CMIO Podcast

Al was a previous guest on the show and he did such a great job in May of 2020 that I brought him back for the sequel. Al is now 1 year into his CMIO role at Nuvance Health and in this episode we discuss what that year has been like, his influence within the C-Suite, and the impact he is having on the care in his community. I know you will like the work he is doing with virtual scribes and the digital front door too.

IT culture is a unique beast, especially in healthcare where there is such a focus on safety. "Go slow and say no" seems to be a common mantra and can create a lot of tension between operations and IT. Adam has a ton of experience with assessing and changing culture as a healthcare IT consultant. He and I discuss changing IT culture, treating IT more like a consultancy, partnering with operations, and having transparency around resources and projects.

Ori is a CMIO with a ton of experience. His recent blog post about training physicians really resonated with me. Train the workflow, not the functionality. Build muscle memory. Allow providers to listen to the material at home and then let them practice. Provide as real a scenario as possible.

This week I cover 2 stories about health insurers pushing us more towards value than volume. Humana launched 2 new bundled payments; one for CABG and another for shoulder replacement. United Health Group CEO discusses how the COVID pandemic is putting more pressure on primary care to switch to at risk contracts rather than fee for service, but also highlights the difficulties. CMIOs should be aware of the technology challenges these models bring to their clinicians. I also cover the INOVA breach of more than 1 million patients related to an attack that occurred to a 3rd party vendor that sells donor engagement software to non-profits. The most interesting article of the week comes out of the latest issue of JAMIA where a team developed an app that lays on top of Epic to provide the user a disease specific view with a very clean interface. This is the future. Watch for more of these SMART of FHIR apps coming out as the APIs open up. Those stories and more on this weeks CMIO News to Know.

Michael has a unique role in healthcare. He helps startups connect with health systems to solve the most pressing problems facing the system. In this episode we discuss how a CMIO is involved with innovators, what to do when a colleague presents an idea they think will be the next big thing, and how to build that critical relationship with a startup if they are partnering with your system.

Hope you enjoyed your Labor Day weekend. It was beautiful here on the east coast and the beaches were plenty busy. This week I cover some of Judy's comment about Epic's Cosmos, nursing optimization, and a bunch of articles around telehealth. One of the bigger moves last week in the telehealth space was Google investing $100 million in telehealth provider Amwell. Finally, I cover the AMA release of the 2021 CPT codes and the HUGE benefit coming our way for documentation relief on Jan 1.

Bill Russell and I discuss the first 90 days of taking over a new team. A quote from Bill: "Our problem in Health IT is we consider it a good day if nothing went down and we got our work done. The reality is every day that nothing went down , and you got was all your work done, you fell one day behind because at the end of the day, the whole world is changing but you're standing still."

This week I cover the Amazon Halo wearable and all the things it can do. Toy or healthcare game changer? For you to decide. I also cover a cool AI story about uncovering illicit online pharmacies, ways to make CDS better, and AI for documentation assistance. Those articles and more on this weeks CMIO News to Know.

This week I cover the letter from AHA to the HHS about keeping telehealth going. We seem to be losing momentum, but we are not out of this pandemic yet and there are certainly benefits beyond COVID-19. I also cover a new tool that normalizes the local COVID-19 lab test names we all use to standard LOINC codes. A friend and fellow CMIO Dr. Dirk Stanley covered the challenges we all face (and created) with finding if the patient has COVID-19 when looking in the EHR in his June 2020 blog post which you can find here. This new tool proposes to help fix this for research use. I also cover a great article by Bill Krause at Change Healthcare that really articulates why the EHR portal is not enough for your digital strategy. I believe the portal is your first step but it definitely has limitations which Bill covers very well in his article here. Those stories and more on this week's CMIO News to Know.

"Why does my computer lock at 8 minutes" and "How come I can't use the VPN to connect to the hospital" are questions I know you get too. So I found a CIO to help me answer them. Dave Lehr is the CIO for Lumenis Healthcare in Maryland and he jumps into the hot seat to take on these questions. Practical advice on IT security and HIPAA protections from Dave that you can put to use right now.

