. The rule was put out earlier this year, and it created a little tussle, a little back and forth on.

First of all, what the rule was, and, and Epic had some challenges with it. So we talked about that. The first one, actually, these are probably out of order, but the first one we talked about is, is some of the challenges that Epic has with the interoperability rule and, uh, some of the things that they were, uh, talking about earlier in the year.

Here you go. Here's the next clip. I like the fact that Epic brought these things up. But your recommendation is essentially put something in place to protect their, their privacy and, and, and make the requirements more solid. It's, I dunno, it's a, I really wish there was more meet to this. I wish there was a link to another page that would say, here's what we recommend as Epic as the leading EHR provider in this industry.

As a patient advocate, we recommend these changes to the rules and these things be put in place. That's what I would like to see. So my take. The, the argument's interesting, to be honest with you. It's an, it's an unpopular argument and I think it's an unpopular argument because it appears to be protecting monopolistic practices of the HR providers and it's just the appearance of it.

And the other side seems to be being the patient advocate, saying, Hey, shouldn't the patient have their own data? Shouldn't there be transparency? And so that's . And just from sheer optics, it's always gonna look better. Let me tell you how this is gonna play out. So if it gets approved the way it is, the biggest winner is gonna be Apple and Google.

Google. Lemme tell you why they'll become the security mechanism for health records. The API will open up the data from the EHR providers and they will bring it into their phone apps. They will bring it into Apple Health and Google Health record. I, I don't know what the Google one is called, but essentially Google's health record, Apple's health record, and because that's gonna be the mechanism, that's gonna be the platform we all bring it into.

So they're gonna be the big winners. Health systems are, are then going to . Really be forced to put things into place that allow people to come in with their phone, that has their complete medical record, stored by Apple, stored by Google, and give them the ability to give them the record and give the record back to them, uh, when they check out.

All right, before we get to our next interoperability one. Uh, the next clip actually is from a friend of the show, ed Marks and, uh, ed made some, uh, predictions, uh, predictions, I'm not sure if predictions is the right word. He made some, uh, comments, had some commentary around why digital lags in healthcare, and it was interesting because it was probably pretty prescient for him to talk about this because digital became

Not a nice to have during the, uh, era of the pandemic. It became a must have during the area of the pandemic. So here's a, a few comments from, from, uh, a story that Ed wrote Digital Healthcare Lags. This is Ed Marks former CIO of the Cleveland Clinic and, uh, frequent guest on the show. Ed wrote this on LinkedIn.

So if you wanna find this article, go to LinkedIn and find his profile. And pull it up. So he gives 10 reasons why digital healthcare lags. I love it. It's, it is really good thinking. So IT leadership, he says, gulp, this is me, my circle, my friends. We unintentionally became inbred. We believed that to be effective, our workforce had to possess healthcare experience.

We are special, unique. Spalder. We stifled innovation that comes from hiring from outside ourselves to include progressive industries. We insisted everyone have 10 years of this or that in healthcare. Worse, we specify technical degrees. The best teams have a mix of degrees and experience in and outside of healthcare.

We can fix this. Alright, so he goes on 10 more of these. I'm gonna gonna touch on some of 'em. I'm not gonna read all of them. People development. We stopped growing our teens once they left orientation. Great point. Finance. He talks about old practices and how we, we have this return on investment metric and these governance structures, but digital changes things.

It's marked by agility, velocity, return on experience, but we still employ the old methods, a supply chain. He talks about operations. We desire digital technology adoption, such as virtual care, but struggle to evolve because of tradition and cannibalization fears. There's a fear of use cases for.

Emergency departments to adopt virtual care, but resist because of potential revenue loss or ed. Patient volume decreases. This is all true. Clinics Digital S synonymous with transparency, simplicity, service and automation. Bottom line, the experience. USAA. Marriott American Airlines know more. About me and my family, and then my hair healthcare system.

It is easy to communicate through multiple channels. Easy to make appointments, easy to interact, easy to share information. Easy, easy, easy. We can fix this. He talks about fear. Uh, fear failure. People have said, fail fast. This is what they do. And then, and then healthcare says, Hey, we can't fail fast. We're talking about people's lives.

And he talks about failing safe, utilizing the technology in areas where it's not gonna impact patient care. But you can see how it impacts the overall environment and then slowly adopted in other areas. But failing safe, but still failing safe. Alright, as I promised, we're gonna get back to the, . To the comments around interoperability.

