AHLA's Speaking of Health Law

C-Suite Roundtable: Digital Health and IT Trends and Strategies

September 17, 2021 AHLA Podcasts
AHLA's Speaking of Health Law
C-Suite Roundtable: Digital Health and IT Trends and Strategies
Show Notes Transcript

Rob Gerberry, Senior Vice President and General Counsel, Summa Health, and Emily Grey, Partner, Breazeale Sachse & Wilson, explore the role Chief Information Officers currently play in helping health systems and plans execute their strategic plans, along with digital health and IT trends that have accelerated during the pandemic. Some of the trends discussed include the rise of telehealth and remote monitoring, addressing patient care through data management and analytics, and the role of digital devices from a clinical standpoint.

Rob and Emily’s panel includes Michael Hyder, who is a consultant and former chief medical officer and chief medical information officer, Harun Rashid, who is Vice President of Information Services and Chief Information Officer at Akron Children’s Hospital, and Tanya Arthur, who is Vice President and Chief Information Officer at Blue Cross and Blue Shield of Kansas City.

From AHLA’s Hospitals and Health Systems Practice Group. Listen to the first episode in this series, on health system strategies during disruptive times.

To learn more about AHLA and the educational resources available to the health law community, visit americanhealthlaw.org.

Speaker 1:

This episode of A H L A speaking of health law is brought to you by A H L A members and donors like you. For more information, visit american health law.org.

Speaker 2:

Thank you everyone for joining, uh, this next, uh, episode of our C-Suite podcast series. Uh, our first podcast was with different strategic planning officers as they looked at industry trends and where they saw work going within hospitals, health systems, and health plans. Today, we are lucky enough to be joined by three talented individuals in the information technology space as we continue to look at its effect on the healthcare industry. I'm Rob Gerber. I am currently a board member of the American Health Law Association. I want to thank our hospitals and health systems practice group, and then also introduce my co-moderator today, the former chair of the hospitals and Health Systems practice group, Emily Gray. From there, I'm gonna introduce our three presenters for today. First, we have Dr. Mike Heider. Mike is a, uh, currently a consultant in his past roles has been a Chief Medical Officer, a chief medical informations officer, and has really helped organizations to focus on advancing their population health strategy through digital technology and analytics enablement. Our next presenter is Harun Rashid Harun is the Vice President of Information Systems and the Chief Information Officer at Akron Children's Hospital. And finally, Tanya Arthur. Tanya is the Vice President, uh, and Chief Information Officer at Blue Cross and Blue Shield of Kansas City, and my former colleague, uh, at Summa Health System. So we want to thank each of our presenters for joining us today and participating in this podcast. With that, I'm gonna turn it over to Emily to kick us off.

Speaker 3:

Yes. Thanks so much, Rob. Um, so since we are talking this time with our Chief Information Officers, I thought it would first be helpful, um, to hear more about how the CIOs in your role, uh, play in helping health systems and health plans execute their strategic plans. As outside counsel, I don't always have as much insight, uh, as those who work in-house like Rob do. So I was hoping you could tell us a little bit about your role and also what industry trends you've been seeing as we come through the pandemic. Um, and why don't we get that started with Tanya, who can give us some insights there.

Speaker 4:

Yes, absolutely. Thank you. Thank you, Emily. Um, I'll tell you, lot has changed over the last, I would say, 18 to 24 months. I think, uh, from a chief information officer perspective, we've always in healthcare, really been focused on the quadruple aim and really looking to improve experience, really lower the cost of healthcare and, and facilitate, uh, health and wellness, um, across populations and with, with individuals. Uh, with the pandemic increasing, uh, the pandemic, uh, happening, w that has only e accelerated. So we've, we've seen a lot of challenges with, um, increasing case mix, which, you know, the severity of illness, the severity of illness with, uh, the pandemic itself. And we continue to focus on, um, we've continue to focus on, uh, accelerating health outcomes and reducing, reducing the cost of care. And really, uh, health systems as well, both on the payer and provider side, are looking to, uh, technology to help, uh, accelerate capabilities in that space, whether it be virtual health, whe whether it be through automation or leveraging data. Uh, those are the areas that we really, um, place our, our place, our efforts. In addition to that, it's been, it's from an industry perspective and with the proliferation of data, um, security risk has, uh, only been elevated, uh, in, in our industry. And we see a lot more sophisticated attacks and attacks from, you know, all parts of the globe, um, particularly targeting healthcare and healthcare information.

Speaker 3:

Thank you so much, Tanya. Um, Mike, do you have anything to add to that? Do you have a little bit of a different role coming from your perspective and consulting and with a physician background as opposed to what Tanya sees with the plan?

