Conference, Connecting Stand Out Technology and Twitter Lifeboats
Written by Dr Nick on December 5, 2022
Conference Season Opens
This month’s episode of “News you can Use” on HealthcareNOWRadio features news from the month of November 2022
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners. This week we discuss the recent spate of conferences and some of the highlights and positives from the experiences.
We both agree that in-person reconnecting is a big plus but there were some challenges with so many people coming back to overwhelm the conference organizers and their capacity. It also added a little strain to the risks with in-person meetings requiring a little more personal masking for me at least.
We discuss some of the focus on health equity and gender equality that did shine though and I mention a couple of highlights for me at the recent show from Caption Health and Eko Health – both of whom have taken an incremental approach to improve technology for healthcare. As we discuss the use of AI to allow greater access to technology and innovation in places where there is little or none.
The exhibit floors were large at HLTH and had seating in the corners in addition to the main stage seating at least 2,000 all within easy walking distance although distances remained large because of the overall size
We discuss the recent challenges at Twitter and while Craig sees a potential demise of the platform I am not convinced – but we have both set up accounts at Mastadon. My Mastodon Address is DrNick AND Craig is CraigJoseph.
Listen in to hear our discussion on the recent announcement by the Cleveland Clinic that they will be charging for myChart messages. As we explain it is never quite as simple as this and feels like yet another layer of complexity in the administrative and billing side of healthcare
You can read more about the series here and the concept of keeping up with innovation in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter by tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today as I am each and every month, I’m delighted to be joined by Dr. Craig Joseph. He’s the chief medical officer at Nordic consulting partners. Great. Thanks for joining me on News You Can Use. I look forward to it every month. I doubt that for at least a nanosecond, but okay, I’ll buy it this time. So Happy Thanksgiving to you, of course. And hope the year has been good. It’s certainly been an interesting year. And I would say I did more travel in the last month than I’ve done almost in the entire year, maybe not that there was sort of some ramp up, but a lot of conferences going on. I know you’re, you’re a bit of a slacker. You didn’t go to any of these. But you stayed on top of it. Right?
Craig Joseph
I did. And, you know, I think the predictions of the depth of the in person conference are, are a bit off. And so people really do want to be with other people in the actual same room and having lunch and dinner and other things. So yeah, glad to hear that you were out and about at the conferences, and I was keeping track on social media and other news to make sure I knew what was going on. But you were you were there. What, tell us everything.
Nick van Terheyden
Yeah, so I don’t know that I can tell you everything. In part, my memory fails, at least after a period of time. So let me try and cover the generalities of the couple of conferences that I went to. And you actually captured one of the key issues or issues one of the key positives for me, and I think that’s the fact that it was it was in person. I did wear a mask occasionally. But it wasn’t all of the time. So it was more associated with times when I felt like there was a need, because we’re still not sort of entirely out of this pandemic. But without the mask, changed the whole experience. And as you rightly pointed out, we’re social human beings. And I had a number of instances where I just got to meet people that were really cool. Very impressive in terms of, you know, individuals and the sort of opportunities that you know, might arise I, I had breakfast with John Glaser, I mean, he’s like a, a major person in our industry, he sort of set a number of things. And I sat down and had breakfast, and got to talk to him and pick his brain about some of the history which was great. And I ran into some old friends. So that for me was the big, big positive. I think then negative or, you know, not so good experience, certainly in at least one of the conferences was the mismatch between numbers of people that they expected coming and what actually showed up and what showed up was way over the odds. It was far more of that was part of the mask issue. For me, we saw a little bit more. Oh, and by the way, from a security standpoint, walking around Vegas, I always wear a mask, because if anything, defeats these cameras, I’m hoping that those masks are going to do the job.
Craig Joseph
We’re not We’re not recording, are we right now? No. You know, talking about how you’re trying to evade security.
Nick van Terheyden
Let the bag out. Oh, no, I’ve let the cat out of the bag, not the bag out.
Craig Joseph
Yeah. So I thought you you went to these conferences to learn about healthcare and it and it sounds like you’re just going to Gamble’s what I’m hearing?
