Reporting from HIMSS
This months episode of “News you can Use” in the traditions of “Ask Me Anything” on HealthcareNOWRadio features news from the month of September and was recorded at the HIMSS 2021 show that took place in Las Vegas from August 9 to 13
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:
As I did last month I am talking to Craig Joseph, MD (@CraigJoseph) Chief Medical Officer at Nordic Consulting Partners with the show show recorded from the HIMSS21 show floor.
We discuss the HIMSS conference and the safety protocols and protection that have been put in place to protect the reduced number of attendees that we saw at the conference. As several commentators noted this provided some advantages to those that did attend in person allowing for more time and space for connections, albeit limited by the mask requirements that made personal facial recognition of friends and colleagues much harder than in the past.
We discuss the latest vaccination guidance including the updated CDC guidelines that recommend the vaccination for pregnant women, boosters, and the release of research data that suggests we will likely see approval for vaccination for children 5 and up and the potential full approval for the vaccines that are currently on EUA authorization from the FDA.
Listen in to hear my interactions with the local homeless population (you can read more details about my experiences with Mental Health in Las Vegas here) and the conversation that drives on brain health (aka Mental Health) and the challenge we have seen worldwide as psychiatric facilities are closed and what care did exist has shifted to the streets burdening systems that are not well equipped to effectively or safely manage this vulnerable homeless population.
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.
Listen along on HealthcareNowRadio or on SoundCloud
Raw Transcript
Nick van Terheyden
Thanks for tuning in today to make the incrementalist. Join me as I seek out the small incremental changes being applied in other industries that we can learn from, and that can be applied in healthcare. Can these changes bring immediate value, but also add up to the big improvements and revolution we need in health care. Come along with me to explore the possibilities. My innovative guests from around the globe have used small incremental improvements to achieve their moonshot. And this week, as I am each and every month, I’m delighted to be joined by Dr. Craig Joseph. He’s the chief medical officer for Nordic consulting Craig, as usual, thanks for joining me today. As usual, it is a pleasure, thank you for having me. So I try each and every month to not talk about the pandemic and variants, but unfortunately, we have to once again, we seem to be knee deep in these continued challenges. The Delta Varian continues to expand its reach hymns taking place we’re doing this at hims. What’s been your experience so far?
Craig Joseph
It’s I wouldn’t say surreal, but maybe a notch below surreal. It’s, uh, everyone is wearing masks everywhere you go in Las Vegas. And, you know, I had to go through a as all of us go through a pretty rigorous check to make sure that we were completely and fully vaccinated against COVID-19. So obviously, the numbers here are down. I don’t know if hims is are going to release their their attendance numbers. But just looking at it, it’s it’s clear that the the number of exhibitors, and the number of attendees is significantly down than in previous years,
Nick van Terheyden
I think we saw a decrease even in the near term of numbers of people coming based on the incredible increase. And we’ve seen a number of states that are just in disaster zones when it comes to this new variant, or it’s not a new variant at this point, it is the major variant that we’re struggling with the Delta variant that continues to expand, I think the two states that are competing for top position Florida and Texas at this point.
Craig Joseph
Yeah, well, it’s the you know, I don’t even think we should talk about the Delta variant anymore, because now it’s just the SARS Cove two virus that is omnipresent in the United States, it’s almost all delta. So it’s, it’s the speed with which this variant has kind of taken over and is now responsible for virtually all disease from from source code to from COVID-19. Is, is amazing, in a bad way. And so, Florida, Texas, there are a lot of states that are much worse now. Here we are in August, I think it’s August. And they were, you know, much worse than they’ve ever been from the entire pandemic. And we have a vaccine that protects against hospitalization and death very, very well. And so clearly this is related to people not getting vaccinated.
Nick van Terheyden
Yeah, so that’s the number one strategy is get vaccinated. But unfortunately, we don’t have everybody taking that on board. news out recently, we’ve seen that Pfizer announced the results for their vaccinations for five minutes. And the results are great. Good news. I think we’ll see. I’m hoping a rapid move towards approval for five and up. We’ve also seen something on pregnant, the sort of approvals around pregnant women. I’ve heard of a number of cases, in fact, with people that could not or were not able to get the vaccine because they were pregnant because we didn’t see an authorization for it. But now we’re seeing that. Any thoughts around that?