Speaker 5:

Yeah, no, thank you, Emily, uh, and Rob for asking for inviting me today. Um, yeah, I do, and I'm, I'm really synergistic to the role that the CIO plays within the organization, especially when we're talking about a integrated delivery network or a payer. But in the healthcare world, um, you know, often as, as Tanya said, it's really critical to make sure we understand what our true north is, regardless of what's happening in the world. And of course, the pandemic has really created quite a bit of disruption to healthcare operations. But at the end of the day, it's about health and wellness and making sure that, um, we translate that, uh, those sort of lofty goals of, of high quality at at, at low cost and high satisfaction into specific deliverables, clinical deliverables, clinical outcomes at the disease level, working with our clinicians to then be able to come up with a capabilities roadmap in order to execute. And when I say capabilities roadmap, it's what are the technology capabilities required in order to deliver on those health outcomes? Um, and, and then based on that, kind of working with it to then say, okay, here's what's needed, uh, from a technology perspective to deliver on the outcomes versus coming to the health system, coming to the, uh, to the, to the clinicians with, with tools to say, we have this type of tool or that type of tool, or this type of system. Um, so that we're have, we have, you know, clarity around cause and effect, uh, when it comes to our technology assets. And, uh, I think that's how folks like myself who sort of play these, what I call an IT broker role, really brokering between the clinical world and the technology world. It's sort of that Rosetta Stone, it's, it's really being able to sort of link the clinical initiatives to the technology capabilities, and then smart folks like Tanya and Harun go off and figure out how to execute on those technology capabilities. Mm-hmm.<affirmative>. And that's, that's really how organizations truly execute on their strategic plans when they think in that type of a perspective.

Speaker 3:

Thank you, Mike. And Harun. Um, do you have anything to add a little bit, you know, of a different, uh, part to your role and what are you seeing through the pandemic

Speaker 6:

Y Yeah, thank you again for the opportunity. I, I think Tanya and Mike both have, uh, eloquently commented on what are CIOs doing and helping health systems and, and execute plan, I mean, similar to it. And I, you know, I mean, similar to what Tanya said, you know, we're very focused on safety and quality. That is our number one initiative. We're focused on research, we're focused on academic support, you know, because we have to grow that program. And, and also innovation. You're seeing more and more healthcare organizations really, you know, playing a lot of emphasis in you innovation as a, as a, uh, rule of thumb to be able to deliver new ways of doing things in medicine to take care of the patient, you know, and then, of course, true not objectives. All of us have strategic objectives that are, uh, big and bold that we need to focus on, and they all fall in that category. But I think what we've seen through the pandemic, uh, and the trend is that consumers have increasingly, uh, are prioritizing digital health and digital tools, as you know, as, and they want convenient technology based on their, to help them with their patient experience. It needs to be seamless, you know, and it needs to be prepared for the shifts. So we, we in healthcare are still working to shift to meet that they're so accustomed to having, uh, a, you know, digital, uh, me media or digital, uh, availability. In all other industries, whether it's banking or whether it's airline and all, we're not there yet. We're still, you know, bricks and mortars and paper centric and, and what the, what the covid has done or post pandemic has shown us that we need to start thinking differently, and we need to shift our cultures and systems to meet the patient where they are and not where we want them. You know, they're more interested in digital health ever than, than they have been because they want to take more ownership. I mean, today, people can get kits for covid at their home and do self-testing, and, and they're doing all this self-diagnose and management. So this go, this growth in the digital shift and through the pandemic is demonstrated to healthcare that we have to create a bridge to gap, uh, and invest in that digital to drive for patient satisfaction. Telehealth, I know we're gonna talk about that is a classic example of how Covid has propelled that 10 years forward to be able to create that experience and, and improve, uh, the, uh, patient engagement and outcome by allowing us to connect with them, uh, through digital mechanism, all because of pandemic. So there has been some great things that has come through, uh, and these are all part of our strategic objectives in the organization to care for our patients.

Speaker 2:

So, Harun, building on, on your comments about digital health. At the beginning of the pandemic, we transitioned and accelerated the telehealth model as we were trying to keep patients, you know, out of our, uh, facilities. As the pandemic has evolved and we're facing now staffing shortages, and we're looking at novel ways to monitor patients remotely and to take care of a patient at home, what is your strategy to implement those capabilities, and what do you think the timeline is to really build out those capabilities to see patients in a different way?

Speaker 6:

Well, in many cases, if I were, if you were to ask my organization what the timeline is, they, they would tell you, that was a year ago, right? Because we needed systems. Uh, actually, uh, in my opinion, uh, I was doing this in 2009 at a very large organization in U P M C, and at that time, the adoption rates were not very high because people still believe that patient wants to come, patients want to come into the hospital, they want to interact with the human, uh, side of it. You know, they like that. But that's not quite true. I mean, there are, telehealth is not for every, every services telehealth are for specific services that can augment. It's just another tools to our provider to engage in care delivery. You know, there's still, it's never going to replace the face-to-face interaction, but Telehealth brings a high tech environment into our patient population. So what the pandemic has shown for all organizations, and we were prepared for it. We had telehealth already invested, and our telehealth exploded by hundreds of percentage. You know, when Covid came into play, and it made a believer, a lot of people are clinicians and all that. We can do this. We can deliver this kind of, uh, you know, uh, value to our patients and families because the genie is out of the bottle. We're not gonna be able to put this back and say, well, telehealth only works during pandemic. It doesn't work during regular mm-hmm.<affirmative> visit, that's not going to happen. I think what you're going to see is, uh, a most organization now pivoting to some model, whether it is 20% or 30% or something that is, that they're comfortable with, where outpatient visits are going to hap happen through telehealth. Maybe it's pre or post-surgical in a consultation. Maybe it's just, well visit maybe lots of other ways that telehealth can be used to engage and actually, uh, facilitate better interaction in, you know, with our, with our consumers and patients. It can also reduce the time, the travel time that the, you know, time it takes to see those patients. In many cases in specialized services, where you are seeing a huge explosion in this country with telehealth is behavioral health. You know, that was a great need of behavioral health, and people had to wait long time to be able to see that. You know, if you think about the opioid crisis and all that, telehealth has facilitated that, and, and Covid has assisted us. So I do think that you're going to see pretty much every organization in this country healthcare organization has, has some level of adoption with telehealth. Uh, and it is going to continue to grow. I think you're gonna see the payer models slowly, uh, start accepting the payment. You know, the government has made some inroad during the covid, but I think you're going to see more and more payers see this. You know, there are payers that still say it does, it's costly because patients see that through telehealth, and then they have to be referred back to the primary care. But there are ways to, uh, create avenues that, uh, make this a viable solution for our consumers, uh, where they have better ex, uh, experience. And also, surveys shows that 99% of the people that are seen in telehealth, they're more satisfied with the experience than they are when they come for in-person visits. Mm-hmm.<affirmative>.

Speaker 2:

So maybe I'll call Tanya next, uh, making that transition, Tanya, from a provider to the plan side of the healthcare industry, how do you all on the plan side view, not only telehealth, but potentially, you know, the future of remote from home hospital visits? Mm-hmm.

Speaker 4:

<affirmative>, I think that's, that's a, a really interesting question, Rob. You know, moving over to the, you know, focus on the payer side, the objectives of the payers are really very similar and almost the same, um, as those on the provider side. So really that focus on quadruple aim, that focus on health and wellness and, uh, population health that focus on reducing, reducing the cost of care. And we, hey, Haroon, blue Cross Blue Shield is not one of those<laugh> that is behind the curve by the, by the way, in, in this respect. Um, and so really looking to virtual health, uh, to, to drive and really enhance, uh, the experience, uh, with, with those consumers, and leverage that as a way to be proactive, uh, with respect to prevention. So, as we know in certain disease states with, for whether that be asthma or that is, you know, diabetes or congestive heart, heart failure, uh, prevention and engagement is, is really, uh, critical to the, uh, specific outcomes of those, uh, those co cohorts. And so we are, uh, leveraging virtual health. We, we leverage, uh, a vendor to provide, provide those services. And we've integrated that with, uh, we, we've integrated that as options with respect to, uh, how we, uh, define our benefit plans as well as we've integrated into, uh, primary care and behavioral health. So we've got a pretty unique program, uh, at Blue Cross Blue Shield that combines, uh, the in-person care of, uh, the primary care with, uh, behavioral health and, um, the option to, uh, provide virtual health and, and are continuing to evolve that. One of the things that we see as critical is, um, whether you're a payer or provider or, um, you know, an integrated delivery network, healthcare is very siloed, and there is no one aspect of that, those care delivery models that contains all of the information, um, that is needed to best care for those patients. So we're expanding our model to be more of a, more personalized, as well as to engage the various aspects or the entire continuum, um, of how care is being delivered through partnerships with the, the IDNs as well as, um, you know, local, uh, care providers of, of various types of services. And I think it's the combination of all of those things, leveraging the data and insights that comes out of that, and engaging the patient, uh, the patients slash members, which happen to be the same people, um, in ways that facilitate, uh, that, uh, better care delivery overall.

Speaker 2:

Great. Dr. Heider is a physician leader in this space. Where do you see for the provider community, uh, where do we rest on the IT continuum to having the tools necessary to manage patients in this different way? You know, either again, uh, having a patient, you know, rather than coming into an inpatient facility, being able to monitor them at home or for outlying facilities, having an I C U that's maybe, um, at the mothership hospital, but managing patients in an outlying facility through technology. Where do you see us in the adoption of those different ways of managing patients?

Speaker 5:

Yeah, no, that's a great question. And just, you know, commenting on my comments of my colleagues, totally agree. And I think Harun, you know, you make it sort of a, say an example, you know, patients are, are used to this type of technology. You have an iPhone, you know, you expect everything to happen virtually now, just like banking. And, um, I think where healthcare is evolving right now is really starting to understand how to apply the population health framework to the digital capabilities that are available. So, just maybe two seconds on sort of what does it mean to have a population health framework. You know, about 10 years ago, population health was this sort of vague, amorphous thing that people didn't really understand. Um, but I think what we've evolved over the past 10 years, and it's, it's really even evolving beyond this now, but when we think about a population, it simply is breaking them, breaking a, a large cohort into smaller cohorts, into smaller groups. And, and really you can think of it in four ways, at, at the very base or bottom, is you're really healthy and well. These are people who have not been diagnosed with any specific disease, who are generally healthy, who are generally well and wish to stay that way. Um, and that's, that's really the goal of that specific, uh, cohort or bucket of, of patients. The next level up from that are those that which we would call rising risk. These are folks who, um, whose body mass index is increasing, whose sugars might be going up, but they don't exactly qualify for diabetes whose blood pressure's not quite normal, but not fully abnormal. So they're in a risk category that's going in the wrong direction, but they're not formally meeting the criteria of a specific disease. Um, that's another sort of secondary bucket that needs a, a different approach and a, and a and a different way to treat them. The third bucket is really the chronic disease management folks. These are folks who have been diagnosed formally with a specific one or more diseases, high blood pressure, high cholesterol, C O P D, um, diabetes, atrial fibrillation, lots of them. Um, and those folks are treated differently than than than the other two. And then the final grouping is really the sort of sickest of the six or the highest utilizers. And these are folks with multiple comorbid diseases who are falling off the curve and who needs specific attention. And so that's, if you think about that as sort of a pyramid, um, you know, the folks at the top utilize about 50% of the healthcare. The 20% at the top utilize about 50% of the healthcare expenditures. So there is a significant push to try to reduce, um, you know, negative out outcomes and improve cost and utilization. So we know that, and that's really how pop health folks have been thinking about this for the past 10 years. Digital capabilities now are an extension of care delivery. So we think about within a rising risk population, what are the tools that we can apply to those folks to be able to get a handle, uh, on their health. Um, if I'm, if I'm understanding what someone's weight is doing, who, hey, I suspect and you come in to see me in the office or a tele visit, you know, you're not kind of headed in the right direction, what are the tools that I can augment my care with so I can get more information in more real time to be able to affect their course of care and keep them, uh, from getting to that next level up that, that chronic disease, I, I'd like to actually push them down into the healthy and well population. So I think as we're thinking about this from the healthcare clinical perspective, we're looking at these different strata of the population. We're thinking about specific diseases, whether it's cancer or, or cardiac disease or pulmonary disease. And within those, those different categories, what are the specific diseases that best qualify for these types of capabilities? Um, because part of the education to the public and managing expectations is that sort of virtual care and telehealth isn't the answer for everything. Um, you know, if, if someone's gotta make a difficult diagnosis and, and tell someone they've got cancer, that's a hard thing to do virtually. Um, there are certain types of conversations and events that need to happen in person, but there's a lot of things that don't. So as we start to think about it, we're trying to understand the different disease threads that, uh, we can apply the right digital capabilities to, to bring the best outcome, the best, the best clinical outcome, uh, with the best patient satisfaction as well. We, we, we, you know, it's really critical to do that. I think behavioral health is a great example of where the pandemic sort of pushed us into that space. It wasn't really very prevalent, but now that we're there, people are realizing, you know, behavioral health virtually works really well for most people, um, but not for everybody. And I think that's kind of where we're in a state of right now. Um, where we're evolving to is the, the, the place after population health is really precision medicine. And it's starting to say, now we've thought about people in four different buckets. How do we actually take that and understand enough about a person to know what exactly to do to both diagnostic and therapeutic wise, um, so we can provide targeted therapy digitally or otherwise, uh, so that, uh, you know, we're, we're specifically addressing their needs versus lumping them into a, a bucket of four. Um, and I think that's really where the next, the next, uh, five to 10 years is gonna take us into that, that area. Mm-hmm.<affirmative>.

Speaker 2:

So, you know, building on that concept, uh, as we look at trying to address the cost and quality issues that we see in the healthcare industry, leaders are looking to you all as the IT strategic leaders, uh, to define what are the business intelligence and data analytic tools to best take all this new data we're having now on patients and put in place better models of care. Maybe I'll start with you, Tanya. From a payer perspective, with all the information you have, claims, data, et cetera, on patients, where do you see us in that evolution of being able to impact the patient's care through the data that we have?

Speaker 4:

Oh, yeah, for sure, Rob. I think this is, this is an area that, um, we have the most opportunity in, uh, with respect to healthcare and really establishing the, those dis uh, distributed architecture, um, across not only, not only internally to our organizations, but externally, to really pull in the type of information, leverage artificial intelligence and machine learning to take that information and to drive insight. So Mike just talked a bit about, you know, precision, precision medicine. Uh, I talked a little bit about personalization, bringing those things together to be very pres precise and prescriptive around the actions that we need to take, um, not only with the individuals and their particular care, um, in helping to drive those outcomes, but what do we need to do more systemically? What kind of programs do we need to put in place? What kind of prevention mechanisms do we need to put in place? Um, what kind of experience do we want to create? And ultimately, strategically, how, how do we evolve as an organization, uh, to really accelerate, uh, meeting those goals? I think this area around data and analytics has by far, um, the most promise, uh, particularly with connected devices, um, you know, connect more connected infrastructure, whether that be with social media, whether that be with other services, whether that be with, you know, um, you know, your traditional health health systems. I think there's a lot of great work going on, even in the genomic space, right? Where, you know, with the click of a button or a, a flip of the toggle, you can share your genetic information and get feedback around your health status blended with other information that is held, uh, simply on your iWatch, um, or your iPhone. And so I think that is the, that is the promise and evolution, and I think that's going to explode over the next five years, three to five years, quite frankly.