This one, I just, I, I laid out what the, what CMS was actually proposing. A set of APIs they're proposing pulling in some payer data. Well, actually, I, I'm going to ruin the clip. Here's the flip that talks about what CMS was actually proposing in the interoperability rule letter written. CMS. Let's see. Let me hit their website real quick.

Here's what administrator Sima Verma said in this. In this frequently, uh, asked questions type thing, far too long, electronic health information that's been stuck in silos and inaccessible for healthcare consumers at CMS Administrator CIMA Verma. Our proposals help break down existing barriers to important data exchanges needed to empower patients by giving them access to their health data, touching all aspects of healthcare from patients to providers, to payers and researchers.

Our work leverages, I. Identified technology and standards to spark new opportunities for industry and researchers while improving healthcare quality for all Americans. We ask that members of the healthcare system join forces to provide patients with safe, secure access to the control over their healthcare data.

Okay, here are the proposed changes. Number one, patient access through APIs, which are application pro programming interfaces. This is how innovators and Silicon Valley types get access to the patient data, health information exchange and care coordination across payers. So they start to include payers in this whole mix, which is an important data set that in some cases goes untapped.

At least you don't bring these two together very easily. API access to publish provider data. Provider directory data. Again, another important data set care coordination through Trusted Exchange framework. Improving the dual eligible experience by increasing frequency of federal, state data exchanges, public reporting and prevention of information blocking provider digital contact information provisions to conditions of participation for hospitals and critical access hospitals, and advancing interoperability in innovation models.

All right. This next clip is, uh, interesting 'cause it starts with me being wrong, . So, but we pulled it out because it was a, it was a big story. I mean, we didn't go to hims this year and, uh, Drexel and I did a show just prior to himss and this was right at the time where we didn't know people still had their, their flights.

They still were planning to go. Some people were actually, I think already in Orlando trying to . Get set and I mean, it really came down to the wire. And so he and I sort of talked about it and gotta remember when this was, when this was recorded. We had no idea if they were gonna cancel or not. We didn't think it was a great idea, uh, to have it, but, but we weren't, we weren't sure what was gonna happen.

So here, have a listen to this though. I don't think hims cannot do this conference and survive financially.

Back to the organization, they would've to do major cuts and change things. And it would, the other thing is if you take away a major revenue source, it, it showcases all the other areas where they're not making the money that they thought they were making. Mm-Hmm. . So it would, it would cause a major restructuring.

I, I think the responsible thing would've been to. To pull out they could and re reschedule for the fall, try to do a fall or some aspect of, and I, I realize the logistics, I'm sure smart people sat in a room and tried to figure this out, and logistics around that are probably just, uh, just incredible to even contemplate.

Yeah, no, I'm sure you're right. I'm sure there was a lot of discussions and a.

Be would.

A lot of this kind of gets down to the, when you about hospitals and.

Doing these kinds of, they're not really incident response exercises, but they're that kind of thing where you are, where you always have a backup plan, especially for major things that happen with your company or with your health system. How would we do X without Y? Or what happens if we have to stop doing X for some period of time and how do work under those conditions?

How do we operate under.

Is not the.

We, we saw sars, we saw Ebola. We're now seeing, uh, coronavirus. I think this is the new norm. I think this has to be taken into consideration for these conferences and for travel and those kind of things. Yeah, so one of the things we, uh, obviously we had Drex to Ford on as to go back and forth. On the show, but one of the things we did is Drex was kind enough to step in.

One of the weeks I couldn't do the show, and he did the Newsday show by himself, and I really appreciate that. He did a story of, I think it was from Politico, where it was, uh, telehealth. I. Advancements deferred. And he sort of addressed some of the, some of the challenges that were, were being faced.

Telehealth was interesting this year. I mean, I clearly, we saw an explosion, but we also saw, uh, a lot of regression towards the end of the year. Now it didn't go back to where it was prior to the pandemic, but it, it did regress a fair amount. So have a listen to this, uh, clip where . Drex talks about telehealth.

One of the articles that, that I'm bringing this week is from Politico, and it's, uh, titled Telemedicine Revolution Deferred and. I think Bill talked a lot about numbers last week that were pretty, pretty insightful. The idea that we've got, we, we've taken telemedicine from like a few thousand visits a week to like over a million visits a week.

But what the article here, . Talks about is that we're starting to see those curves flex down now, so telemedicine, fewer and fewer visits over time, and I think it's logical, right? There were a bunch of basically other care that we may have put off during the early stages of the pandemic so that we could create capacity and create more bed space and do other things to make sure we can take care of covid patients.

