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

 Today, on this week in health it, the ideal technology is not necessarily in your face. It's the innovation that melts into the background that's invisible behind the scenes that just makes things better.

It's Newsday. My name is Bill Russell. I'm a former 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 it has one to four 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. It's Newsday, and today we're joined by Justin Collier with WW t Worldwide Technology.

Justin, welcome back to the show. Good morning. Great to be here. Welcome back from vacation as well. You took a little time off. Congratulations. It's not always easy to get away in these times, is it? No, that's true. That's true. And of course, we intentionally chose things that would be more outdoors, just to be more on the safe side.

Plus it's. A really nice time to be outside. So you're sporting your, what is that? Is that a pink shirt? It is, yeah. So October, as we know is, is Breast Cancer Awareness Month. So our company like to support Breast Cancer Awareness Month. Wow. Well that's fantastic. It's also cybersecurity Awareness Month. As I've been told, it's hard to actually keep up with all

What month it is or, or what day it is because there's so many of 'em. But cybersecurity is interesting topic. We actually don't have any stories, which it, I mean, we could have done stories, but we've been doing so many. There's the brute force Azure story we could have done. But there's also the, the story that you were just sharing with me out of out of Alabama, you wanna touch on a.

Big headlines two weeks ago, really tragic situation. Hospital was breached at a ransomware event, and unfortunately, they have directly tied those clinical systems being unavailable to the. The death of an infant. I think everybody realizes and recognizes that when the clinical systems are down, when hospital systems are down, that there is risk and certainly danger and problems that happen with patient care, but to have it this directly tied to an actual patient death and nothing more tragic than the death of a newborn, I'm actually doing the cybersecurity, uh, ransomware webinar.

In about three or four hours, but I did meet with them prior to the event and you got to listen through it. It really kind of interesting when that event hits. One of the things they tell you is shut down the systems as much as possible so that you actually not as much as possible shut down the systems period so that they don't get that.

That spread horizontally across your network. And that includes a lot of clinical systems, only the clinical systems that absolutely have to stay on, and then they go into local mode. Communication breaks down, ra, your badge system, whatever, that all breaks down. Your phone system in a lot of cases is, is digital now and, and that goes down and

We heard the story from John Getty's, uh, sky Lakes Medical Center, who was, who was breached, and he said they were, essentially, they were communicating on their mobile phones, but, you know, a coordinated attack of some kind that took down the mobile phones. And I mean, a lot of things went back to just manual.

I mean, runners going from place to place, overhead pages, it's really hard. And the other thing is you plan for a, let's say an hour outage or a . Four hour outage or an eight hour outage, but none of us really have phenomenal procedures for. A 30 day outage of systems and a lot of these devices are talking back to the EHR communicating information back.

And when those systems are offline for a week, two weeks, three weeks, uh, four weeks, it almost becomes another go live to bring it all back online. It's really . Kind of an arduous process. And he talks about it's been months for them to get all that information back in the EHR from those 30 to 40 days that they were down.

The EHR was down for I think 20 some odd days. Yeah. And some people think that that's, uh, an overestimate of how long you have to really prepare for, but. The scripts outage was from May 1st to May 25th. I mean, it was almost a full month, and that's a world renowned health system, little over 3 billion. So they're, they're at scale.

They have budget. You could look at Sky Lakes and say it's a 200 bed hospital. They don't have the resources and whatnot. So maybe, maybe that was the reason. It took them 40 days to come back. But at the end of the day, he talks about. We had to rebuild everything. We had to rebuild active directory. We had to rebuild their routing tables.

They, they had to rebuild everything from scratch. And if you could imagine just wiping out your data center today, right now and then going, all right, start over. And by the way, most of your digital systems are locked, so if you, documentation is digital and online, you, you can't have access to it. Now, go ahead and rebuild.

Yeah. Business continuity, disaster recovery. It's not just for natural disasters. It's not just for fiber seeking backhoes. We've gotta consider that anytime we're talking about cybersecurity, and yet everybody says it, but you really have to believe it's not. A matter of if, it's a matter of when you're gonna have a cybersecurity event in your organization.

