Looking forward to 2022
This months is our final episode of “News you can Use” on HealthcareNOWRadio features news from the month of December 2021 and a close out to the year
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners as we review the latest news in the healthcare industry
With so much focus on the latest variant of concern, Omicron and we review the background, the latest news and what we can expect from this latest episode on the Pandemic story that keeps surprising us.
We review the recent news of Oracle purchasing Cerner and speculate as to why that might be and what it may mean for healthcare, Cerner and EMR clients. And we talk about the remote based monitoring that is exploding onto the scene with Know Labs who posted their non-invasive Continuous Glucose monitor device and the potential impact this will have
Listen in to hear our thoughts as we close out the 2021 year and what we are looking forward to and hopeful for in 2022. We both wish you a very happy and peaceful holiday season
You can read more about the series here and the concept of keeping up with innovating 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 tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
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Raw Transcript
Nick van Terheyden
As I am each month, I’m delighted to be joined by Dr. Craig Joseph. He’s the chief medical officer at Nordic consulting partners, and we’re doing our monthly news, you can use episode, Craig, thanks for joining me today.
Craig Joseph
Thank you for having me.
Nick van Terheyden
Well, I’ve got to be honest, when we started talking about COVID, as part of this monthly update, I’m going to say I did not expect at the end of 2021, to be talking about it. But here we are. We’re working our way through the Greek alphabet and omachron is the trending topic. Certainly, big focus of attention deserved on on.
Craig Joseph
Oh, I think, very much deserved. I will agree with your premise that we shouldn’t be talking about this at this point. That and in fact, I thought in the middle of the summer, I thought that we would be getting away from this by by now. But the variance that variants have gotten us and, and omachron is different enough. That it’s a whole it’s a whole different conversation now. And I think it’s it’s astounding what this what this, what this, this version of the virus is doing. It’s it’s, it’s unbelievable. It’s doubling in one to three days in big cities. And
Nick van Terheyden
in technical terms, we say it’s running through as like a dose of salt.
Craig Joseph
Is that what we say? A salt? Yeah. All right. Well, yeah, let’s go with that. So it’s going fast. And it seems to be right, it seems to be that it’s a less dangerous form of the virus. Although I think the jury is certainly out still, we need more evidence to push us one way or the other. But what clearly we don’t need any more evidence is that it’s incredibly contagious, incredibly contagious. And, and it’s, there are people who I respect who I listen to, who are saying, like, hey, it’s really just a matter of time. So we all get this, it’s, you can you can run, but you can’t, may not be able to hide from this one. And, and so kind of taking that into consideration, you know, it’s really fairly devastating, even if it’s not as dangerous in that it doesn’t cause as many people to become very sick and hospitalized and need intensive care and oxygen and all of that. As someone said, on one of the Sunday morning shows a fraction, a small fraction of a large number is still a large number. And so if even a small fraction of people if everyone’s getting sick, and just a small fraction of those require hospitalization or medical care, our system is pretty much at the brink right now. And if we start pushing more people there, it who knows what’s gonna happen? It’s
Nick van Terheyden
it’s interesting that the the places that we’re seeing the sort of big impacts, it’s New York has reared its head, again, as a location that sees this explosion. We’ve seen this sort of conflicted state of affairs out of South Africa that I’m struggling with to make sense of in a country that has a relatively low vaccination rate unless they were hit so hard with the previous variants and actually have native or natural immunity from people having the disease before in a previous wave. Why then do we not see continued peaks and, you know, increase in cases they’ve already peaked out? It’s, it’s a struggle to sort of comprehend it. But I think you’re right on all of the counts around. You know, it’s incredibly contagious. I don’t know what the the our north is certainly above 10. I don’t Well, I say it’s certainly I believe it’s above 10. And probably higher than that. And it’s not having the same significant clinical impact on most people. But as you rightly say, a small percentage of a large number of folks is still going to cause major challenges for the healthcare system. So what are places to do? I mean, it’s almost, is there mitigation that we can develop against this or do we finally say this is you If you’re ending up getting it even if you’ve been vaccinated, because that’s happening, too.