That meant we pushed more and more things either off the plate. Postpone them. Not gonna do them now, or we push them to telemedicine telehealth visits. So there's logic to the idea that telehealth, medi telehealth visits are gonna fall off. I don't think that's really a, a big deal or a big surprise. So when you read articles like this, my point being don't be dismayed, don't be disappointed.

I think an amazing thing happened. At the beginning of the, of the pandemic and telemedicine really became medicine, and I think we're gonna continue to see telemedicine, telehealth expand and grow in ways that we really haven't thought of up till now. Home care, home monitoring, lots of other stuff that we're just starting to

Get our arms around and I think it's gonna be pretty interesting to see, uh, where this goes and, and how it continues to grow and expand. Don't be frustrated, okay? There's a lot of folks who are probably, uh, saying or thinking that we're gonna have to back off on telemedicine. It's just not gonna hold up.

I think no matter where this goes, as we move into future healthcare, whether it's at risk, healthcare value, best value-based healthcare, the digital front door patients and families want. Telehealth, they want telemedicine and we're going to have to give it to them. So stay the course, keep on the path that you're on 'cause I think it's, it's really a good one.

Alright, so one of the shows that we did, and this is the number two clip here, is I, I shared my 72 hour healthcare journey and it was with my, uh, Father-in-Law. We took him, uh, to the hospital. He had some, some challenges and I. It was interesting. We had some significant interoperability challenges. The medical record didn't follow.

I. It just a whole host of things. So I decided to, we have this platform, it, it's relevant to what we do, and I wanted to get it out there. It's interesting because this more than any other story I did this year generated an awful lot of email, a lot, awful lot of back and forth. I had people call me up and explain how Epic's interoperability worked, why it didn't work in this case.

How it could work. I actually talked to the health systems, the CIOs and, and the various technology leaders at the health systems I'm talking about, and, uh, we worked through why this did not work effectively. The good news is great professionals, everybody wants to get this right. The, the, the bad news is, I don't think this is an isolated story.

I don't think my story was isolated, so I decided to share it, get it out there, get it into the, the canon of the show so that we could talk about it a little bit more. So here's a, here's a little rundown of the, the things we learned during that 72 hour journey with my father-in-Law. 72 hour healthcare story.

Here's what I learned. Not all APEC implementations are the same. Training is critical. I. I had forgotten how valuable the experience of walking in the patient's shoes is. And as A-C-I-O-I got the chance to, uh, experience things that as a civilian, if you will, I don't get to experience as much, and, uh, I welcome that it was, again, it was great experience for me.

I want to, I will really drive this point. Home interoperability should have the patient as the locus of data and as the, as the locus of movement of that data. And my point on this is always the patient is the only constant at the point of care. Epic isn't Cerner, isn't. Meditech isn't. Each point of care could have a different EHR.

Each point of care could have a different physician. Each point of care, you, you name it. The only constant at the point of care is the patient. I think the patient needs to be the locus of the data movement. Other thing I learned, duplicate tests are prevalent. Clinicians need to listen to the caregiver, a primary caregiver when they make requests, and one of my personal parts of my personal mission statement is that healthcare suffers because health, it is lagging.

It isn't the only reason for sure, but it is a primary contributing reason for duplicate tests, poor experience, and lack of information at the point of care.

Let me tell you how my father-in-law's visit could have gone with patient-centric interoperability. I wanna explain this as it could have gone, so I hopefully will do it as clearly as I can. So, record firmly in hand in on his, in the Apple Cloud or wherever it is on his phone he presents. We pull out his or primary caregiver, my wife's phone, and which we will have the record on it, and we select.

A handful of things. Emergency, a few parameters, how long they can have the record, how they can use the record, and it generates a barcode. I present that barcode to the hospital we're checking in at, and they scan it and the record goes into their EHR. They view an add to the record. During the visit.

When it's determined the transfer is required, they download it back to the . To the patient's phone or cloud solution, whatever it is, they keep the information as required. I understand they have to do billing, they have to do, they have to have legal review capabilities, maybe an archive of some kind, and they have to be able to do a.

Some training and stuff off of it so we can grant them the rights to use those things, but nothing else. There's no other way they can use the data except what is dictated by the patient. So then my wife presents at the Cerner shop. She pulls out her phone, makes the same selections, presents the barcode, even though it's a Cerner shop.