Yeah. I, I want to talk to you about the labor market. There's been a couple of things that have come out. McKinsey has the great attrition graphic. I'm gonna share some information with you from that. And then Mercer came out with a report. Healthcare labor shortage will continue to grow. And that's, I, I pulled the story from Healthcare Innovation.

Around primary care physician shortage. I think the other one that was interesting was the comments around the labor shortage for, according to the report, about 9.7 million individuals currently work in critical, albeit lower wage healthcare occupations. In other words, medical assistants, home health aides, and nursing assistants.

The need for these workers will grow over the next five years to around 10.7. Million. Million. And the report goes on to talk about how there's gonna be significant shortfall in that group as well. I, I assume you're reading the same things. You're hearing the same things. How acute is this problem today?

Certain specialties aren't. Having people enter them and all around just not educating as fast as we need to, to keep up with demand and having enough interest amongst those who are entering the labor force and moving into those kinds of careers. We could talk a lot about why people are leaving, but that's not really the direction I want to go on this week in health IT direction.

I want go. What's the role it, what role are we gonna play in developing solutions? Right? So technology's phenomenal at increasing efficiency, but. Generally speaking, what we've heard from the industry so far is we have not provided more efficiency to, to the industry. Now. We've provided more insight into the data and into disease states, and we're digitizing pathology and other things, all great things that are gonna lead to cures and, and wonderful things, but the efficiency aspect of technology, every other industry, it's like.

We have really made people much more efficient. What areas can we, or have we really seen success in driving efficiency in healthcare? I'm gonna actually flip that just a little bit. I don't know that driving efficiency in and of itself is the answer here, if that makes some sense. Sure. It's, it's more the experience.

Of the workflow, the performance of the workflow, taking away the rough edges, the friction points, the things that aggravate, I mean yeah, make me efficient. Everybody loves the efficiency experts, right? They come in and and, and look at things, tell you you're doing your job wrong. Yeah, we, we, we just like 'em.

'cause they come in and they essentially say, Hey, you could do this with 50 less people. And we're sitting there going. Okay. Just put it on a piece of paper how we do that. And we will embrace you. Yeah, exactly. Exactly. And, and in many cases, either because of the shortage or just because of the way that staffing ratios are, are set up, there already are too few people for an ideal work environment from an experienced standpoint.

And so that has to be looked at as well. But really finding ways to help people work in the way that is most comfortable for them, I think is important. Letting people be more mobile. That's a key trend that we're seeing and seeing a lot of improvement with as well. Nurses and others being able to do more work from a smartphone like device, do more work from tablets, do more work in other ways.

The, the rise of voice assistance, I think is an interesting one as well, that ambient AI technology is in a great place. Not gonna. Necessarily name drop, any companies that are working on that, but have done a lot of work in that space so that you've got that ambient data collection happening as the clinical encounter is going on, lets the clinicians focus more on the patient and on that patient interaction.

I mean, that's the thing that really fuels our engines, right, is that interaction with the patient. That time to provide the care of healthcare and letting technology in the background actually, you know. Help us get our work done while we're doing the parts that mean the most to us and mean the most to the patient.

I think that brings up a key and critical point, is that the ideal technology is not necessarily in your face. It's the innovation that melts into the background that's invisible behind the scenes. That just makes things better that we need to really focus on if we wanna improve that experience. I want to touch on a couple of those things.

I remember having a physician who was highly inefficient with our EMR. And so we had the ability to collect all that information and now it's pretty common, but we had Meditech, and back in the day it was not that that common, but we collect all the log files, we could tell what physicians were struggling and we would send people out to be at the elbow.

And I remember the physician champion who came back to me said, if I practice medicine with the way he had customized the EMR, I would've quit a long time ago. And then he created all sorts of. He customized that environment. He spent probably a week with that physician listening to him creating different ways to interact with the EHR and highly customized to it.

