This Just In HIMSS 2020 Special Edition

Speaker A: Welcome to this Justin the show, bringing you the latest advancements in healthcare strategy, innovation and public policy. And now for the fastest voice in healthcare, here's your host, Justin Barnes. The show will go on. Welcome to this special edition of this Justin Radio. I'm, um, your host, Justin Barnes. Today we're broadcasting live from the Atlanta studios. As most of you know, we're supposed to be in sunny Orlando for the HIMSS20 conference. But with that being canceled due to the coronavirus precautions, I could not be happier that we're still able to pull this show off. Many thanks to all of my guests that stuck with me and all of you to make this show happen today. Before we get too far though, let me introduce to my radio and on air personality and producer Stone Peyton from Business Radio X. Welcome my friend. Thank you, sir. It's great to have you here. This is actually stone, in my sixth year in a row, broadcasting live from a hims uh, event. But himss, uh, 15 was the very first one in Orlando that we went off with and that was a 90 minute show, but it was 90 minutes live on air. My very first and my longest broadcast of the time. But it went off perfectly. And you are a great producer. You made me so comfortable on air. So thank you so much, my friend.

Speaker B: My pleasure.

Speaker A: That uh, was just a great, phenomenal time for all of us. We launched a great annual trend of healthcare strategy and thought leadership. Um, also in studio today is a great friend of the show and producer Roberta Mullen, broadcasting US live to 30,000 people across the Healthcare now radio network as well. Welcome Roberta.

Speaker B: Thanks Justin for inviting me. I love being in studio with you.

Speaker A: Yeah, you're always a great personality here to have with us and we um, truly appreciate you taking the time out of your busy schedule to join us. You're going to obviously be with me in Orlando as well, along with Stone. Uh, but again, it's great to be here all together in our Atlanta studios.

Speaker B: My schedule is a little freed up today.

Speaker A: Exactly. All of ours are. Uh, but just so everyone also knows, you can stream us live until 4pm Eastern today at BRX live, thisjustinradio.com and certainly healthcarenow radio.com we have several other stations and networks also picking this live broadcast up. So many thanks to everyone for tuning in and uh, again, I'm so proud. This is now our sixth live syndicated and multi network radio broadcast dedicated to the HIMSS annual conference. Over the next three hours we're bringing you the industry's most sought after CEOs, CIOs care providers, policy leaders and visionaries. We we even have the 2 hour uh PM slot slotted for special guests from the ONC to discuss the new interoperability rules just published yesterday. You certainly do not want to miss that and hear directly from the ONC leadership. If anyone does miss any part of this broadcast though all of my this Justin Radio shows are always posted on iTunes, iHeartRadio, SoundCloud, Spreaker, Google Play and the TuneIn platforms. As many of you know, my goal in broadcasting live each year from the HIMSS Annual Conference is to create an information medium that shares best practices, strategies and actionable intelligence from the industry's leading sources and experts. We're very fortunate that most of these guests are also members of our Health Innovation Think tank where we transparently share healthcare and health IT best practices as well as strategies. You can find out more about the think tank@healthinnovationthinktank.com While this is our six year broadcasting around a HIMSS annual conference, this would actually have been my 23rd HIMSS conference. So this is a really tough trend to break. Um, but I know a great announcement is coming up later regarding a HIMSS20 conference opportunity for everyone. So if you checked out the run up show. Actually Hal Wolf will be joining us at 3:40pm today to make a really cool announcement. So President CEO of HIMS. Um, but before we go any farther though, I want to put out a special thanks to this just in Radio uh, production partners, Lenovo Health Business Radio X Rama on Healthcare, Healthcare Now Radio and certainly the HIMSS organization for all their continued support through the years. My goal with all of my guests today will be to offer tactics and strategies to not only survive, but to thrive as you navigate your hospital, your physician practice, your clinic, your company or even your family. Through all of these changes occurring across healthcare, there is more opportunity than ever before for all of us to thrive. But you must understand how healthcare is evolving, where it's evolving, how policy and reimbursement is shifting, and where best practices and innovation can support your efforts and all of our efforts. I hope you glean all of this over the next several hours. At least that's my goal. So now I'd love to introduce my very first guest, Dr. Bob Monteverdi, global Director of Healthcare Solutions for Lenovo Health. Welcome back to the show Bob. Great to have you here.

Speaker C: Hey Justin, how are you?

Speaker A: Fantastic. Thank you for taking the time out of your busy life to join our show today.

Speaker D: Sorry it's not face to face In Orlando. But uh, circumstances have changed that, right?

Speaker A: I know, but we always do. You guys are great partners. You guys just help us produce the show every year. We're grateful for that. But um, let's take a moment to glean some of your thought leadership. Obviously you're always a great guest that we have, uh, each year. But what health, uh, care or health it trends are you seeing in the industry and that you're going to navigate in this coming year and beyond?

Speaker D: Yeah, to me it's really a lot of the usual suspects with a couple of new things popping in. But um, you know, obviously with the uh, advent of the interoperability rules, which I'm sure we'll be talking about quite a bit on this show with the onc, uh, there's that that just kind of begs the, this balancing act of data access, convenience and security. That has been something that healthcare has been juggling for uh, since the beginning of data being captured electronically. And uh, I don't see it going away anytime soon. You know, very interesting ruling this week. There'll be people on both sides of that argument. But overall I'm uh, a fan. I think patients uh, owning their data, being able to gain access to it while still maintaining security and having the APIs in place to enable that are important. Um, you know, AI augmented, uh, is really another big play. Artificial intelligence, augmented reality. There's a couple of big ones there that we get involved in here at Lenovo. But that um, whole idea of using analytics and taking it beyond to be able to help, uh, you see a lot of AI with assistive diagnosis occurring. There's a lot more places we can go. And augmented reality of course is something that will become an increasingly more used tool in healthcare. Um, as an assistive tool, I think, uh, during the day to day life of physicians, uh, all of those are, you know, they've been around um, for quite some time. The one that I kind of see is the newer kid on the block and it's virtual health, goes by many different names, virtual health, virtual care. But um, it's moving quite a bit beyond telehealth. And that's the one that's really been intriguing me over the last couple of years when you start looking at going from just the basic E visits and moving into remote patient monitoring and patient adherence to behavior modifications. That's a big, big difference. And where I see that really focused on is chronic care. Chronic care contributes to the biggest portion of our cost in this nation. Arguably depending on which stat you want to use somewhere in 75% plus range of the three plus trillion dollars that we spend is focused on chronic care. Not really a big surprise considering aging populations increasing physician uh, shortages, uh, actually another factor in that as well. Um, it's just a uh, it's something that needs to be addressed by this nation and it's never going to replace care, but it's a good augmentation of it. So I see that you know many drivers along the ones we just mentioned. When I start looking at the value that could be achieved from that, it really is very patient centric. I see improvement in patient adherence, definitely more patient engagement. While you're able to do more frequent monitoring of the data on a recurring basis and interact remotely through assistive AI devices, patient satisfaction increases. The potential to expand geographic patient access of course increases when it's more remote. And then of course data outcomes improving, which is really the key game. Um, also there's some financial advantages too where you look at anything that can help reduce patient admissions or readmissions specifically within a 30, 60, 90 day timeframe back into the hospital, avoids penalties and makes patients a whole uh, lot happier. And then lastly of course you're aware with all the new codes that keep getting more and more robust each quarter, uh, and each year cms, uh, with increasing reimbursement of that remote patient monitoring and other private insurances following suit. So I'll stop to breathe, but those are the big ones. Uh, and again I think virtual play is really becoming very, very intriguing.

Speaker A: Yeah, actually I couldn't agree more. And I think the only, you know, if you want to look at a silver lining to what's happening right now across our country and obviously globally is that a lot of these uh, precautions right now and what we're, how are changing health care and looking at health care regarding coronavirus and COVID 19 is just the um, um, push and focus on what telehealth, what remote patient monitoring, remote care can do and what it needs to do today. Uh, we've known this, you know, you're a leader here. We've been doing this for 10, 15, 20 years. We've known the opportunity here. But now this is bringing to the forefront. So now it's certainly part of our conversation on a daily basis. States like North Carolina actually where you reside, um, is moving forward, uh, right now actually started yesterday, um, where you can actually be paid same as an office visit, uh, a virtual care visit, you know, a telehealth visit. So that's those kind of changes we've been asking for and needing for a while they're, they're basic common sense, uh, and now you're starting to see them take hold. So I couldn't agree more with what you just, you know, went through, uh, and the strategy that you defined so you know, kind of as a, as a closing next step. Just to give my next. We've got about 30 seconds here to go. Um, but, uh, where do you think people should be looking at, uh, in the next, uh, two years? Um, when you say virtual care, like give us just a kind of a heads up of where you think we should look at on the horizon?

Speaker D: Yeah, I think it's some of the things I just kind of said at

Speaker C: the end of that there.

Speaker D: It's thinking well, well beyond the whole idea of just these visits and think of it really focused around behavior modification. It's really about getting patients, uh, who aren't always necessarily the most adherent to do what you want them to do, to be able to monitor them more frequently, to know that the monitoring effect that their physicians and providers are looking in on them and trying to help. AUTOMATED ALERT uh, that whole mix can help make patients want to do better. There's the gamification aspect to that, but additionally the uh, stakes are high. It's their health. So you want to know that someone's checking in on you, that someone's there for you. And uh, all of those factors, in addition to building those tiny little habits of making sure they're eating the right foods, getting to sleep, taking the meds where they're supposed to, they're all really, really important. I see more and more of that growing and potentially even expanding into more linking together with smart home and less of the uh, FDA centric, uh, approved devices which are core to the health care aspect. But seeing that expand out to smart home and then of course family members being able to tap in as well and help with that care, I think this is a bit of a juggernaut that's not going to slow down.

Speaker A: Excellent. I love it and you're spot on. Bob. Thank you very much. I appreciate you joining our broadcast today and obviously you're always a great, great partner of the show and we truly appreciate that. You have a great rest of your day and obviously stay tuned because we've got some great guests coming up as well. Bob, thank you my friend.

Speaker D: It's an unbelievable agenda there. Just a very great array of people. So thank you very much.

Speaker E: Happy to participate.

Speaker A: Thank you my friend. Take care. And now Stone, do we have the next All Star celebrity Joining us, I believe we do, is Anish Chopra on

Speaker B: the line, the one and only.

Speaker F: Hey, Justin, it's Aneesh. It's so nice to hear your voice.

Speaker A: How are you, Aneesh?

Speaker F: Well, I couldn't be. Well, we're of two minds, right? We're ecstatic about the state of policy, but really despondent about COVID 19. And so how can I be both exuberant and enthusiastic but somber at the same time? It's a little bit hard.

Speaker A: Excellent. But you are wearing your pink socks, correct?

Speaker G: Virtual. Virtual.

Speaker A: Virtual pink socks.

Speaker H: I love it.

Speaker C: I love it.

Speaker A: I know we can't. It's hard to be. We've got so much happening in our lives right now. But I love your energy, your enthusiasm. And I know with bright people like you and brilliant people like you, we will solve these issues and we'll solve them more quickly. So thank you for being here.

Speaker F: Well, I'm excited to join you this morning and excited about, uh, uh, you know, hopefully, uh, keeping the momentum, uh, moving on the heels of yesterday. So happy to dive in.

Speaker A: You got it. So what health care or health IT trends are you seeing in the industry, my friend?

Speaker F: Well, look, I see the lens as I see it, which is the public private interface. And there are three things that I'm paying attention to. Number one, the regulatory, uh, news from yesterday. There has been this consistent drumbeat for the last decade that the information we need to do a job to make health care better is a little bit of a collective action problem. No one actor is evil and getting in the way. But collectively we just haven't made as much progress with a new floor, a regulatory floor. I'm very confident that this will lead to a trend of less discussion about the need for interoperability and much more of a focus on uses. So that's point number one. The trend here is liquidity, uh, is coming, uh, interop talking points are going to fall as hope Number one, the second public private interface that I'm focused on is payment reform. All of this is moot if we don't have an economic model that drives better value in the healthcare delivery system.

Speaker A: So true.

Speaker F: Paying a great deal of attention on two models. Specifically, uh, CMS launched primary care first to rip the band aid off, uh, primary care capitation, and has opened the window for any other health plan to join, whether that's a commercial plan, another Medicare Advantage plan, a Medicaid managed care plan, or a healthcare.gov plan. Any kind of plan can participate in the model so that a greater share of A physician's panel could be organized under the same economic arrangement. Uh, that should make it a lot easier for doctors to participate in this new model when you don't have to practice one kind of medicine in the morning and then a second kind of medicine in the afternoon, depending on the particular contract with which that patient is, uh, the insurance contract tied to the patient. So point number two is how many plans will join CMS in ripping the band aid on primary care capitation. Related to that is the new direct contracting model where uh, CMS basically said we've had these two worlds unmanaged, uh, fee for service. That's evolved into ACOs. But there's also been this sort of dive into Medicare Advantage if you want to go full risk. Now there's a happy alternative which is for physicians that want to stay in the traditional Medicare program but want the economic arrangement to align the incentives for uh capitation akin to what they might do in a global risk contract in ma. That's the second uh area in this uh, pay to value, uh, trend that I'm exploring. How many health plans join Medicare and how deep does the Medicare program on capitation run across the delivery system? So we talked about interoperability as trend one, we've talked about payment reform. Is trend two near, uh, and dear to my heart in trend three is the broader transparency movement. How do we make aggregate data sets available for us to understand what works and what doesn't in the healthcare delivery system? And that is where, first of all, my day job at Care Journey. But it's also uh, CMS leading the way. Adding Medicaid encounters to the Medicare open data sets means that 120 million Americans claims history is available for research to study what is or is not working, which physicians, networks and facilities are delivering better care relative to their peers.

Speaker A: I love it. I love it.

Speaker F: So, source of all that public private collaboration. Yep.

Speaker A: Yeah. So just on that last part there, what can we do? That's an area where transparency is massive. Significant in my world as well. Well, where can we push on that? Or how do we become more transparent and what levers do we pull there, in your opinion?

Speaker F: So the government, starting with what it can do, which is uh, that which is under its control to release the very obvious next step is how do we create a comparable uh, movement amongst the private plans? I'm on the board of the Healthcare Cost Institute. We've been a voluntary collaboration amongst uh, few key plan partners. Can we scale that model where health uh plans create effectively a virtual research enclave so that uh, we can look across all population types, not just government sponsored for understanding what works. That's on the claims and administrative data side. You and I Justin have talked in the past that the holy grail is to get to quality data which involves the ehr, uh, uh information. And so how do we create the same culture of openness and sharing as it relates to quality data and will that come because the government will mandate some of that? Will it become part uh of the norm because we voluntarily created the conditions for these sort of clinical registries to pop up? That's an open question but one that we will be spending the next X number of months and years grappling with. Justin.

Speaker A: No, I completely agree. I think my closing question is to stay on this a little bit. M. Roberta just shared it with me. What plan? Do plans have incentives to do that yet? Or what do you think they're the other plans?

Speaker F: Well that's a great, that's a great question. I think the uh, no individual plan feels like their willingness to go open is going to give them an immediate advantage. We almost need to have multiple plans diving off the deep end at the same time to really feel like we all know that it's better to have transparency but we're anxious about going first. So I fear the industry is waiting on government action. If you remember the bipartisan Lamar, uh Alexander, Patty Murray, uh bill lowering uh Health care costs act I believe they called it last year included a national all payer claims database that would have been a vehicle for that public private model to take hold with a bedrock of government uh action. Short of that I think there may be a few opportunities for us to do that. States are doing it with APCDs and the more we both collect the data and open it up for a myriad number of uses the better we're going to be.

Speaker A: Love it. So in our final minute or so, first of all what do you love most about the interoperability rule yesterday? Since that is so timely, what do you think is the best component of that bill, that rule?

Speaker F: Well look, culturally and technically making sure that everyone has to point the data to consumers just completely reduces the concerns about. Well I can't share because of hipaa, what's data minimization, all the contractual call them in the US Government we used to have a term for this which is the non technical trade barriers. So you'd have global trade and then you have all these random barriers that get in the way that are not tied to the trade agreement we have in the B2B world of healthcare, data sharing, a lot of non tariff trade barriers, uh, on the consumer side it's clear. So as long as everyone knows the rules of the road, connect to the consumer, then uh, we can empower individuals to trust the networks that they believe will help them make smarter decisions. That has to be the most important takeaway from yesterday. And my hope is that uh, once we get beyond this, we will move those non tariff trade barriers uh, through policy and other means, uh, in order to get to the better place. So uh, uh, that's what I take on the conversation.

Speaker C: Yep.

Speaker A: Awesome. Aneesh. I truly appreciate your time my friend. I know you have a busy schedule, you have a lot going on, you're always a phenomenal guest and supporter of the show. So thank you my friend.

Speaker F: Keep up the great work Justin.

Speaker I: Have a great day.

Speaker A: You as well, my friend. Talk to you soon.

Speaker E: Take care.

Speaker I: Thank you.

Speaker J: Bye bye.

Speaker E: Bye.

Speaker A: And continuing on with this amazing Lineup, I believe Dr. Rasu Shresha, EVP and Chief Strategy Officer from Atrium Health, you're on the line.

Speaker K: I am indeed. How are you doing, Justin?

Speaker A: Fantastic. I'm sorry we're not in person right now my friend, but obviously things change. But I'm grateful for your continued support and you joining us today.

Speaker K: Absolutely. It's a pleasure to be here and I'm glad that we're actually doing this virtually right with uh, with everything that's going on around the COVID 19 outbreak, uh, I think this is not just the prudent thing to do, but this is also the right thing to do in terms of um, us doing our part to contain um, the outbreak, but also at the same time engaging in stimulating conversations like what you're having uh, right now.

Speaker A: I completely agree my friend, and I will be remiss if I did not say I walked into the studio today and our producer Stone had a thing of Clorox bleach, free hand sanitizer right in front of my microphone and headphone headset. So thank you for that Stone.

Speaker K: Yeah, wonderful.

Speaker A: I love it.

Speaker K: The right approach.