Speaker 2:

So, Dr. Heider, as you look at accountable care entities and other entities involved in value-based care, trying to utilize this data to impact cost and quality, how far along do you see us in that, uh, progression?

Speaker 5:

Yeah, it's definitely a journey. And I think, you know, many there people are in different places. Um, I think those who do it well are very, and I, so I'll take everything Tanya just said, and she's a hundred percent correct. And the only thing I'll add to it is to say that it needs to be purpose built, right? So the concept of bring it all in, let's bring all the data in and we'll figure out what to do with it that doesn't work. And organizations that try that approach often fail because it's like going to Home Depot and just buying everything to build a house, right? You, you really need to be very purpose-built for what you're doing. So the, the organizations that execute well in the pop health space are very specific around a disease outcome that has a known r o I to it. And, and if, if, if you approach it from that perspective to say, okay, what do I need now to, well, and for this specific disease, what are the data pieces that I'm gonna need to bring in from all these different sources? Um, if you take it from that approach, you, you now know what your costs associated are, but you know what your value is, and you can build off that iterably. So pop health is really one disease at a time. And, um, those who aggregate data and normalize it and be able to serve it up in ways that make sense specific to disease states, uh, are the ones that are, are succeeding. And I think, you know, the big IDNs like, you know, Kaiser and Geisinger, they're, they're doing it very well, Ossner, um, because you hear them talking not about, not about their big data platforms, but about their disease outcomes and the specific areas that they're focused on.

Speaker 2:

So harun is the Chief Information Officer for a pediatric health system. How is the evolution of data analytics impact in that population?

Speaker 6:

Well, I, I, I can tell you, I, I think, uh, what I see in this industry is that most organization is data rich and information poor. They have significant amount of raw data. Everything we do spits out some level of data, you know, I mean, you name it, we have it mountains of data, but we don't have information that is meaningful for those data. And, and we are behind in this industry, in my opinion, in terms of analytics journey and business intelligence to do the things that we need to do to make them more meaningful. You know, to make it more where a clinician can have it at their fingertips to be able to make decisions readily. We have a lot of evolution that is still needs to happen. And I think part of that evolution that you're going to see, you know, uh, as, uh, Tanya and talked about mic, is that we need to infuse more artificial intelligence and ma machine language into this digital, uh, you know, uh, in the digital component of data analytics and data sharing. It's something we haven't done as much. You know, when you look at, uh, on the adult side or even on the pediatric side, you know, to do predictive analytics and, and, you know, we we're only doing eight or 10 or maybe 15 of those things, we need to be doing more than that. We need to be able to understand things better. I tell this all the time. I was like, you know, my car doesn't tell me I ran out of gas after I ran out of gas. It's giving me a warning at a quarter mile, you know, a quarter tank saying, look, you're going to, you need to fill your gas or you're going to have a, an adverse impact. We need to become like that with data to be able to arm our clinicians and our leaders to be able to make decisions that are informative based on the data that we have. And this is a journey that healthcare has had for quite some time. You know, you've heard of big data, all this different initiative, but I think we are still behind significantly compared to that of other industries. The health plans are a little bit better off because they've been at it a lot faster than we have because they've been keeping track of this Google, Amazon, they know more about us than we do sometimes, you know? So we need to start thinking outside the box around how we take this data to be able to address, you know, our population, our community, and then also shared that data among us. That's been the other challenges. We don't, you know, we are so dependent on our healthcare, uh, EMRs to do this data sharing through HIEs or, or through other mechanisms, but, you know, we still struggle to be able to give patients the, the kind of data they need or clinicians, the data they need when they travel outside their, their home region, you know, and so the in information blocking and others are going to help. But, you know, there's that whole component of HIPAA and p h I and one hand is saying, you know, you have to really protect that data and there's also that component. You've gotta share that data. So it, it's a double-edged sword. You have to do this in a mechanism that's more balanced. But I do think that healthcare is significantly behind on this. There are some organizations that have done some good things, but we need to do more and we need to inject more machine language and other kind of things that's going to allow us to become very proactive in managing care and changing the future of medicine. Mm-hmm.

Speaker 4:

<affirmative>. And I think your point, um, I just wanna add r real quick to something that Harron said, um, around data and data sharing. I think that interoperability between systems, both internally and, and externally is, is in incre is very critical. Um, and you see some of the industry leaders, uh, in system, um, vendors like Epic and Cerner, and, and those starting to address that particular aspect. You know, they're adding machine learning type of capabilities and, and artificial intelligence and looking, looking for more ways to connect, not only, um, just from a health system and provider standpoint, but connecting payers and providers and services and, and, uh, those types of capabilities. And, and as I mentioned earlier, I think that will, uh, accelerate, uh, over time here. Yeah.

