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Today on This Week Health.
They call 911 because there is no way for them to get to the hospital, and so the only way is to actually get an ambulance and go to the ER. Like, imagine, what that costs. For that hospital Welcome to Newsday A This Week Health Newsroom Show. My name is Bill Russell. I’m a former CIO for a 16-hospital system and creator of This Week Health, a set of channels dedicated to keeping health IT staff current and engaged. For five years we’ve been making podcasts that amplify great thinking to propel healthcare forward.
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Now onto the show.
All right, it’s Newsday and today we’re joined by Dennis Joseph, Senior Director of Healthcare for Digital Scientists. Dennis, welcome to the show.
It’s been a while. We’ve got the end-of-year stories that are starting to pop up and some of them are pretty interesting. We got, doctor exits. We’ve got Walmart, friend or foe. We’ve got radiology and some financial things as well that I think are an interesting conversation.
I want to make sure we get to this last one, which is IT issues affecting health system financials. I think sometimes the IT stuff gets lumped in with significant financial implications, ramifications. So I think that’s going to be worth a talk, but we’re going to start with the AMA website.
40 percent of doctors? What can organizations do to keep them? Let me give you a couple of excerpts real quick. While many physicians retire due to age, others have chosen early retirement due to the current state of the US healthcare system. And too many young and mid-career physicians intend to leave their organization within two years.
With an ongoing physician shortage in medicine, finding ways to identify and address doctors’ intent to leave a healthcare organization is vital, and it may require smarter uses of technology. Between 2021 and 2022, when asked about the likelihood of leaving, obviously It’s going up. the finding comes from an exclusive survey by the AMA these are some of the things they’re saying we can do. Be smart with the use of technology. In her work with the U. S. Surgeon General’s Office, Dr. Shah said one of the things she noticed is that we have a lot of evidence-based tactics. But we’re really underutilizing technology. way to beat back EHR burdens is to deploy new tech. The next one is to let doctors be doctors. That is, let them actually do what they got into this to do. And then the third is to work as a team.
Let’s talk about the use of technology. Is the use of technology, do you think it’s increasing in healthcare? Or do you think we’re sort of stagnating? Or even atrophying a little bit.
Well, I think that the use of technology evolving , right? And obviously, as you think about
You have the old EHRs, you have the old diagnostic systems, you have the old medical devices. And now as you think about getting into spaces like clinical decision support where, it’s providing you information that speeds up. at least your early evaluation or assessment of the patient.
I think that definitely has a lot of promise, but I think the thing that we got to watch out is in the name of technology, right, people bring in a lot of these systems and solutions which it’s creating a barrage of information that they have to react to. So now they not only have to care about the patient that they need to assess and diagnose and treat, they also got to keep listening to the technology system that’s telling them 15 different things during the day.
I just think of all the alarms that they have to react to on a daily basis inside of an ICU, right? So there is a proliferation. I just don’t know if it’s meaningful proliferation, right?
Yeah, meaningful proliferation. That’s the rub. Yeah, meaningful proliferation is a that’s a good term.
I like that. What I find is there’s people that are Optimists, oh my gosh, generative AI, it’s going to change the game and ambient listening is going to change the game, so there’s the optimist. There’s the pessimist that’s like, look, we’ve been putting technology to work in healthcare for decades, and it’s not improved anything.
So you have the optimist and the pessimist. And that phrase. That’s where I find a lot of people, it’s the pragmatist. It’s the, hey, you know what, let’s do technology that actually works. Let’s make sure that we’re just not throwing technology at a problem. Let’s make sure that we talk to the clinicians, we understand what they’re trying to do, and we implement technology that helps them, I guess to the next point, let doctors be doctors.
Oh, I agree. The other thing that’s not talked about much is the whole concept of decision fatigue. Right? With the proliferation of technology, that also means that every time they look at a notification, look at an alert, they look at a recommendation. Okay, they’re still on the hook for the decision, right?
And that’s how they see their role, which is, hey, all of these recommendations are good, but I’m still on the hook for the decision. And ultimately, if I’m going to get sued, I’m still going to get sued, not the decision support system, right? Right. And so that decision fatigue hasn’t gone away, and that’s what’s wearing them down.
Yeah, it’s interesting you bring that up, it’s one of the things, as I talk to physicians, they want more transparency into these AI systems, because essentially these AI systems come back, necessarily, by the way, I mean, the amount of information that clinicians are trying to deal with is staggering.
So we want to put systems in place that are going to be able to digest a ton of information and then, essentially say, hey, here’s what I found, or here’s the summary, or here’s What’s important, but physician doesn’t want to take responsibility for that system worked appropriately because they’re now making decisions based on information that’s being put through a set of algorithms and then come out the other side.