Speaker A: There you go. So Rasu, what healthcare or health IT trends are you seeing in the industry that you can share with my guest today? Yeah, so uh, you know, there's so

Speaker K: many trends that uh, are out there. One thing that I thought I'd point out um, would be a good perspective is I'm seeing a lot of M. Cross fertilization happening, a lot of morphing happening in front of our very eyes. There are providers who are becoming payers, there are payers who are becoming providers. They're employers who are becoming providers. And there are a bunch of other vertical plays at that. Right. So it's really interesting, a lot of, uh, you know, cross fertilization. You know, I was um, at UPMC before I moved to Atrium Health. Right. And upmc, as you know, was a large or is a large provider organization and is doing very well on the PEAR side. Memorial Herman, similar story. And there are others out there and then pears like Optum and Humana, uh, you know, they're getting into the provider space, whether it's in primary care or in other areas. Ah, employers, uh, becoming providers as well. So you're seeing a lot of that happening, whether it's in Health Stat or Marathon Health, and then a number of other vertical plays. You know, CVS and Aetna coming together and doing a lot of interesting things in that space. So it's really interesting when you look at these trends, to say, all right, what does that then mean for us? Right. For the rest of us, in terms of healthcare, whether you're actively, uh, uh, part of that vertical integration play that's happening, or you're essentially trying to either react or be more proactive, uh, in those trends that I just mentioned, I think the onus is on us to make sure that we're able to be a lot more intelligent, not just wait and watch, but be a lot more intelligent and proactive in, uh, seeing all of those trends and coming out as winners.

Speaker A: Yeah, I completely agree with you. I've seen everything that you just walked through, um, from the health systems being, you know, I call them pay riders or employers becoming providers. I'm either a part of that or I've seen all of that right in front of us, even in my community, but also nationally. And I think it's an essential part of communities pivoting to survive and to offer healthcare at, uh, the most affordable option that they have available. So I think it's a, uh, phenomenal trend to point out. What do you. So I guess taking a next step, what would you point out as a best practice or strategy that you can help others to navigate those trends or point them in the direction to explore? What would you say there?

Speaker K: Yeah, I'd say a couple of things. Um, you know, first and foremost, I think it's really important because you see a lot of the hype, a lot of the trends out there, and even in these vertical integrations, you know, you're seeing a lot of startups and larger entities capitalizing on capabilities like artificial intelligence. And blockchain, there's a lot of hype out there. I'd say three things. One, it's really important for us to break out of that hype cycle and really focus on what's real. And there's a lot of things that are real out there. Even in AI, even in blockchain, there's a lot of things that are real out there. So let's get out of our own way when it comes to this hype cycle and let's focus in on what's real. That's number one, excellent. Number two, I'd say I think it's important for us to push forward with digital health solutions that really focuses on the whole person versus and you're seeing air quotes here. So if I were with you in the studio, Justin, it would be air quotes. Just the patient, right? Yeah. So it's not just the patient anymore, it really is the whole person. So I really buy into this notion of person centered care versus patient centered care. So not to say that patient centered care isn't important, obviously it's very important. But let's push forward with digital health solutions that really focuses on the whole person versus just the patient. And then thirdly, I'd say, um, we will see massive advancement at this intersection of big, uh, data and big pharma. And I think that's going to be really important. It's a space that I think we need to continue to not just indulge in, but really watch and, and understand what the right economic models might be, what the right uh, plays might be for capabilities like AI and analytics, uh, cloud. This, uh, perfect intersection almost of big data and big Pharma. We'll see a lot of advancements in that space, uh, so faster, cheaper, better drug discovery, for example, um, and development. Even as we're in the midst of the COVID 19 outbreak here, uh, and we're talking about, hey, is it months versus years for the vaccination to come out? Right. I believe wholeheartedly that when we're able to tap better into that intersection between big data and big Pharma, we're gonna see a lot, um, more advancements come out. And that's a space that uh, I think is really, really exciting as well. So three things there I thought I'd share with your audience.

Speaker A: Sure. So I know this is tough, this next question, because we have a lot before us and we still have a lot to achieve in the next year or two, but looking out, um, at some key trends or just things, uh, to keep an eye on and you may have just covered it there in your close but you know, in three to five years from now where do you think we should have an eye on or just to know what's ahead of us? Anything there?

Speaker K: Yeah.

Speaker F: So uh, a lot of it was

Speaker K: what I mentioned but if I could distill it down to a ah, specific thing that we should I think be aware of it is essentially us leveraging data uh, and coming up with insights in ways that we've not managed to do so before. And in a nutshell I call that being hyper aware. Becoming hyper aware I think is um, something that's going to be the reality of where healthcare will be in the next three to four years. I mean three years is a long time when you think about the pace of change that we're seeing uh, today. I think in the next three years we're going to see the amount of change that we've seen in the last, I'd say five to 10 years. Right. So becoming hyper aware where you know, we're seeing real digital transformation, where we're seeing algorithms, intelligent visualization, smart user interfaces allowing for us to be hyper aware of ourselves, of the populations that we belong to, the conditions that we live in, the preferences that we have, the economic capabilities that we may have as an individual or as a group and then helping us through that hyper awareness make more informed decisions and execute uh, and nudge behavior in the right way, the most impactful ways forward.

Speaker A: Yeah, I think that's great. And if anybody's ever seen some of your social media out there, you know, we also know self awareness is a critical step in that direction and you're, you currently um, discuss that and speak about that and I think that's an important concept of being hyper aware. Just being self aware as a starting point. Would you agree with.

Speaker K: Absolutely. I think it is so important for us to just, especially in this busy world, the busyness of the business that we do. It is so important for us just to pause and reflect and be self aware. And that is such a critical element of being hyper aware.

Speaker A: Excellent. And just one closing piece. I know we weren't going to speak about it but uh, I do want my listeners to check out. I think there's a couple of posts uh, out there where you've, where it's highlighted your concept around unlearning. I think it's really important as we, to be able to run faster. Sometimes we have to undo things and undo our own barriers in our head or undo silos that we've Created, um, but the whole concept of unlearning, you're an expert on it, you've helped kind of coined that term, at least in my world. And I would certainly point my listeners, uh, to any talks that you've ever done on that, but any couple of 30 seconds of words you want to see on unlearning or Sue.

Speaker K: Yeah, no, absolutely. I think, you know, we go to whether it's conferences like hymns or you know, what's next that's going to uh, go down the way of himss by canceling the conferences itself. South by Southwest, maybe the Health Evolution Summit. We'll see. Um, we go to these conferences and these groups, uh, even uh, this radio show that we're having today to learn and I think it's important as much as we learn for us to actively unlearn, um, as well for us to let go of older paradigms that maybe haven't worked as well, maybe haven't produced as many results. And when we unlearn actively, we're able to create space for us to actually take those newer concepts, those newer frameworks, those may be different ways of looking at older problems that we've been trying to tackle forever now and get to newer results. So it is as important for us to unlearn as it is for us to learn.

Speaker A: Fantastic. Agree Rasu, you're always an amazing guest. Again, I truly appreciate you reprioritizing this in your day and making the show happen. Without you we could not have done it. So thank you again my friend.

Speaker K: Thanks Justin.

Speaker L: You got it.

Speaker A: Have a great afternoon my friend.

Speaker G: Take care.

Speaker K: Thanks. Yep, be well.

Speaker A: Thank you. All right, and my next guest is president Mayo Clinic platform, Dr. John Halamka, as well as author Paul Serrato. Gentlemen, are you there?

Speaker C: Yup, we are indeed.

Speaker A: Excellent. Thank you. Welcome back to the show.

Speaker C: My pleasure.

Speaker G: So I must listen to my friends Anish and Rasu.

Speaker A: Exactly. Thank you John, but, and I'm going to take point, uh, of privilege here just because I would love for you to give a 10 second plug of where you're calling in from. I hope you're calling in from Unity Farm Sanctuary, John.

Speaker G: Uh, I in fact are at Unity Farm Sanctuary, though tomorrow I'll be heading to Mayo Clinic Jacksonville because I did promise my Florida colleagues that I'd spend several days with them. Cancellation with him has just required us to be agile.

Speaker A: Excellent. Well, I love what I'm just, I'm part of that community. I love what you do there, your generosity, you're giving back. Uh, but obviously the show Today is about your leadership in the industry. Um, but I love the Unity Farm sanctuary, so I always like to bring it up as you know. Thank you. So, John and Paul, I, Paul, assume you're calling in from upstate New York as usual?

Speaker C: Yes, yes, from my home office in Warwick, New York.

Speaker A: Excellent, excellent. So let's start off with, um, just what trends to follow, uh, the show here. What health IT trends are you guys seeing in the industry? So, uh, John, I'll start off with you, uh, and then Paul would love for you to chime in with yours.

Speaker G: Sure. Well, so I joined Mayo Clinic January 1st, and the three major areas that I'm working on are. First, how do you take large amounts of data from the past and use it to inspire new cures and optimal care plans for patients in the future? Do that in an ethical way that's a privacy protecting way and a way that's scalable and allows you to participate with multiple constituents, payers, providers, patients, pharma, uh, all learning together. The second area is how do I take a, uh, high acuity patient and care for them in a non traditional

Speaker F: setting in your home.

Speaker G: And as we think about lowering costs, as we think about COVID 19, we're going to have to start delivering care in places other than bricks and mortar. Finally, how do we take the novel signals we're getting from your wearables in your home and turn those into wisdom with AI algorithms that bring you value because right now you're wearing things. But who's looking at the data and what can you do with it?

Speaker A: Oh, I just got a hashtag in there. WearablesWisdom. I love that. John, that's great.

Speaker M: Perfect.

Speaker A: Paul, what are some of your thoughts and trends that you're seeing, my friend?

Speaker C: You know, it's funny, John and I have been working together for so many years that we're starting to finish one another's sentences, as he has said before. And when he mentioned the talk about moving from brick and mortar to, uh, virtual care, that was on my list. Um, it's happening and we've got to be prepared for it. And the two major buckets are telemedicine and, uh, hospital at home. Those are the two movements that have the most traction. And as M. John mentioned, with the coronavirus being such a big issue to say, telemedicine is certainly one of the ways to, to address that problem. But in order to make that doable, we have to have a better understanding of what type of remote patient monitoring systems, uh, work and which ones don't mhm.

Speaker A: Yeah. And I think if there's a positive that can come out of all this right now with M. What's happening across the country and across our world as I open the show with as well is that um, we are going to start to hyperspeed. Uh, I think the promise of telehealth, the reimbursement for telehealth, virtual care, remote patient monitoring, just remote care in general, uh, and platforms around that. I mean we've all known, we've been in this industry for a long time in the forefront of it. We know what it can do for us, we know its efficacy. Uh, in many cases, there are always many use cases. Uh, but we've been very slow I think to uh, um, support it properly, uh, in different uh, care strategies and care settings. But I think now it's going to be moved to the forefront. We see what North Carolina is doing. They've started reimbursing, um, basically full fare as of uh, Monday, uh, for visits, you know, whether you're in office or virtual care, certainly, you know, via telehealth. So I think that we're going to see, see more of that. So if something positive can come out of all of this, it's certainly moving all of these uh, technologies innovations to the forefront.

Speaker C: But absolutely.

Speaker A: What best practices, um, or strategies can you guys help share to, for us to navigate those trends from your individual perspective? So, so Paul, I'll start off with you. What are some of the things that you would share there?

Speaker C: I think as I just mentioned earlier, we have to distinguish between what remote patient monitoring systems really work and which ones that don't have much support or just are silly and useless. I mean you take things like glucose monitors, obviously they've been in use for a long time and they were effective. Just recently, uh, the FDA approved a uh, glucose monitor that does not require finger pricking, which is a major problem,

Speaker D: problem for a lot of patients.

Speaker C: So there's a little um, monitor that people put under their skin and then all you have to do is put the glucose meter right next to the um, meter, the monitor and it tells you uh, what your blood glucose levels are. So that's the type of technology. Yes, we know it works. Let's push forward with it. Whereas some of the less useful and sometimes silly uh, um, monitoring systems, one thing, one that comes in mind, um, I wrote about a couple of years ago, there is a uh, booty that newborns can wear. So the new patients put this little boot on the child's foot and it monitors their blood pressure, it monitors their heart rate and so on and so forth. Uh, totally useless for some, a normal healthy child. And in fact the American Pediatrics um, Society has come out saying that you're probably doing more harm than good for that kind of patient, uh, monitoring. So obviously we've got to be discriminating when we use these type of tools.

Speaker A: Very, very good point. Totally agree. Uh, John, what would you like to share there best practices? Uh, two points.

Speaker G: I think Paul is exactly right. We have all these novel sources of telemetry and figuring out the provenance, what devices generate what signals for what utility. But also we're getting so much data we're going to overwhelm our clinicians. And so the question is how do we separate signal from noise? And the answer, there has to be machine learning used to augment human decision making so that as we get these terabytes of new signals, the humans get engaged when there's something material to review. And figuring out how to build platforms that ingest the data and connect them to partner companies that do the machine learning processing is a lot of my effort, but also protecting privacy. And that's of course a really challenging thing to do as you generate more data for more purposes. And so much of what I've also focused on is how does one uh, de identify the data or let's just say this, lower the re identification threshold so substantially that the data can flow to multiple parties while also ensuring that patient privacy is respected.

Speaker A: That's excellent. So on that note and kind of pivoting over to the new interoperability rule because obviously some of this is covered in there. What would you like to share? I'd love to know what you thought of the rule yesterday, John, and certainly Paul, if you have anything you want to add. Um, but I'd love to know your thoughts as well. You know, we'll have Dr. Rucker on at 2pm today, but we'd love to send me your preview there.

Speaker J: Sure.

Speaker G: So I think it's as Aneesh said, it's cultural and it's ecosystem. It's suddenly instead of walking into the basement of medical records Monday through Friday 9 to 5, asking for your medical record and being asked would you like that single or double sided?

Speaker F: Right.

Speaker G: The culture will be, it's an expectation of digital first and you can't say no. Uh, I mean there are eight exceptions.

Speaker M: I get it.

Speaker G: Right. But I mean in general the answer is hospitals and clinics will be offering a digital channel for patients to become stewards of their own data and that's really a cultural change.

Speaker A: That's fantastic. Did you like anything else about the rule?

Speaker G: Well, I thought it was extraordinarily accommodating to all the players in our environment. Right. I mean, we all know there was a lot of controversy about what would the rule require in terms of intellectual property disclosure and fees and all the rest. And I think the folks at ONC worked pretty hard with our stakeholders to come up with something that everyone would say is reasonable.

Speaker A: Yep, I agree. I heard, uh, accommodating is one of the terms that I heard last night as a few of us were digesting the day and the comments and, uh, the, uh, different calls that we were on. So I completely agree. John or Paul. Anything else you want to add to that?

Speaker C: Yeah, I've got mixed feelings about this new rule. I think a year from today, we'll be able to answer the question, yes, it does work, or no, it doesn't. But, um, earlier this morning, I looked at the, uh, hhs, uh, news release about this new rule. And I've been doing this for, you know, working as a medical journalist for about 30 years. And this news release was a lot different than a lot of the others that I read, because it spent the first three or four paragraphs, and it looked more like a political campaign released than an explanation about how the rule works. So I don't know how much of this is political grandstanding and how much of this is actually going to benefit patients down the road. So we'll see.

Speaker A: Well, I think the ONC has been so, I think, just battered from all sides. So I think they almost had to put a statement like this together, um, to kind of pacify everybody to the best of their ability, knowing they probably couldn't, but they had to at least give it a shot. That's. That's my take on it, because I

Speaker C: agree you're probably right.

Speaker A: Yeah, they are. They are a very nonpartisan group, in, uh, my opinion. Uh, but they have a lot of politics to navigate, let's just say that. So, um, John, I know my audience would love to hear more about your new role as president of Mayo Clinic Platform. What would you like to share regarding that? Your new post?

Speaker G: Sure. So Mayo Clinic has enormous talent and reputation. And the question is, how can you share that broadly with a world that, as we know from COVID 19 is shrinking every day? And the idea is, can you take the AI algorithms that have been developed by Mayo Clinic experts, or the content or care plans, and make that broadly available through a variety of Channels so that there can be much more extended benefit. And platform is really that it's how do you connect producers of innovation with consumers of innovation and do it to very large scale with very low friction. And so my challenge, of course, is in 2020, I'm expected to have a series of major go lives once a quarter. And so I would tell you this is probably, uh, a, um, bit of a sprint, but it's also a marathon. So am I sprinting a marathon? All I can tell you is it brings me joy every day and that's what's important.

Speaker M: I love it.

Speaker A: It's, uh, very optimistic. It's great. I've read, uh, what your Go Live plan is, so it's, um, it's impressive, it's monumental. And we obviously look forward to watching, uh, the journey. So, um, and thank you for, again for. I know you got a busy schedule for joining us. Do you want to join in? You say question here, John, this is

Speaker B: Roberta from Healthcare Now Radio. Just want to know if your Boston Marathon is going to go on this year.

Speaker C: Oh, good question.

Speaker B: I read that this morning.

Speaker G: Wow. Do you know, you know, if they, if they've canceled the St. Patrick's Day parade? Doesn't that, uh, isn't that a harbinger? I don't know. I have no inside information.

Speaker B: All right.

Speaker A: Yeah, that's actually a great question.

Speaker B: Neither does the Atlanta, uh, journal have

Speaker A: much to say about ours.

Speaker K: Yeah.

Speaker G: But I think what you could say this is that we are seeing the, um, catch words, abundance of caution being used in virtually every public event. So, uh, I take that to probably mean public events of that magnitude will be canceled.

Speaker C: Yep. Yep.

Speaker A: I tend to agree. Um, so I think looking over, um, you know, closing out there with Mayo a little bit, what, uh, three, I think would be a couple initiatives. AI or machine learning, Artificial intelligence. Machine learning initiatives that Mayo is launching this year, John. Or that you plan to launch over the next year or so.

Speaker C: Right.

Speaker G: So the first, which, uh, we just finished the comprehensive DE identification of 9 million historical records, and we'll be moving those into a secure container where we can invite innovators into the secure container to run AI algorithms. That is the data will never leave our control. It's fully DE identified and certified as DE identified. But we can invite innovators in. And I think that's a really interesting model. And so you'll start seeing the first invitations, if you will, happening in April and May of this year. Going live with Home Hospital. And to the comments Paul made, uh, we believe that it's going to be increasingly important in society to have this capability. And our first home hospital, uh, Go Live, is in Florida in July. Our second in Northwest Wisconsin in August. We're trying just two totally different geographies, supply chains, reimbursement mechanisms and ecosystems. And we'll learn a great deal, uh, as to how this can scale. And then I am increasingly working on connecting the devices, the kind of things that Paul described to algorithms. And by the end of the year you should start to see some of those algorithms applied to some of the devices we're wearing today.