Craig Joseph
Yeah, I, again, that number, we don’t have definitive data. So and we’ve gotten in trouble before, right by saying, talking about things that we thought would happen based on how things have happened in the past with similar viruses. And so why don’t make sure that everyone understands that that’s this is how science works. We write, we’re making get people are like, Oh, you’re making guesses? Yep. That’s what a hypothesis is. It’s a guess. But it’s an educated guess, based on the data and our experience and history. And so we’re guessing here, but it seems to me like we’re all going to get us and and, and that the vast majority of us who are fully vaccinated, and by fully vaccinated, I mean, three, three doses of mRNA, or one j&j and one dose of mRNA are going to have mild disease and by mild disease, and I hope I’m wrong, I might be wrong. But that’s the mean, we are not that high with with, with so contagious, it’s going to be, you know, unless you’re in your house and never leave it, it’s going to be hard to avoid this thing. mild disease is still pretty nasty, right? mild disease could be asymptomatic, but it can also be, you know, feeling like a nasty bug hit you. Right. And so, and we would still call that, you know, one of my daughters had, as a media, you know, got out kind of mediums, grade fever, you know, 101, and headache, and a couple episodes of vomiting and kind of felt like a truck hitter. And I don’t know what she has, she’s got three doses of vaccine. She’s also had COVID. And so she took a COVID test, and it was negative. And does that mean, she doesn’t have it? Maybe it might be also that she tested a little too early. So I don’t know, as I was trying to explain to her, she felt horrible and wanted her head to kind of explode off her shoulders. I said, you know, this is mild disease. This this is it, right? mild disease, meaning that, hey, you’re managing this at home with Tylenol or Motrin, and lots of fluids. And then you don’t need to go to the hospital. And that’s great. or urgent care or anywhere else. And so, you know, mild diseases, maybe just maybe more than a cold. And I think, you know, I’m certainly preparing for that mentally and emotionally. I don’t want that. And I’m a I’m a full grown man, which means I’m a baby, doctor, Nick, like I do not, I do not deal well with, with, you know, bad headaches and vomiting and muscle aches. I don’t want that stuff. But so, you know, what do we do? I think we continue to do what we’re doing. So everyone should be fully vaccinated, again, to be fully vaccinated means that third dose, everyone should wear a mask when they’re out in public. If it were possible, it would be great to, to test yourself frequently, especially when you’re going to be visiting with someone or going to a large group like a party, or visiting with someone who’s immunocompromised in some way. Elderly or they don’t have a good functioning immune system. I think it would be incumbent upon us to make sure that at least we knew that we weren’t contagious. So before we go and meet with those kinds of folks, so I don’t hear any any any super smart epidemiologist telling us to hunker down and not leave the house. Like I think that that that shifting sale. But at the same time, you know, if I if I were going to if I were going to visit a family that had an elderly person or immunocompromised person, I would absolutely want everyone to be tested the day of or the day before going in meeting and of course I would, I would demand that everyone be fully fully vaccinated. Now say for the third time fully vaccinated means three doses, in my opinion of the mRNA or the j&j plus another dose of an mRNA vaccine.
Nick van Terheyden
Yeah, I think you’re right. It’s sobering to hear you talk about the mild disease. I think it’s important for people to realize that because if you haven’t had it, you know, avoiding it or trying to mitigate it as much as possible. And that’s, you know, as much a function of the vaccine purpose as anything is to mitigate the impact of the disease to make it mild, or at least the symptoms milder. The important thing that sort of comes out of this is the you know, this increases the numbers of folks that are going to be suffering from long COVID. I haven’t seen a full sort of data analysis for vaccinated versus unvaccinated and long COVID. But my understanding is both what can potentially get it, there may be a difference in the percentages. So we’re gonna see more of that. And from a mitigation, I think you’re absolutely right. I think the travesty of our response has been the lack of available testing, because that’s probably one of the best tools to say, I’m gonna test myself as close as possible to the time necessary to give you the most relevance of that test and be it antigen or PCR, the PCR tend to be too slow, although there is the rapid PCR test that’s available. And that’s true from a business standpoint. I mean, we’ve seen a number of conferences have, you know, already flipped, we saw JP Morgan pull back and said, We’re virtual, we see that CSX is still going ahead, which is interesting to me, because that’s only in three weeks time, which feels like right about the time that this is exploding across the country. So I’m, I’m wondering how that’s going to play out. That’s for the new year. And, you know, subsequently, what happens at this point, it’s impossible to predict but, you know, testing mitigation using all of those strategies, I think, essential going forward. And, you know, that applies to businesses and individuals and protecting the people around you so 100% For those of you just joining, I’m Dr. Nick the incrementalist today. I’m talking to Dr. Craig Joseph, he’s the Chief Medical Officer at Nordic consulting partners and my monthly episode on news you can use for this past month, December the last month in 2021. We were just talking about Omicron, which seems to be the prevailing topic does your unfortunately. But let’s move on. There’s been some other pieces of news. Not least of all, there was noise about Oracle purchasing Cerner. And then it happened. They bought sooner. I, I don’t I’m not sure that I’m surprised. Are you surprised?