And they’re saying, like, I need some transparency in order to have trust. In order to be able to perform my job effectively and provide the best care I need to know what happened behind the curtain.
That’s exactly right. They need to know the logic behind it because ultimately that gives them a rationale.
to drive that decision, right? But I do think, in all of this, there are some low-hanging fruits. You can’t deny that documentation being a big one, right? As you think about telehealth encounters and we recently created a technology that automatically transcribes the telehealth conversation, recommends, okay, here are some of the Diagnostic value that, that comes out of that telehealth encounter.
I think those are all low-hanging fruit where you can leverage technology, where the physician is focused on the patient, but at the end of the encounter, they’re reviewing their notes, they’re making sure it’s accurate, making minor modifications, and uploading that into the EHR or EMR.
So I think that there are definitely opportunities there. But there’s got to be a lot more effort to, address the underlying issue of that many doctors eyeing exits. That’s a bigger issue. And I think technology alone is going to solve just a portion of it. I agree. This problem is here to stay.
This clinician burnout and clinicians leaving the field. And so I think this is going to be a continuing conversation into 2024. Are we putting technology in place that is stemming this tide or actually exacerbating the problem? We do not have the luxury anymore of exacerbating the problem, which in many cases with the EHR implementations we did exacerbate the problem.
The next story is interesting. Walmart, friend or foe to hospitals. And it starts with talking about Sam Walton, who’s the founder. He had harsh words for hospitals. He said we’ve got to get hospitals and doctors in line. 30 years ago, I mean, this is before he died. So it had to even be farther than 30 years ago.
He was saying, we’ve got to get hospitals and doctors in line. He said this at a Walmart leadership meeting, they’re charging five to six times what they ought to charge us. We need to work on a program where we’ve got hospitals and doctors and workman’s comp and pharmacies saving our customers money and our employees’ money.
And so he identified healthcare. Pretty early on as something he wanted to address with their footprint across America and especially in rural America. And recently they partnered with Orlando Health. and a lot of the stuff around here is they’re saying, we’re going to be able to go farther and do more in partnership than going alone.
They compare it to One Medical which appears to be going it alone for the most part, and now they’re starting to talk about partnerships as well. And it’s also interesting to note that, yeah, they’re partnering, but they also have. Quite a number of locations, over 50 locations now where they’re providing primary, behavioral, and dental care across five states.
I’m wondering if health systems really see Walmart as a competitor or a foe, or if they see them as somebody who’s a partner in their communities to deliver better health care. And I think more of them view them in the latter category than the former category.
Yeah, I mean, I’ll be honest with you. I don’t care how they view it. I think there’s potential here, right? And when you think about the partnership between the two organizations, what was interesting about the partnership, somewhere in the article, they mentioned that there is there’s no money that’s, that exchanges hands between the two organizations.
So it’s not really transactional. They’re looking at it holistically in terms of managing continuity of care for the patients, which is a very interesting and a very foundational approach to managing those patients, which I think is different from the Amazon and One Medical collaboration. So to me, obviously, I don’t know all the details, but I think that to me is interesting because what they’re saying. is with, in partnership with the hospital system, in partnership with their facilities where they’re providing primary care, behavioral health, etc. They’re basically providing a holistic solution to the patient. Which is definitely important. The other thing that holds promise here is exactly what you said, which is Walmart’s real estate footprint is immense, especially in rural locations in the United States.
And so access, there’s a lot talked about access and COVID obviously brought that to light. And so this is, to me, one of the ways you could address it, right? So. Could you bring some of those basic health services to retail settings that already exists, but you actually have access to them and you know that these people are going to have to come into Walmart anyway for other requirements.
And so it’s almost like, as you think about the broader issue, the classic question of how do you eat an elephant? It’s one bite at a time. I think to me, that’s, this is one bite.
Yeah, I agree with you. I think this is the model this is a model for solving the challenge of access, especially rural healthcare access.
And a lot of times when I talk to people about this, They will say, oh, access to broadband and remote locations and all this other stuff. But I guarantee you, every Walmart has access to broadband and a significant amount of broadband. Because in order to function as a retail organization today, they have to have those kinds of connections for point of sale and for inventory management, supply chain, and all that stuff.
Distribution. Yeah, exactly. So, this is When I think about it, this is the kind of partnership that makes perfect sense to me. I mean, outside of going directly to people’s homes, this is the next level up. So we do want to continue to do this push towards people’s homes to the extent that we can do that.
Also, by the way, besides the footprint, keep in mind that they’re the largest employer in like 20 of 50 states. And if they’re not the largest employer in those other 30 states. They’re in the top 10 for sure, just because of the sheer number. You could actually partner with them as a branded healthcare organization, let’s say Mayo or Cleveland or Cedars or something to that effect or the UC system for that matter.