And that physician was incredibly grateful because he gave him back a significant amount of time. So workflow should not be underestimated. I've also talked to nurses. Who feel like they're the for forgotten clinician in the process of the EMR optimization. And if we look at these numbers and look at the, the nurse shortage that is happening to us today and the nurse shortage that we expect coming down the pike, we, we really can't ignore.

That important group. And, and one of the ways we make them more efficient is through those automated systems, through those customized workflows. And as you say, taking the friction out, taking the rough edges around the workflows. And that's a fair amount of hard work. It's not just, Hey, go out and buy this, pop it in and everything's gonna be good.

'cause we're talking about good EMRs here, we're talking about. If there's only a handful left, we're talking about decent EMRs. It's really about what we do with them. So where do people start with those projects? How do you identify areas where clinicians specifically would benefit from better workflow, better processes?

I think you have to start by. Talking to them. We can't, in healthcare it, assume that we know the answers or assume that other stakeholders know the answers you've, you've gotta actually talk to them. Do the journey mapping, walk through a day in the life with them. They'll tell you where the friction points are.

They'll tell you the things that frustrate them, keep them up at night, so to speak. In some cases, quite literally, keep them up at night, keep them from getting pajama time. They'll tell you what those challenges are. And then once you have identified what those challenges are, spend time with them doing at what, what we call innovation sprints.

Something that we do with our partners, our customers. Really looking through here are the technologies that could be. To solve those friction points, which ones make sense to you? And really having that a sort of focus group mentality to walk through what's gonna make the most sense, what's gonna make the most impact, interestingly, but sometimes it's not the things that you would expect.

On the IT side to be the things that they gravitate toward, or there may be other perceived barriers that prevent certain technologies from being the right answer, if that makes some sense. That does make sense. I do remember having some of those conversations and the nurses going, if you just put a printer over there instead of over there, and I'm like, well, I mean, sometimes it's a low tech fix.

Exactly. Yeah. It's pretty straightforward. It's not only in. And by the way, I don't want people to get the impression, I think that technology can solve this problem. It's, it's, it's not strictly a technology problem. I think we can help with this problem, but from a technology standpoint, I think the thing I would be thinking about is how do I bring clinicians up to speed quicker?

Right? The onboarding process. The onboarding process is, is in a lot of health systems, is . I mean, they request access to systems. It takes a couple weeks to get their credentials to get everything sort of online. Now, I know some health systems are sort of looking at me like, what are you talking about?

For us, that's a 24 hour process, but others, it's, it's a two to three week process before the clinician's actually functioning. And I would look at that process. The other process I would look at is. If there is a shortage like they're talking about, we've experienced that during covid and some of the stories we've read is we bring in people like the National Guard or we hire 20 nurses and we, we put 'em in the, in different areas in the hospital and I'd be looking at how do we bring them up to speed very quickly on our systems.

These are traveling nurses and traveling clinicians of some kind. I think there's a, an assumption. If there was an assumption in one of the stories that everybody's on Epic, they went to one of the hospitals that wasn't on Epic and like five of the traveling nurses walked out and said, I'm not learning a new EMR.

There's not enough time to to do that, and so the staffing agencies have to be aware of what's going on, but on our side, how can we bring them up to speed quicker? If you bring in traveling nurses and help from afar, what are some of the practices we can look at to bring those people up quicker? Well, and, and sometimes it's not quicker.

It's better, if that makes sense. Sometimes we force things to be fast that maybe shouldn't necessarily be fast. What we really want is to do a better job of it, to do a quality job of it, and spending time on training is one of those things that's been proven to improve. Worker satisfaction with any system in any industry, but it's definitely been proven in healthcare.

The hard thing is you're bringing these people in for a search, how you find the time, and they're only gonna be there for, hopefully they're only gonna be there for a month, let's say. How do you make them efficient? I, I mean, I realize there needs to be training, there absolutely needs to be training, but how do you make them more effective?

Or is it more of a logistics thing where you say, okay, these people are gonna operate in, in this capacity. Because they're not gonna have full access to the EMR. I don't know that I have a great answer for that. Honestly, you've gotta do the right thing for the employee and for the patients that they're gonna take care of.