This week I cover the FANTASTIC news that CMS is delaying the penalty phase of the PAMA law that requires providers to consult with clinical decision support before ordering advanced imaging tests. The delay is for another year; perhaps someone will wake up and kill this awful thing before it drains more money from the system. I also cover an interesting article about the strain on primary care caused by COVID and then a different article about how Duke is partnering with One Medical for primary care services. Both issues have Health IT implications. Those articles and more on this weeks CMIO News to Know.

Craig is now a CMO at Nordic, but has significant experience as a CMIO and with informatics. He has his own blog and I picked a few posts to dive in a little deeper on those topics. We cover "Leading the Curated Life", a post about delivering what we know is right and NOT always exactly what the doc asked for. Then we discussed "Healthcare IT Guiding Principles". As CMIOs we can have a significant impact on the workflows so a provider is doing the work that only they can do. The final blog post we hit was "Are Quality Metrics Becoming McGuffins of Healthcare". I love Craig's philosophy that the EMR is a tool for taking care of your patient and not a place to go to enter quality data. Finally, we discuss if he is funnier or better looking than Dr. David Butler. Evidently, they have a competition going on; David may not be aware of it.

This week I cover how UCHealth automated prior auth processes and saved a ton of money; we should all be looking at these technologies to reduce the cost of manual data entry in healthcare. I also cover the difficulties of installing Cerner in the VA, Cerner and Xealth connecting for improved patient experience, and telehealth difficulties for 38% of those over 65. Those stories and more in this week's CMIO News to Know.

Are we getting to the place where AI speech to text is ready to go mainstream? Gabe is a vocal proponent for fighting physician burnout and is always seeking new technologies to make charting more efficient. In this episode, we explore AI speech to text from a company called Saykara and how he uses it in his clinic.

This week I cover a study from JAMIA about the completeness of problem lists; good info for you to compare how your system does versus what they found in the study for completeness and duplicates. The House approved a bill that moves us one step closer to having a unique patient identifier. Inbasket messages cause burnout and none of our EHR tools for efficiency work. Wait - that is not the real takeaway from the story about the JAMIA study on inbasket messages and burnout, but it does raise some interesting points on the topic. I spend a bunch of time talking about the reporting requirements for COVID testing that went into effect Aug 1. Our health department said to hold off because they are not in a position to receive the data. Seems like HHS rushed this one. I also review how some of those measures are very vague and difficult for non-clinicians to answer. Those stories and more on this week's CMIO News to Know.

The Digital Front Door is an area typically covered by the chief marketing officer or perhaps a CTO or CDO, but I think there is plenty for a CMIO to be involved with in this area as well. In this episode, I interview a clear expert in the field. Paddy is well published in the field of digital transformation and shares some of his insights about what a CMIO needs to know about the Digital Front Door.

This week I cover the New Yorker piece on how primary care is struggling; worth reading about to help understand what is going on in private practices. Another article I like from this week is Google's announcement about BigQuery Omni, that lets you evaluate data regardless of your cloud vendor. Seems like a good idea to not get locked down in a single cloud vendor relationship. I also covered the Information Blocking Boot Camp from The Sequoia Project, which is helping us prepare for that Nov 2, 2020 deadline for complying with the ONC rule. Those stories and a lot more on this week's CMIO News to Know. And as usual, I ran out of time so I will cover some other great pieces of news to know again next week.

Everett has an interesting journey as a former CMIO and previous employee at Allscripts. We discuss the importance of showing value to your health system and get very tactical. We provide real life examples of where we focus to generate a positive ROI for the programs we participate in.

This week I cover 6 articles, including what UC health is doing with huge data sets to help us all understand what is working and what is not with COVID treatments, a new bipartisan bill hit the House on Thursday that aims to keep telehealth alive and well into the future (bout time!), RWJBarnabas sent their IT staff home and saw productivity increase (perhaps we do not have to micro manage analysts after all), and an upcoming study that should help with patient matching - eventually. Those stories and more on this weeks CMIO News to Know.

Special 100th episode anniversary for CMIO Podcast. I have Dr. Matt Mesnik on the show to talk about the collaboration we have between Spok and Peninsula Regional. Matt is their CMO and has a phenomenal background in healthcare IT and is an entrepreneur as well. Great story about how he got to where he is today. We discuss clinical communication and how CMIOs get involved with these projects. Everything from paging other doctors, critical response teams, to nurse call integration into your mobile phone system is all possible with today's technology. As the EMR APIs open up we will see more communication coming from our EMRs bringing the clinical data to the clinicians in real time.