You could partner with Walmart. Go in with them in terms of the build-out that’s required in some of these remote locations and provide the services from your core campuses and your core locations to those remote facilities and even to a certain extent. Use those as facilities that you could send clinicians or even hire clinicians out.
And so those clinicians, this was the old CVS, what CVS was going to try to do, and it just sort of fell apart for whatever reason. And I think there’s a lot of reasons actually, but it just fell apart. I think this could work with a Walmart. I don’t see. Walmart getting into acute care services.
I don’t see them getting into specialty services, so that’s why I don’t see them as a competitor. That’s why I see them as a friend because of their overlap with the existing services that many healthcare organizations provide Today, it’s gonna be pretty nominal. I mean, that’s my thinking, but I think it’s good model to create access to the rural communities.
Yeah, I’m fundamentally excited about this actually because it goes back to the whole concept of extending reach, all of these acute care facilities. I was speaking with Centara Health a few weeks back, and they were telling me that, there are times where people in rural locations, they call 911 on very simple health issues.
They call 911 because there is no way for them to get to the hospital, and so the only way is to actually get an ambulance and go to the ER. Like, imagine, what that costs. For that hospital. so as you think about those primary services, I think it’s definitely a lot of potential.
The other is, if this model works right, how do you proactively keep this population healthy? in a way that you’re not expanding your own footprint, right? And you’re extending reach and you’re giving them proactive health. And so I think it also addresses the whole cost of care equation, which oftentimes is challenging when it comes to the rural locations.
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All right, we’re going to close this out talking about IT. We’re going to skip a couple of stories. I want to talk about these IT issues affecting health system financials, and I want to talk about how healthcare IT organizations approach technology, specifically with you, and just go back and forth a little bit.
This talks about HCA and Northwell. It says Northwell is pointing to IT investments, and it’s EHR, digital health systems, and telehealth as part of the reasons for operating expenses growing 9%. In a nine month period ending September 30th, I’d have to look pretty closely at those financials. I can’t imagine that unless they paid for their EHR upfront, because I know they’re doing the EPIC implementation, unless they paid a significant amount of front, that the previous.
Years results were hit by that much, but that’s that’s neither here nor there. HCA also cited it. Issues could affect future earnings. I’m gonna put you in the CIO role. You’re a CIO for, Northwell’s pretty big. Let’s give you, let’s give you something else. It’s not as quite as big as Northwell.
Let’s give you I don’t know, mercy Bonsecourse. We’re gonna give you Mercy Bonsecourse, Virginia area. Pretty good footprint, that kind of stuff. You’re now the CIO.
How much of your strategy is build versus buy? Platforms versus best-of-breed solutions? How are you approaching the technology?
Because a lot of times when you see this big hit It’s because they made bets that didn’t pan out, and now they have to pivot, and essentially they’re paying for something a second time.
Yeah, no, it’s a tough nut to crack. I think as it relates to decision-making, for me, the true north is going to be clinical workflow and patient outcomes, right?
And any and all combination of technologies that drives that is going to make sense because ultimately what you want to, what you want to see is.
Where the process is laden with either cost or delays, right? So, we talk about profit pools. I think about delay pools and cost pools, right? So, as you think about the overall hospital operations, you want to drive to a point where your workflow is streamlined, your workflow is not laden with unnecessary steps, and the other is you have a line of sight to the patient outcomes and how it’s improving.
The other piece is you just take a sample patient, right, and going all the way from admit to discharge and all of the steps in between, it could be admitted through ICU, step down and discharge. How do you make that the most efficient and how do you get patients out the door, which is throughput?
Those are all, I think, areas where if you can improve that. Then you’re looking at a more efficient footprint from a technology standpoint. where hospitals are running into problems with is the fact that these technology ecosystems just grow and grow.
It becomes more and more complicated, takes a life of its own. And now you have your staff trying to, they spend their entire day trying to figure out how to maintain the system as against figure out how to treat the patient, right? And so I think that’s probably where It’s going to be difficult, but overall it is a tough nut to crack, right?
And you still got to have an EHR. You still got to have some sort of a telehealth service, and some of the other ancillary services from a technology standpoint.
Yeah it’s interesting to me because the, you don’t get to do greenfield. More times than not, when you take something over, you inherit a bunch of things.
Now, it’s almost obvious to somebody now, it’s like, hey, you want to get to a single EHR system. Now, there were some health systems that tried to, Buck that trend for years and the largest of which that hasn’t consolidated on a single EHR right now is Ascension, right? you go into Ascension and you look at their EHR footprint, it’s all over the board and what their concept is Hey, we don’t care what you use to run the hospital, but we have to bring all this information back and be able to process the information, improve care, get the alerts out keep the throughput and all those things.