Craig Joseph
I was very surprised. Yes. I was very surprised. And it? Yeah, it could be that I I’m not aware of, of some of the merger and acquisition type work that’s going on. But yeah, I didn’t I did not, I did not see that coming. And I’m, I’m here to admit it for for those of you who don’t know, centers, one of the largest electronic health record vendors in the United States, and probably around the world. And so a lot of doctors and nurses and physical therapists and dietitians use their software every day to do their jobs, both in the hospital and in the clinics. And the question is really what will happen now? Will that will sooner change? How will it get better, certainly from their press releases. One thing that Oracle is talking about doing is leveraging their their voice recognition technology. That’s what I that’s what I’ve heard one of the one of their plays is going to be to say that, hey, you know, now doctors and other clinicians will be able to just talk and orders will magically happen. And perhaps notes will magically write themselves. And I kind of being a little bit too sarcastic that is happening today. There are software packages that are attempting to put a note together a progress note together based on what you and what the doctor and the patient are saying in the room in the clinic. So that’s not a it’s not science fiction. It’s actually happening. It’s not not necessarily ready for primetime, but it’s getting it’s getting there. So I don’t know, I’m not sure what benefits besides that that, you know, that one would get from from Oracle or Cerner.
Nick van Terheyden
So, I have a more basic question around this. And it’s really why what was it that drove Oracle to purchase Cerner? Is this a play into healthcare, a space that they must have, you know, substantial presence because, you know, the underlying databases, you know, tool sets that they’ve offered This expands it in some way as this access to customers. I’m really curious. That was the piece that really intrigued me. And part of the reason that I’m, I just I didn’t have an immediate reaction because like you it certainly wasn’t something I was thinking about. I guess Cerner has been an acquisition opportunity. It’s sort of bounced around a little bit, it struggled as the second tier EMR in some regards, not always, and not all around the world to be clear, but certainly in the US, they seem to have lost a fair amount of ground to the epic. EMR. Why is Oracle interested? Why is Larry Ellison interested?
Craig Joseph
Well, yeah, I don’t know there is, to some extent, it might be that they’re interested in the customer base, right. And if you have another way of getting into healthcare, getting into Haas, you know, to be able to visit with the the folks who make decisions at the hospital level, that’s a benefit. It is, it is very interesting. You know, Microsoft, several months ago, purchased nuance, which is a major, big company that does chiefly voice recognition, so that that ability to talk and now does a lot of the natural language understanding. So it’s one thing to record and write down the words, it’s a completely different thing to actually know what’s being said, and being able to leverage that information. That made more sense to me, you know, I got that why Microsoft would want that presence. But yeah, this is, this is, this will be fun to watch. And I’m most interested not so much in the financial rationale, but like, how will this affect the end users of Cerner? Will they notice a difference? will things get better? Is there now an infusion of cash, which means potentially an infusion of developers and to improve aspects of the product that that people have asked for improvement? I don’t I don’t know.
Nick van Terheyden
Yeah, I agree. I mean, I think that’s the the positive is another player, perhaps with a different perspective, different approach that can bring about, you know, a solid set of competition in the EMR space that is in sore need of innovation. In my view, I think we’ve struggled in terms of delivering value, in particular to the clinician, it may deliver value in other places, but most of the results of the EMR in my mind have not really given clinicians as much of a value in the care of their patients. So perhaps that’s what we’ll see. I’m I’m hopeful, too, but obviously interesting. And we’ll continue to watch it and talk about it as more information and perhaps insights emerge. Meantime, other things, I think, we’ve seen a big focus on remote patient monitoring, you know, the shift of the hospital into the home. One of the things that I found intriguing recently was the content or not contactless that would be wrong, but the known labs, non invasive, continuous glucose monitor. So we’ve seen this move from finger sticks, where you used to have to punch your skin, get some blood tests, the blood and you know, some of that was digitized, you can put it into a machine and so forth. But it was a painful, I don’t know it for anybody that’s never had a finger stick for glucose testing, I can tell you, it gets painful, not least, because you have to do it so many times and you end up doing it in the same place and they get super sensitive. Not fun at all. Along comes the continuous glucose monitors. But that’s a big needle I if you’ve ever seen, go look at the videos for this. It’s it’s interesting, and I’ve done it I don’t know if you’ve ever tried one I put one out and it was really insightful taught me a lot of things about my habits, you know, where my glucose fell and Rose and so forth, particularly around exercise that was the most interesting for me. And that’s better, but it’s not. It’s still a needle in and it’s still, you know, challenging. This is more like a Fitbit style device, I think extraordinary progress. And I think very exciting from a diabetes management, especially for the young, you know, the pediatric age group, I would imagine managing diabetes must have been very, very difficult in the pediatric group.