You've gotta have adequate training that's gonna make them competent, number one, but you have to go beyond just competent. If they're gonna be comfortable, well let hit on it. Shortage that's happening as well, and that is attrition. They say, or the great attraction because they have great marketing people.

A record number of employees are quitting their jobs as the pandemic has irrevocably changed what workers expect. Organizations that learn why and act thoughtfully will have an edge in attracting and retaining talent. I actually talked to ACIO this week because of the vaccine mandate. They're looking at potentially losing 10%.

And as we went through the conversation, I said, okay, that's worst case scenario. What's the best case scenario? And he thinks it's gonna be 5%. Well, I think back at at St. Joe's, I had 700 staff members. If I lost 5%, that's a dent. If I lost 10%, that's a significant dent in our IT capacity and capability.

They give some stats here. 40% of employees say they are likely to leave in the next three to six months. 64% of employees are considering leaving. Say they would do so without another job in hand. That's a startling statistic to me. 38% of employers believe attrition is due to compensation, but 54% of employees leave because they don't feel valued by their managers.

While 51% of employees leave because they don't feel a sense of belonging at work. These are some interesting numbers and I, if I were ACIO today, I think I'd be planning on a significant amount of turnover. It doesn't matter how good your culture is, I think I'd be planning for it and then I'd be working on the culture.

As much as I possibly could. It's every workplace. Yeah. And, and I, I think that latter point that you made in terms of a sense of belonging at work, how do you feel a sense of belonging when every meeting is just like what we're doing right now? Yeah. Interacting over video. It's not the way that deep relationships are built and trust is built, it lacks the depth of human interaction that we were used to pre pandemic.

Those remote workforce scenarios, that's just the nature of the beast that you're gonna see more turnover, particularly people that didn't have a long work history with the companies before the pandemic hit. Once I. That have come in since the pandemic. How incorporated are they into the culture? It's tough on that employee and it's tough on those coworkers that they're interacting with to build adequate relationships that make teams work well.

It's interesting because the conversations I'm having with certain people, they're saying from the employee side, they wanted to continue as long as possible. And they, they like it. They're okay with this meeting thing. 'cause when they walk out that door, they're with their family and that's really who they wanna spend time with and have community with.

And they just want it to be a job and get the work done. Not all of us, but there's a portion that are saying, Hey, I really like the autonomy and flexibility that this gives me. And as well as productivity, one of the things we've heard is that people's home environment is more conducive to. Those times where you need to have heavy thought and really work through problems and those kind of things.

But I hear managers saying, man, we really miss getting together. There's a value to getting together. There's a comradery that gets built. There's a, a sense of mission of solving problems together. In health. It, one of the biggest challenges is there's a sense of connection with the people you're serving.

If you're remote, I mean, at, at the end of the day, it can be this health system over here, or it can be this health system over there. It almost doesn't matter anymore. You're like not connected to the mission of the organization that you're, you're serving. And so I'm, I'm hearing managers. Step back and say, okay, we, we can't do this.

It's gotta be hybrid at a minimum, and they would prefer it to be more onsite than remote, if possible, just to get back some of that connection with the team. Yeah, I think that's important, and you highlight something that's absolutely crucial. One of the key drivers of joy in work is knowing that your work has meaning.

Connecting to that mission, understanding the impact of what it is that you do. Reminds me of the the Patrick Lencia book. You know, five Signs of a Miserable Job. Not having that connection to the meaning and the value that your work provides. Who your customers are, what service you're providing to them.

Makes you miserable. And so I think, I think that is very important. Yep. I, I want hit on a couple things here. I, I wanna do a, a telehealth update with you. I wanna ask you about some CPT codes and, and stuff that, that's driving that. Before we get there, a pretty interesting announcement last week, it was just last week, leading Health systems launch Graphite Health, a new member led.

Nonprofit company to accelerate digital transformation of healthcare. Three health systems. SSM, healthcare, Presbyterian Healthcare Services, Intermountain Healthcare. These are some of the members that were a part of Civica rx, which was about generic drugs, uh, being manufactured for hospitals. That's actually a pretty large group of health systems, so I expect this group to grow.