This week I cover a story about providers predicting that their telehealth visit volumes will drop to

We are closing in on our 100th episode! Happy July 4th weekend and I hope your holiday was safe and social distanced. This week I cover that HHS is extending the public health emergency another 90 days; telehealth payment rules are part of this emergency. Walmart plans to expand its health supercenters; currently at 4 but plan for how you will respond before they move to your market. Howard University is partnering with digital Apps to help with diabetes management; crowded space but more research in this area is welcome. Finally, I talk a bit about "digital front doors" and 2 articles that cover the need for seamless patient experiences. I have a guest coming on within the next 2 weeks (Paddy Padmanabhan, CIO) to talk more about why this topic is important for CMIOs.

Michael is from the University of Rochester and recently published an article about the digital landscape in healthcare. U of R is doing some amazing things with outcomes data to deliver meaningful insights to patients and providers. Michael says "I see U of R becoming a digital first healthcare system", and I believe they are closer than most of us. Listen to what they are doing on this episode of CMIO Podcast.

"And what I wanted to instill was curiosity. It was okay not to know. It was okay to be bewildered and to wonder, and to be curious and whatever we were curious about, we would come back and see could we find information about it?" Mark sent me a paper he authored in 1985 about the need for microcomputers to assist with information retrieval (written on an original Mac). As an internal medicine doctor he saw where the industry was heading over 35 years ago. He is probably the most humble, wise, and talented CMIO to never have a CMIO title.

I am back after a 1 week break, although I did record a show with Bill Russell from This Week in Health IT that will air on June 30th. I will send out a post on LinkedIn once it airs. This week I cover burnout that is NOT EHR related. Imagine that?!? Financial stress is hitting the primary care offices hard. Good news from AAFP as they enter phase 2 of the AI assistant and are looking for physician volunteers. I also cover the FDA approval of a new tool that captures respiratory rate without touching the patient (perhaps we will see a number other than 16 in the EHR). Also discuss the integration of a CRM with EHR and ADT data; essential combo for pop health. Finally, I cover a great article in HealthTech Magizine by Michael Hasselberg: https://www.healthtechmagazines.com/fast-following-amazon-to-the-patient-centered-healthcare-system/ . Another one of those Univ of Rochester crew doing some amazing things.

This week I cover stories about patients finding errors in their medical records; a lot of errors and some are scary. I go on a minor rant about that darn PAMA regulation and the burden it places on providers; there is an article that covers the burden but until you go and try it out you will not understand how useless this will be for everyone. I cover an interesting article about using Uber to reduce no-shows for vulnerable patients. And finally, I cover some of the legislation being proposed to keep telehealth in place permanently.

JD is the CIO at Dayton Children's hospital in Ohio and I reached out to him to discuss CMIO/CIO relationships. The reporting relationships for CMIOs varies widely but the most common are the CMIO reporting to the CMO or reporting to the CIO. An interesting dynamic develops when the resources the CMIO needs to be successful live in the CIO shop. The CMIO/CIO relationship becomes critical to getting things done.

This week I cover an article about inequities in digital healthcare, either due to lack of internet access or lack of devices. I also review what the state of Colorado is doing to make sure that telehealth is here to stay; we should all push for such legislation. There is an article about pay cuts to providers at Providence that is a bit scary. And I went on a bit of a rant this episode because there is an insurer in my area that is denying audio only visits for specialists, but they do cover it for primary care. So our sicker patients that need specialty care can't connect to their specialists and we have to make them come into the clinic. Doesn't make medical sense to me, so I suspect the rationale is financial. I'll keep you posted as I advocate for those patients that are either unable to get access in our rural community or who do not have the device to make the connection. Probably futile, but my heart is in the right place.

Welcome to the first week of June and another episode of CMIOPodcast News to Know. This week I talk about non-contact patient monitoring solutions; cool tech if it works. I also cover an article about the potential for improved safety when risk management and clinical data is merged together. Requires resuscitating your director of risk management after you tell them you are consider this. Mayo clinic reveals a bit about their very sophisticated AI tools and what the future might look like. Finally, I wrap with a small rant about the difficulties in telehealth when some of our patients cannot get access to the tools they need to get a visit. We need some pressure on the wireless carriers to have any chance of making this better for our communities.