And so, obviously you’re not doing that in a region. If you have a region that’s trying to function together, you wouldn’t have two EHRs. But, when you’re looking at. Michigan and Texas, their concept is, look there’s not enough benefit for us to do this multi-billion dollar. EHR consolidation that, and they’re the largest one who’s decided to do that.
With that being said, most of the others have decided to consolidate and essentially have thrown up their hands and said, I don’t care what it costs. We’re getting on a single EHR. That way we can have a single platform from which to build and a single hopefully set of workflows. Now, we also know that’s not always the case, right?
Cause you go in and they say, well. We have five builds, or we have an older build, or we have a lot of customizations of a single EHR, which creates that disparity as well. So even if you get to a single platform, it’s not necessarily a guarantee that you have something that you can be agile on top of.
But it does improve it. like, I talked to Sophy Lu over at Northwell, and their move to Epic, is really around this whole concept of if we get to that single platform, now we can plug in a single telehealth solution across all of our system. And we can even do some custom development.
If you still decide to go in that build route for certain items you’re going to do it once and implement it across. The entire system. And that’s the hope doing platforms. And then you have that, you have your PAC systems, hopefully you have an enterprise PAC system.
But what I’m finding is more and more health systems, if you go in there, they have 10 to 30 PAC systems. And so the inefficiencies you’re talking about generally come about because you inherit, you’re not inheriting a greenfield situation. You’re inheriting a situation where either the system has grown by acquisition over time or it didn’t have good governance and it allowed different health systems, different hospitals to do different things.
And now when you get that job as the CIO and you sit there and you look at it, you’re going, wow, like this, it’s not easy to clean up and cleanups. sometimes can take five, six, or seven years to clean up.
No, I agree. I think the one thing I’m curious about is how do you know whether it’s working for you or not?
What are the metrics that these CIOs use to say, okay, you know what, I’m inheriting a system. Maybe it’s working fine because if I were to transition that from whatever I am to like a Cerner or an Epic or a Meditech, it’s like maybe it’s going to get worse. And so how do you measure that?
Right? And how do you know that it’s working for your organization? I think that’s the hard part. You are a pragmatist. That’s, I mean, that’s such a pragmatist answer. It’s like, but I’ll give you some of the metrics. I mean, one of the main metrics I looked at, and again, I was from outside of healthcare, what did I know?
But it was clinician satisfaction with the systems. And, they’re the ones using it, and they’ll let me know if, essentially, and so we did surveys pretty regularly with our clinician base to find out, hey, the systems working for you, that kind of stuff. And then you can look at things like quality of care delivered and throughput.
I mean, you can look at the objective the concrete metrics, if you will across the board, I mean, those, you can just pull out of the system and see what’s different systems and see what’s going on, because there’s the subjective and then obviously the quantitative kind of things, but then there’s the things that we don’t measure that I think have a significant impact, and those are the efficiency.
Thank you. Right? From an IT perspective, the health system doesn’t feel what I feel when they say, Hey, can you build out a clinically integrated network where we share the data across the board? And I go, yeah, yes, that’s going to be really hard to do, cost a lot more money than it should, and take a lot longer than it should, because we haven’t done this work.
We haven’t consolidated our EHRs, we haven’t consolidated our workflows, we haven’t created an integrated data-sharing platform. We haven’t figured out how we’re going to normalize that data. Like if that stuff isn’t done, then when they come to ask you to do something pragmatic or something that’s necessary, you just essentially sit back and go, yes, it can be done because the answer is always yes.
Its going to cost a lot more money or a lot more time than you think it should. I remember saying to people, Hey, that’s going to take three years and do this. And they just looked at me like, are you talking about? Like, we need this like in three months. And I would have to explain to them you’re essentially asking me to build a house with Lego bricks that has plumbing and electricity.
Well, that’s really hard to do.
And so that’s where it’s incumbent upon you as the IT leader to keep coming back and saying, all right, hey here’s what we have, here’s what we have to work with.
And sometimes it takes a hit like this, 8.9% that Northwell. talking about to make the turn. So, will see what happens. Dennis?
But scary territory, right? when you run into implementation issues and your financials are all over the place and now, oh, you’re looking at being in red versus in black.
Yep. And that’s part of leadership is to anticipate the needs of needs of the organization before they actually happen. And to make people aware of, Hey, I know we’re going, I know telehealth is gonna be huge in the future, and we don’t have the systems I know that we need to do online scheduling and digital scheduling across the board.
And we have not set up. I mean, that’s part of the. What the leader does is to say, Hey, I know these underlying things, these underlying capabilities are going to be important in the future and we are this far away from it and by the time you come and ask me for it, you’re going to want it in like this time.
So let’s get started on some of these core underlying things. Hey Dennis, I want to for coming on the show for the second time. Hopefully, we’ll keep in contact next year and run into each other at some of the conferences.
Yeah, I appreciate you having me.
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