It's an interesting business model. They're coming together. The problem they're trying to solve is, uh, standardizing the way that data and applications are built. They're trying to build an interoperable data platform that's not only gonna work on, it's gonna work on the major EHR platforms, and it's gonna give innovators the opportunities to write applications in sort of an app store kind of model.

You write it once and it works on any of the underlying. Systems that happen to be connected to Graphite Health, and I love the name 'cause it takes out the friction of and And we've all been there, right? You bring in this really new thing and then they've gotta integrate with the EMR and they have to integrate with this and they have to share data with this.

And each one of these projects almost feels like you're just repeating that the same steps over and over again with every vendor you bring in and they're looking to alleviate that problem. I. The business model, a Tru Veta is a similar model. A lot of health systems coming together. Is this gonna be how we innovate going forward?

Is this gonna be how we scale innovation in healthcare? I think collaboration's always been the right way to scale innovation in healthcare, and so I do think that that makes a lot of sense, and I think it gives them better negotiating power with those entities that are not necessarily as. Ready and willing to allow interoperability or if they're slowing things down for various reasons.

If you are a one hospital system or a two hospital system, you don't have a lot of negotiating power when you're trying to make the EMR let you do something. But if you're a coalition of larger. Entities or a large coalition of small entities, you've got a lot more negotiating power there. Uh, you have to be taken seriously by the epics, by the Cerners, by the Meditechs of the world.

I think that's the direction that this is going. So from that standpoint, it makes all the sense in the world they're gonna be able to get a lot more done working together. Plus you've got just . You know, more smart people working on the same problems. I mean, exchanging ideas, finding solutions. All right.

We're gonna hit on a bunch of stories real quick. Anything else you want to add on that story? No, I think it's, I think it's great. Uh, I think it's great as well. I think we'll see where, where this goes, ONC. So ONC, more patients are downloading their medical record and using portals. I found this interesting.

I wanna say the portal is dead long live portal because we see . Digital front doors is, is now the new terminology and we see people, uh, really heading down that path. What do you think portal usage uptick is due to and what is the future of the patient portal? I didn't give you any of these questions ahead of time.

So these are on the fly. Is this Collier right on the fly, coming off vacation answering these questions? Yeah. So I'll, I'll answer your last question first. So what do I think the, the future looks like in terms of patient portal? I, I do think digital front door is catching on and for good reason. And that's if you provide a platform.

That does more than just serve up maybe lab results. That provides the ability to have meaningful interaction with your patient. It's great for the patients and it's great for the health system. That's how you can drive patient engagement. That's how you can drive patient satisfaction, patient interaction, but you have to have.

Not just, you know, a massive library of point apps, if that makes sense. Niche solutions that, you know, you can app your patients to death if they're not a single platform that brings it all together. But the more features and functionality you can provide in that digital front door, the more access you can give patients to what they want or what they need to do to interact with the health system, the more powerful that's gonna be.

You know, it's the same kind of omnichannel strategy that we see every other industry has had and has been building on over the past two years throughout the pandemic. Any other big brand that we interact with, we've got one place to go. You can do it on the web, you can do it on your phone. You can do it from whichever device, but it's one app where you can do everything that you need to do to interact with that brand.

Your bank doesn't have a bunch of different apps, right? Your bank has one app. Your airline, back when we used to travel a lot, you, you didn't have to go a bunch of different apps to do everything you needed to do to interact with Southwest or Delta or any of the others. Yet all those platforms are a platform.

That has a bunch of different features. And of course, Amazon's a great example of that too, right? You can get to prime music, you can get to Prime video, you can shop, you can order your groceries, like all of those things, all from a one stop shop and healthcare's just catching up to that trend. But it's the right trend and it's the right value to deliver to your patients, right?

Give them their education, give them their place to jump to a a telehealth visit. Give them their place to store their information, to provide information to the health system, to get information from the health system to schedule an appointment, to do all the things they need to do to interact with the health system.