Will had an early start in computing and healthcare (he clearly was one of those overachiever kids in high school) . His journey took him to the vendor side of healthcare where he worked for companies such as Zynx and now for TigerConnect as their CMIO. We talk about coronavirus, telehealth, and the importance of good communication tools to help in the crisis. His old, large, blue pager from Bellevue Hospital that only flashed one number at a time is not included in the list of good communication tools.

Happy Memorial Day. This week I cover 7 articles CMIOs should know about; bedside smart speakers to improve patient satisfaction and reduce falls, custom app to help with communication around a go-live, super-user development for go-lives, and patient generated health data are some of the topics on this week's CMIO News to Know. Stay Stay.

When I read through the summaries of the 21st Century Cures act, I interpreted the line about not having to release information that could cause harm to a patient to mean that we did not have to auto-release pathology results. I held that belief until I got a message from Justin pointing out the discussion in the Q&A section of the final rule. Sure enough, they clearly state that having a policy for withholding results across the board is considered information blocking; the requirement to withhold information must be individualized. Justin and I discuss the implications of this including the possibility of patients learning they have the genes for Huntington's disease or the diagnosis of cancer from the hospital electronic portal. Yikes. We also discuss their use of chatbots during the COVID crisis and their journey towards better clinical decision support at the University of Rochester. They have a great informatics team at U of R. I have been fortunate enough to interview a few members of their team and they are doing great things.

This week I continue to work from my home office (also called the kitchen table depending on the time of day) and hope all of you are staying safe as well. I cover thermal scanners for catching people with fever (doesn't work), the rise of telehealth but not for the poor, and the rise of chatbots into healthcare. Those stories and more on this weeks CMIO News to Know.

David is a very experienced CMIO that has taught at the CHIME CMIO boot-camp, served as a strategic advisor to Epic, and now is on the consulting side of the business. He should also have a gig as a stand-up comedian. In this episode we talk about critical skills for CMIOs, the value of mentors, and his journey as a CMIO.

"The patients see the back of their physicians heads. That is not healthcare. That is data collection." - Love that quote from Al. He has a wealth of informatics experience and in this episode we explore a bit about what it was like to be a CMIO before people knew what a CMIO did for a living. We also take about virtual scribes, telehealth, and how to look at new technologies as a CMIO just starting with a new system.

This week I cover a lot on telehealth, because it is finally coming to center stage in healthcare. I discuss Epic's foray into the telehealth delivery side of the visit, new CMS regulations about telehealth, and talk about Seema Verma saying "The genie is out of the bottle", referring to telehealth. I also cover a study from KLAS Research about EMR market share and we see who is increasing and who is decreasing. I also discuss the NEJM article about physician burnout, interrupted. It's about the opportunity to reset healthcare in the face of the crisis.

Elsie has been a CMIO and is now a CMO for a startup and CEO of her own physician coaching program. To become a leader, she needed to transform the way she interacted with others. It's widely claimed that being in informatics is 20% technology and 80% people skills. This episode is all about how to develop that skill set.

This week I interview Naveen, a pediatrician with CHOP (Children's Hospital of Philidelphia) and a fellowship trained informaticist. We talk about clinical decision support, usability, and applying what he learned in fellowship to real world problems. For those of you keep track, I did miss recording last week. Forgive me. We are up to our eyeballs in COVID patients as the surge is now happening on the eastern shore of Maryland. I am sure all of you are working incredibly hard as well and I appreciate you taking the time to listen to CMIO Podcast. Stay Safe.

This week I cover more about the Coronavirus outbreak. The article concerns me the most is about the Mayo Clinic anticipating a $3 billion loss from the lost elective surgery revenue. The impact on hospitals across the country will be significant and IT programs for training and optimization are pretty quick to get cut. This week I also cover a story about Chatbots at Henry Ford, OpenNotes becoming more mainstream, and nurse practitioners being granted more authority to help in the COVID-19 crisis. Those stories and more on this episode of CMIO Podcast.

