Health Tech Havoc
This month’s episode of “News You Can Use” on HealthcareNOWRadio features news from the month of May 2024
News You Can Use with your Hosts Dr Craig Joseph and Dr Nick van Terheyden
The show that gives you a quick insight into the latest news, twists, turns and debacles going on in healthcare withmy friend and co-host Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners and myself, where every diagnosis comes with a side of humor. We hope you stay curious, stay engaged, and keep seeking the truth in healthcare in a world that thrives on information.
Buckle up as we dive into the ER of excitement, the ICU of irrationality, and the waiting room of wacky wisdom in this months show that features a review of:
- Ransomware attacks in healthcare
- Advances and controversies in AI
- AI for healthcare communication
- Study of Patient preferences for virtual consultation backgrounds
- The life and legacy of healthcare advocate Marshall Allen, author of “Never Pay the First Bill”
Hospitals Under Siege
This week we kick things off with the elephant in the hospital room – those brutal ransomware attacks hitting major health systems like Ascension. As we bluntly put it, “It’s just going from bad to worse.” Despite the catastrophic Change Healthcare breach serving as a wake-up call, these massive digital assaults keep happening, leaving patients stranded in corridors. The odds are stacked against preventing infiltrations into the hugely complex tech infrastructures at big organizations. There is more need to prepare for these events with tabletop drills which based on my recent volunteer incident response event for a hazmat release, is well worthwhile to develop experience.
The AI revolution also took center stage this week, with the reveal of ChatGPT’s new voice model embroiled in a consent controversy after allegedly using an actor’s voice without approval. Craig wasted no time offering up his vocals: “Open AI staffers listening can use my voice – no charge!”
Spilling the Beans on What Patients Really Want
But AI presents a double-edged sword – handy for automating note-taking but ripe for misuse if the wrong voices make the cut. Just ask the lawyers whose AI committed accidental “user divorce!”. And we review the findings of a study showing patients overwhelmingly prefer video consults with professional backdrops over home settings.
On a sober note, we pay tribute to author Marshall Allen, whose tragic passing silenced a powerful voice in the fight against medical billing injustice. He has a GoFundMe page here. His book should be required reading for anyone who’s gotten those dreaded surprise bills. The bureaucratic headache concluded with a rant about Facebook and LinkedIn making it a 12-click ordeal just to report fake accounts and bots. Maybe they’ll fix that…right after the ransomware debacle!
We hope you enjoy our take on the latest news and developments in healthcare and want to help you keep untangling the web of information, dodging the sensational pitfalls, and emerging victorious, albeit a little dizzy, on the other side. In the end, the stories we uncover, and the discussions we ignite, all shape the narrative of our shared future. We want to hear from you especially if you have topics covered or questions you’d like answered. You can reach out directly via the contact form on my website, or send a message on LinkedIn to Craig or me.
Until next week keep solving healthcare’s mysteries before they become your emergencies
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
First off this week, let’s talk ransomware. And sadly, it’s just going from bad to worse, or at least it feels that way. We had the whole change debacle. And you know, you and I have both commented on this extensively. Let’s be clear there. But for the grace of God, I think is the term that most people in healthcare are going by. And there’s no no joy in any of this at all. Not on my path. I know not on yours, and certainly not anybody in the healthcare business. But we’ve just added another big organization, ascension has been taken down. And by all accounts, it seems like it’s just completely and utterly debilitated than they’re struggling to see patients patients have been left in corridors. You know, I just I struggle with a that this is happening, and it continues to happen, and certainly at this size. But also, given that we saw the terrible impact of change. I would have thought more people would have prepped and had policies and procedures and in fact this week, or was it last week? No, it was last week, I participated in a major incident. I was a patient. I volunteered before I was told it was a chemical spill. And yes, I did have a Decon Shower, I’m just gonna say,
Craig Joseph
but I need to get some details here.