Joe's. It was interesting because. We were spending so much time on getting the medical record presentation just right, and we had a list of like 10 features we were working on, and that's when we were spending all of our time, and I don't remember who suggested it, but we ended up going out and doing a survey of our patients and saying, what do you want most out of the digital front door?

And it was that communication. It was, I wanna schedule an appointment, I wanna communicate with my doctor, I wanna, I want to interact with the health system. And I think storing and viewing the medical record was like number eight. And the aspect of storing and viewing the medical record they wanted to have was to be able to give it to somebody else.

Like, so they, they have their medical record from us. They're tired of being asked by somebody else or filling out a form to request that medical record to come over. They wanted to just from their phone, be able to go, would you like my medical record swipe? Here you go and give it to that next provider.

And, and that really changed how we were thinking about it. Not that we didn't spend a lot of time making sure that that presentation of the clinical data was right, but we did direct a lot more resources to the communication and the scheduling and all those things that they really wanted to do through those, uh, through that application, be it called a portal or whatever we call it.

And, and that that desire to exchange information or to be the driver to get the information to the right provider at the same time, it could be within the same health system in a lot of cases, unfortunately. We experienced that last year. When my mom was going through her terminal cancer journey, if we went to the hospital, we had access to things, but we had to bring things from the physician and vice versa.

Even though the physician was part of and an employee of that health system, it was absolutely miserable. So being able to just have that information flow with . Less friction and with more ease. I think that's a huge desire for patients. So I think that's fantastic. But you know, to your point on communication with physicians, that's not even new news, right?

It's, you know, five, 10 years ago, Kaiser had already had more interactions happening asynchronously, and not in-person, phone message, email, other avenues with their primary care than they had in-person visits. And that's a longstanding trend, but it's because they made it available. And patients gravitated.

It was easier for the patients, in some cases, easier for the physicians to do things asynchronously. You get an email, you answer the email, but at the same time, you don't want to overload the physicians with, you know, their in basket. Well, the reason they made it available is 'cause their business model's different.

They're not fee for service. They're the carrier. And they're the provider. They're aligned. Yeah, they're aligned. And. It's interesting 'cause we're gonna go into telehealth here and take a look at, just get a little update on telehealth and where it's at. There's a handful of stories. CMS is boosting telehealth and remote patient monitoring with new CPT codes.

A Maryland insurer, CareFirst launches virtual first primary care business. Telehealth uses surging, but patient satisfaction with the service has declined. And new study fines. That's shitty power and associates. Survey and then telehealth, experience growing pains along with expansion. Let's touch on the patient satisfaction real quick.

So Sure. I have a theory. I have a theory on this one. I think it's because the novelty is gone. I think that's a big piece of it. I think that I. Early in the pandemic when it was a new thing and it was easy and convenient and that new experience. I think some of the newness of it probably was driving some of the higher satisfaction before and now it's if you're having a televideo visit with your physician, it's, it's no different than your Zoom meeting with your colleagues at work or your customers.

It's just another Zoom meeting, so to speak. Yeah, from my parents' perspective, it is they're afraid that they're not gonna catch everything. So I guess their hope is that when they're sitting in front of the clinician, they will see something and my mom has a story where they actually did, uh, see something and say something's not right.

And she wonders if they would've seen that through telehealth. We can't ignore, there's different. Views of where we are at in the pandemic and getting together and all those things. There's a whole host of people that are essentially saying, you know what, I'm, I'm ready to get back in front of my physician.

I'm ready to get back out into the world. I'm vaccinated, I'm protected, is the thought process. So I want to get back out there. And so there's almost a dissatisfaction if you don't, let me come in and see you. Which my mom actually expressed to me this week. She's just like, the doctor wouldn't let us come in and see her.

We have to do it via telehealth. Whereas during the pandemic, almost everyone was saying, Hey, I'm satisfied with this. 'cause they understood and recognized the safety aspect. And I realize we're still in the pandemic. I, I'll say early on in the pandemic, we didn't know what we didn't know and people, there was a high level of satisfaction because.