They inherit all the information, including the chest X-Ray, which can automatically go into the workflow from the previous location. Uh. My father-in-Law gets the sleep that he needs because the questions have already been asked. They just need to verify them. He gets discharged, the entire record comes down to his phone.

We move to Florida in two weeks, which we are, and the next health system picks up where the last one left off. Yeah, I wanna thank everybody for who sent me notes, who allowed me to talk to them about that journey. It was really, uh, helpful. If you've listened to this show to the end, you're probably wondering if a, a pandemic actually happened.

And it did happen this year. We did not put a ton of the stories in here because we're gonna do a whole covid series, uh, where we look at what different health systems did. So we decided not to . To inundate you too much with that, uh, single news, uh, news story. It's a lot of news stories, but it's single event, so.

But the number one story is about the emergence of digital, the emergency of virtual care as a result of the pandemic. We took a story from, uh, Patty Penon, who is, has also been on the show, and he was on with Ed Marks. They've written a book this year on digital transformation, and he shared a little story on the advancement of virtual care, and I think it captures.

A lot of what we've been able to do this year, a lot of what we've been asked to do this year of creating safe environments for care. So have a listen to this clip. The virtual care technology trends that will transform healthcare. This is healthcare IT news. Patty wrote this Art Patty Pat Manon, who does consulting in the industry who stuff I I I like.

He has a podcast as well. He's with DMO Consulting. Let's see. He wrote, uh, a handful of things, so I'm just gonna pull out the, you know, 20, 20 or 10 stories in 10, 20 minutes. Three main points. The rise of contactless experiences as is often happens in major catastrophic events. Natural or human made. Many societal practices change irreversibly.

The pandemic has made us all afraid to touch any surface, ex exposed to the public, so there's gonna be a rise of contactless experiences is first point. Second one, contact tracing. Inspired by the success of Singapore and South Korea, contact tracing applications on Bluetooth enabled devices have been positioned.

Has an effective means to track and trace infections to reduce the spread of covid 19. And, uh, his third thing is remote monitoring and au automated communication. Healthcare executives are more motivated than ever to keep their populations healthy in their homes. The rise of telehealth and intelligent remote monitoring devices now allow patient populations to stay at home and manage their chronic care conditions, avoid visits to hospitals and communicate on real-time basis with their caregivers.

Here's the so what. Absolutely, yes. On the contactless experience, I'm starting to experience that I had some furniture delivered. We moved into a new house, we got a new chair and they delivered it, and the whole experience was contactless. They took a picture in the house of the thing. I didn't have to sign anything.

I didn't even have to do the finger thing on somebody's phone, which as a phone is one of the, just the complete carrier of, of . Germs and viruses. I think that contactless experience is gonna be a new thing in our, in our culture, contact tracing. I think it's going absolutely nowhere. I think it's gonna be swallowed up in the political abyss.

Again, not a technology problem. I think it's a, it's an adoption problem and I think it's a politics problem and I, again, not stating whether we should or should not be doing it, I'm just saying it's gonna get swallowed up. We are not South Korea and we are not Singapore. We don't have this, the same culture.

And so I think that's going get swallowed up. Remote monitoring and automated, uh, communication. Absolutely. I think we're gonna see the rise of the home as the. Locus for caring for the aged. I think we're gonna see people really try to stay away from going into, uh, long-term care facilities, stay at home more.

I think you're gonna see chronic patients start to, uh, wire up their homes with Internet of things, devices, and you're gonna see a whole host of things happen around that. I think that's the thing to keep an eye on. Uh, it is really gonna be interesting. That's all for this week. Don't forget to sign up for CliffNotes.

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Please check back. We've got, uh, two more end of the year episodes. We're gonna do a countdown on social media where we go 10 to one on our top 10. Culminating with the actual full show airing on the, uh, podcast channel. So, uh, keep an eye eye out onto that for social media. The last two weeks of this year, I'm not posting on LinkedIn, not, I'm not posting, uh, news stories on LinkedIn.

We're getting ready for the new year when we launch today in health it, so if you haven't subscribed to today in health it.com. Uh, just go there today in health it.com. Click on uh, whatever your, your preferred method for listening to a podcast is. Uh, that's gonna be audio only. I'm gonna cover one news story a day, just like I do on LinkedIn, and it'll be five to seven minutes so you can, uh, batch 'em, listen to 'em on the weekend.

You can, uh, listen to 'em one at a time. It's, it's entirely up to you. We, we just, we are excited about trying this big commitment on our end and we hope that, that you find value in it. Thanks for listening. That's all for now.