Speaker 6:

And if I can add to that, cuz Tanya's, uh, and you know, traditionally we've always been very good about knowing what the patients, uh, conditions are when they come into the walls of the hospital, you know, but we don't know enough about them, the social determinants of all the conditions. And now when they leave the hospital, when they leave the clinic, and this is why data is so important for us to manage that care in the future, because we need to know all the social determinants that's really going up. You can't tell a person, you know, to smoke, uh, quit smoking if they're in a house full of people that are all smoking, right? So you have to understand the climate and, and what the background is to be able to understand how to address those challenges that come with it, uh, from a social determinants. So data is very much front and center. We need to do more of this in healthcare and, and really, uh, do some rapid growth to be able to address the future care that we need. Covid is a classic example. Look how we struggle to understand who was positive, who was not positive, you know, where where are all the beds available, you know, that has taught a lot from a state level, from a federal level, the need for data into interoperability to address this kind of pandemic.

Speaker 2:

Great points. So next, uh, I'll turn over to Emily, uh, to address digital health.

Speaker 3:

Sure. So, and you all have been talking, um, about the huge volume of data that's out there. We're gonna kind of drill down into, um, digital health and, and devices in particular. Um, and I'm interested in, you know, what do you include as, you know, a part of devices? We often think of wearables, and we've mentioned smartphones, smart watches. Um, how do you see that as, you know, how helpful is that data collection? Um, how are, what are you seeing used now? What do you see prospectively as a place to go? Um, and I'll start with Dr. Heider maybe, um, to see if you can give us some insights on that.

Speaker 5:

Yeah, no, that's, it's a big, big topic for sure. You know, I think at the basic level, you are right, we are sort of at the wearables sort of level right now where you've got basics like heart rate, temperature, O two sat, uh, blood pressure starting to get looked at for sure, where you've got remote blood pressure monitoring, heart rhythm, uh, the Apple Watch can now diagnose whether or not you're an atrial fibrillation. You can get an EKG off your Apple Watch. Um, there's all kinds of gadgets out there, nose scopes, throat scopes, ear scopes. Um, we're measuring things like mobility and sleep. Folks are looking at e EEG and brain wave analysis. Uh, sleep apnea can be diagnosed at home now. Um, you know, I think the evolution, it, it gets even more exciting. Uh, facial appearance, your mood, um, your risk of fall, your, your, your sweat level, um, all of these types of things, you know, blood sugar's coming online in the next, uh, couple of years, being able to not invasively measure glucose, um, from a smartwatch. So I think, uh, all of these capabilities and more, especially as Harun talked about, sort of that AI ml, uh, where we can now take this and start to make predictions based on, um, all of this data that's streaming in. I think when you combine that with other types of data that, uh, folks have been talking about, social determinants and even apps, I mean, I, I consider an app where it's asking me, what did I eat today? Did I take my medications? Uh, interactive type of, um, applications with you and your phone, whether it's passive or active. All of that now, um, is available. And, uh, I think it, it really feeds into the diagnostic components of many, many types of diseases. And so I think each disease is gonna have certain requirements for diagno, you know, for diagnostic elements. I think the evolution then becomes into therapeutics, right? So we've got this information, we know something is going to happen. What can we do digitally or virtually to help mitigate that? Um, and those could be all kinds of robotic type things and, and who knows what, uh, inventors and engineers can dream of. But I think ultimately the, the therapeutic arm is going to be an explosion of, uh, of technology, you know, in the future.

Speaker 3:

So, and ty, it, from a payer perspective, how do you see devices playing into how you manage the members, how you, how you, um, improve on health and, um, you know, a addressing it from your perspective?

Speaker 4:

Yeah, absolutely. So, you know, some of the areas that, you know, the payers are focused on is really filling some of those gaps and providing options and alternatives, uh, to help en enhance, uh, care and help enhance diagnostics. So for example, um, and creating incentives, for example, for a, from a fitness standpoint, using the iWatch or some type of, of device to monitor fitness and, and activity, um, sharing that type of information, um, and engaging with the, the providers, providing those types of capabilities as benefits. So as we look at, um, the different type of, uh, clients that we have, uh, in, in our organization, really looking at, okay, what are the, what is the right mix of capabilities and, and technologies that they need in order to help facilitate health, uh, whether that be with us directly through care management or whether that be with their, with their provider, um, which I think is where most of the, you know, the care is, is actually managed. Um, I did wanna comment, um, because one of the things that you had asked about was where, where do we see the, the, the technologies, um, going? When you look at all of the, you know, the, the span of the different types of capabilities and devices, um, that is, that is also evolving. So we, we see apps and we see different types of, um, connected devices. Those devices, I think over time, um, will become more and more passive. So le leveraging geospatial, um, type information and, and providing ways to influence the behaviors of, of consumers based on where they are in space and time and the activities, um, and the activities that they're doing. So I, I see some of those things coming down the line, um, in future years. And then, uh, the other thing that, that I'm starting to see spring up, uh, with respect to that is, um, those types of capabilities actually starting to go more internal than external. So today we use, like I, we use, uh, you know, our iPhones or, um, you know, watches and external, external devices, and there's a lot of research and, um, innovation dollars going into how to make that more passive, how to leverage internal biology and, and devices and mechanisms, um, to provide that type of information and, uh, and feedback as well. So I thought that was interesting. One of the things that, um, Dr. Heider and I have, um, looked at is really around, you know, voice analysis and how voice analysis connects to health and behavior and, and things like that. So, you know, in your day-to-day activities by, you know, simply having a conversation analysis can be taking place about your health. So there's a lot of, uh, research and innovation that's going into that space.