Speaker A: Wow, that's amazing. All the best there. That's phenomenal. I did not know about the home hospital, so terrific. So let's pivot now to your new book, um, that you guys co authored, Reinventing Clinical Decision Support. So let's talk about um, uh, Paul, why don't you start off here? The Promise of AI. The book talks about the promise of AI, machine learning and helping docs make better clinical decisions. But what are some of the barriers and limitations of these new tools?

Speaker C: Probably the two most important two that we were going to talk about at the HIMSSA conference were resistance from clinicians and the relative lack of scientific evidence to support some of these tools. Uh, resistance, we've spoken about that often. Uh, part of the resistance comes from not understanding the complex data science behind some of these uh, AI tools. And one easy way to address that is better education. Uh, we were planning to give a presentation where we showed a video of how convolutional, ah, neural networks work. And then I also had a video to show how random forest modeling works. Those are two foundational stones used to um, do machine learning and AI. So um, education is one of the first steps which by the way, if any of your listeners are interested in those videos, they can email me and I can send it to them directly. I'm@serato.com and then the second issue, relative lack of evidence. Um, there are thousands of scientific papers out there about machine learning and AI as it applies to uh, healthcare. But most of them are proof of concept papers or retrospective studies. That's really not the kind of high level research that we need in order to put this into daily practice and risk patients health. Um, so one of the things that I plan to hand out at the uh, conference was a list of about 10 or 15 uh, studies, randomized controlled trials, prospective trials that show the strongest amount of evidence for certain categories of machine learning. So once again, anybody interested in that handout serato.com I'll be happy to send it to them.

Speaker J: Yeah.

Speaker A: And we also broadcast a show, had you both on a couple weeks ago. So they can also go check out your radio show. This Justin Radio. There, there's all my shows listed. You guys are just a few weeks ago. And that's a phenomenal show. We actually did a double episode, so almost an hour. Just focused primarily on reinventing clinical assistance support in this new book. It's fascinating. So this is just a real kind of, we're just touching on it today. But we did an in depth double episode um, a couple weeks ago, so everybody can certainly check that out. And look, uh, look Paul up there. So John, what else would you like to add to that? I mean, how can we make, um, you know, docs make better clinical decisions in that regard and some of the barriers.

Speaker G: Couple of thoughts. Um, Justin, you have been interviewing many, many people. How many clinicians have told you how much they love their EHR regarding a brand or vendor?

Speaker I: None. None.

Speaker G: Yeah. Well, yes, those tools are fit for purpose. I mean, in the sense that they're required by regulation and there are certain compliance issues. So I get that. But most clinicians would say on the whole, this is a burden. It isn't a tool I look forward to using every day. So to Paul's point, if you bring those validated algorithms and workflow enhancements into the EHR as an external product, it's sitting within the framework of the EHR that reduces the time spent, reduces the administrative burden, brings more confidence and decision making. The hope is you can restore some of the joy in practice. And I was recently visiting a large software company somewhere in Wisconsin, can't imagine which one. And the senior leadership embraces that idea of taking everything that's in the book and making it through FHIR cds hooks available within the workflow of the EHR to enhance the usefulness of the ehr, recognizing it will take a village of third parties to do so.

Speaker A: Fantastic.

Speaker M: Yeah.

Speaker A: And we're all supportive of what electronic health records can do, should do, um, and need to do. So for the record, we're highly supportive because they're essential functions and infrastructures to our healthcare system. Would you agree with that, John?

Speaker G: There is no question that EHRs are needed, but my hope is they become a bit more of a back office function.

Speaker I: Yeah.

Speaker G: And that is ambient listening technologies. And some of these AI tools we've been talking about become more what the doctors and nurses are interacting with every day.

Speaker A: Yep, completely agree. Excellent. And our remaining 30 seconds, I guess, what would you, um, say we should be looking on the horizon for AI and machine learning, living up to its potential. What do we need to do?

Speaker C: John, you want to take that? Yeah.

Speaker K: Okay.

Speaker C: Uh, so we talk a lot about how the healthcare system is broken and fragmented, but frankly, AI to a large extent is fragmented as well. So many providers are only using one aspect of AI, like the predictive analytics aspect. But what we really need is an integrated approach which includes predictive analytics, prescriptive analytics, and AI that helps with patient, uh, engagement. So you have the entire universe from soup to nuts, as they say.

Speaker A: Excellent. Fascinating. Gentlemen, Paul Serato, Dr. John Holamka. You guys both are amazing guests, great supporters of the show, and thank you so much for joining us today. Have a great afternoon, my friends.

Speaker C: Thank you.

Speaker G: Thank you so much.

Speaker A: Thank you. I believe we have Dr. Karen DeSalvo, Chief Health Officer from Google. Welcome back to the show, Karen.

Speaker N: Hey, it's great to be here.

Speaker O: Thanks for having me.

Speaker A: You got it. Thank you. Thank you. Hopefully those are some, uh, familiar voices you just heard as well. Yes, phenomenal. So, first of all, congratulations on your new post. We would look forward to. I, uh, mean, I'd love to take 30 seconds. John, uh, just described his new post as president of Mayo Clinic Platform. But would you like to take 30 seconds to kind of let my audience hear, um, about, you know, what you plan to achieve or, you know, as a new chief Health Officer for Google?

Speaker O: Yeah, you know, well, Google has, um, has entered into, um, an endeavor to see if we can leverage the, uh, tools and capabilities of our company in areas like artificial intelligence and computer vision, but also organizing, uh, complex information and making it accessible and useful to, uh, applying it to the health sphere. And our mission in the health work is to give more life to everyone every day. So it's broad, it's more than just, um, what we can do in the healthcare environment, but really thinking also about upstream and global opportunities to really focus on quality of life and putting consumers much more in charge not only of their own information, but of kind of the actions that they can take. And give you an example of something that the team's worked on, which is in the area of, um, applying computer vision and machine learning to reading, um, mammography so that, um, we can not only do a better job of identifying cancer, um, where there might be cancer in mammography, but reducing false positives as well. And, um, in places like the uk, uh, where they need, uh, secondary readers for every mammography, shorten the timeline to when a woman's going to get the results of her mammogram test. So it's a win on the accuracy of the test, um, based upon the results that we published back in January, but also when for uh, the consumer or the patient who gets their test results earlier. So that's an example of how we're trying to improve the efficiency and effectiveness of the current system. But we're also doing a lot in our platforms around search and YouTube to improve authoritative content that people get. And it's uh, an exciting place. Lots of people come into us every day with health questions and we look forward to partnering with others to see what we can do to improve health.

Speaker A: I love it. Congratulations. Phenomenal. So Roberta, you want to ask a question?

Speaker B: Yes, I do. Karen, this is Roberta from Healthcare Now Radio. I'm wondering, you've been in the government, you've been in provider, you're a doctor. Public health. Yeah, public, uh, health, uh, all that stuff. Tell us what the culture change is going to big corporation.

Speaker O: You know, um, first of all I came to Google because this is a place that puts community first. It's all about the user here. And um, you know, you never know till you step into a company how much what you believe or are told is real. But it's real. And you know, when I left public service at the federal level and before that I was the health commissioner in New Orleans, one of the things I loved about those jobs was that you're really able to put the community first. So culturally it's been really great. Um, I think what else has been amazing is the level of talent in the company that um, wants to put our tools to good and the uh, freedom we've been given to really think about how to do this in a way that is really driven by partnership and um, so it's not so much about replacing or disrupting negatively, but sort of figuring out improve the system.

Speaker A: Excellent.

Speaker B: So you're liking it?

Speaker C: It's great.

Speaker O: I love it, I really do. And maybe I'm still in my honeymoon phase but it's really been, it's a tremendous platform and the global nature of it is also what's really exciting. I mean you think about the opportunity we have from a public health lens to provide better information through our services like search and YouTube. We have for example been um, working for a while with the cdc, um, so that when people search on diabetes they can go to a CDC developed screener that gives them their sense of their own risk and then pushes uh, them to a CDC list of accredited diabetes prevention programs. That's an example of how we can do sort of the search to action work, um, that puts the consumer more in the driver's seat. There's an awful lot more we'd like to do to help them have better insights into their own health information, et cetera. And so I think um, it's really we're being as responsive as we can to what consumers are interested in. And um, that by the way is one of the things I've been starting to do since I was a chief health officer. Here is some listening sessions to hear directly from our users, consumers, doctors, others about what are the ways that we can be more helpful in their daily lives.

Speaker A: That's fantastic. So Karen, what uh, just on the flow of the show, what healthcare health IT trends are you seeing in the industry from your perspective, from Google, from you personally. I know you just covered a bunch, uh, as we open, but what else would you like to share there?

Speaker O: Well, you know, one of the reasons I came here is because I've always believed that the consumer should be at the center and increasing, increasingly believe they should be a lot more in control. And I don't think that's true just in a US context, but I think globally and policy uh, work that we did as national court when I was national coordinator, um, we wrote a new strategic plan that put the person at the center wrapping the data around them. And as John was saying earlier, the EHR is but one of many data sources that tell us about someone's health and quality of life. So starting to shift that paradigm and that power so that the consumer really is more um, at the center of that uh, this whole movement towards figuring out how to assemble data that tells a broader story about somebody's health and quality of life, including like social drivers of health or behavioral drivers of health and doing that in a way that their health information is accessible and useful to them and those they trust is the trend that everyone's trying to figure out how to meet that expectation from consumers and do it in a way that is really um, uh, secure and private but useful to the consumer, uh, over time. And I just want to call out, because I know Dawn's coming up next, how delighted I am um, to see this next step of the rulemaking on the part of hhs, which builds on work that um, we did when I was the national coordinator around the 2015 edition and working with Congress on the 21st century cures. And I think the fact that the HHS, ah, that FEMA and Don have really pushed forward this next iteration should be a clear signal to the industry and to consumers that health. It is not partisan. It's really about doing the right thing for their health. And so that the uh, um, industry always ought to have some clarity that the policy is moving in more of a consumer centric direction. We need to build tools and businesses that are B2C very consumer centric and be thinking about building an industry that allows for cost and quality transparency and people to be able to take access. Look, I have worked in, um, communities that are with seniors or communities of color or communities that are uninsured. So I fully, completely understand that with my patient base for 20 years, that what we have to build has to be culturally and um, competent and from a health literacy standpoint. But we really do need to build a future in which the power is not all in the hands of the health system or in the companies that hold the health records, but rather that the power is shifted to those who are really putting the consumer first.

Speaker A: That's fantastic. So I mean I'll even give you the last, uh, 30 seconds or so a minute on. I mean you just obviously gave some praise. You actually helped start a lot of this back in 2015. So I certainly want to publicly thank you for your hard work and dedication through the years. But what would you want to say regarding the interoperability rules that were launched yesterday?

Speaker O: You know, in addition to everything that ONC did? I think what CMS has signaled in two important areas. One, around the conditions of participation, expectations around interoperability. That is a clear shift away from meaningful use as the driver of interoperability. But just to saying it's the 21st century and health systems need to be interoperable. I think there's another clear shift of expecting the health plans to aggregate longitudinal health records, which is a signal that trusted third parties could be a health plan. Um, tech companies have already been in this space that there will be ways that people want to have their health data aggregated to it. One person, one record across their lifespan. And that the companies that do this by giving people, um, digital dignity are going to be the companies that really help, um, that really, I think are successful. So it's really thinking about putting the consumer in the driver's seat and doing it in a way that gives them um, visibility into their data so they can put it, um, where they uh, can share it with those that they want to, when they want to. And it has to be people that they'll trust. And by the way, I want to give Grace Cordovano credit for that digital, digital dignity term. I borrowed that from her, um, in one of the listening sessions that I had. And it's such an important concept that

Speaker A: coming out of this.

Speaker O: These rules is now 21st century model. Now we got to figure out how to make sure that we're doing everything we can around privacy, security, and digital dignity for the consumers to make this work in real time.

Speaker A: I love it. I actually wrote that down. Digital dignity. I've heard a few quote, um, unquote, hashtag, today, wearable wisdom, dignity, digital dignity. I love it. So who again, coined that term, digital dignity? Karen.

Speaker O: Grace Cordovano. C O R D O V A N O.

Speaker A: She's a. Oh, yes. Yep, I know.

Speaker J: Grace.

Speaker A: Fantastic. Well, Dr. DeSalvo, I truly appreciate you time. You taking the time out of your busy schedule to join us. I know you have a lot going on. I'm sorry we did not get to see each other in person at hims, but, um. But thank you again for showing up today and being a part of our show. You're amazing.

Speaker O: Thank you. Wash your hands for 20 seconds.

Speaker A: I have. And I have hand sanitizer. Yes, I will. 20 seconds. And I do have hand sanitizer in front of me. The studio had it on my computer when I walked in the door, so.

Speaker B: And we're gonna check in in one year when your honeymoon's over, to see the privacy guys. Uh, see you next year.

Speaker A: Thank you. All right. Stone.

Speaker B: Yes, sir.

Speaker P: Yeah, you got.

Speaker A: You got your HHS purse.

Speaker B: I think you got Don.

Speaker A: Excellent. Dr. Don Rucker from the ONC National. Excellent. Welcome to the show, my friend. Welcome back to the show. I should say Excellent.

Speaker G: All right.

Speaker J: Yeah.

Speaker A: Thanks, Justin. You got it. Appreciate you taking the time out of your busy schedule. Obviously, you have a lot going on, probably more than anybody else. Well, except for the CDC right now, maybe, um, going on with, uh, with what you, uh, released yesterday and your team. So we're grateful for you joining us today. You have a great audience here of listeners, so I would. First of all, I'd like to offer you the floor. I know you have some, uh, some great points that you want.

Speaker Q: Want to share.

Speaker A: You did a great job. You and your team did a great job yesterday just setting the industry up, doing your call, sharing some of the outlines. But I'd love to offer you the floor, um, for you to, uh, share some of your insights right now.

Speaker J: Yeah, no, thank you. Uh, thank you. Um, first, I'd like to, um, thank Karen and team, because, um, obviously, as Karen pointed out, uh, the journey on interoperability has been a, a multi year, almost an entire generation. When you go back, I was talking with David braylor yesterday ah, 2004 um when you know um, the office of the National Coordinator started framework a long journey here um to get that. I think the rule that we put out, the uh, 21st Century Cures act rule is a major milestone. I think it reflects a couple big things. It reflects that while we've had I think for a couple years the bandwidth, the amount of electronic now finally health information to actually have something to share. Um, you know we have not had the policy incentives because all of the policy incentives that we put over into American healthcare literally since 1942 stabilization act during World War II that made um, health insurance a pre tax benefit have um, put us um, where health care is under the control of third parties as opposed to being a direct conversation with a patient consumer and a provider, you know, doctor, hospital. It has been a ah, three party conversation and that um conversation because the economics are really under the control of everybody but the patient consumer has been an increasingly expensive, increasingly unhappy um, situation. The Cures act says wait a minute, let's put some provisions in place that combined with modern computing will put the patients back in charge. And those provisions at top level there are two big provisions. Um, technically it says that the application programming interfaces if you will have to be allowed to work. They can't be hidden by you know, contractual blocking, um, or you know all the sneaky ways that you can sort of look like you're doing something but aren't. So they have to be real bona fide interfaces. On the one hand Congress termed it APIs without special effort and on the other hand the information has to be shared for patients. Um, the days when you can say well um, we're not really going to share the information because they're not in our network or maybe even um, we'll share the information on a private network of you know, where maybe the other members on that network are also high priced and also not really offering competitive solutions. Um, Congress said those days are over. The patient controls where that information flows. Um, our rule um, makes that law, um, you know, puts that law into effect. Um, it happens over a couple of year uh time frame. You have Steve Posnack on soon I believe to talk about the details. But um, anyway that's the top level. We're very excited as Karen mentioned, we think this will be um, one of those things we look back on as an absolute game changer in getting the American public back in the control of health care. And certainly, um, I think as everyone knows, President Trump strongly believes that the American public should have the ability to shop for their health care.

Speaker A: Yes, yes. So what, what um, are some of the major takeaways for providers do you feel, from this, uh, from this rule?

Speaker J: Well, I think there's a couple big takeaways for providers. I think first of all, um, you know there's a lot of brouha about the role, obviously a lot of lobbying, um, a lot of business models that need to get rethought. Um, and you know, maybe this is a forcing function for business models, especially the non transparent business models, they have to be rethought. But ultimately what is required of providers, what's required of providers is an unattended endpoint to their EMR secured by security provisions that I think Steve will tell you about in great detail. Um, but it's a, ah, it's a pretty straightforward thing. You basically have a server on the Internet is ultimately what this is. Um, so unlike some of the prior rules where all kinds of physician and hospital behaviors had a change, which is quite hard to do, uh, this is really taking the data you already have that's already formed will already be formatted and making that available on a secure API to the public, which means you hook up a computer to the Internet that has an API. Um, that's the mechanics of providers. What I um, think it really means is that providers can start thinking about a new world, a big data world, about having new insights into what they do, new control over their data. We've heard from some of the most sophisticated providers in America that um, they don't even have control of their data. Um, they don't even have effective access to their data to do what they want. Um, we think that's going to be powerful. As a m. Practical matter, having these APIs will mean that a lot of the huge burdens that um, are forced on providers with our dysfunctional payment system can start going away.

Speaker Q: Right?

Speaker J: If payers can get the data and really see what providers are doing, we can really think about eliminating all this, um, faked up documentation for, you know, to get a higher CPT code. Um, we can, if we have all of the data, we can basically think about stop playing the quality measure game. Right? The quality measure game is because we have no other way of evaluating value. That's why we started doing this 20 years ago, roughly. Um, now with these APIs, you're going to have many ways of evaluating value. Um, another payment game that will Just, I think over time, melt away with data is the whole prior auth business. So these are huge burdens on providers that just destroy the provider quality of life. Horrible terms like pajama time. Um, and these APIs are the pathway to make this kind of hand entered, manually curated, no value add data entry. This clerical work basically melt away. It's going to be great for providers, I believe over time it will, however, force them to think about transparency and customer service in a new way.