Craig Joseph
Yeah. Well, I think for for pregnant women, it was basically what is your obstetrician say? And so it was available, but a lot of people were naturally hesitant. CDC, I believe today came out and said that they officially recommended it. So it was available, but a lot of people were reasonably concerned and wanted to talk with their, with their physicians. So hopefully this will make Pregnant Patients much more willing. And now that we have more more science, and more data To support the fact that it’s safer and, and just as effective. And I’m gonna say the five and a half is good news, but not a block of the population. I wouldn’t even say good news. It’s, it’s just incredibly great news in and once we get in, you know, an official, emergency youth use authorization for kids five and up, it will put so many parents minds at ease, I completely understand that. And really, it’s, you know, you think, well, this is only affecting kids 12 and under, and that’s a small percentage of our population. But there’s so many parents that are afraid to kind of get back into society, even though they’re fully vaccinated, because they know that there’s a chance even being fully vaccinated, that they might get infected, their risk of serious disease or death is very, very low, but there is a risk of them communicating, even asymptomatically to their to a child. And so there are a lot of parents who are reasonably saying I’m fully vaccinated yet, I’m still not going to go back into society. And it’s a shame. And if we can do anything, you know, this will actually help kind of us move back to what we used to think was normal, that would be great. So yeah, I think it’s, it’s fantastic news. And once it’s actually approved, it will be fabulous. You know, another thing that’s happened is that Pfizer’s seemingly getting closer to full authorization, not the emergency, you use authorization, and there are folks who, I don’t, to me, it’s it’s six of one half a dozen on another at this point, we’re so close. And we don’t we understand so much about how the vaccines work. But there are people who were like, I won’t do it until the FDA gives it a regular license. And so if we can get that for even one of the three vaccines in the US, I think that will push some people over.
Nick van Terheyden
And I think the full use authorization has been a sticking point for some of the mandates that we’ve seen, in fact, there’s a large number of places that are now coming out in healthcare facilities that are saying, you know, if you work here, we’re requiring it. In some school settings, we’ve seen it with some colleges, not with other colleges as a big spectrum. You know, perhaps that’s the trigger, because mandating vaccines, as my daughter pointed out to me, is not unusual. She had to have vaccinations to attend her college, and she did for school as well. So this is not anything that’s really new at this point. That’s, that’s true, although many people forget that.
Craig Joseph
Certainly, to get into kindergarten, you have to have a whole series of vaccines and every state and there are various states have different rules about how that works, and how you can get an exemption. And so this is nothing new. But to your point, none of those are EU a those are all fully, fully approved by the FDA. And so the sooner we get to that, with the data to support it, the better no question about it.
Nick van Terheyden
And I think it’s gonna happen soon, the general consensus that I hear is, you know, we’re talking in the next month or so, which is, again, very quick for the FDA actions, but, you know, appropriately cautious, they’re trying to do the right thing, review all of the data. Obviously, at one end of the spectrum, it’s you know, What’s taking you so long, and at the other end of the spectrum is Oh, my God, this is going to fall.
Craig Joseph
I think that’s those are both true. And the FDA has been saying from the beginning that they will not rush any process, they will, they’re going as fast as they can. And once they have a sufficient number of data points and and convincing information, then they will, they will change the authorization status. And so I am with you, I wanted to go faster, and I also with you and that I want them to take their time. So it’s hard to be them.
Nick van Terheyden
Yeah, no, I envy that position. They’re obviously navigating a tough line. And, you know, part of the discussion that’s been trending is around these booster shots. I know you talked about illegal boosters, right?
Craig Joseph
Well, I that’s not the best adjective, but it is the adjective that I used. You know, there are folks that think that they need a booster that a booster is a good idea. They may not be wrong, and but you today, you can’t just walk into CVS or to your doctor’s office and ask for a booster, at least in the United States. And so there I’ve read about certain folks going to different states or doing other things to ensure that they can get a third dose of Mrs. Oregon, you know, if they got the j&j to get a second dose of a different vaccine, so
Nick van Terheyden
we don’t cross state lines for accessing alcohol or tobacco or whatever the other things that people used to do. I don’t think that happens anymore. But now it’s going across state lines for booster doses of vaccine.