Craig Joseph
Yeah, well, absolutely. I’m a pediatrician. I’m not an endocrinologist, but everything was more difficult. Although I’m not so sure, actually, sometimes some adults I’ve met recently, I’m not so sure that toddlers are have anything on them in terms of being obstinate. But you’re absolutely right, whether you’re, whether you’re a child or an adult poking your finger, for at least four times a day forever, is, is not a great, not a great lifestyle. And the data are not that rich, right? You’re only getting four numbers and the ability to have a continuous glucose monitoring system of any sort of really is a miracle, we’ve now kind of come to think of that as a normal everyday thing. But the idea of just having essentially a watch on that that ability for that thing to for that, that wearable to give you numbers that then you can take and translate into instructions as to how you should take your medication. It’s it’s, it’s, it’s, it’s great, right, that pill? Well, can you say it’s just, we’re moving in the right direction? And now I think that everything is the contact lens? Yeah.
Nick van Terheyden
I think all of that is going to expand. So in the closing couple of minutes 2022, what are you looking forward to? I’ll tell you, my optimism is around continued innovation in terms of this, specifically, this remote patient monitoring clinical grade devices that, you know, provide real time data. And I know lots of my colleagues go, I don’t care about the number of steps, I don’t this. And it’s not about that it’s never a data problem. It’s always a filter problem, I think you can present that data, the idea that we measure these things, you know, occasionally when you happen to visit the office, and by the way, my experience, just based on the weighing scales that I use at home every single day, and then go into the office and find that suddenly I’ve gained X number of pounds, is I just I know that there is not that large of a discrepancy, not least of all, a different number of clothes that I’m wearing when I’m in the office, but that contributes for sure. But even the consistency of it provides me insight. It’s kept me I’ve managed to stabilize my weight. And I think more of that is going to start to deliver exciting innovations. What about you what what are you excited for in 2022,
Craig Joseph
I’m less worried about innovations, I’m more excited about the potential of not going backwards. And so that would be great if we could continue to just leverage the some of the telehealth tools and opportunities that we’ve gotten because of this horrible pandemic regulations in the US that have been loosened to allow physicians to practice and nurses to practice in different states that they were not fully licensed in, to do telehealth to do remote patient monitoring. And these things have all been technically okay easy to do. It’s just that no one paid for them. And there’s no one pays for them. Miraculously, they don’t seem to happen. And now they’re being paid for. And so my hope for next year is that we don’t as the pandemic hopefully starts to peter out and becomes less of a daily presence for us. It’s going to get worse before it gets better. But hopefully it will get better. I hope that we don’t go backwards and lose some of the progress that we’ve we’ve made in in the ability to leverage technology.
Nick van Terheyden
Yeah, I agree. I’ve seen a little bit of that. And it’s somewhat troubling to see the amount of pullback in some states where now suddenly you’ve got to have an in person visit. And, you know, they’re putting the old style barriers that are all about economics and making restrictions where there should be no restrictions. I think, a great thing to continue to focus on and fight for, for the benefit of the patients. Unfortunately, as usual, we’ve run out of time, it just remains for me to wish our listeners a very happy and peaceful holiday and a fantastic 2022 And thank you for listening in. And importantly thanking Craig for joining me each month to talk about the latest and greatest in healthcare. Craig, thanks for joining me.
Craig Joseph
My pleasure. And I’m looking forward to the gold ujar that you’ve been promising me It hasn’t been delivered yet but I’m sure it’s in the mail.