Nick van Terheyden
Oh, definitely not. I would say that I am certainly at the other end of the spectrum from a gambling standpoint. Both with my well actually, maybe that’s not true. I have jumped out of planes, which you know, is probably a little bit of a gamble. When it comes to money, I’m I’m a definite nuts. That’s just not going to happen. Same with my health these days. So I try not to but yeah, it was and as I said, I got to interact I and the other positive with real in person interactions was a number of people that I saw on stage talking about some of their experiences that just really lifted my spirits and, you know, for the most part, I’m a proton I try and remain positive. And I have to say some of my recent experiences with healthcare have not have been a little bit negative, shall we say? I’m trying to be as nice as I can, but It’s a real strain. And I witnessed a number of folks who really managed to pull the thread of positivity and the potential to really make some impact in inequity in gender bias. And in the delivery of widespread health care. And that was inspirational for me couple of the sessions that I saw some of the folks that I managed to meet, and I’m looking forward to having on the show in the coming weeks.
Craig Joseph
That’s great. And I think everyone really wants to know what did John Glazer, half of breakfast? No, no, no. Seriously, though, I do think that you learn more at these in person conferences, and you possibly could, because your focus is on the person that’s talking, you know, 20 feet or 30 feet away from you off. And then as opposed to sitting in a computer screen and staring at the screen. And then you’re also looking at other things that are happening and answering email. And so what what was the standout for you over over these conferences that you you attended in the last couple of weeks? Would you say?
Nick van Terheyden
Well, it was certainly the application of solutions, and not always technical, but you know, ideas to really solve for the the folks that need care the most, but are not getting it, thanks to poor access, poor equity. And you know, when it came to technology, and obviously, I’m a geek, so I’m tend to be more focused on the geek thing, I had a few organizations that stood out. And to be clear, I may have missed some, it was quite overwhelming. It was a lot of square footage, a lot of people I tried to do as much walking as I did. And certainly my step counters showed that I did. So I may have missed some but in I’m going to call out at least a couple. Caption health, for me was a real standout. And it was a standout because it was an add on it was an incremental improvement. And what they do is allow people to acquire a ultrasound image without all of the expertise that a ultrasonographer has and all of the training by using essentially what they termed GPS. And that was a little bit confusing to me, because I was thinking they had some chip in there, and they were, you know, low. But that wasn’t the case, they were using the image processing to say, I can understand what you’re doing wrong. And I can guide you with the screen using essentially some software components.
Craig Joseph
So moving you in the essentially trying to make an expert Sanada for your average, not an expert.
Nick van Terheyden
Yeah. And, you know, there’s certainly going to be some Ultra cinematographers and folks who are going to say, Oh, my goodness, that’s my job going out the window. But the reality is, we don’t have enough access, we don’t get it out into the community. This is the potential to push out skill sets. And, you know, folks that know me know that I’m very passionate about other continents, particularly the African continent, because I have some roots there. And that’s something that’s very underserved in terms of health care, solutions and offerings. And this is a great way to deliver it. And it can be life changing. I’ve done a number of interviews with folks that are actually out there doing some of the work, but there’s not enough people to do that. And this is one of the ways. And the other one that stood out to me was the other incremental improvement around the stethoscope, which, you know, famously has been called dead. It’s interesting that there’s barely a picture I see of any, anybody that is a physician without, you know, some accouchement. In fact, my own logo has that over it. So let’s be clear, it’s almost as good as the the little logo that we have, which I can’t remember the name of right now. But it’s, you know, it’s old technologies. I think somebody said over 100 years old. And what they’ve done is added some tech into it to amplify it. Well, that’s good for hearing and you know, do some noise cancelling. That’s also clever. But it was the difference. They said, let’s take this, and let’s process it, upload it to the phone, show your waveform. So that gives you some additional insight. They’ve also matched it with an EKG that you can run at the same time through a similar device. It sort of attaches to the scatter stethoscope, but importantly, send it to the cloud and listen for murmurs. And, you know, again, you might hear some folks say, well, wow, that if we’re going to do that we don’t need the physician and that’s not true. The problem is that the very narrow band of cardiologists who you must have had these in medical school, the cardiologists that would take you on round So right go listen to that grade X murmur, this position and, you know, all the medical students and even the residents would go Oh, yes, yes, I can hear that loves. Yes. Oh, yes. Classic. Oh, yeah. And and how many others were lying? Let’s be clear, at least I’d certainly remember it was a real challenge. But here they’re saying we’re going to expand that capability into the community and again, to underserved communities where you can put it in the hands of people that are probably not best experts at it, because they don’t hear them often enough, don’t have, you know, sufficient exposure. And we’re essentially expanding access and allowing for earlier diagnosis. That seemed pretty cool. To