Craig Joseph
You know, and so in certain countries are already giving boosters and for certain patient populations, so certainly for immunocompromised for elderly, you know, over age 65 or 70, there are there are people that are, or countries where they’ve decided that they do want to start boosters. So I suspect we are not far away. That’s, that’s just, you know, based on what others are doing. And I so, you know, I, if you want to place a very low weight, we’re out in Las Vegas, if you want to place a very low wager, I would bet that all of us will be getting a booster at some point. Not in the far future, some point later this year.
Nick van Terheyden
So in fact, the data is now out, they published the data. And in the case of Pfizer, I haven’t seen it for any of the other vaccines at this point. The results are astounding. We already saw astounding results for the effectiveness of vaccines from these two messenger RNA levels that, you know, we haven’t really seen in typically in these kind of vaccines before, but you put in a third booster, and it’s like it Superman’s involved in terms of protection.
Craig Joseph
Yeah, I will. As soon as the CDC says that we think this is a good idea for most people, I will be at the head of the line. To get my booster for sure.
Nick van Terheyden
You and me both. As I’ve said frequently, I’m always at the front of the line on everything’s a competition for me. So I’m right there with you. Fair enough. So for those of you just joining, I’m Dr. Nick, the incrementalist is am I I am each and every month, I’m joined by Dr. Craig Joseph, the Chief Medical Officer for Nordic consulting, we’re talking and doing our show from hims, where we’ve had our sort of lighter experience. And before there’s pros and cons. And I have to tell you a little story, I took my hit for mental health. A couple of days ago, as part of my regular exercise routine I was out. And I go up, I don’t know whether it’s north, south, east or west. But I go along one of the tracks in the Las Vegas road system for my exercise. And I find all sorts of mental health or brain health as I prefer to call it people, people who are lacking any lucidity, it is very clear that there is something going on in their world that doesn’t connect them with the same reality that I’m in, I see them I avoid them, you know, I look at them. And I’m troubled by the whole experience, I’ve had a number of images that have really sort of troubled me. But in my early morning walk a couple of days ago, I was attack, oh my and somebody came at me. Normally this happens and they sort of veer off or I dodge them and you know, we keep walking and nothing ever happens. But this guy actually not sure where he was going what was going on in his brain. But clearly I was some something in his world. He struck me a few times, pinned me against the jersey barrier. You know, the positive of this was there was a number of people that actually came there was roadworks going on, and probably four or five folks came running up to sort of, you know, help me out. I didn’t feel terribly threatened. I’m more so than I thought I would be from that experience. But I was most troubled by what this message was, and the experience of this and what we are doing in society and the juxtaposition of this city. And the challenge of all of these people that you see everywhere, Oh, you don’t see, as you’ll see in my post talking about this, they are almost invisible to us. We have tossed them out into the community and all of the folks that were being nice supporting me, this guy disappeared off into the distance, they wanted to call the police. And I’m thinking that is about the last thing in the world that this guy needed. He did not need a police interaction. And yet we don’t have another solution. How can we fix this problem?
Craig Joseph
Well, first of all, I’m glad to hear that you’re okay. Secondly, I’m a little upset that you’re giving me this problem to fix and expecting a solution. Can I get 10 or 15 seconds to get my thoughts together and then give you the answer? No. Clearly, it’s a rhetorical question that you’re asking and there’s no one solution. I think there are cities and cities here in the US where they’re looking at not sending the police right so when you when you call 911. They will be sending a team of social workers paramedics. Others who have extra special training and dealing with folks who are in a different reality than then you need to, you know, to your point, because often the police know how to do one thing. They are very good at that they are not excellent. And I never claimed to be excellent that, you know, dealing with brain health problems is I like, I think I’ll adopt that. And so I think there are there are groups in cities and states where they are trying, it’s a problem. Obviously, it’s a problem when when I was a medical student, I rotated doing my psychiatry rotation in a hospital that that’s all they dealt with. And, and those are generally state facilities, because there’s not a ton of money to be made in dealing with those kinds of folks in our in our US system. And though many of those institutions are no longer open, they don’t exist. They don’t exist, then to your point that so where do these folks go? Who need that kind of help, and they might need it extensively and for for a long period of time. And the programs just aren’t there that were even there 20 or 30 years ago? Because, well, for a number of reasons, money is one of them. Also, you know, some of those institutions were not great. And so you can imagine folks saying, well, we don’t want those around. And they’ve proven that they can’t really do a great job. But we’ve, we don’t have a replacement, right, the replacement is let’s pretend it’s not a problem anymore.