Nick van Terheyden
i It was really interesting. And they were super interested in my feedback when they discovered I was a physician. So it was it was even more interesting. But yes, I did undergo the Decon shell. But my point of raising that is that this actually was really insightful. And did they do a perfect job? Absolutely not. But they learned a tremendous amount. And you know, there were parts that went well, parts that didn’t, and it feels like we need to have the same for ransomware. Is that, you know, is that what’s missing? What do you think? Well,
Craig Joseph
it’s, you know, it’s it’s the, the odds are stacked against you, right? When you’re a big complicated organization, like any, if you’re a one hospital, you know, smile 30 bet, you have complicated software. And if you’re a 10s, and 10s, dozens of hospitals in one health care system, they have so many systems that are all connected, and all it takes is one mistake, all it takes is one mistake somewhere some some software that was not patched or updated to fill a hole. And that in this case, with ascension, I don’t believe we we’ve heard, you know, we have they found what the cause was, but so all it takes us is one piece of software that’s not up to date, might have been up to date two weeks ago, but not up to date now, or one person to be at a helpdesk to be fooled by someone who is calling claiming to be an employee who forgot their password and getting their password reset. And so the odds are so stacked against these large behemoth organizations that it just I’m not sure there’s anything that you can do to 100% prevent. Now, are there things are the can we do more? Of course, always, always. And, you know, it’s a it’s always going to be a balancing act. Right? between security and usability. I can shut I and I’ve seen, you know, CISOs chief information security officers tried to do it, you know, we can we can really crank down crank up the security, such that it makes it really, really difficult for people to actually do work and see patients and get insurance. Yeah,
Nick van Terheyden
it’s almost as bad as the ransomware attack. Right? You stop being able to write
Craig Joseph
you have to find that sweet spot where it’s enough security, but it’s not so much that it’s it’s onerous. But what can you do? Certainly, I think most organizations do tabletop simulations where they where they get The lot of representative folks in the room in a room and say, Okay, this is what’s happened. What are you going to do? Right? And they act like what they’re going to do. And that’s absolutely
Nick van Terheyden
Can I just say, I wish that my Decon Shower was a table topics? Slide. I was warm water, but ah sounds?
Craig Joseph
Are i Is there a video to you? Is there is it on YouTube is there, thankfully
Nick van Terheyden
not like, I stored away my phone. But some of the people that were patients weren’t as, as informed as I was, and they lost everything for the duration of the exercise. So no, there was no video from my mind.
Craig Joseph
That’s unfortunate. Yeah, well, you know, the problem is, you can’t pretend to shut down a hospital, right? Hey, from on Sunday, when we’re kind of slow from 3pm to 6pm, we’re shutting down the emergency room. That just doesn’t work. And so everything really has to be a simulation when you’re learning healthcare. And that’s as good as it gets. And that’s something but it’s not amazing. And we’ve all become so accustomed to our electronic health records and to having data all the time, I know that when my patient portal goes down just as a, as a patient, trying to remember what that progress note said from from last week, and I want to go check it. And if it’s down, my first actual response, this just happened to me a few days ago, was Oh, my God, are they in trouble? That was my first my head. And then my second response is, oh, it’s probably just down for, you know, some service or something, it was not a big deal. Yet, I’m still kind of irritated that I can’t get what I want when I want it immediately. And, you know, we’re talking 1015 years ago, I’d have to fill out a form and who can pay money and wait two weeks, I was lucky to get a copy of that progress note. So our expectations are kind of crazy high nowadays. And we want all access all the time and and that the hackers, the the evil doers are a it’s all in their favor. So it
Nick van Terheyden
is because it just takes one instance and you know, there’s multiple sharing of the potential avenues or breach opportunities, I’m I would be shocked if there isn’t even a marketplace for, you know, information that offers insights into where there is scope for breaking into institutions. And indeed, the whole social engineering piece of this has gotten so sophisticated. As we talked about last night, you can’t trust a voice you can’t trust, you know, video at this point. There’s extensive use, and, you know, much like everything AI is in use in these places, and they’re using to attack and it just takes one one individual. And I’m willing to bet that you’ll find that change was probably a single individual. may well be we know nothing more on certainly not a lot about the ascension who knows what the story is, but likely, same kind of thing. So it’s it’s a huge challenge. I think, you know, I would summarize it as, you know, looking forward to wedding but preparing for divorce approach, which is, you know, you want to be positive and say it’s not going to happen, but you got to prep for all of this. And I think the tabletop exercises, an excellent recommendation. So good to hear that. Perhaps on a sadder note, I could just bring up. I’m I would be overstepping my skis, if I called Marshall Allen a friend, but certainly an inspiration to me. He wrote the book Never pay the first bill. He died rather suddenly, very sadly, left young family. He was a real advocate for fighting injustice in the healthcare system, you know, really worked hard to sort of combat many of the misbehaviors there’s a GoFundMe site that will link to in the blog post that goes along with this, you know, very sad I mean, I didn’t know him personally, I know many people that did, he was a true inspiration certainly inspired me. If you haven’t read his book, please go and buy it. I would hope that that would help as well. Even if it’s not the GoFundMe.