Craig Joseph
me. That’s great. And I think it’s, it’s, it’s hard to underestimate how helpful something like that could be. or overestimate, I think, is what I meant to say, it’s a good thing. It’s a good thing a lot of us don’t have are not cardiologists, and every certainly it’s it’s when you are someone who specialized in just listening to heart sounds, you get very good at that. And, and the rest of us are not just listening to heart sounds and don’t have the breadth of experience and just a little boost can get you in the right direction to say, you know, can I handle this? Or do I need to refer this patient out? And those are the kinds of things that I think really can be a difference maker, just to point you in the right direction, you’re not making a definitive diagnosis. Same with that pocket ultrasound material to be able to just say, yeah, there is something big there that I need to be worried about, or there’s not. And that point, if I’m if I’m trying to decide what to do that can help point me in the right direction.
Nick van Terheyden
Right. And, you know, the other thing about the noise cancellation in the stethoscope that I think’s interesting is you know, and I would think about this in pediatrics from your perspective, but you know, getting a child to stop breathing. So that you can hear the heart because those both those sounds are present in the chest is quite difficult. It’s for some adults is quite difficult. But the noise cancellation can do that. And that’s what you saw in the waveform was, you just saw heart sounds versus the overlay of the respiration, because you can say let’s subtract that out digitally. already improving things from a diagnostic standpoint.
Craig Joseph
That makes a lot of sense. I, you could one could imagine someone getting more comfortable kind of looking at the waveforms then listening to the sounds, which is a very interesting concept.
Nick van Terheyden
Right? So for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Craig Joseph, he’s the Chief Medical Officer at Nordic consulting, we were just talking about conferences, some of the innovation, obviously, the spread. And then one of the other things that I’m trying to think of the timing, it’s hard to know, it’s sort of moved relatively rapidly was the change in social media. And I’m not sure what’s going to happen with Twitter, obviously, I’m going to ask the expert here, and Craig will tell us and watch what we should all be doing.
Craig Joseph
Okay, that’s a lot of pressure. After Nick, to tell you about what’s going on on Twitter, it seems to be in the death spiral. As we record, it seems as if the new owner wants it to go away by some of the actions that he’s taken, either purposefully or not, but so I don’t know, obviously, no one can really know what’s what’s going to happen. It’s, it’s, it’s confusing. A lot of the safeguards seem to have been removed. The questions about the ability of the infrastructure to withstand attacks and and, and big uses that are coming from, you know, big events, like the World Cup and other things. And so, I don’t know, certainly a lot of people are, are considering alternatives. And there’s a lot out there, of course, within Instagram, but the Twitter really hits a sweet spot for a lot of people. And I know I learned a lot about the news and I’ve learned a lot about healthcare from experts that I follow and I would certainly be sad that this the entire website goes down. Mastodon, which is a word that I’ve only used in the past to refer to a very large mammal seems to be the new thing and that people are saying okay, you know, this is going to be this is how you hedge your bets by getting a mastodon account, so I’m very proud to say I have now acquired a mastodon account and I also want to be clear that I have no idea of how to use it. So So it’s much more Mastodon is kinda like Twitter, but it’s not, there’s no central kind of holding company. So anyone can create a mastodon server and so but they all talk to each other. It’s, it’s confusing. So in summary, I don’t know what’s going to happen. But I do think that there are lots of reasons to be worried that we’re going to lose this very nice resource that a lot of us use for good and some use for evil. And to be, you know, to kind of watch what’s happening and looking for the alternatives in the near future in case Twitter either just goes away or becomes unusable because it’s, it’s all all the good stuff, or at least the things that I think of the good stuff go, you know, become a minority of the of the tweets and other requirements that I have to look at, you know, ironically, more bots or more malicious material.