Speaker A: It's fantastic. Roberta, you have a quick question?

Speaker B: Yeah, I do. Um, this is Roberta from Healthcare Now Radio. Hi, Dawn. Um, so you brought up Braylor. I was reading, um, about that the other day in 2014. One of the missions of ONC has always been patient access. This is like a decade and a half later. This rule that came out, right? Uh, this rule that come out, what do you think? Mission accomplished or one small step?

Speaker J: Um, well, um, without getting into the history of the phrase you've cited in

Speaker L: American political dialogue, they're both very famous.

Speaker A: So without getting into that, I think,

Speaker J: I think it, um, you know, more concretely, um, I think what it says is in a world where we have not economically empowered the consumer, right, in our business models, the healthcare, that's changing, high deductibles, employers are shifting more and more of the costs back on consumers. Even, you know, Medicare puts lots of costs on their patients. Um, when you get right down to it, as we are shifting these costs back to the American public to get some control of the cost, we are fundamentally giving the public, um, an entree into modern tools to, um, make those decisions, both in terms of choice, um, of what to do and then how to shop for what you've decided to do. Uh, so I think, um, it has been the missing ingredient here. I think it's going to be very powerful.

Speaker B: Giant step forward.

Speaker E: Yeah.

Speaker A: No, excellent. Dr. Rucker, thank you very much. I know you have a busy day and a busy afternoon, so we certainly appreciate you joining the show today. And, um, thank you for everything you do. We appreciate it greatly.

Speaker J: Oh, no, thank you. Great, great tragedy, guys. Sorry we couldn't do it in Orlando.

Speaker A: You got it. This is the second best, though. We, again, we're grateful. Thank you. And I think Stephen Posnak is on the line. Deputy national coordinator.

Speaker G: You got it.

Speaker A: Excellent, my friend. How are you doing? I'm sure it's good.

Speaker M: Can you hear me?

Speaker A: I can. I'm sure it's been a crazy, uh, I can't imagine what you're going through. Never Mind all of us just kind of scrambling. You've had to not only scramble but you've had to do a lot of work over the last six to 12 months to five years. So to get us here.

Speaker M: Uh, yeah, those are all appropriate units of measure.

Speaker A: Exactly. Um, so uh, first of all thank you my friend for taking time out your busy day to uh, to join us. So we'll kind of dive right, dive right in. I'd like to actually give you kind of the floor and let you hit on some of your high points. I just have a, we'll have a couple of follow up questions but I really know there's some real important pieces that you want to get out to a large audience today. So I'll kind of give you the floor and some of your high points from the new rule.

Speaker G: Sure, yeah, absolutely.

Speaker M: And just to follow on to Dr. Arker's remarks, um, you know, unlike the other rules that we worked on in the past, um, you know this one is both larger obvious statements but also has a much more transformative impact that um, we feel will make to the entire healthcare industry as a whole. Uh, both to enable patient access but also to give providers better choices in terms of how they use uh, the technology that they have available to them. One thing I wanted to be clear, which is certainly one thing that got brought up uh, as part of the rulemaking process was stakeholders uh, request for more time to understand and comply with the rules. Obviously information blocking is a new uh, legal and regulatory paradigm and so what we did was to uh, uh, allow for more time for education and preparation in the beginning. So for the first six months uh, there are no compliance requirements uh up front to just say that colloquially. And then over time there's a gradual phase in for the information blocking scope and uh, obligations overall on industry stakeholders. So we hope that that will give a gradual way for everyone to come into compliance with the rules. And um, answers a lot of the concerns about um, having this apply come day one when the rules become effective. Uh, similarly on the certification program side, and that's probably the other important point to make, is that uh, our rule is really two rules in one. Uh, a portion that applies to health IT developers only in terms of updates to our certification program and then a portion that applies to health IT developers, health information exchanges and health information networks and healthcare providers, which is the information blocking related provisions. So when it comes to changes to our certification program, again only applicable to certified health IT developers, there are a number of changes there, uh, some of which as we uh, visited last time I was on and as Dr. Rucker mentioned, um, relate to benefits that will ultimately accrue to healthcare providers in getting more confidence and assurance and their products. Congress required that real world testing be performed of those products. And that's one of the things that we've uh, subsequently included in that final rule as well. Um, so happy to turn it over to you. Ask any more questions.

Speaker A: Sure. So I think the biggest thing, and you guys did a great job with your infographics. I will commend the office. You guys do a great job sharing very complex information as simply as possible. So certainly I encourage my audience to go out there and look at your website. You first of all go give us your URL really quick. Uh, the short and sweet one for um, the website or these key time.

Speaker M: Yeah, absolutely. So healthit.gov will always get you to the right place. Uh, but it's cures rule is the uh, extra to add on to healthit.gov curious rule.

Speaker A: Yep. And if you're on Twitter, it's hashtag onc. Cures rule.

Speaker B: Cures rule. Onc.

Speaker M: Yes. Cures rule O and C. Perfect.

Speaker A: Here's rule O and C. That's right.

Speaker M: In the beauty of picking out what hashtag to do, we noticed that there would be two Cs uh, if we did it in a certain way. So we put our name last.

Speaker A: Excellent. Very smart.

Speaker B: You are up on the Twitter.

Speaker A: Yes, he is. Yes, that is true. Did a great job. So what are some of the key timelines there that you want to share specifically Steve, with my audience and our audience today?

Speaker M: Yeah, absolutely. And there is uh, one of those fact sheets that you mentioned that lays out a highlighted version of some of the milestones. So um, you know, first and foremost I'll stay with information blocking because that one's uh, a bit simpler from uh, a timeline perspective. You have the first six month period, which is when compliance, uh, with information blocking would be set to begin between month 6 and month 24. The only data that all of the, what we call covered actors are responsible for, uh, not information blocking, is the uh, US Core data for interoperability, which is that new standard that we adopted, uh, new core data set, uh, and that's how we helped to create this kind of gradual and incremental approach for uh, stakeholders to adjust to the rules over time. So uh, between month 6 and month 24 only the USCDI is in scope from an information blocking perspective. And then at year two and beyond, that's when the full scope of as we've defined, quote unquote electronic health information, uh, is in place. And that's really to say it no more simply than that. That's how information blocking lines up. From a timing perspective when it comes to certification, uh, some of those rules become uh, effective 60 days after the rule is published. And uh, one bit of clarification I can note here. Even though we released the rules publicly uh, yesterday, they are not officially published in the Federal Register yet in that tricolumn format. So everyone has a bit of a warm up and stretching period uh, before the official start date, uh, and starting line is laid out. And that'll be when the rules are published in that tricolumn format from the Federal Register. Um, so when it comes to health IT developers they've got a number of different timelines along the way. But the one that I'll emphasize most will be uh, that two year milestone where uh, just like with information blocking, um, the U.S. core data for interoperability, uh, that standard has been updated into a number of different certification criteria including uh, the new secure standards based API uh, certification criterion that Dr. Rucker mentioned. And um, that will be need. Health IT developers will need to roll those out products certified to that criterion, uh, to their provider customers within that two year period of time. So in very short order, uh, in the grand scheme of things, uh, all of us as patients will uh, be able to use smartphone apps to uh, connect to these uh, standardized and certified APIs.

Speaker A: Excellent. Did you have a follow up question, Roberta?

Speaker B: I did Steve. Uh, tell us a little bit about the industry in itself. You've been putting this out for a year now. The proposed rules have come out and everything. What do you think the vendors, are they prepared, how prepared are they to actually doing the integration of apps?

Speaker M: Yeah, so um, that's a perfect question. I think preparation always goes on a spectrum. Um, we've looked at some numbers and certainly have done some uh, data briefs and blog posts in the past about uh, industry adoption of fhir. Uh, and that was with regard to release two which is the Argonaut version original. Many of those health IT developers which uh, you look at the data, occupy a large provider market share. Uh, many of those health IT developers have been in motion and moving toward FHIR release 4 which is what we adopted in the final rule as the sole uh, kind of API ah, based standard. Um, so from that perspective they've been I think relatively well prepared to move in that direction. There are a few other areas where we gave them more time uh, to make adjustments relative to our certification requirements. I think the biggest adjustment for them overall is looking at their processes, uh, looking at some of the business arrangements, uh, that may be different or may need to be adjusted as they start to go through the conditions of certification and the changes that Congress directed us to make to our certification program. And I think, you know, some that have been tracking along with our regulation, uh, from the proposed rule stage even, uh, dating back to, you know, the Health IT Advisory Committee and uh, other comments that we received should be well positioned to comply with our rules in, um, I don't want to say short order, but along, along the timeline that we've laid out and uh, as you mentioned, for the infographics and other fact sheets that we put together, uh, that's our attempt to get everybody else up to speed as quickly as possible.

Speaker A: Yeah, you did. You guys did a great job. I went through a lot of that yesterday. I sat on as many calls as I could and, um, I think just some of the feedback that I've been getting from the industry, it's very accommodating. And so I think you guys have done a phenomenal job, uh, handling a very difficult and um, tough piece of legislation. So. Phenomenal job. Steve and team.

Speaker B: Mhm. And audience. Follow him on Twitter.

Speaker A: Yes, great insight.

Speaker B: I say it all the time.

Speaker A: Yes, you do. Yes, you do.

Speaker M: Come for the policy, stay for the gift, right?

Speaker B: That's right. I believe he calls fire muy caliente.

Speaker M: My Spanish teacher would be proud.

Speaker A: Awesome. Steve, always a great guest. Thank you so much, my friend. I know you have a busy afternoon, so we'll let you go. I believe we have at least Sweeney Anthony joining us now, but, uh, thanks again, Steve. All the best. All right, a pleasure.

Speaker M: Thank you very, uh, much.

Speaker A: Take care, buddy. Elise, are you on the line?

Speaker Q: I am, I am. Hello, Justin. Thanks for the invite. Happy to join you.

Speaker A: Got it. Welcome back to the show. Executive Director, Office of Policy at the onc. And I know that your schedule, I can't imagine what you, uh, what you're in the middle of right now. Um, so we're grateful for you and for your time. Thank you.

Speaker Q: Absolutely. Happy to do it. Happy to do it.

Speaker A: Thank you. Um, so I'll kind of open it up. Uh, I gave Don and Steve the floor. I know you guys have a lot to, uh, cover with the audience. We have about 30,000 people in the line, so a great audience out there. The floor is yours. So I'll kind of ask you me some follow up questions, but I'd love If you're going to get a couple of points, significant points across, you uh, can have the floor. So.

Speaker G: Sure.

Speaker Q: Thank you, um, so much. I guess I want to start out by saying thank you. We've been working on the final rule for um, quite some time. As you can imagine. Uh, we received more than 2,000 comments submissions on our rule and that's from across the landscape, from individuals to um, organizations to developers, uh, to app developers, just across the landscape. And all of that feedback really helped us to get to where we are now. Um, you know, as I say, you know, we read every single comment. A lot of people talk about the length of the rule. But um, of course one of the things we do is we respond to those comments. So we talk about um, this is what we heard or this is what you asked us about and here's our response to it. But altogether all of those comments really help us to inform the final policy and get to a place where what we're doing not just works, um, in terms of what we want to achieve from a policy basis, but also works on the ground on what is needed for patients, providers and the ecosystem as a whole. So I want to start by just saying thankful. Thank you. In that respect. Um, a couple of things I'll highlight um, is I want to talk a little bit about the information blocking provisions because we received a ton of different comments around how it should be set up or the exceptions that we laid out. And all of that feedback really helped us to come um, to the right place. And we proposed seven exceptions. We actually ended up with eight exceptions. And that last exception on content and manner is really key because it allows an opportunity for the healthcarest user and the developer to engage and to see if they can come to uh, a common place in terms of that electronic health information as we call it, that needs to move. But um, we also include, if that doesn't work, a way for that information to move. And we start by looking at standards based mechanisms, um, for that. Our goal overall is to make sure that the information is moving securely and appropriately. And the way we've laid out the information blocking exceptions are designed just to do that. So that's one place that I would direct folks to. I heard earlier talking about um, the website and um, I'm glad it's working for folks. There's definitely a section in there on information blocking. We'll also be doing a webinar on information blocking and I know that's an area of keen interest among any. So please do check that out. Yes, so I'll start there, but, um, feel free to ask me questions.

Speaker A: Sure. So, I mean, let's, um, first of all, do you know the date of that webinar? Just use this as a public service announcement right now if you know that date.

Speaker Q: Yeah, so the first webinar will actually, actually be tomorrow. Actually tomorrow at three if you go to our website. I think Steve already did the plug, but I'll do it again, please. HealthID.gov curesrule. You can, um, follow the links to the webinar and you can register for the webinar there. We'll also be doing some additional ones, um, next week as well, um, on the condition certification and then on information blocking itself. But the first overview one will be tomorrow. So join us.

Speaker A: Excellent. Thank you, Elise. So I guess my first question, um, kind of a big question, but what are some of the major changes from the proposed rule? A lot of us were very familiar with the proposed rule and now we're scouring through the final rule. What are the maybe two or three things that you would highlight that we should really know?

Speaker Q: Well, one I would say is, you know, across the rule, we took into consideration a lot of the comments we received just to stay on the information blocking side for a little bit. Uh, we heard a lot about the definitions of health information network and health information exchange. Um, and as folks who have been following this closely know, there are actors that Congress has identified under the information blocking section. So in other words, ah, a potential information blocker could be a health information network, a health information exchange, a healthcare provider. Excuse me. Or a certified health IT developer. So one of the things we heard a lot about were the definitions that we use in the information blocking provisions. And that's exactly what we wanted when we put out a proposed rule. Our goal is to hear what folks are thinking, to hear whether this will work on the ground, to understand where we may have missed something or where we may have gotten it right. So what we did, um, is we updated some of those definitions in the information blocking side, we updated Health Information Network and Health Information Exchange to make it one, uh, combined definition, uh, that meets the goals that we're trying to achieve. Um, another component that we heard a lot about was thinking about the movement of information and the mechanism in which it moves. And that actually led to the creation of that new exception I talked about, which is the content and manner exception. So that's another piece as well. Um, we also fine tuned, uh, the structure of the FEES exception and the licensing of intellectual property exceptions and those are really designed as a means to what we put them in a bucket of is, um, how information moves and how you can support the movement of them. Um, so those two exceptions are designed to do that, to really think about what are the ways in which you can charge fees and the appropriate ways to do that and the same thing for the licensing component. So those are two additional areas where we thought about updating the language of it as well. And I think folks will see that. Um, also I think the compliance timeline, which is part of what Steve talked about, is we really wanted to consider, uh, making sure that implementation of the rule is as effective as possible and thinking about the time it takes to make sure things are in the right place at the right time. So you'll see that across that compliance timeline that Steve talked about, really thinking about the timeline not just for, uh, the certification criteria and the components on that side, such as prior4, et cetera, but also thinking about the timeline for information blocking. We want to give folks the time to consume understandable and then from there go full force into implementing it to make sure that patients and providers have what they need.

Speaker A: Excellent. Did you have a question, Roberta?

Speaker B: I did. When. Now that the rules are out and we're starting our. Once the Federal Register comes in, are you going to be over. Are you the person that's going to be over the compliance when people are not compliant? Will that be your purview?

Speaker Q: Well, you know, as most uh, folks tend to say in policy.

Speaker L: Right.

Speaker Q: It depends. So it depends on what? It depends on what hasn't taken you long. So as Steve talked about, there's kind of two rules in one. So on the certification side of the House and the certification components, we put in place new conditions of certification that are required of the developers that come to us, us to be certified. And those are things related to their business practices, to making a, uh, secure, standardized API available. All of those components, um, those fall under, under our certification program. So yes, we would make sure that compliance is in place, um, on the information blocking side of the House. Um, some of that falls with, um, our partners at hhs, such as oig, for example. Um, so that's. So there, you'll see. OIG would be more. And we talk about that a little bit. Um, and then I think overall we think about how we work together and that's something that we've always done. Uh, so you'll see that Congress actually laid out in the Cures act that the information blocking component is not only a requirement under what we call 4004, which is a section in the Cures act, but it's also something that's required of certified health IT developers that they don't information block. So there could be situations where ONC is stepping in that component as well. So it depends and would be a balance. But our goal is always to make sure we are very clear and aligned in terms of how we are approaching, uh, those components.

Speaker A: Terrific. And I know there's a. We're still waiting on a little bit of the teeth, right? We're still waiting for some more, um, some additional. I don't know if it's rule or content or guidance on, you know, some of the teeth to this, to this rule. Is that correct? I heard that yesterday. Kind of called out.

Speaker Q: Well, yeah, OIG is working on, um, um, a rule that will be coming out, um, hopefully soon. So they'll be looking. So you'll see more of that enforcement or the teeth, as you say, as part of that component. And that would come from oig.

Speaker B: Will that be, will that start as a proposed rule?

Speaker Q: Yes, it would be a proposed rule for comment first and then from there they'll consider the comments and the feedbacks in the same way we do. We did, I should say, with our, um, notice of proposal making.

Speaker A: Excellent. Terrific. Well, Elise, you're always an amazing guest, very succinct, very crystal clear with a very complex topic. So, um, we truly appreciate you, uh, joining us today and being a wonderful guest. As always.

Speaker Q: Happy to do it. And thank you so much. And thank you again to everyone who has engaged with us throughout this process. We look forward to the next step.

Speaker A: You got it. And for one last plug, I will give you, um, so healthit.gov uh, um, cures. Cures rule.

Speaker Q: Cures rule. Nice and simple.

Speaker A: Yeah, you got it. And again, I went through that site in depth yesterday. Yesterday. It's very simple to understand, easy to navigate, um, content specific in all the areas. And so I highly recommend, if, uh, you haven't visited the website, please check it out because it's gonna, this is gonna transform our industry. It's gonna unleash data, it's gonna allow for innovation, turn innovation on its head in a lot of areas. Add transparency, uh, increase patient access. So from that standpoint, um, I'm extremely excited for what you guys are doing. What we have.

Speaker Q: So wonderful. Thank you so much.

Speaker A: Thank you, Elise. Take care. Have a great afternoon.

Speaker Q: You as well.