Speaker 3:

Thank you. And, and Heron, do you have anything to add, uh, regarding devices and digital health, particularly from the perspective of the special patient population that you serve?

Speaker 6:

Yeah, I think if you look at the industry, um, wearables are all around us. Most each and every one of us have probably have some level of wearables that we use on our day-to-day life to manage, you know, and the reason we're doing that is because we are trying to take charge of our own healthcare. You know, we, we want to be, uh, you know, it, it, it's convenient. First of all, it's a consumer preference, but it's also creating an experience. And so if you look at the huran, I think it was, Huran did a, um, study in 2021 where they found that almost 31% of, of the patients that were using, uh, wearables were sharing data with their providers, uh, from those wearable. And another 48% or so are willing to do so. And going forward now, our EMRs are not yet tweaked to handle all that data, which is another limitation. Uh, you know, so because it, we would get bombarded with all this data, and we wouldn't have, we don't have the resources to be able to address that. But I do think that we will find a sweet spot as we grow to take and ingest that data and put it into some sort of a, uh, plan in, in the organization where a provider or even our systems can react appropriately when they see elevations or when they see a, uh, opportunity for which we need to intervene. So I do think you're going to see that, I mean, there's more and more of this coming out. And what you're seeing with the peripherals is that, uh, while we do great job of taking care of it, is all of those disruptors that are coming into our industries because they believe there is, um, uh, whether it's a monetary gain or market share, whatever, you know, they have the peripheral. And where we are not as good at that, where patients can take self-control. And that's why you are seeing all this, you know, know, uh, items coming into the market every day in new gadgets. I mean, there's, you know, digital socks, digital bell, digital pants, I, I don't know why you would need a digital pan, but you know, it's there, you know, and, and, uh, uh, you know, wearables, you know, Google Glass, and people have this understanding that this disruptors that are coming into this industry doesn't understand healthcare, and that's not true. They've been in healthcare for 20 plus years, you know, Google Glass, look at that, they've been in there, they learned, they failed, they learned, and, you know, and so they're learning as they go to see where there are opportunities in healthcare to bring about those kind of technology that engages the patient, creates their personalized consumer, uh, preferences and allows them to take charge. So I think you're going to see more, uh, infusion into this. And I think, um, more of this is going to interconnect and eventually be, uh, hopefully seamless at someday, uh, with our electronic health record to appropriately take that care that's needed, uh, you know, uh, real time and proactive.

Speaker 3:

Thank you. Thank you so much. And thanks to all three of you for these, these great insights that you're sharing. I think it's, you know, tremendously helpful to our audience to, to have these perspectives. Um, and as we're closing out, uh, one of the things that is helpful for the lawyers who work with you folks is to understand what your needs are and to understand how legal counsel can best support you. So, you know, as some, some closing thoughts, um, I wanted to see from, from your perspective as CIOs and, um, as inside the industry, what can legal do, uh, to be a good partner and to support you? Um, and Harun, why don't we start with you?

Speaker 6:

Well, the first thing I will say, keep us out of trouble, you know,<laugh>. So, you know, because, uh, you know, we have, uh, very engaging clinicians and they're all very well intended, but sometimes they don't understand that a simple, we, you know, cuz they're a lot of vendors that are recognizing that, uh, there are a lot of, um, cybersecurity requirements to do business with our organization. And we have to, we have to do that because we have to protect it. So they've come up with these new ways of, you know, plug and play. You don't need it for it. And they realize that when they plug it in, it's not playing because, you know, it, it errors in the cloud. And, and as a result, you know, they're not recognizing that sending that data to the cloud is now available to everyone. So I think that's why it's so important for our attorneys. And I, I work real close with our legal team to make sure that our contracts have the appropriate conflict of interest addressed. You know, they, they follow state laws, uh, you know, uh, their, uh, indemnifications, cyber liabilities, all of those. So it protects us and it protects a vendor against any challenges that may come up out. But we do look at them often, and we are in a locked in partnership to make sure that everything do we do it is following those rules and, you know, keeping us out of trouble.

Speaker 3:

Mm-hmm.<affirmative>, thank you. Yes. A lot of risk areas to be on the lookout for. Um, Tanya, do you have anything to add, uh, advice for legal counsel on being good partners?