Nick van Terheyden
Yeah, it’s interesting you say that, so first of all, I have a mastodon account. And I’m super excited, because instead of having Dr. Nic one, Dr. Nic, the number one I have Dr. Nic Dr. Nic K, which is really what I’m, that’s me. But I couldn’t get it on Twitter, because somebody had pulled it very early on and used it five times and then disappeared, and the rules precluded any sort of reclamation of that. And it’s frustrated me, I’ve got to say, so in that sense, it’s a good thing. I arrived there, and I looked around and thought, wow, it’s pretty lonely around here and decided, I just grabbed my name. And that was enough. For the time being, when it comes to Twitter, I think I have a slightly different view of this. And I, I just don’t see, whatever the number is 40 to 46 billion or something. seems an awful lot of money for somebody. And let’s be clear, I’ve heard all sorts of things about Elon Musk. And, you know, he certainly is eccentric in some of his behavior. And you know, I don’t have any insight don’t know him. But I have two sort of data points that stand out to me. One is, he turned single handedly, in my view, turned around the US space program, the US space program didn’t exist. He was told it was impossible. He came really close to failing but persisted, and is now launching rockets that we all take as passe. They’re not even watched launches. But if you like me still watch them. And you know what, some of the capabilities, not only did he launch them, but he did something really extreme. And the first time I saw this, I still have it, I have it as one of my backdrops for zoom, I’m that impressed? Was the landing of the two, right, not just one, but two simultaneously, which the last time I saw that was on, you know, Buck Rogers, and the 25th century when you know, was with wires and whatever. So somebody that I’m sure he didn’t do that himself, but he guided that company to do it. And to be clear, he did the same with the electric car industry, which was going nowhere. Turn that around, it became cool. And sure there’s some fluff with that. But I, you know, I see Tesla’s all over the place, I can’t believe how many I’m seeing. So they’re certainly coming off the production line. So I look at this with slightly more positivity. And yes, there’s some concern about the negative pieces. But here’s what I would turn around and say about that, that’s up to you and I, and not just, you know, us, but all of the people that are involved in this, we’ve got to be there to counteract the negative. And I know, that’s very worrying. There’s some people who I just have such enormous amounts of respect for who really fight this on a day to day basis. So I think, I don’t think it’s going to disappear. And to be clear, did you take your Twitter follower list and import it and put it into master?
Craig Joseph
No, I did not. Okay,
Nick van Terheyden
I have not. I’m just say, I don’t know that that’s possible. I’m pretty sure it’s not at least I haven’t read anything. So these people that have this huge following, this is a big deal. You know, everybody isn’t gonna jump across and say, right, I’m going to follow so I don’t know that there’s going to be this mass exodus and, you know, there’s more good than evil in the world. I just, that’s, I think that’s a premise for me. So I’m, I’m gonna go with the positive and say it’s going to survive it. It will be different, but I still think it’s gonna be good.
Craig Joseph
I’m hoping you’re right. Okay,
Nick van Terheyden
so um, let’s talk a little bit about the Cleveland Clinic and the The the new policy, can you tell us what’s going on there? And any thoughts?