Craig Joseph
Yeah, I was not too aware of what Marshall Allen has been doing. But looking at it now he’s spot on. And I mean, just that advice of don’t pay the first bill. Right. That’s great advice. And I would I would second that. My my, I kind of expand that a little bit. I say I never pay a bill until I get The explanation of benefits from the insurance company Yep. That, you know, if the insurance company says I owe money, then maybe, right maybe I owe money. But if they say I don’t owe money, or they haven’t decided yet how much money I owe, there’s no way of paying a doctor or hospital if I can, if I can, if I cannot do it, because once I pay them, and then they just then the insurance company says, Oh, you shouldn’t have, and I gotta fight to get my money.
Nick van Terheyden
Yeah, good luck getting it back. Although I you know, I’m just going to shout out to small claims court, because it’s probably not worth their time to send a lawyer to that. But anyway, moving on, chat GPT. Lots of announcements in the whole AI space. They announced chat GPT I think it was four. And I believe it was the letter O Omni o from me there. We always have
Craig Joseph
sources of input. But
Nick van Terheyden
it sounds a little bit like it should have been asked for Scarlett No, because there’s been a little bit of a kerfuffle about the voice that was used. And apparently, she was approached to ask if she would allow for this and, you know, never agreed to it. And then it sounds like that’s what they did, or maybe created one of us. So they’ve had to pull that and said that they’re getting some others. But, you know, just a nod to chat GPT. If you’re putting out GoFundMe pitches, they apparently are much better at creating compelling pitches for donations for catastrophic medical expenses, and probably pretty much anything they were. They come across as more compassionate, which you and I have talked about.
Craig Joseph
Yeah, absolutely. And same thing with responding to patient messages. Right. That was the that’s when we had this conversation. And the first hot take was physicians are not empathetic. And then the second more reasonable hot take was physicians do not have unlimited time. Right. And, and MLMs do. And so yeah, let me just put it out there. Dr. Nick, and I, I’m sure there’s a lot of open AI, the creator of chat GPT. I’m sure there’s a lot of open AI staffers and employees listening. I will they can use my voice. And there’s no charge for that. All right.
Nick van Terheyden
I’m sorry. You know, if it’s a bake off between the two voices here, can I just say that the British accent wins out every time? Are you planning to your life and forever?
Craig Joseph
Are you putting your hat in the ring? Oh, always. All right,
Nick van Terheyden
but mine comes with the cost. So see,
Craig Joseph
see. So I might win. Because not because I’m the best? But because you’re the cheapest? Yeah, yes. Yeah. It’s a it’s a life lesson, Nick. And you know how time you learned
Nick van Terheyden
right now? To be cheap? Yes. Okay. Got it. Cheap wins, sometimes. Well, so moving. Moving on to the latest in terms of ai, ai, I’m sorry, but this is another one left me shaking my head. And I’m really not sure. Microsoft is offering a an AI with Total Recall on your PC. And I gotta say, the first thing I thought of was the black mirror episode, which when I asked you, if you’d seen it, I’m sorry, I just fell off my chair to discover you’ve not watched any of the Black Mirror. But apparently, I’m in trouble for the three body problem recommendation, because that wasn’t a hit in your household. But aside from that black mirror, I feel like everybody needs to watch those episodes, because they’re so predictive of what could possibly go wrong. And to be clear, I could only ever take one at a time. But
Craig Joseph
half of them have already happened. So I prefer that to happen in the real world, as opposed to watching. It was a 10 year old, you know, a video series about what’s going to
Nick van Terheyden
be rolled out it might be actually possible. I don’t know. No, they’ve had they did have a new one. And then they had the one that you could pick your own something nd nd ending kind of thing. But that was less of a success. But no, it was. And, you know, the effects are not super, you know, graphic or whatever. But the thinking behind them and some of the stories and that particular episode, the entire history of you was, you know, an insert into people’s eyes that allow them to record everything and then they have full control so that if you got into an argument as we always do, I would be able to recall that precise experience in video and audio to say no, that’s not what you said I was right as usual.