We could still get care and we were doing it in a safe way, whereas there's just different views today than there was early on in the pandemic. Yeah. And in the long term, once the world is healthier, I think it's going to be convenience. I. Ease that will drive continued Telehealth encounters it. It will be, you know, an option.

Not really. I mean, if I thought about it, not really. A lot of IT related things. I guess 24% are, well, not lack of awareness of costs. Not sure what we could do from a technology standpoint except for have the costs easily seen. Yeah. Transparency. That's that's pretty easy to fix. So this is the trend that we're seeing across the country, across the world with our customer base, is the need to mature what was slapped in very quickly, in some cases with virtual duct tape and bailing wire to have a.

Telehealth solution, telehealth, but it really wasn't a full telehealth solution even then. It was a televideo solution. So the, the limitation in services that you cited is one of the number one examples. That's a great area where we're seeing things mature. We're seeing the addition of remote patient monitoring and, and certainly that.

O-N-C-C-P-T code, A change making things more permanent in terms of remote patient monitoring in terms of what can be delivered virtually. I think that's great and I think that's gonna drive some of those improvement in terms of improvements in the number and variety of different services that can be provided.

You know, when it's just video interaction, that that limits things quite a bit and it really limits things. When you're dealing with patients who have chronic conditions where you need more data points, you need to know what their vital signs are. You need to know those other things. Once you can virtualize that, it, it makes that care much more, uh, efficient and much more effective and lets you do more things.

But there's also gotta be. Better technologies, better experiences. Perhaps it's incorporating it in the digital front door that we talked about earlier. It's making it easier to access, easier to use, making it something that's as easy as the click of a button, not a confusing technology where you have to download something and then you have to verify and validate something, and you have to connect this way and do that.

It's. The maturation process that it's all going through that's gonna solve at least some of those drivers and dissatisfaction that you mentioned? Yeah, it's interesting. They ranked one of the major providers for telehealth. Teladoc was ranked the highest in customer satisfaction among direct to consumer brands with a score of 8 74.

MD live ranked second and my telemedicine 8 59 ranks third, United Healthcare ranks highest amongst payers with Humana and Kaiser. Tied for second. It's interesting. I don't think I've used my provider telehealth, but I have used my payers telehealth it. It's included in my plan. The initial visit is free because quite frankly, it saves them money.

They get to direct my care and make sure I don't over utilize or go to the wrong place and that kind of stuff. So I guess there's a benefit in that and both my wife and I. Have started visits in that direction and in every case, we never ended up at the provider like it was taken care of without ever going to the, the local provider network.

And I think that's one of the things that healthcare providers need to be aware of is that there is, that, that's the point of entry I believe that everyone's trying to get to, which is we want to be your first call. CVS wants to be your first call. You know your payer wants to be your first call. Uh, Amazon Care eventually wants to be your first call.

Be an Amazon employer. Transparent is a, a new model that they're, that Glen Tolman's bringing out. They want to be your first call for an employer plan. Everybody wants to be your first call because if you direct the care, you can either, you control the experience, you can drive cost out of the equation.

And I think that's where people are starting to find the dissatisfaction with healthcare is in transparency and cost. And they're saying, all right, if somebody else can help me navigate this to drive out my cost. And a lot of times I hear people say, well, you're not paying for it anyway. Well, I, I sort of am, I'm an employer.

I have people on my insurance plan, and yeah, I don't want to just use that because eventually what that's gonna be is hire premiums for me next year. And so that's why we're investing all sorts of. It things around wellness, uh, you know, programs for stretching and programs for things that keep you from injuring yourself and whatnot.

Those are valuable to employers and we're, we're trying to drive costs down and it's that first phone call. I guess the question I have is, can providers step into that gap and are they going to step into that gap of being that first phone call to help direct care? I think they already are in many cases, and I think it's, I think it's absolutely crucial as we see things move toward a more value-based care system, where it's a move toward true health assurance, toward toward wellness as the focus and not just sick care fee for service.