Speaker A: In stone, I believe we have our next guest. Catherine Marchesini, Chief Privacy Officer from onc. Are you there, Kathryn?

Speaker L: Hi, Justin. Yes. How are you?

Speaker A: Fantastic. I'm terrific and welcome back to the show. Grateful for your time.

Speaker J: Glad to be back.

Speaker A: Thank you. So as we've been doing, as you may have heard, kind of giving you the floor. I know there's some real key points, um, from your perspective that uh, that you want to share. So I'm going to give you, you the floor, uh, and then um, and we'll do some follow up uh, based on what you uh, shared. So is that fair? That good?

Speaker L: Sounds great. Thanks Dustin.

Speaker A: All right, the floor is yours.

Speaker L: Uh, yeah. Appreciate it. So I think since we've been last on your show, I've been last on our show with my colleagues. Um, there's been a continued and resounding support for most industries for patients to get access to their health information. As you mentioned, um, Justin, um, not only just their health information but their health records. And so particularly for our purposes at onc, we've been spending a lot of time looking at patients getting electronic access to the record so they can receive it and share it with whomever they want, however they want. Um, this includes personal mobile health applications. So you know, as a Cheryl, we spoke previously, we see that providing individuals with easy access to their health information empowers them, as you heard Dr. Rucker speak earlier, about controlling their decisions regarding their health and spending and cost and their overall care. I, um, know you had mentioned, I've been listening in that you've seen our final rule and as listeners can um, probably attest to, we remain committed to providing individuals with the opportunity to receive electronic access to their health information as well as giving patients choice. So generally from um, onc's role, this deals a lot with patients access and the portability of their data. This includes selecting which data elements they want to share, which you know, what do they want to transmit to a third party outside of their healthcare provider's control. Um, for a healthcare provider the final rule actually will allow providers to use technology to automate, um, as well as support the existing HIPAA right of access. So ideally it should make it more convenient for patients as well as allowing healthcare, um, providers to work with developers to implement um, the HIPAA right of access. I did want to share that a little over a month ago. We at ONC had our annual meeting and we actually had a patient focused access panel discussion. So this was before the rule was out. Um, there was a large discussion around the underlying benefits for patient access, but there also was a discussion about consultation concerns that might exist. Um, particularly around when a patient chooses to Share information with a third party app for example. Um, so I wanted to share that we at ONC respect um the public calls for privacy protections and industry taking actions. Um, from my perspective concerns around the data uses um, by those that patients choose to receive data on their behalf, they're valid. Um, this is part of a national discussion around the secondary uses of data and apps that actually extend beyond health care. So there is this wider discussion about data privacy, stewardship and data when there should be regulatory interventions to protect that data. Um, so through the ONC cures uh final rule we tried to strike the right balance um and trying to find you know between the patient's right of access to more um information so they can make decisions about their care um, and the data use concerns. And so we work to build in specific technical requirements that would empower individuals um to make choices um, and they actually are making the choices to share as well as provisions that allow for information blocking um, actors to educate and advise um individuals about privacy and security protections um, or risk um, that the third party applications might pose. So just wanted to kind of focus the conversation um there and happy to answer um, any other questions?

Speaker A: Yeah, I'm going to ask one just on the consumerism side because it's one of where my passions have kind of evolved uh over the past five to 10 years in health care. So this certainly enables consumerism in some capacities. But this is also a very complex and complicated topic uh, for a standard consumer to get their head around. So do you have a simple way to explain that to the average consumer of healthcare? Obviously consumers are becoming much more informed. They're paying more for the healthcare than they ever have before. So they're self educating with which is great. Um, it's a good first step but this is a complex topic and so we can get, you know I'm sure Roberta's gonna do a follow up on the from a health IT vendor perspective but from a consumer perspective, the average consumer, which I have a lot more of those now listening to my show than ever before just to navigate healthcare on their own. What would you say to them? How does this rule, um, how could you simply explain to them this new rule or how this rule benefits them?

Speaker L: It's a great question, um, and it makes me think a little bit about. It's almost like a different take on health literacy. Um, but in having to explain it currently you as an individual have a legal right to electronically or digitally obtain all of your medical records from your healthcare provider in whatever form you choose. Yes, um, and your healthcare provider, if they're using certified um, health IT technology, um, they should have that capability and it should be easy for them to do um, with no additional cost. Um the question about, and I'm not sure if this is where included in your question but I would touch on there is as I mentioned earlier there is a concern around, we've heard from stakeholders that individuals, consumers, patients may not fully understand that when they receive their data or when they get their medical records from their healthcare provider and they might share it with someone um, or something that that information is not as protected um, as it would have been had it stayed with their healthcare provider. Um and what I would say to them is just know that even prior to our rule being released there is a strong interest and support by industry groups um, that are encouraging healthcare companies, app developers, you know to what we would call self regulate. M But to a consumer it'd be you know there are folks out there that are really trying to look after the consumers um and trying to get folks to voluntarily adhere to what are called codes of conduct or guidelines and really trying to encourage education transparency. Much like in our role um, we allow for health care providers to partner with um, health organizations to really try to educate um because from my perspective we all have a role to play um and we at ONC are trying to do our part and I'm just hopeful that others uh, would step up to the challenge.

Speaker A: Yeah, that is actually terrific and I couldn't agree with you where you closed there with um most companies, you know they do follow self regulation at least from when I've been able to see certainly the innovative players. Nobody wants a breach, nobody wants to create a breach. They don't be a part of it. It's probably the end of your company in the today's day and day and age. So at least if it's a smaller organization. So I mean people really do um, do their very best on the sides of codes of conduct and hopefully transparency or at least you know these types of shows, these conversations, we educate people to do that. Um so thank you for bringing that up Roberta. What would you have a follow up question?

Speaker B: So privacy really has been the key component to those, those anti, the people that are, are against. And so I've read some things and people are saying that they think that there needs to be some new, new privacy laws put in place or at least uh addressed. Is that something that you agree with or that you think is that is a conversation there?

Speaker L: Uh so I'd say yes and yes um, we actually at ONC, um, the High Tech act of 2009 actually required us to issue a report to Congress on this specific issue, HIPAA non covered entity. So we actually um, would support, um, that this conversation continue as mentioned earlier. I mean, the concerns around um, data use are not unique to healthcare. Um, I think that, you know, there are existing national conversations that are happening and I think in the future, um, that those would probably either accelerate or become more focused, um, in that when looking at how organizations, entities that are not currently subject to regulatory regimes or any type of requirement, uh, be it health care, not in healthcare, because, you know, information about your health can be derived from many things. And so I think that we as an organization, um, as well as the United, you know, within the US really need to look at how we are tackling the uh, data use, um, of information across industries.

Speaker B: I also noticed yesterday the FTC came out with a statement on your, on your rules and you, you actually agreed with them on Twitter. Can you explain that to us?

Speaker L: Um, yes, I know that we at ONC received um, a lot of stakeholder interest and feedback, um, that wanting ONC to go further in type of um, regulation mobile apps and trying to get into the space of consumer, um, protection. Um, we as a federal department, we respect our other federal agencies authority and that to the extent there's concerns around data use and broader consumer protection across industry, not just health. Um, just as a reminder that the FTC currently, um, has jurisdiction over consumer protection issues of which the non, uh, HIPAA covered entity kind of discussion would already fall into. Um, I would be remiss though if I wouldn't, you know, speak to. There are interest and concern in industry as to whether the FTC's current jurisdiction and authority is strong enough. Um, or if there's a need to create some other type of mechanism. Um, um, because right now the only way, generally speaking, that the FTC is able to enforce or protect against certain, um, type of actions, it's only as a result of an actor or an organization making promises, um, that the FTC can then, uh, enforce against.

Speaker A: That's excellent. It's a great point. Catherine Marsasini, thank you so much. You're always an amazing guest. Obviously an important topic and growing every single day in healthcare, which is a wonderful thing.

Speaker L: So thank you, Justin Arbetta for your time.

Speaker O: Appreciate it.

Speaker A: You got it. Thank you. Chief Privacy Officer ONC Catherine Marcesini. Again. Thank you.

Speaker B: All right, you need to have her, um, on.

Speaker A: Yeah.

Speaker B: As a guest and talk about privacy.

Speaker A: Will do love it. Great idea. Dr. Jamie Skipper, are you with us?

Speaker N: Yes. Can you hear me?

Speaker A: I can. We can. So, CEO of Elevation Health and former ONC research data scientist and a very good friend of mine, a very good, uh, colleague who always, uh, keeps me well informed, well in line. And so do you. Do it, Roberta. And so do you, Stone. Um, uh, but Jamie's always there for my emergency phone calls and something that I need to understand, um, uh, or a brainstorm. And she's obviously one of the first people that uh, supported the health innovation think tank from day one from a content standpoint. And, uh, she was one of my experts. So. Dr. Skipper, without introduction, welcome to the show. Welcome back to the show.

Speaker N: Oh, thank you, thank you, thank you. It's always fun to be on your show, Justin.

Speaker A: Always excellent. Thank you. So we're going to do a little bit of an O just for my listeners. Uh, we're going to do a little bit of a wrap up. From what we just heard, Jamie comes from, uh, actually the ONC comes from Capitol Hill. That's where we first met many, uh, many moons ago when she worked with Dr. Gingry. Um, uh, but health, it has been in your blood for a long time. You're actually, I mean, to be honest, you're one of the first legislators, um, and legislative staff that actually helped us create some of the very first days of health it back in, uh, the late 2000s. So not to put age on any of us, but you're one of the pioneers. I know you don't see yourself as that, but you are.

Speaker N: I know it was an honor and privilege to be part of those pre high tech talks and sausage, uh, making of what then became high tech. But I think we did some really great work and it's been really exciting to see where we have come. A lot of people are wanting us to be further while others want us to be slower.

Speaker A: Right.

Speaker N: Uh, but I think we are where

Speaker L: we, where we need to be.

Speaker A: Yeah, I call those people ankle, um, anchor droppers. People who are always trying to slow us down. I say you need to drop the anchor right now. Like literally we're in a test, we're testifying or we're giving comments or something and they're like, drop the anchor. I'm like, no, no, no. Pick that anchor up. That's right. Let's go, let's go. Um, so this is going to kind of wrap up what we just heard over the last 40 minutes with Dr. Rucker, Steve Elise and Katherine. So, um, first of all, I'd love to get your impression. I know that you also dove into the rules yesterday. You've been ferociously reviewing everything and putting even some comments together. But I'd love to offer you the floor for a couple minutes to give some of your high points. Either what you heard or what you read or what you just had validated from what you saw and read.

Speaker N: Yeah. So um, you know, at elevation, what we focus on is working with a lot of um, those third party apps, as people would call it, the health IT developers that uh, might not be a cover of a business associate, um, and those that are really trying to be accessors of the data. And so it was really exciting and really interesting to see how they newly defined health, uh, information networks and health information exchanges. I think that was one of the things that we were really interested to see how they defined because the way it was worded in the proposed rule kind of created this large bucket that made a lot of uh, the um, health IT developers fall into that bucket that probably shouldn't have been in that bucket. So the definition is something that we're excited to see how it came out. Um, the way that they have now newly defined or focused the definition of EHI is also uh, really important. So we're getting to what we need to get to. And I think what's really important for folks to understand, especially among my audience, is to understand from uh, those that are uh. So you have people looking at it from the data holder. How can I not. Information block. And my job is okay, so how then for the people who want to access the data, how can they access the data? How can they put themselves in a place where uh, the data holders can't claim one of the exceptions. And so I think some of the uh, provisions in the rule really clarify some of the pieces for them. So for example, um, one of the areas, um, under the privacy piece, um, talk about a hospital or a data holder needing to make sure that consent is in place and for a third party app. Ah, well, you know, how do you do the back and forth to find out how the data holder can't claim the expense exception? And now the rule specifically says um, that the data holder has to have an authorization form that they need to give out that then specifically says what criteria need to be met. That in itself I think is a huge, huge win for the app developers so that it's very clear to them on what they need to do. There's a lot of other pieces like that that I'm excited about. Um, but it I could talk on forever. So I'll stop here.

Speaker A: Yeah, no, this is exactly what I want to dive into. I want to kind of, you know, give the floor to you a little bit and let you say, hey, you know, this is what, uh, that hurt. I heard, I mean I've only heard really at this point kind of favorable feedback, um, from the rule. From what I've read, from what I've seen from clarity. Uh, I think that some of the terms, you know, this was very accommodating to the industry. I heard that even this morning speaking with somebody, uh, before we went on air. So I mean, I think overall it's being well received. I think it's very fair. We still going to learn more of the teeth, I believe that we just heard and this came out in some of the calls yesterday that I was on, but also that the OIG will be putting out a proposed rule, uh, here in the short run on um, on how we're going to do some enforcement and some quote unquote, the teeth, um, of. Of how we're going to enforce some of these components. Um, but uh, yeah, but I think all from it, from a fair timeline, this has actually the clock, the six month on the um, information blocking rule hasn't even. Timeline hasn't even started yet. It won't even until it goes into the Federal Register. So I think all this is just again very fair. So what are some of your thoughts there?

Speaker N: Yeah, so I think it's really interesting that folks, you know, catch that, you know, it's uh, once the rule gets into the Federal Register, there's six months. Right. As Steve said. Um, then after that, based on what, as Elise said, once the OIG specifically defines in their rule and you know, you guys specified, you know, there's going to be a proposed rule and then a final rule around what constitutes, uh, you know, civil penalties and what that's going to look like. Then OIG is going to be able to go after the folks that are information blocking. Um, there is going to be another piece in there that I haven't got clarity on myself. But we're looking into it and it's going to be a really important question to ask. And Elise alluded to this, um, where she's very, uh, very astute in um, making sure that she leaves the door open because it's going to be interesting to see what other players also have enforcement capabilities. So for example, um, uh, under, you know, uh, DOJ can go after, you know, the um. I'm losing the words here, um, in terms of uh, you know, trade practices where they say that you have to, you have to live by what you say.

Speaker O: Right.

Speaker N: So it's going to be interesting to see how DOJ comes into the practice there too, in addition to what OIG can do, uh, in terms of uh, information blocking. And so, and as uh, Elise, I mean, sorry, as Katherine said, in terms of what FTC's uh, enforcement capabilities, uh, are going to be, this uh, kind of landscape of enforcement between all these agencies is going to be interesting to stitch together. But again, I'll have to say those are for the folks that you know, are aiming to, you know, try to block information. Um, so, uh, from the point of view of the folks that are kind of broadly in my audience, which are the folks that are the data accessors, this is also important to understand because as they try to access the data, what's the ace in your pocket to know what the data holders can and can't do, uh, is going to be interesting to have as they go to those conversations, to those renegotiation tables. Um, but I will say that, and we said this before in some of our own blogs in Elevation, you know, of course you're creating business relationships here, so it's important to know what the landscape is, but uh, go forward very, you know, very lightly and very, very smoothly.

Speaker A: Yep, no, very good point. One of the other pieces that I wanted to call out and that we covered pretty well with Steve are the key timelines. So you know, zero to six months, um, to start off with, with the um, information blocking and then you've got six to 24 months we've covered the US CDI and then 24 months after that for the full scope. So I think that gives the industry a lot of time. You know, obviously as, as my previous hat in the vendor world, you know, we wanted sometimes 18 months before any significant changes. But they do a good job with laying out some timelines, um, there. Roberta, you want to ask a question or make a statement there?

Speaker B: Yeah, I asked uh, Steve the same thing and that how do you see the industry? Are they prepared for this?

Speaker A: Right, yeah.

Speaker B: You work with third party people, you said.

Speaker A: Yeah. What would be your opinion on that?

Speaker N: Yeah, uh, yeah, it's um. Well, I think the fear that I had, I will say is go is was around how they were going to define hie h I n because the folks that may have fallen into the bucket, if they would have been more broad about their definition, I think there would have been a lot more folks Uh, a lot more third party entities that wouldn't have been prepared because they are not watching this. Um, but I um, think that the way that they defined it, a lot of those players hopefully have been uh, watching it to some degree. But I really, really hope that folks work with entities uh, like Elevation and folks that have been in this sphere. Because uh, what's really important is understanding how all of these pieces of legislation and regulations work together to stitch together the business model that they need to have to be successful in the healthcare paradigm. Because you know, uh, we had a lot of discussion around the ONC information blocking in the certification criteria. But as Karen alluded to before the ONC folks came on is that there's a huge play here with CMS's rule that also came out on Monday with how the health plans need to act and how the data needs to be uh, exchangeable and how they need to be transparent with their information. Um, and there's other rules also that are going to be at play in terms of how this landscape shapes up for data to flow to uh, optimize care and to improve patient outcomes.

Speaker B: I'll be looking for your blog post on Hie vs Him, is that right?

Speaker N: Yes, absolutely, absolutely.

Speaker A: Put that in the queue.

Speaker N: You know, one of the blogs I want to point to is last year, uh, last summer right after the uh, comments came in from the proposed rule, uh, once uh, the comment period finished, we did put out a couple blog posts on what the comments overall said and that was really interesting as well.

Speaker A: Great, that's excellent. So one thing I'll kind of wrap up here, and I get your opinion too, is Dr. Rucker started off with just the importance of having a transparent business model. And if you did not have a transparent business model, and I think even John Holamka talked about that, Aneesh talked about that, um, and even Karen mentioned uh, that a little bit as well, Dr. DeSalvo. So I think that's important. If you don't have a transparent business model you could be in trouble. And so this rule really highlights that, uh, and not only does it uh, support interoperability and uh, consumerism, but really API based transparency, um, out there in healthcare. So I love it. So what thoughts would you have to add to that? Um, Jamie.

Speaker N: Right. Well I would be remiss to say that two of the things that we've been watching here is around the effect of interoperability and the future of interoperability and info blocking as well as the huge trend that we're seeing around telehealth and you know, and I know that that's your next panel, so I thought maybe I can make a comment that will be a segue, thank you. In that, you know, the data that you need to flow to optimize telehealth will also rest on some of the provisions in the uh, ONC and CMS rule too. So the interplay between those spheres are going to be very important to uh, uh, you know, process.