Craig Joseph
That would I would be that would be scary. Yeah, to be able to have that.
Nick van Terheyden
It was probably one of the darkest episodes I can recall. Certainly in the way it devolved into paranoia, the lack of trust of anything or anyone you know, I can only rely on my recording and The Lord it was, but you know, I think you have to understand all of these things. And you know, it’s one of the reasons I go to the hacking conference DEF CON, is if you’re not looking at what’s going on and what people are thinking and saying, and that’s one of the, you know, tamer ones these days, I suspect, who knows what else is going on? You really are unaware. And it’s, you know, it’s an essential part of trying to adjust to all this new technology in my view, but maybe I’m completely out there.
Craig Joseph
Well, a you’re definitely completely out there and be thanks, Powell. All of this was, you know, invented in Harry Potter, right? We’re talking about the pensive where you could, you can take your memories, and they they looks like they’re cotton candy. I’m not sure what that technology is. And then it goes into some thing, and you can stir it up with your want. So really, it’s all behind the times, because we know that Harry Potter was developed in the 1400s.
Nick van Terheyden
A lot forgotten about the pencil. But yeah, you’re right. I
Craig Joseph
might have my days off. I might have my dates off a little bit. But yeah, well, yeah, it would be interesting. Hey, you know what we’re starting to record people are starting to record their business calls. I know this because I’m on these calls. And yeah, it’s our recording them with an AI is joining, you can see an AI is joining. I
Nick van Terheyden
was on a call web, both the customer and our solution, were they both they
Craig Joseph
were both fighting, but they produce it. First of all, there’s a transcript. So if there’s something important, you can go back and see it, but also the transcripts easy. The hard part is, hey, I’m the supervisor of the sales department, I would like to know how my salespeople are doing have been LLM joining these calls, and then grade them. Or you know, which of the three customers we’re on we’re on are most likely to be the one to, to buy this product or promoted. Like. It’s kind of scary stuff. Not sure how good it is. But it also does a great job of follow ups and to dues and Hey, you said you were going to do this, Oh, that’s great. I automatically put that in my my To Do app. And so I can remember that.
Nick van Terheyden
I’ve got to say I’m a fan. But you know, once again, if you don’t see the potential negative downside, and don’t don’t sort of mitigate against that you’ll run into problems. But as as one single value proposition alone, the notetaking is absolutely fantastic. I cannot I mean, first of all, even if I could take notes at the rate of you know, the content, I missing things, as I’m taking it, I can’t read anything I write at all never had been able to that was, you know, handwriting 101 In my medical school. And I you know, I just miss all these things and want the recall of it. And I’ve just, I’ve got to say I found it fantastic. It’s been really, really helpful in our world. So, you know, there’s the thumbs up, but you know, Roger Ebert might give the thumbs down for the potential negative and that, you know, potential misuse of it.
Craig Joseph
Yeah, you’re definitely thinking more about what you’re saying, right.
Nick van Terheyden
We build the Heisenberg Principle. Right now you’re being observed, you’re gonna say, right,
Craig Joseph
right. Yeah, a little less likely to make a joke that someone might miss interpreted, but because now I know it’s being recorded. Right.
Nick van Terheyden
Probably gets flagged with a red flag. Yeah,
Craig Joseph
send this to Craig’s boss.
Nick van Terheyden
Yeah. All right. So moving on, you found an interesting piece on patient preferences and virtual backgrounds. Tell us more.
Craig Joseph
Yeah, this is in that list of research you never thought you needed but once it was done, you’re like well, that actually is pretty good. So it was in in JAMA I think and basically they took a bunch of patients and gave them pictures of physician of a the same physician dressed in the exact same way but with different backgrounds and said hey, which which is the kind of physician you would want to interact with and you know, which which doctors smarter and more professional and will help is more empathetic those kinds of questions and surprise, well not surprisingly, a doctor dressed in a white coat in front of a bed in a bedroom or kitchen was ranked love that patients don’t like that kind of neutral was just a neutral background. So just like a colored background people are were I
Nick van Terheyden
hold on before we move on. This is really interesting. Did the White Coat impacted or not? Was that a positive or a negative?
Craig Joseph
Yeah, well, I in this study the white coat it was the exact same doctor with the exact same outfit. Oh,
Nick van Terheyden
he always wore a white coat. So that’s it. She show I’m sorry, Dr.