And even those fee for service systems that are slow to move into at risk models, if they can do a better job, drive cost out of the system, be more efficient, it's gonna help them negotiate their insurer rates, their payer rates with private insurance and, and move in a better direction from a business model standpoint.

But the other thing that's gonna drive it honestly. I truly believe, and it's been happening and it's been accelerating, is the consumer expectation that those technology tools will be available, and that it's not just that you could be my first call, it's that you are the first call that's easiest for me, that has the best experience, that gets me what I need.

That's what's really gonna drive success in the space. So it's not enough just to have an option. It has to be a good option. Yeah, convenience is king and experiences everything. This will be the last thing I'll touch on CMS boosting Telehealth and RPM and CPT codes. 'cause at the end of the day we can talk about adoption from a consumer standpoint, but the incentives have to align, the culture has to align.

Clearly, the technology has to be in place, but quite frankly, policy has to align. And the biggest payer is CMS in the country. They pay all the Medicare claims and so they're adding some CPT. And I think that is one of the things I've heard as I've talked to people is that they wanna, they want to see the government and both federal and state, step up and recognize areas where telehealth has been beneficial to the community, driving better health, driving down the cost of healthcare.

And I start to support that. And I think when you see. Additional CPT codes, especially for remote patient monitoring. I think you see that they, they now have a wealth of information. They have the, in the, the entire pandemic of claims data and codes to look at. To say, okay, this was beneficial. This was not, this was just an added expense.

And there, there is a case to be made. The telehealth can be just an added expense, if not in the right area. They're starting to add those things and they're also starting to identify fraud and go after the fraud that they said was the reason we did not expand this earlier. And they're not wrong.

There's a fair amount of fraud they're going after right now. Yeah, and I, I think the other thing that they're looking at is what was missing? What could have been that would have made a difference, that would have been an improvement as the pandemic has grinded on What we've seen is that some things.

You can take care of great over televideo, but televideo alone doesn't give you great insight on everything. The other thing CMS is looking at is those health systems that do provide remote patient monitoring for chronic disease or post-acute care, their outcomes. Are better because they have more data on how the patient's doing.

They can be predictive, they can catch things early, be preventative or at least be earlier in terms of treating things rather than waiting for somebody to crash. So huge benefits, and that's another thing that's being weighed in. To me, that's the exciting part about seeing the permanence starting to happen as these CPT codes are being changed, instituted, seeing some of the things that have been.

A permissive environment transition to being a real and more permanent kind of a thing. And remote patient monitoring I think is, is absolutely crucial. If you have, let's, let's keep it simple. So if you have high blood pressure and you're dependent on a couple of visits at your physician's office to be all the data that's collected about your high blood pressure, or maybe you're keeping track of it and writing it down with a blood pressure cuff at home.

And bringing that in to the physician's office, that's one thing, but it's a very analog, very episodic monitoring of that condition versus moving to something that's remote patient monitoring of your blood pressure. You still have the blood pressure cuff at home, but that data's being uploaded. And it's digitized and it's going into the system where it can be analyzed, where AI in the background can take a look at it, see trends.

Your clinician can see it graphically in the digital tools that they use to do their job. They can understand what's going on with your condition over time. Anything that's a real danger sign that AI can flag. Bring it to the awareness of the right, uh, clinician at the right time to say, Hey, this is not a good trend.

Something's going on with this patient that we need to address. And there have been health systems that have been moving in that direction. St. Louis, for example, mercy Health, mercy Virtual, they've been doing this for a long time where they've had their chronic disease patients being. Monitored continuously through remote patient monitoring.

They're able to catch a lot of things, prevent a lot of things, see a lot of improvement in terms of reduced rehospitalization, reduced infections, reduced septic shock tests, things like that. By doing these things. Seeing the government start to recognize that it's not a new trend. The places that have been doing it have better outcomes.

Let's make it available for everybody so that the incentives are aligning around taking better care of those patients. It's absolutely fantastic. It's a great note to end on. Dr. Collier, thank you for taking the time out of your vacation to spend some time with us. Really appreciate it. Absolutely pleasure.

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 want to 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.