Twistle is a doctor to patient communication tool that I heard Swedish was using to keep track of PUIs or COVID positive patients leaving their ED. I reached out to the CMO and Dr. Bill DePaso joins us to talk about how patient communication and engagement is important during the crisis and for routine care.

More Coronavirus news this week. ONC basically suspends HIPAA so states and health departments can get the data they need without organizations worrying about HIPAA violations. I also discuss some telehealth items including a survey of 2000 adults where 72% of them didn't understand telehealth; important for us to know what the public thinks about telehealth. I also cover an article about cardiology burnout which once again people are probably over-attributing to the EHR. Finally, let me know what sites you use for following COVID-19 data. I found great graphs on http://91-divoc.com/pages/covid-visualization/

Brett is at the epicenter of the Coronavirus outbreak in Seattle as the regional CMIO. We discuss what the first days were like for a CMIO as the organization moved into disaster mode, hear about the innovation they are applying, discuss their telehealth initiative and more on this critical episode of CMIO Podcast.

Of course I cover Coronavirus, but it's from a CMIOs point of view. Telehealth is the big thing this week as systems try to stand up programs. I wrote an article in HealthTech Magazine (https://www.healthtechmagazines.com/coronavirus-pushes-telehealth-adoption-nationwide/) about getting up and running in under a week; not without speed-bumps, but we are conducting visits. I cover some of the hot topics being discussed in the AMDIS.org listserv, the stimulus bill from the government and how small independent practices are going to be seriously hurt financially, and I discuss two non-COVID articles as well just to give you a break. These two articles come from JAMIA. The first is about the EHR contributing to burnout and has some great metrics in there to consider for your own practices. The second is about the impact of moving external records into an integrated view has a huge impact on utilization of that data. Stay safe.

Sandy is a physician coach who helped over 500 physicians to grow their administrative careers. In this episode I ask her about the skills physicians should work on to advance their careers, how to stand out from the crowd, and how to maneuver with office politics.

The Coronavirus is in the center stage and all the news stories are touching on this unprecedented times. Today I will cover the changes to telehealth, Quality programs, HIPAA, and what others are doing to prepare from a healthcare IT perspective.

Imagine sitting in the exam room, talking to your patient, not touching the keyboard, and when you are done with the visit your note is ready for you to sign. This week I interview 2 CMIOs from Nuance and we discuss Ambient Artificial Intelligence. HIMSS didn't happen so I wasn't able to see this tool in person, but this technology is the future of medicine. This isn't a hypothetical situation. Ambient AI is working for 100,000 patient visits a month. Take a listen to hear how it is going.

Coronavirus is the main topic in every podcast, blog, or other news medium so I can't really avoid it. But I promise not to overwhelm you with it either. Check out what the systems are doing that are at the epicenter of the crisis; Univ of Washington and Providence St Joesph have blogs and other tools you can review to see how your preparations stack up. I also touch on an article about e-consults, a survey about how young doctors look at data, and a Health Catalyst article about growing market share. Those stories and more on this week's CMIO News to Know.

Colin was a CMIO for a looong time before making the jump to the vendor side. He is now at DRFirst and he talks to us about making the transition. We review the skills to have, the war chest you need, and the gut check it takes to make the leap outside of the hospital world. Great insights for those looking to get into the CMIO role or those looking to make their next move.

The absolute most important thing to read this week is....My interview with Jackie Drees in Becker's about physician builders. Other less important articles include HIMSS being cancelled due to Coronavirus, the Final Rule about information blocking should release on Monday. Those stories and more on this weeks CMIO News to Know.

As CMIOs we do not learn a lot about HIEs and there isn't a class you can go take to brush up on this topic. So to learn more, I interviewed the smartest person I know on the topic. Dr. Samit Desai is an emergency physician, and the chief medical officer at Audacious Inquiry, a company that partners with our state HIE (called CRISP). We discuss how HIEs help us with population health, how these entities function, and where we hope to get to with improved interoperability.

This week I cover 2 articles relating to difficult EMR installations, healthcare IT and coronavirus (no great options here), who is going to HIMSS and who withdrew (because of the virus epidemic), Nuance has their new ambient AI tool ready to demo, and I cover a blog post from Health Catalyst about getting the right pieces in place for successful data driven improvements; something we can all use in our roles. I'll be at HIMSS next week. Presenting on Thursday - session 218. Come say hello.