Speaker A: Oh, excellent point. And you do cue me up very well because we do have a virtual Care strategy and innovation panel coming, which we actually had that panel scheduled four months ago and planned four months ago because we knew the importance of it. However, you know, now with COVID 19 coronavirus and preparedness and all the cancellation of hymns, and then all of this is happening across the country and even globally, um, virtual care is more prominent than ever on everybody's radar screen. Uh, so I think we're, we're a visionary, we're timeless and uh, obviously grateful for the opportunity here. Um, but Dr. Skipper, always amazing. Um, partner, ah, guest, um, friend, colleague, strategist, um, I'm grateful for your time and thank you for uh, joining us. But I'll give you 30 seconds on um, anything that you want to say regarding what we should be keeping an eye on from a strategy standpoint, from a policy standpoint. Um, what do you think? Floor is yours.

Speaker N: Yeah, so it's going to be really interesting to watch regulation as it changes and legislation that's ah, right on the floor now. Uh, that's coming on the floor soon in terms of expanding telehealth, ah, reimbursement, um, and so that's something to definitely bring up in your panel. Um, it's also going to be really interesting to watch some of the other rules that are going to be coming out later this year probably or very soon. Not only the OIG rule around, um, how to enforce around information blocking, but also around sharing, uh, health it, uh, in terms of uh, uh, anti kickback and stark as well as possibly some updates on HIPAA itself. So uh, keep uh, all of that, you know, in the forefront. There's still a lot of changes coming.

Speaker A: Yeah, no, great point. I mean as you and I have worked for well over a decade, I mean you've got to successfully navigate legislation, regulation because it can either fuel your strategy and fuel your company, fuel your efforts, or completely hinder them and, or eliminate them. So you got to stay on top of this. As you just said so eloquently. Excellent.

Speaker N: Thank you so much for Having me.

Speaker A: Justin, you got a doctor, Skipper. And we're going to take a quick station break. Roberta, I can hand it over to you for a second. Um, but, uh, but we actually got our next guest starting to come on. But, um, we'll take a quick break here. Not even 90 seconds. We'll be right back. But the floor is yours, Roberta.

Speaker B: Thank you. I. I'm actually wanting to thank everybody that is. Is tuning in right now and thank Stone for Business Radio X for helping us and connecting. Hi, Stone. Well, hello there.

Speaker A: No, I've had a great time, everybody. Everyone on the show today has so

Speaker H: many IQ points on me, and I'm

Speaker A: in awe of that.

Speaker H: But I got to tell you, as

Speaker A: a lay person to this whole conversation, I'm resting a little bit easier. I feel like some smart people are putting some real energy and effort and resources into this, and I'm actually going

Speaker B: home feeling a lot more comfortable than

Speaker A: I did before I got here.

Speaker H: So, for whatever that's worth, guys, thank

Speaker B: you for what you're doing. You. That's right. Um, and I also wanted to take a couple minutes on Healthcare Now Radio. Um, if you don't know me, I'm Roberta Mullen. I'm the station manager. And Healthcare Now Radio is owned by Answers Media. You might have known us in the past with our sites of high tech Answers and HIE Answers and Health Data Answers and RCM Answers. We had a whole slew of answers, um, sites. But we have, since the beginning of the year, consolidated all of our sites, all of our media sites into healthitanswers.net and so all of our news now you can find there. And our other site is, of course, this Healthcare Now Radio, which Justin is one of our original, original hosts. He's. He's had more than. He's. He's closing in on 200 episodes, I believe.

Speaker E: Believe.

Speaker P: Wow.

Speaker B: Um, but you can go to healthcarenowradio.com you can see all of our lineup. You can listen, you can ask Alexa to turn us on. You can, um, you can go out to our SoundCloud channel that you can get through to from our Healthcare Now Radio, and, um, and listen to all past. All. All past episodes of all of our shows. Our newest addition to Healthcare Now Radio is our podcast. So we have Healthcare, we have Healthcare Radio station, and that has our shows like this just in. But now we are now syndicating and promoting podcasts. So if your company has a podcast, let us know. We'll put it in our network. And Justin is back.

Speaker A: Excellent. Thank you. Very much. Everybody appreciate it. We've got a great listenership today. Hopefully. This has been, uh, informative for everybody. I love doing this show every single year. Uh, again, this is our sixth year around hymns. Ah, it's been a pleasure. Very fortunate. Roberta's uh, been with me since beginning. The actual show was her idea initially many, many moons ago. She brought it to me and pitched it, um, and I was all bought in, um, and the rest is history. And the rest is history. Uh, and then, uh, Stone, um, married up with Stone and Business Radio X and they've been broadcasting also live from hims, from hims 15 and just phenomenal partners. So.

Speaker B: And we're all here in Atlanta, so it's very easy for us to get together.

Speaker A: Fantastic. Excellent. So yeah, this, this uh, makeup show or this show must, uh, go on. It did go on. And uh, we're very fortunate for this opportunity. So, um, I want to say welcome back to everybody, uh, and then certainly, um, we're grateful for this uh, panel that we're about to do here. Uh, but I also want to say, uh, many thanks to our production partners, Lenovo Health, Ramah and Healthcare and certainly, uh, Business Radio X and Roberta Mellon with Healthcare Now Radio. You guys have been great supporters through the many, many years. It takes an army to, uh, put this together, uh, and then support this throughout the year. So many, um, thanks to all, uh, and I could not be more excited. And the most timely panel I think we've ever done. Again, I think a lot of our listeners heard before we planned this panel four months ago. Uh, but now just with COVID 19 coronavirus more timely than ever. And to have these experts coming together to discuss best practices strategies and uh, then really, um, how it's core to healthcare. It has nothing to do really with even COVID 19 or Coronavirus. Just how virtual healthcare, virtual care, telemedicine, remote care, remote care monitoring are all they need to be central. Uh, the only thing positive that comes out of this is that hopefully this is all going to expedite. But, uh, you know, from chronic care management and what we need to do in healthcare to reduce our cost, reduce, increase our efficacy, um, and uh, just really expand and treat that patient where and how they need to be treated is extremely important. So, um, let's go ahead and kick uh, off our Virtual Care strategy and Innovation panel. I believe all my guests are there, Stone, is that correct?

Speaker B: I believe so.

Speaker A: Fantastic. So, uh, Dr. Sylvan Waller, are you there?

Speaker G: Good afternoon.

Speaker E: I am. Thank you. Justin, how are you?

Speaker A: Fantastic. My Friend, welcome to the show. Thank you. And uh, Mac Mikula, are you there?

Speaker E: Yeah, I'm here.

Speaker H: Pleasure to be on.

Speaker A: Excellent.

Speaker P: Hey, Justin. I'm here as well. This is Matt. I had a different headset on.

Speaker D: I apologize for that.

Speaker A: Excellent. Now, Matt, welcome to the show, my friend. So, Sylvan, uh, Waller, local physician, executive and virtual care expert and member of our health Innovation Think tank. Welcome Sylvan, and thank you very much, Justin.

Speaker E: Appreciate the chance to be on and had a chance to listen to many of the, um, speakers that uh, were on the show earlier today and really a fantastic lineup. So excited and honored to be part of that.

Speaker A: Thank you, my friend. Always. Uh, Matt Mikula, uh, Global Manager, Healthcare Solutions, Lenovo, and certain member of our health Innovation Think tank. Welcome, Matt.

Speaker P: Well, thank you very much. Glad to be here.

Speaker A: You got it, my friend. And Farhad Chowdhury, CEO, Vianova Health, and member of our Health Innovation Think tank as well. And obviously there's a, a great theme here, but from our think tank. But welcome, Farhad.

Speaker H: Thank you.

Speaker A: Um, and I, and I did have my opening comments here. It's sad that it takes a pandemic to get us, uh, here and talking about this, but we did have this planned, um, many, many months ago. But, um, but this momentum I think will capitalize on this momentum at least. You, uh, know. And I was even talking with, um, you know, uh, one of your peers, Bob Monteverdi, earlier today, how it, um, you know, it's uh, it's unfortunate about, uh, Covid and coronavirus, but it's, it is, it is important that we really take up the topic and move virtual care to the forefront of healthcare. Um, and so I know that's one of our, you know, our main topic today. And what we're going to do is share best practices strategies, um, where it's evolving, how it's evolving, what we can see and really tackle this chronic care, because that's really the issue out there. I mean, I know some of the, what the headlines say today, but really trying to tackle, um, chronic conditions and just get this under control. Our consumers deserve it. Our health systems, our care providers deserve it. Our nation needs it, the world needs it. Um, and I know at least we're going to be moving forward much more quickly now. So I'm going to start this off real quick question. Um, over to you, Dr. Waller. Uh, do a little bit of a level set. I mean, I think. Where do you see virtual care innovation evolving? Where do we see it today? A little bit. Uh, but Then certainly, where do we see some evolution?

Speaker E: Yeah, thank you for the question. Um, so, you know, a couple of key data points as we talk about, you know, level setting here. Um, but when we talk about, you know, where virtual care can provide value, Anthem recently did a study showing that millennials are at risk for having about a 4, 40% higher disease burden than prior generations.

Speaker Q: Ah.

Speaker E: And so if you think about that, um, part of that is, you know, access to care.

Speaker Q: Right.

Speaker E: Still takes about a month to be able to see your family doctor in the US Part of it is how they access other services they're used to, you know, uh, using Uber, using, you know, uh, on demand apps to be

Speaker R: able to get all of their services.

Speaker E: And so because healthcare isn't designed that way, it's not really created to. You don't really get to say, like, oh, I want healthcare delivered on my terms. It creates a barrier to access for a large generation between born between 81 and 96. When you look at, uh, again, an Accenture study that showed sort of who has a PCP. So it was like 85% of baby boomers, 75% of Gen X, 65% of millennials, and then 55% of Gen Z. So when we think about, you know, virtual care, the goal here is to be able to do things like reduce that potential disease burden on millennials that is going to be 40% higher than previous generations and really deliver care on their terms. And so I think that the two things that are going on today are very timely. Right. So one is coronavirus. Um, you know, this is really. It has the potential to be a significant driver for people to adopt more virtual care. You know, before a lot of pundits felt that people still wanted to do see their doctor go to a brick in office setting. And what we're seeing now is a massive disruption of that because it's being forced on them. And CDC came out and said virtual care telehealth should be the first, um, sort of point of access in a situation like this. And so we can address the acute issues, but we have to be able to do it in a way that empowers the consumer and allows them to have, um, you know, care delivered on their terms. And that's really the second point, you know, that you and I have talked about before in terms of consumerism. But I think with the HHS interoperability and access roles that we were just talking about on the show before this, um, that is tremendously powerful to help consumers. Again, you know, they have access and ownership of their data. They can then uh, help, you know, take um, control over how healthcare can, can be delivered to them and there can be more engagement and more agency of those patient populations. And so I think those are just a couple of the things that you know, we're seeing virtual care, um, you know, in particular on the innovation side, evolving as it has been and then will continue to evolve over the next couple years.

Speaker A: I love it. So before we move on, I would like for you to cover because you really have a great hands on um, with patients too in the industry. What innovation, you know, does this, what does this mean, um, for patients, uh, what does virtual care mean for patients out there? Because I'm shifting uh, my show significantly also on the consumerism side of the world. And I'd love to, I really like to bring education to them. This is complex, this is complicated for them. It's um, there's a lot of fear at times. But uh, I want to help people with, you know, kind of get over some of these hurdles. But what does innovation mean for patients in healthcare?

Speaker E: Yeah. So in terms of, you know, virtual care specifically. Right. If we think about it, the doctor's office visit hasn't really evolved in 100 years. And this is just a really simple example. Um, but virtual care now means we can use technology to break down a lot of those barriers to access. Uh, so it doesn't necessarily involve um, right. Scheduling to go in and see your doctor, which could be a month in advance. It doesn't mean, you know, an episode of care, which is, you know, the seven or eight minutes that a primary care gets with a patient these days. It doesn't mean building a business, ah, a visit around, you know, what do we need to do to make sure that we're um, we're being able to satisfy um, you know, practice requirements here. Uh, it's really looking at the consumer and saying what's providing value to them on one end and then what's providing value to the clinician on the other. And the goal is to connect those two and remove as as many of those traditional barriers to care as possible. And so virtual care can be, if you think about it, um, right. Everything from Chatbot, uh, on the front end. Like we're seeing a lot of companies introduced to be able to deal with their questions around coronavirus, um, using AI to be able to determine sort of who's high, medium or low risk.

Speaker C: Mhm.

Speaker E: It can be, instead of scheduling software, it can be then uh, interacting with a health coach or a physician to be able to answer some of their questions. And it can be, you know, leveraging longitudinal care to say, we know, you know, why, we know what your past medical history is, you know, what we know what else is going on with you. We can incorporate things like social determinants of health into the care that we're providing. And it moves away from that concept of just an episode of care to now being able to deliver a much more longitudinal experience. And I think that's one of the key things that, you know, how virtual care will continue to evolve is it'll move away from the idea of an episode towards much more of, um, you know, an ongoing, you know, constantly on ability to access care. And that doesn't mean it has to be high acuity, high intensity. But I think if we can provide consumers with answers to their questions that they have and guidance early on, we can prevent the complications of chronic disease that you were talking about just a moment ago.

Speaker C: Yep.

Speaker A: No, that's terrific. And I think three, if not four of my guests brought up longitudinal care and how, you know, this not only does new rule help create that, but that is an important key strategy. I mean, Dr. Holamka, Dr. DeSalvo, Don Rucker all brought up Aneesh, brought up the import. Actually Rasus, I think almost every single previous guest brought up the importance of a longitudinal care record, um, for patients. And this is not again, we're getting so far and fast away from episodic care and episodic records to really understanding the long term. And then that's when you get into a lot of the intelligence behind all of this as well. So I think you support that completely.

Speaker E: Yeah, and I think that's a key component. Right. And as we talk about virtual care and innovation, um, it is the data and analytics. You know, now we say AI, but it was big data before and sort of business analytics, you know, before that. Um, but even, you know, in some of the think tank, uh, presentations that you and I have have seen and participated in, um, the level of detail in terms of the data that we can capture, um, and how we can make that actionable. I mean, I think I go back to a presentation we saw on social determinants of health, um, but that has a tremendous impact on these patients. And so now virtual care can be really, um, relying heavily on data to provide actionable insights and then, uh, ways that clinicians can help, uh, coach patients, uh, provide, you know, earlier interventions for them. And uh, I think, you know, the data is a key component here and our ability to use machine learning and AI buzzwords and they're really powerful in terms of what we can deliver to patients. And I think we'll continue to see the proliferation of that.

Speaker A: Excellent. And to be honest, I actually have your notes from that last think tank. They were phenomenal from our care strategy discussion. So I would do recommend all my listeners to go to healthinnovationthinktank.com and uh, and Dr. Walter does share a bunch of great insights. They're in uh, think tank six but I actually have them up in front of me right this moment in case we have time to get to them because they were, they were phenomenal and there's some great key learnings that uh, you shared during that think tank. Um, but, uh, but maybe we'll get to a minute M. Thank you. In a little bit. You got it. My friend, uh, Matt McCullough from Lenovo. From your perspective, what are some of the virtual care trends that you're seeing in the industry, my friend?

Speaker P: Yeah, I think it's very synergetic with uh, the last statements that we just made. Fundamentally speaking, I think it's about making the technology easy and that is both from the provider perspective as well as from the patient perspective. So consolidation of technologies. If you talk to certain hospitals you may have for or five or six different ways to do an E visit, having that be more fundamental and more platform oriented in its approach, it's necessary, really necessary to drive into being able to operationalize it across uh, businesses. Secondly, if you just look at uh, assistance in terms of the treatments or the care plans that are being administrated, doing that in a digital sense, making that easy for the patient and from a provider perspective, allowing that to spend more than a single treatment so you don't have each treatment type having its own dedicated device with its own dedicated app, its own dedicated technology on the back end and of course each of those uh, platforms having to be integrated with the ehr sort of span off some of the earlier discussions. So um, from that perspective, making it easy to use from a patient perspective, having it in a home environment, it's a lot about just uh, education and being able to deliver education through the virtual platforms into the home environment where it can be more targeted to their condition, keep the patients um, off their web browsers and giving them relevant information specific to their care condition. So I think that's uh, from a Lenovo perspective, that's some of the things we think we can help with. And I think that's ah, a lot of the Going trends that we've been seeing.

Speaker A: Yeah, I completely agree. Certainly, you know, the remote care, um, even Dr. Halamka brought up this morning, the home hospital, which I had not heard of that, uh, that term before, but yeah, we're shifting care dramatically. We need to, as a country, we also need to make sure that, um, our payment reforms and our payment models support that. That's something very. I think that's one of the big key pieces, I know that sue talked about that during his talk is the need for us to keep our, um, public policy, uh, evolving so we can support these type of infrastructures. Aneesh brought it up as well. We've got to make sure that we have the right payment models in place to support this because we can have all these great innovations. We know the need is there now. We know the need is there even more greatly with what's going on today. Uh, um, but we've also got to make sure that we have the payments follow suit just to support this. Um, and consumerism, I think that you guys are on the forefront of consumerism. And that's, as I mentioned a couple times, not and dear to the show now. And uh, even I think it's one of the great pieces about the interoperability rule yesterday is how consumerism. This really enables much more consumerism, patient access, uh, and certainly interoperability, uh, with a lot of these, um, app based app devices and um, app based devices. So. And certainly API based interoperability. So anything you want.

Speaker P: Yeah, about, about that, Justin. It's just also you uh, got to look at the logistics involved in, and again making this easy to use and span into the patient population. So once you start going after these treatment types and it involves bringing say kits into the home environment, a lot of logistics involved in both connectivity and the connectivity challenges that are there, but also in just pure, um, distribution of the kits that would be needed in a patient's home, making that very easy to use, making that adaptable into the patient environment. What happens when the patient's done? How do you collect the kit and manage those logistics? Really? The care providers obviously want to be focused on providing the care. They don't want to necessarily delve into the logistical elements of this to make this sticky and have the broadest impact. So I think this becomes a little bit about the logistics and again, trying to make that seamless and as easy to use as possible.

Speaker A: Yeah, and you bring up a good point there. Remote care logistics is a term that you guys actually educated me on and I love it. And I appreciate it, and I know it's something key. So, I mean, just so from my audience, people who may not have had that on the forefront, can you give me 30 seconds on the importance of remote care logistics?