Craig Joseph
Sure. So leaving clinic announced, and I stood up at first, but I think by far the largest, they announced that under certain circumstances, they were going to start charging for patient portal messages. So when you log on to your your patient portal, whatever it’s called, and send a message to your doctor, you’re going to get a little pop up, if it’s Cleveland Clinic, saying, Hey, we might charge you and or your insurance, if you have it up to think $50.05 $0. To answer the question that you’re about to pose, and don’t worry, because if you have insurance, it will likely cover some of it. And they couldn’t really say much more, because it’s a very nebulous policy, what they said is, well, if it takes a clinician to respond, so if you asked about your appointment, and or you’re asked about billing problem, no, they’re not going to charge you for that. But if they if it takes a physician or a physician extender, more than five minutes of time, they’re going to charge you. And it’s, it’s and one doesn’t know if even if you need to have insurance, how that’s going to get paid, if it will, and certainly at the beginning of the year, most of us have deductibles and lots of other out of pockets that even if it’s covered, we’re still gonna end up paying for that. So. So it’s clearly they’re trying to solve a huge problem, which is that physicians are spending a lot of time responding to these messages. And almost none of them are getting reimbursed for this. Because it’s kind of considered the same as answering the phone or someone calls and says, Well, I’ve got this rash, and I don’t know what to do with that. You would never think about charging for that, but that it’s become so voluminous, the number of, of requests that someone they’re trying to do something which I completely appreciate. And I think that five minutes, four minutes, six minutes, however much time petitions are spending should be taken into account and should be, you know, part of this should be paid for that. I think that’s all that that’s hard for anyone, I think to argue against that. The question I have is, boy, how do you implement this? And then how do I know as a patient? I’m a physician, I don’t know, sometimes when I send a message, how much time that’s going to take? And I think, if I don’t know, and I can predict it’s going to be very hard for people to, to, to know how that’s going to impact them. And so, you know, what’s the question when the doctor says, hey, you know, if this doesn’t get better, I want you to call me. But what does that mean? And again, inclusion clinic, I think has rules. I saw like, well, if it’s within seven days of you already talking to us for something that we billed you for, if it’s four days after the hospital or six days after an office visit, it’s, you know, then then we won’t charge you. It’s all very complicated. And there was just a lot of conversation about this and Twitter and other places, where doctors are like, well, we need to do something, but I’m not sure this is the thing that we need to do. And how do you solve this problem? And I don’t have any great answers. I would think that if I’m a patient now and you’re telling me this, I’m going to be like, well, maybe I’ll just call on the phone, because you’re not going to charge me on the phone. And then if I’m on the physician side, I think it’s reasonable for them to say, you know, I think oftentimes you’ve been looking at a problem though. Yeah, I’m not going to solve that in five minutes of talking, or five minutes of typing. So let’s change that either into an office visit or a video conference, you know, a video visit, which then everyone understands is gonna get billed and in the same way, so I would predict that might happen, but boy, I don’t I don’t know if is, are we just turning back the we’re going back to the the Stone Age aka 2019. Where anything you wanted almost it’s going to be if you had to talk to a doctor, it’s going to be in person. Nowadays, maybe maybe we can can continue those as video visits. Because oftentimes, it’s all if we’re just talking and we don’t need to touch me then we could talk and you can build the insurance company the same but I don’t know it’s very complicated and there is no I totally understand why they’re doing it. I just don’t understand. I’m not too excited about the you know, the direction going.
Nick van Terheyden
Well, I’m just going to close by saying it fits in Perth. sickly with the current billing strategy, which is how much will this cost? I don’t have the faintest idea couldn’t possibly estimate it. His better pay is he has no data or so much data that you can’t make any sense of it. So I feel like there’s going to be a data transparency for my chart messages, regulation that will come out in 20 years time when people have realized that this doesn’t work. I of course, I’m gesturing a little bit i I’m with you, I see both sides of it. But I think that’s it’s, it’s, it’s, it creates a very challenging problem. We’ve already got enough of this, we have to find a better methodology. Unfortunately, as we do each week, we’ve run out of time. So just remains for me to thank you, as always, for coming on the show, sharing your fantastic wisdom, and delightful insights that continue to make me laugh, which is one of my other key strategies of surviving this world. So, Craig, thanks for joining me today.
Craig Joseph
Thank you for having me. I’m glad I could be so definitive in telling you exactly how to move forward