Craig Joseph
Net, she always wore the white coat she the exact everything was identical about. So it’s basically she was just to cut out and then put in front of these backgrounds,
Nick van Terheyden
which she really accounts out or was it a real person?
Craig Joseph
I cannot say definitively one way or another whether she
Nick van Terheyden
so it might be aI generated might
Craig Joseph
be an AI generated physician, I don’t know. I just know it’s a person wearing a white jacket. I don’t even know if this person this person could be.
Nick van Terheyden
I have so many quite long or short jacket, what is it?
Craig Joseph
Possible to tell? I can tell you, I’m looking at the pictures right now. There was no stethoscope over the shoulder. around the neck. There was no stethoscope. So I’m not sure what that means. I’m sure some surgeons who were listening will say well, it’s clearly not a surgeon. Anyway, the outcome of the study was that patients preferred a professional setting. And so you know, they want you in your office. And then if you were to take that even a step further, they really like being in the doctor’s office, as opposed to literally in your office with a you know, with your degrees in the background as opposed to an exam room. Which I would have I would have thought that might have been made most people would have been high, right? Yeah, no, it wasn’t. A home office was also kind of downgraded. So really the winner was in your, in your office in your in your clinic. And, you know, maybe it’s a maybe that’s a little bit more calming, because, you know, bad things happen in the exam room?
Nick van Terheyden
Yeah, no, no, I
Craig Joseph
don’t understand. They’re interesting. parcels that address Yeah, it’s not, I’m
Nick van Terheyden
just going to say one of the big cultural differences. If you’ve ever been into a physician’s office in the UK, the idea that you would see the wall of degrees, essentially framed, mounted, you know, and, and a lot of them just not, in my experience, even with, you know, some of the most senior, but I just, I don’t report No, no, no, it just it wasn’t, that was not the way I don’t know, I think it’s the sort of reserve nature of the British. Yes, I have qualifications. But let’s not talk about that. Maybe I’m not sure. But no, never. And I remember the first time and I worked with a US physician. And he he actually came to the UK worked in the hospital that we built the international hospital. And I remember unpacking all of his things, we were helping him, you know, set up his office, and I was just good love where all these things. How did you have time to practice any medicine if you got all of these qualifications? So it’s a big cultural difference. I don’t know what it’s like in other countries, but I think very much in certainly UK, Ireland. I’m not even sure in Ireland, but not the big thing that yeah,
Craig Joseph
and now you’re making me feel badly about framing the certificate that said that I was rushed Chairman during my sophomore year at my fraternity house, because I am ready to put that up in my office. But now I’m thinking, maybe that’s not a qualification for being a good physician.
Nick van Terheyden
It’s a good thing that I actually know what rushing is because it wasn’t it wasn’t that long ago that I actually learned what that
Craig Joseph
All right. Well, everyone else thought that was really funny when I said, Nick, okay.
Nick van Terheyden
Well, that’s good, because I’m sure it was. Alright, so we’ve, we’ve just got a little bit of time, I’m just going to, I’ve got one big Mon. And I have to get this out. So, you know, I’m sure you like most people get all of these. Reach out. And you know, in the case of Facebook, you know, people want to be your friend, and LinkedIn, same kind of thing. And I’m really trying hard to be the good citizen in all of this and report them because I think if you report them, there’s some opportunity. And I actually counted the number of clicks it took me to report in Facebook 12 clicks, to report an individual to say, this is not a real person. I mean, you just have to look at the picture to know it’s not a real person. LinkedIn, I didn’t count, but it’s still also I have to do you know, there’s more steps than needs. It should just be a one click. This isn’t a real person. I don’t know. Am I wrong?
Craig Joseph
Oh, well, you know, you’re not wrong. I think that there might be I’ve got
Nick van Terheyden
that on record. It’s recorded. No, no, you’re
Craig Joseph
not wrong. You’re not wrong. I think sometimes, you know, they want more information. Right? So is what you know, are they the bots you think it’s a bot or they think it’s a human but they violated the terms
Nick van Terheyden
so just put it in the list. I can click one Don’t be done once in turn two clicks that’s that should be the maximum anyway and that we find ourselves at the end of another episode exploring Healthcare’s mysteries before they become your emergencies until next time I’m Dr Nick
Craig Joseph
and I’m Dr Craig