Speaker P: Well, sure. So, as I mentioned, um, ultimately speaking, if you're a provider that's looking to get into the virtual care space and you want to go deeper with patients than just doing an E visit, it becomes about that data collection that keeps being brought up. How do you get the data that would be relevant to their condition back into either the, uh, care environment or fundamentally into the EHR in itself. So that involves distribution and ensuring that you have something that's extremely easy to use, that's well tested, that works out of the box, that likely has a display that can, uh, work with the patient in a way that's meaningful to them. Could it be displaying patient education? Could it be remotely, uh, administrating, say, a digital care plan, prompting them with questions about how they feel, the diet that they're on, and sort of, uh, you know, walking them through how to use the kit? So, uh, that pure delivery element of it is a big part of logistics that can be challenging for, say, some of the small software companies that are entering into the space. Um, and then once the overall impacts start to occur, the habits are formed, the patients are then better at their care. We'd love to see the patients continuing to use technology like this, but the reality is oftentimes that they move on. And then there is what to do next. That can involve collection of the biometric kits, refurbishment of the kits, redistribution to new patients. All the training and the, uh, overall overhead that comes along with that is a big part of the consideration and going deeper into the home environment.

Speaker A: It's fantastic. Thank you. No, it's something that's just not part of our vernacular today. And so I, um, appreciate the education and the insight. Farhad, welcome back to the show, my friend.

Speaker H: Thank you.

Speaker C: Pleasure to be here.

Speaker A: You guys got a great company. Um, so first of all, I know about Villanova, but please give, uh, me 30 seconds. Give the audience 30 seconds on via Health.

Speaker H: Um, yeah, so Via Nova Health is, you know, we've been around for three years. I would consider ourselves really a habit formation company. Um, the entire team is certified by the Stanford Behavior Design Labs founder, Dr. Fogg. And Habit formation, I think we have the best science and IP related to habit formation. And Dr. Fogg even came on as a, as an advisor, um, of our organization. And we basically said we are obsessed with Tiny, healthy habits. And how do we, you know, bring that about to people? And said, let's target, you know, the most difficult demographic that's out there, chronic disease patients who definitely, really, you can have the most impact on. And applied this methodology to that. And so we took our habit IP and applied it to a remote patient monitoring platform and said, let's go ahead and build called, um, an omnichannel approach to meet patients where they are. So, as you know, your Dr. Silver talked about, you know, millennials are on their smartphones. The average millennial uses their phone about six hours a day. And, you know, we have this. You know, people keep talking about home care, and, you know, it's the last mile. You know, if they say home is where the heart is today, we think home is where the smartphone is. And that's the truth with Millennials. Um, but at the same time, you got a great challenge of only 25% of seniors are on smartphones. So you can't have a smartphone solution. You really need a solution that uses the phone. Uh, but the phone is just not rich enough. It doesn't engage. It's not easy enough. And so we need to provide something that is the richest experience for telemedicine and monitoring. And we felt like going back to our core principle. Habit formation can only occur if it's simple. We got to make it super simple. And so we built. Like we said, Vienna is a hive information company that is now purely focused on remote patient monitoring for chronic disease patients. We work with the largest hospital systems in the country. And, um, we've recently partnered with a great company that will help us do the distribution. It's called Lenovo. And so happy to, uh. I hope I answered your question.

Speaker A: Yeah, no, it's great. Actually, I'll take a quick point here because I. I love my conversations with you. You've just. You've built a great company. But the habit formation, I just want to take a moment because I don't want to kind of gloss over that for my audience, because tiny, healthy habits is how I've recently lost 35 pounds. And I did it over a period of time. I mean, several years. I wouldn't stress about it. It was a minor goal. It wasn't like I needed to, um, but it was just getting in shape. I decided to about five years ago to. To begin a process to live a healthier life, eat healthier foods, exercise on a regular basis, um, moderate habits, all this kind of stuff. It was all tiny, healthy habits on a regular basis. Sometimes it's not even a daily basis. It's not about doing something dramatically one day because you're probably going to not do that then again a week later. But if you have these tiny healthy habits. It was a significant uh, change in my life. I have more energy than ever. I'm at my ideal weight. And uh, it came from tiny healthy habits. So just from a psychology point, not um, even about technology. It's not about interoperability rules, it's not about virtual care. It's about what everybody can do in this, in my earshot, in our earshot, to, to have a better life, a healthier life. Yeah. So what do you think of that?

Speaker H: I agree, I agree with you 100%. And I think you stated it beautifully. I think at the end of it and uh, we get caught up with a lot of terms, but it is a psychology problem. And I would say that health, healthcare really is a habit formation issue. Um, that's what we got to start shifting to. It's all about habits. We have to go from health care to health coaching and coaching patients to better habits, which leads to better health. And that's literally our tagline, better habits, better health. That's the tagline of the company, that's the mission statement. And we think there's a definite mindset shift that has to happen for that to occur. And uh, the fact that you state that is beautiful. We about. I just wanted to add there's two ways to approach that.

Speaker Q: Mhm.

Speaker H: You can have an active engagement with patients, uh, an app or a tool that alerts a patient, that's engaging them, that notifies them, that reminds them. Kind of like what we built with Rosie. Rosie's our digital assistant to remind you to follow up, to engage you. But we also are now moving into a trend of what's called digital phenotyping, which is the passive data that you have on a person's phone, how they sit, how they move. You can get their social index, you know, how many friends a person has. If they're lonely, you can predict if they're uh, depressed, anxious. And now with phenotyping, which is the passive data on your phone, you can even predict when someone's going to have stroke, if a CHF patient is starting to use their left hand instead of their right hand. So we believe that you can use passive data and active data and combine those two to really develop and strengthen the tiny healthy habits that really bring around long term change.

Speaker A: I love it. I love it. I kind of live and breathe part of that but you guys take into obviously a whole nother level with a lot of, uh, wisdom and innovation. So, um, fantastic. So, um, specifically, I know you covered some good points there, but, um, what are some of the trends that you're seeing in the industry specifically?

Speaker H: Um, we're seeing, like I said, the trends that we see. Kind of interesting, and I'll maybe be a little bit counterintuitive here is telemedicine itself. As you know, as we've seen these deployments, it really is moving away from video calls and phone calls to chat. In some institutions, I mean large hospital systems that we work with, they started telling us that 98% of the telemedicine engagement was chat. Um, and so we've created. But the problem that I said before, 25% of your seniors, they're not using smartphones. Chat is not their forte. So we've created a very rich, simple engagement. It's almost like Alexa live visual Alexa with live interaction with the clinician. And we think that's the future of chatting with seniors and really just taking it to a whole other level. So I think that trend line is very key. The second one I kind of brought up already is phenotyping. You're going to hear this as the hot buzzword. I think hims in two years will be like a talk about digital phenotyping. We work with some of the smartest people at Harvard right now and we're working and we have um, some really good technology. But basically your phenotype is um, you can learn know a lot about a human being based on how they use their phone and think about how many hours a day you're attached to your phone. I can even kind of assess people's personality types, you know, beyond sleep and mood. And so the passive data on your phone tells you a lot about you. And there's this great quote, it's that your phenotype is the new genotype. Just like with genomics, we know so much about a person, I think we're going to know so much about a person based on just how they use their phone, where they are. That is really true AI and predictability biomarkers for detection to, like I said, tiny health, habit formation. And I think the last thing that you're starting to see as a real trend line is um, you know, you need sensors in the, in the world of virtual sensors, care. And you're seeing a lot of devices coming out but they're getting consolidated. One device that can do five readings instead of one device that just does one reading.

Speaker J: Yep.

Speaker H: And that's really the trend line going forward.

Speaker A: That's excellent. Yeah. And I actually, one of the terms that, um, Dr. Halamka mentioned earlier today was, um, wearables wisdom. I loved it. Wearables wisdom. I'm going to keep that one too. So, uh, that's awesome. So I think just, um, sticking with you and then I'll bounce over, um, to Matt after this. Uh, but, uh, thinking beyond today, what are some of the key strategies and trends? And you just covered certainly phenotyping that we must be ready to successfully navigate in three years from now, because we know we're, we know we're looking at it. It's very complex and I get that. But, um, but I also want to keep an eye towards the future. So what words of wisdom or nuggets of wisdom would you share there?

Speaker H: I mean, the last two kind of words of wisdom is I really want healthcare to start moving into the thinking about habit. And like you said before, and I'll give you one simple one. I think we're seeing a massive trend line that shows the correlation between what I call a screen time and sit time. And if you look at the correlation between smartphone utilization and immobility amongst Americans and the obesity epidemic from 2007 till 9, our unhealthy digital habits are impacting our actual health. And I don't think people are making that correlation. And so smartphone utilization, social media utilization, the depression and the anxiety. You know, uh, if a middle, a kid in middle school, a boy starts using is on social media, 25% higher indication of suicide, a girl is 70% higher. If they're starting to use social media when they're in middle school, we got to start looking at the correlation between our digital health and our digital world with our actual health. And so the last point that I wanted to make was to say back to that. For everybody that's under the age of 40, home is where the phone is. Home is where that, uh, where the smartphone is. And we really got to rethink a person based on that.

Speaker A: That's fantastic.

Speaker H: That's the trend line.

Speaker A: Excellent, Farhad. Appreciate those insights, my friend. So, Matt, from your perspective, where should we be keeping an eye on three years from now?

Speaker P: Again, I just think it's about, uh, getting easy to use and having, um, more adoption in the space that we're all here to talk about today. It's moving from the traditional care environments out into the home space. It's about seeing the impact. It's about finally bridging the gap between all the biometric data that's available to us and how we're going to consolidate that in a meaningful way that works for the caregivers. Uh, there's so many different enablers, so many different drivers that are motivating to push into the virtual care realm. I think it's going to become the reality now. It's going to be uh, a lot of the discussions that have been taking place that you know, would have happened this year at HIMSS and it happened in previous years at himss. Those things are going to start to come to fruition now.

Speaker A: Fantastic. I appreciate it. Excellent. I agree. Dr. Waller, what words of wisdom here and certainly looking three years down the road, what should we keep our eye on?

Speaker E: Yeah, thank you. And I agree with Prahad. I think, um, you know, I'm a fan of uh, BJ's work, um, who's, you know, the advisor that comes out of the Stanford Center. I think again the um, tiny habits and that focus, um, helps people understand, you know, where they have control over their health.

Speaker J: Ah.

Speaker E: And I think virtual care can do a better job of, of integrating some of that into the system that we're building to be able to help give them positive feedback around some of these things. Um, and I think that's a key component of it. I agree as well. Um, in the work that I do today, working with a bunch of venture backed, high growth healthcare technology companies, um, that concept of digital phenotyping is a big push for many of them. And again being able to capture that data on, of your smartphone, be able to determine a lot of your behaviors and has become incredibly, um, better refined over the last couple of years and I think we'll see a continued explosion in that area over the next few. Um, and I still go back to automation and I think um, Matt, you mentioned it, or Farhad, you did. But in terms of chat being a major modality, when I was at one of the largest telemedicine companies in the country as CMO, um, you know 98% of our visits were um, video when I started there. And what we're seeing now is, you know, a lot of, you know, I do some work with health systems and hospitals. You know, a lot of what they're looking at is such a great modality but we want to be able to capture a younger demographic, we want to be able to do um, chat and asynchronous visits with them or encounters with them or longitudinal care with them. Um, and so you do have to have A comprehensive solution and a, you know, different choices for different folks. So, um, Millennials, you know, very comfortable with chat, but, um, far ahead, as you said, you know, older generations still want, uh, a more traditional experience and they want to be able to talk to or see. And that's where, you know, you do have to have a more robust, uh, product to be able to offer solutions to those, um, to those stakeholders. So I think we'll see continued focus on consumerism, continue focus on proliferation ways where we're delivering virtual care. I think we'll see. As you talked about, you know, better and better, uh, consolidation of the biometrics, and not just biometrics, but home testing as well. And I think we're seeing that already today. Um, so I think these things, key themes we've all talked about, and we'll continue to see those doubling down on many of those.

Speaker A: Excellent. I completely agree, gentlemen. Fantastic panel. You guys are awesome. You obviously, uh, are invigorating and give a lot of phenomenal thought leadership. I actually took copious notes here and I love the content, um, certainly, uh, phenotyping and habit formation. I, um, completely agree. So love it. Gentlemen, as always, a pleasure. Um, Dr. Waller, Matt, Farhad, um, you guys are phenomenal guests and I truly appreciate you taking the time out of your busy schedules. I know our world's all shifted very quickly with the cancellation of hymns, and so I appreciate you guys, uh, making this show happening. Still in the panel still. So thank you.

Speaker H: Thank you.

Speaker A: Alrighty. Thank you, gentlemen. And Stone, uh, is my next guest here, Dr. Bobjerg, founder and CEO of Cure for you.

Speaker N: Yes.

Speaker A: Welcome back to the show. Thank you. Excellent. And obviously, um, you're a leader and a pioneer in this space as well, so. I know, um, were you able to catch, uh, some of the comments there on, uh, what. What they're doing with telehealth, um, and remote care. And so I'd love to just. Yeah, it's. This is, uh. I was very impressed. I love the chatting with them. I do it every year, but, uh, and every year it gets better. So. But I'd love to hear some of your thoughts on, um, you know, where you're seeing healthcare, the trends, ah, out there in the industry.

Speaker I: Yeah, um, happy to share. I mean, um, so I'm really focused on, um, remote care, um, from a provider perspective, um, what works and what doesn't work. And, um, the big trends right now is really like, what tools can we use to figure out what's happening when patients at our home, like, um, remote Patient monitoring, um, making sure that all the ones with chronic, uh, conditions or where they go home, um, with the conditions, how to make sure we capture the right data, um, but also how can we, how can we say we provide us be more efficient in the way we spend our time with our patients and for the patient perspective as well, using telemedicine. And this is happening big time right now with um, the situation with coronavirus. Right. Everybody's kind of like, whoa, this is probably something that we could use. And so very interesting time to see what's happening right now.

Speaker A: I completely agree. I mean I can imagine what's doing to uh, what your company, um, and others like it. It's just uh, the outreach and the need. I mean we've all known it's been there, we've all been pushing it for many, many years. However, it's just as I mentioned earlier, it takes a pandemic to get people off the sidelines. Not just the care providers, but also, um, the regulators. We're seeing some great just adoption and moving forward of incentives around telehealth. We saw what North Carolina did. Congress now, I know is taking this up at another level. So I mean, what insights you want to share there, uh, from the ground level, what do you see out there?

Speaker I: Yeah, no, I mean it's really interesting. I think a lot of, as you said, a lot of organizations wanted to do this for a long time. But this, this is kind of like, oh, well, better get started now because we might have to shut down our practice in two weeks or maybe even next week. How do we do that? Um, so, um, I think two things are happening. There will be a lot, uh, we see that are just go, go, go right now. And then hopefully it doesn't end up being as bad. But I think that will open the eyes of a lot of organizations. They probably better have to have a strategy about this and get started because it might happen again. Um, but the other thing is also all the creativity we see right now, um, organizations, uh, creating care plans for the patients, giving them devices to go home if they are, uh, coronavirus positive with, uh, oxygen monitor giving them a way to monitor the oxygen saturation at home, turning on the telehealth. I mean it's really cool, um, to see what people are doing out there today. Um, and I, um, think this whole thing, this disaster is going to start a lot of creativity right now and a lot of movement in this market. So it's going to be very exciting to see what's happening next.

Speaker G: Yeah.

Speaker A: And I agree and I think you're onto something there. And even Dr. Alamka mentioned how Mayo Clinic is moving into the home hospital market in Jackson, Jacksonville or they said in Florida and in Wisconsin. So I think you're going to see much more movement in that direction and people are going to be scrambling. Obviously they had already pre planned that. Uh, but now I think a lot of care providers out there are going to start to look at what other options are available. You just said it. If we have to close down our clinic, what do we do? How do we still treat our patients? And obviously telehealth, remote patient monitoring, virtual care, virtual health in general, uh, is going to be a significant component. Um, but you've been doing this for many, many years. We're just reacting to it as a society today. Um, uh, but you know, as a leader you've been doing this for a long time. But what two to three best practices or strategies can you help? Uh, you know, can you share with my audience to navigate some of these trends that you just talked about?

Speaker I: Sure. I mean because I think what is also going to happen right now is that we'll see a lot of like cleanup in mature and non mature technologies

Speaker Q: that are out there.

Speaker I: Because people would go from saying oh I do a telehealth call with one or two patients to say I got to be able to do this with all my patients. Um, which is good. I think that we'll get some mature technologies really out there. Um, as for what you need to look at, I think you need to look at ease of use for both providers and patients. So providers integration, single sign on. I mean something that is not a standalone uh, is always important but also ease of use for the patients. Right. So think of like how do you want this to use? If you go schedule yourself in for um, a flight, uh, how easy is it to use? How do you check in for your airline tickets or for your ah, airline flights? How do you anything you do that is consumer facing out there, this is what you should think about when you want to implement something for your patients as well. Because now they are not patients in your office where you can control them now they're consumers. And if you don't deliver something that is really easy to use for them, they, they just don't want to use it.

Speaker A: Yeah, you bring up a good point. Because the patients, to really keep the patients in mind here as you're looking at technology, you know you mentioned usability, single sign on. But uh, also patients are now being or consumers. We're you know, consumer patients are consumers. We've been, we're being trained by the airlines, you know, we're being, being trained by people who supply apps and banking, you mentioned banking and you mentioned airlines on a daily basis. So I know how easy these apps can be. They should be. And so if you're a health IT vendor and you're not thinking like that from that consumer perspective, you could really be behind the eight ball. And I love that you bring that up.

Speaker I: Yeah, yeah. And I think, I mean a lot of, ah, we've been handicapped a little bit in our industry by patient portals because patient portals were not built for consumers, they were built for meaningful use.

Speaker C: Right.

Speaker I: Um, just to tick the box. Right. And so everybody's saying, well, patients don't

Speaker E: want to do that.

Speaker A: But that's not really true.

Speaker I: Right. It's just that technology was not really built to be used, it was just built to tick a box. Um, and that, that is going to change now. So that's very exciting in my perspective.

Speaker A: So, and I completely agree. So in the closing minute or so, what should we keep our eye on, um, in the future down the road? I mean, obviously we're talking about a lot of futuristic things in some ways, and some of these are here, here today, which is wonderful and amazing. But what should we keep our eye on the next couple of years is in the horizon?