Speaker 4:

Yeah, absolutely. Um, and, and I would, I would really focus in two areas. One is anticipation, right? So anticipating some of the things that are coming down the, the line and, and helping us to really proactively navigate those. Um, there's a lot of landmines in technology, especially when, especially when the technology is so dis uh, distributed. Um, you know, laws and regulations are changing around who can share what information with who. Um, and there's a lot of pitfalls and, uh, and, uh, anant unanticipated, uh, consequences, uh, as a result of that, that I don't feel have been thought through. So, you know, really bringing a legal perspective to help organizations anticipate those potential fit pitfalls, and then, of course, navigate them. And the second is really, you know, um, technology, um, and digital capabilities are everywhere. And that's, that's, that's not going to change. It's only going to accelerate and increase. Um, so looking at ways to expand the technology knowledge, um, and discipline within, not just with the legal specialists that focus in technology, but really, um, finding ways to distribute and expand that knowledge across, uh, the legal, uh, industry as a whole. Because there is no aspect of, um, there's no aspect that isn't, uh, affected by technology or, or implications associated with technology. So I think, you know, in much, uh, the same way that really, um, medical schools had to start to incorporate digital knowledge and leveraging technology as part of their curriculum, I think the same needs to happen in the legal space.

Speaker 3:

That makes sense. And, you know, when it comes to anticipating, I think this podcast is gonna be tremendously helpful, um, for the legal field, uh, in understanding where you guys, you know, as experts in the field see things going mm-hmm.<affirmative>, um, and Dr. Heider, do we have anything from you, anything to add about, uh, what our what our legal council can do to be good partners, uh, to be most helpful?

Speaker 5:

Yeah, I think, um, in addition to, to what my colleagues have talked about, you know, the, the 21st Century Cares Act was, uh, brought in last year and, and that really sort of brought, you know, the mandate of immediate data sharing with patients, everything out of the EMR in real time as it's happening inpatient and outpatient. And I, I think the intentions are good intentions, and I think, you know, folks were thinking it's about patient engagement, it's about patient empowerment, but the reality is that the EMR is, is not for patients, really. It's, it's really for other clinicians and, and for, for coding and other folks to understand what's happening from a clinical perspective. It's typically, notes are not written in ways that that average people can digest the information. And there's a lot of data, raw data within those EMRs that puts a lot of unclear risks out there for providers, clinicians, um, you know, a lot of legal, uh, potential concerns that, that, that can surface from that. And, and, you know, it, it is learning about a cancer diagnosis from, you know, a pathology report online, the best way for a patient to really digest these things, it's not, I mean, the art of medicine is that, is really the interpretation of the data and, and a and a conversation with the patient and digesting it in the context of what's going on with that patient. And the E M R doesn't do that. So I think it's having some awareness that we've opened this box and there's an extreme amount of data out there, but it's not really, you know, information that's readily digestible for, for patients. And so to help navigate, uh, those, those areas with us, I think is, is something for sure that, uh, many of my colleagues are talking about and, and would absolutely seek your help.

Speaker 6:

Emily, the only other thing I would add with the, uh, infusion of all this telehealth, there's gonna be a lot of opportunities there as well to make sure that providers don't get themselves, uh, even though it's been around for a while, you know, there's interstate rules, there's the, you know, all kinds of other rules that are coming that allows you to have parity laws between interstate to do telehealth and, but you have to stabilize license for nurses and doctors. I think those are all things that we need to get better counsel on how best to approach that because we're gonna have people coming into our territory to do telehealth and we're gonna have the opportunity to do it somewhere else, but mm-hmm.<affirmative>, you know, we need to understand the governing laws and how to address those.

Speaker 4:

Right. I in and just one more add, um, around data and analytics. So with the proliferation of artificial intelligence and machine learning, uh, as wonderful as that can be in terms of driving insights, it, it also has pitfalls and in inherent challenges, um, that, I mean, I, I think all of you have probably, uh, seen in the news some of the, some of the, the challenges that organizations have faced by leveraging information that has come out of some of those, those AI models. And so really navigating that space, uh, as well is, is critically important as, as that continues to expand.

Speaker 6:

And I think I'll add one last one. I know we're short on time, given the current climate, and we addressed this earlier where staffing has become scarce, we're now looking for stats. Uh, we have staff now residing in multiple states. So when you look at that, not every organization is aware of what the labor laws are in those states for, and the ramifications of having, you know, cuz some states may say you can have up to three, but after that you have to have certain things, certain presence, certain, you know, you have to treat them differently, you know, so I think you're gonna see healthcare needing to understand that better from a legal counsel as to what, what is available and what can be done as staff are dis, you know, dispersed over the entire country and, you know, supporting a healthcare cuz it's no longer the traditional model of everybody in the same city.

Speaker 7:

Mm-hmm.

Speaker 2:

<affirmative>, great points. So on behalf of our membership of H L a, Harun, Tanya, Dr. Heider, we really want to thank you for sharing your thoughts today, uh, of a lot of thought-provoking things that really will help us as we look to the future. As I've seen you all interact with your organizations, you've built very sophisticated IT structures, you've provided your providers with new capabilities, and ultimately we've seen patients benefit from your hard work. So we really want to thank each of you for that and for all that you've done, uh, in the healthcare industry. So on behalf of h l a, thanks again for being with us today.

Speaker 1:

Thank you for listening. If you enjoy this episode, be sure to subscribe to a H L A speaking of health law wherever you get your podcasts. To learn more about a H L A and the educational resources available to the health law community, visit American health law.org.