Speaker I: Well, I think the, one of the biggest challenges, uh, we are facing now is that as we grow this remote care from being a pilot here and there to be something that we're doing with all our patients, the amount of data we get, um, is going to be, I mean, immense. And how do we, how do we capture the important things and put them in front of the physicians? I mean, the physicians today already have a challenge in looking at what data is in the emr.

Speaker G: Right.

Speaker I: And now we're taking, talking about triple tripling with that amount of data. Um, and so this is a big focus of ours is how do we, how do we make sure we get the important things to the physicians when we are doing remote care. That that is really what I think is going to be the next step.

Speaker A: That's a great point. Actually, a couple of my guests brought that up before. I know, Rasu and Anish and John talking about all this data. Now we're going to, we're unleashing the data with this new interoperability rule. However, we can't serve all this up to the doctor. Um, and so we've got to, I agree, we got to manage this in a very smart way, not to overwhelm, to focus. Focus in. Because also you can completely distract or have meaningless data be presented and that's not very functional. So, um, Completely agree.

Speaker I: And if I can add on then adding on the communication tools right there. So we're not ending up in a situation where we are, uh, virtual in capturing data, but then we tell our patients to come in and talk about it.

Speaker K: Right.

Speaker I: You have to add in the telehaul situated messaging, all that stuff so that you get a true experience for the patients. And not just half experience I'm going to capture, but then I'm going back to my own stuff. That is going to be the next thing as well.

Speaker A: Completely agree. And that actually came up on that last panel where they Talked about how 95% of telehealth now is chatting. Telehealth is one piece, but then keeping that consistent communication. It's not about, oh, well, come see me next week. No, it's about keeping an ongoing dialogue. Dialogue to manage their health and then also habits. I loved what Farhad, uh, brought up about habit formation. Um, and I know that you're probably going to engage all that through your app. So. And you do that today, I'm sure.

Speaker I: So, yeah, I mean an all in one solution for your patients is, is important.

Speaker A: Excellent.

Speaker I: Well, Dr. Boebert, five different tools.

Speaker A: Thank you. Truly appreciate your time. I know we're supposed to have you on air at hims. I know that you're also disappointed that Hims, um, did not go on, but, um, but we completely understand and I'm grateful for you taking time out of your schedule to join us today. Thank you so much.

Speaker N: Thank you.

Speaker A: And congratulations to all what you're doing at Cure for your, to you and the team. So thank you. I'm sure we'll talk soon. Take care.

Speaker I: I appreciate it.

Speaker Q: Thanks.

Speaker I: Thank you.

Speaker N: Bye.

Speaker A: In stone do we have my next guest? Hal Wolf.

Speaker B: Yes, sir.

Speaker A: President and CEO of himss. Welcome to the air, my friend. Thank you, Hal.

Speaker C: Thank you.

Speaker A: Thank you so much.

Speaker R: Thank you. Thank you for having me.

Speaker I: Justin.

Speaker A: Appreciate you. I know that you've been under, uh, I can't imagine what you've been, been, uh, going through for the last couple of weeks and no, it just wasn't that, uh, wasn't a single decision. There's a lot that went into that. So, uh, we're grateful for you. I'm sure you're exhausted what you've been going through, but thank you for joining us on air today, my friend.

Speaker R: Thank you, uh, it's our pleasure to be here. Um, our team at HIMSS has just been doing a phenomenal job and working so hard. A lot went into the preparation for hims 20 and um, of course we've got a lot of work we're doing right now and moving forward as well towards hymns 21, um, the lot in between. So we're thrilled here today to talk to you about it.

Speaker A: Yeah, no, and I do want to take a special point. Um, I have, uh, this would have been my 23rd hymns, um, to attend. Um, but I have never met a more dedicated, thoughtful, strategic, hard working team as the HIMSS organization. I respect you guys from top to bottom and what you deliver every single year to us. And I'll tell you one thing, I mean I have the, you know, thought leaders and uh, marketing directors and sales directors, from very large organizations to very small organizations reaching out to me saying, you know, we just lost our biggest lead generator, we just lost our biggest collaboration at the end of the year. You know, what do we do? And so, uh, people are scrambling. But it's a testament to what the HIMS organization has built over the last uh, 58 years or how long have, I mean how many years have you guys been going? Do you know, is it.

Speaker R: Uh, yeah, hims has been around literally close to 60 now. And um, you know, it was an unavoidable action that we had to take for sure. But really you're talking about protecting the health and safety of the global hymns community. Uh, the employees, our residents, our attendees, everyone who was involved with it. It was, it was tough because you each himss takes about 18 months.

Speaker M: Right.

Speaker R: Uh, to plan and prepare for this was going to be spectacular. No question about it.

Speaker E: We feel very comfortable.

Speaker R: We did absolutely the right thing.

Speaker I: Yes.

Speaker R: Um, and I really appreciate your comment about our staff and our organization. I am so fortunate to have the opportunity to represent them here today. They have worked tirelessly in preparation for this week and of course they have been working even more so, um, to make sure that everyone is uh, settled and we move forward in a positive way. Um, and we've heard that a lot, a lot of people miss it. A lot of lead generation. A lot of business of course is done at HIMS and most the of importantly a lot of tremendous thought leadership.

Speaker A: Yes.

Speaker R: Uh, and the ability to exchange ideas and the power of community together, um, is one of the great hallmarks of himss. We are a mission based, member led organization with over 80,000 members across the globe. And it was heartbreaking. And at the Same time, it also underscores the value of the organization at the same time. So, um, just terrific. And again, thank you for that compliment.

Speaker A: Yeah, it does underscore the value. So please share any thoughts or initial plans that you have for a virtual HIMSS20.

Speaker R: You bet. Um, actually been working very hard on it and we're calling it HIMSS20 Digital. We'll be launching it in full scale next week, but we actually kick it off tomorrow.

Speaker C: Oh, wow.

Speaker A: So, uh, what we've done decided to

Speaker R: do is we're taking, um, presentations from himss. We're getting read permission to utilize them. We hope to bring as many of the presentations forward for the community to see, not just in one week, but we'll spread it out over some time. And tomorrow at 12 noon, uh, Central time, we're actually going to be having one of first live sessions.

Speaker E: And this is going to be with

Speaker R: Dr. Amy Compton Phillips, who's the chief clinical officer for Providence. And she's going to be literally showing how her organization rapidly mobilized on the ground because they are fundamentally ground zero for the COVID 19 epidemic. And we'll be doing a live video stream event with her and she has some tremendous insights. We think it's going to be a great learning opportunity. And then we're going to have further updates on HIMSS20. We'll be listing all of the events that will be coming up and people will soon be able to find that on www.himsconference.org.

Speaker A: fantastic. Thank you. I didn't realize you're launching all this tomorrow. So we're good. Great timing. Fantastic.

Speaker R: Well, we're kicking it off and we're going to have a special section obviously on the COVID 19. We'll also be looking around the globe. There are other hotspots, they're dealing with it. There's some insights that people can gain as to what's happening on the ground and how to take care of it, and learnings from the hospitals themselves. We know that's of huge interest to our members. Um, and we feel obviously rather close to the situation given our circumstance. And so we really want to turn it into a positive learning.

Speaker A: Fantastic. Thank you for that. So what's next for HIMSS this year? Obviously the virtual conference here, the HIMSS20 Digital. Um, but what's next for HIMSS, you know, later this year and in 2021?

Speaker R: Yeah, well, it's a great question. We have a number of major initiatives underway. So first and foremost, we're going to continue to add as much value as possible. To our members. That's very important for us on the thought leadership and learning. Just like what we're launching uh, tomorrow with HIMS Digital. We've also recently been a part of the launch of the, of a global consortium of E Health on interoperability. And this is literally an international coalition. Um, the leaders of it are HIMSS, HL7 International and IHE and fundamentally it's dedicated to ensuring that digital health innovation and efficiency through interoperability deployment. Um, with the patient appointed care gets information. It's available. You can have your information follow with you on a global basis and really put the highlight on the standards. This is critical, this is critical for the exchange of information. As your last guest was just talking. So we're excited about the uh, Consortium One is involved in IT and governments

Speaker A: from around the world.

Speaker R: We're launching. We just recently put out our new definition on digital health. Now digital health is a nebulous term. We really felt it was important for us to get some concrete feel around it and we'll be announcing formally um, our digital health index which utilizes a tremendous amount of the detail within the definition of digital health. Over 1200 data points. We'd be putting that out on the market so that fundamentally systems hospitals themselves can start to access their own digital health. And of course IMS 21 in Los Angeles, Vegas, uh, March 1 through 5 next year. We're very excited about that. Everyone who had a registration this year at HIMSS20 and this is, this is our positive policy that we've always had that's going to be applied to HIMSS21. So if you have your registration this year automatically know that it's going to be forwarded to HIMSS21. And we're excited about welcoming a lot of people into Las Vegas next year.

Speaker A: Fantastic. I always love Las Vegas as one of the venues, so fantastic. It's gonna be exciting. Excellent. So um, your predecessor, Steve Lieber was very close to the show. Uh, as I forwarded to your team yesterday, they um, Steve always helped me kick off my, my hymns radio shows starting with uh, with hims 15 stone. You were there? My producer here in the studio. Um, so I'm not gonna say how old we are though, right?

Speaker B: No, please don't.

Speaker A: But um, personally I want to get to know you better. But also what's your personal vision for my audience? Um, your personal vision for the HIMSS organization over the next three to five years?

Speaker P: Yeah.

Speaker R: Um, first of all it is great to know you and I look forward to getting to know you even Better. Um, HIMSS is a special place. You know, our fundamental mission is to reform, um, the global health ecosystem through the use of information and technology. And it was important. As you remember a year ago, we split apart information technology into information and technology.

Speaker A: Yes.

Speaker R: Because just as you've heard multiple times today, it's how we use the information for the advancement and the betterment of care and care delivery, which now becomes one of our clinical goals and opportunities.

Speaker D: Right.

Speaker R: So the vision where every single person can have the full potential everywhere their health. This is our goal. So what we are going to be focusing on for HIMSS is continuing to educate, bring together the best thought leadership around the globe to create relationships with organizations like the WHO and other nonprofits like we are in order to really improve health no matter where you are. So whether you are in a small village and you don't have access to infrastructure, or if you're in a large city and you happen to sleep next to infrastructure you don't have access to, or simply you do have access to your own information in the best. Our goal, no matter what, is to realize the full health potential of every human everywhere. HIMSS is dedicated to it. It's why you see our staff so dedicated and hard working. We believe in this mission and we are going to do everything we can to continue to improve health around the globe.

Speaker A: I love it. That's fantastic. Impressive. So how long do you think this is going? You know, what does your next couple of months look like as you kind of close that as you're just personally kind of managing? You've got the uh, HIMS Digital coming up. You've got um, just kind of navigate now, even kind of strategizing. As you said, it takes 18 months to pull an annual conference option. You have him 21 coming up. But what is, you know, in a day in the life of what you're looking at, um, what are some of the high points that you're going to be coming into in the next, uh, you know, four weeks, eight weeks.

Speaker R: We're thrilled about launching HIMSS Digital, obviously because it gives us a new platform to be able to continue the learning year round. We already do that through the HIMSS Learning center. But we want to make it a more special environment. We're putting a huge emphasis, emphasis on member value and we'll be expanding our membership internationally. We've been expanding rapidly.

Speaker A: Yes.

Speaker R: So recently a lot of our content has gone all the way out to six different languages. We're going to continue to expand that. That's very exciting for Us.

Speaker A: Yes.

Speaker R: Um, and then I think in the end, when you get back into. What do we do every single day? Well, we have more events. I mean, hymnss, Global conference conference, uh, is fantastic. It's unbelievable in size and scope. But our European conference, um, the HIMSS Health 2.0 Conference in Helsinki in June, we're going to hope, um, that the, uh, virus situation and all the pressure it's putting on health care systems around the globe starts to rescind by June. We're very focused on the Helsinki conference right now, and we'll continue with our webinar and other events for HIMSS, which are available at HIMSS.org really to keep the thought leadership and the conversation going. And I do want to come back to the consortium really quick. Justin. Yes, very important. This is very important, Justin. For the ability of our ecosystem to begin to utilize information, we have got to get the standards communicated and shared. And that is the reason we took on the interoperability consortium that we're so proud of. So take a look at that over the next couple days. The formal announcements of it kick off. Um, we're very excited. We hope many groups will join and be able to share best practices on interoperability and standards.

Speaker A: Fantastic. That's a great position to be in. Hal Wolf, President, CEO of himss. Thank you very much, my friend, for joining the show and really sharing what, what you did. This is, this is, uh, this is exciting to see what's coming up. See you in Las Vegas.

Speaker R: Absolutely. My honor. And we'll look forward to getting together.

Speaker A: You got it. And we'll certainly see you in Las Vegas, if not sooner. Thank you, Hal. Appreciate it.

Speaker L: All right.

Speaker A: And I just want to say thank you to all my guests. This is an amazing show, amazing day. Um, Roberta, thank you. Um, Stone, thank you. Um, but, uh, but we've got to wrap up here. I know we've had an amazing broadcast on almost three full hours. Uh, and just want to offer, you know, just a note of gratitude to all of you know, my dedicated partners out there, certainly you guys here, uh, in studio. But, um, uh, Lenovo, Rama on healthcare. Um, even intel has been great through the years. But, Roberta, you want to say a couple of things here, please.

Speaker B: I have some takeaways.

Speaker A: Don't you, Please. Yes.

Speaker B: On the whole three. On the whole three hours. Sorry. I have some takeaways.

Speaker J: Sure.

Speaker B: First, I love, love the fact that everybody was listening to everybody else. I know that's not what we got when we did the live here this summer because they were coming into the yeah station and you would not have

Speaker L: got that at hims either.

Speaker D: Correct.

Speaker B: It's very cuz every there. So I love the fact that how many of those people said I heard that person and they. So the flow of this was very good. I like.

Speaker N: I really like that.

Speaker B: I think you got three new hashtags. You have to.

Speaker A: I know. I love it.

Speaker G: I don't.

Speaker B: Right.

Speaker A: Curious rule Onc Wearable wisdom and digital dignity.

Speaker B: Right.

Speaker M: Love it.

Speaker L: Yeah.

Speaker B: Those are our new hashtags. Don't forget that all the rules stuff is at healthit. Gov Curesrule and they have like a whole. Whole thing out there.

Speaker L: They.

Speaker A: They do a great job. It's very well organized. It's very easy to understand very complex topics uh explained in very simple ways. Simple graphs. They do very wonderfully comprehensive infographics that you can. It's actual intelligence in its best.

Speaker B: So the other thing I liked and I didn't notice when I looked at the lineup and then we started talking to them. A lot of these people that are now in. In the vendor world and everything else have this government experience and some big and some.

Speaker A: It's helpful.

Speaker B: It's very helpful.

Speaker N: They have.

Speaker B: They have lots of there that. I like that too. Um, and hims 20 digital.

Speaker A: Mhm.

Speaker B: And that's like kicks off at noon tomorrow central.

Speaker C: Yes.

Speaker B: Yeah. Live uh. On YouTube. I guess they're doing it. They said live stream so maybe I

Speaker A: probably from their website. I'd probably go to the. Yeah.org their website.

Speaker L: Um.

Speaker B: The conference.

Speaker A: Yeah.

Speaker B: Hymns Conference. Org.

Speaker N: Yeah.

Speaker A: So what did you think about the day was phenomenal. I mean it kind of. It flowed very well as it always does. I mean I'm grateful for that. Uh, it um. My guests are easy. They're all great close friends and so this is what uh. Makes the broadcast every year as easy as it can be. Um, people don't realize this is a three hour straight broadcast. Think about doing something for three hours straight and it's a live broadcast. When you see tv most things have no more than eight minutes straight. You don't stream more than eight minutes. Or just think of how many times commercials come up. They come up every eight to 10 minutes. We just did three hours straight. So it just shows and again. And my guests are amazing. You guys are amazing. Stone, Roberta. I love doing this. This is one of the reasons why I'll be back. I mean we're gonna keep this going. This is so much fun. Um, I also learned a ton.

Speaker B: I did too.

Speaker A: I mean my gosh. I took Copious notes here. I mean just the panel, I mean when you think about just the quality of speaker, the quality of the guests here, speakers, they're all speakers in their own right. But, um, are amazing. And so what they share in a 10 minute block of time. Time is amazing.

Speaker B: So I was on two conference calls, two press conference calls yesterday with the ONC and with cms and um, I even learned more today too. So, I mean I had done that. So yeah, they're great guests and thank you to the ONC for coming on.

Speaker A: Yeah, um, when I reached out to them, I expected to have one. Um, and they said, how about all four? I'm like, fantastic, that's great. So, um, it made the show much better and obviously there's a lot going on, um, uh, regarding the rules and what was going to be announced. And so it's extremely timing. Again, we're fortuitous with our timing. I mean if him, you know, we

Speaker B: need to get together six months from now to see how the, and get the vendors on the show and see how they're doing on the rules.

Speaker A: I agree, we'll do that. But, um, but again, I just want to say thank you to everybody, everybody who's listening today. An amazing show. I hope you took a lot from it. I certainly personally did. That's why I do it. This is an amazing show, an amazing opportunity. And also just want to say thank you again to all of our production partners, Louisville Health Business, Radio X Rahman Healthcare, Healthcare Now Radio and certainly the HIMS Organization. Their, uh, continued support makes this happen. So and thank you again to all of you listeners. Without you we wouldn't have a show. So thank you for joining us today and as always, you can tune into uh, this Justin radio weekdays at 2:30pm Eastern, 11:30am Pacific. You can go to thisjustinradio.com or healthcarenowradio.com thisjustin and you can hear our show broadcast again daily, 2:30pm M. Eastern, 11:30am Pacific. As always, you can track me on Twitter @hrt advisor and use the hashtag thisjustinradio so we can respond to your comments from the show. If you miss any of this broadcast or want to hear more, my shows are always posted on Apple, iTunes, SoundCloud, iHeartRadio, Spreaker, Google Play and tune in. Also, if you want to see or hear more thought leadership from most of my guests, you can check out the think tank@healthinnovationthinktank.com thanks everyone. Have a terrific rest of your day.

Speaker C: Sa mhm.