Nick van Terheyden
All you remind me of is my experience in medical school, we had a large hospital designed for psychiatric patients, 1300 beds, wow, huge place. And they closed it. And I got a lot of questions from friends, you know, where all those patients go. And I said, Look around you there on the streets. I mean, if I was to take the small incremental step, it’s addressing that issue and saying, you that’s not the answer, you can’t tip people up. So who is doing this, if you’re familiar with experiences in cities, even in a small town is a somewhere that is allowing for these folks to rehabilitate in a safe environment? I think part of the problem is I you know, and I remember my psychiatric rotation very well, I had some pretty interesting experiences. And the problem was, we just didn’t know we don’t understand it’s, it’s a, it’s no different to replacing your hip and, you know, the hips broken, or the brains broken in some way. But we don’t understand it in the same way that we understand the mechanics of it here. And I think we struggle with treatments in this. So you know, in the case of that individual, I knew he didn’t need the police. But I also knew as a physician, I had no idea what I could offer him as a solution. Where do we start? We start by focusing on the money, you talked about that a fair amount?
Craig Joseph
Well, as you know, I’m fairly cynical. And I think it’s all you know, a little bit a little bit. You know, I think step one, which again, some some folks have already started doing is, is involving the right people, right? So to de escalate, at least from that, and not and what happens often when folks with guns calm as it gets escalated, not not pointing fingers, saying it’s anyone’s fault, but that’s just what happens. They have tools that they can use, and that’s what they do. So it’s great that there are no teams of folks, social workers, paramedics, others that can try and de escalate and, and offer assistance. But to your point, what’s what happens after that great, you’ve de escalated this situation. Now, what’s going to happen tomorrow? And so I think we’re just gonna have to be more innovative. There are there are other countries that deal with this in a different way. And it you know, it’s similar to me to the problems with homelessness. Now, a lot of that overlaps. But, you know, giving folks places to live is much cheaper, on average, than treating them. Or, you know, doing these kind of band aid. I guess what I’m trying to say is that the band aid approach seems great in the short run, but it’s actually much more expensive than solving the problem, right? So again, I’m not equating homelessness with with a psychiatric problem, but again, there is there’s a lot of overlap and looking at different ways of figuring out how you how you correct homelessness, much of the same way we should be working on figuring out how do we get to these folks are there? Where is the money? How can we continue to show that it’s cheaper long term as soon as It is I think,
Nick van Terheyden
Well, no, I think it is. So, you know, it’s interesting, you bring that up about the homelessness and you know, having a place. And one of the challenges with the way that we approach homelessness is you, you’ve got to have a job, you’ve got to do all of these things that are very difficult for people in that circumstance. And I want to say it’s a mayor or somebody, a leader in the community that is north of San Francisco, on the other side of the bridge, Oakland, yes, in Oakland, and he has created a program he struggled, it was a big push for him to essentially give, there was no rent, there was no we are going to put people into accommodation, we were going to provide accommodation. And he has shown absolutely hands down, easy return on investment, the savings in terms of what that, you know, what they don’t require, and the positive impact of the community that they were able to generate for these individuals, by just giving them a home? And I know that sounds, gosh, you know, so socialist and whatever, but that’s about humanity. I mean, all I could think of with this guy, was he was somebody song. That is, it’s the humanity of this really bothered me tremendously. And if we don’t approach it on that individual level, we’re failing, but it’s been shown. So why can’t we do that elsewhere? How do we roll that out in other places?
Craig Joseph
Well, I, you know, someone starts it, and then someone appeals to, it’s one thing to appeal to humanity, it’s another thing to appeal to the bottom line. And, and, you know, showing that it can be done safely and effectively. And so often you find folks who, you know, chronically can’t hold a job. And, you know, we’re thinking, I think it’s reasonable to think, Oh, well, you know, that’s why they’re homeless, because they can’t hold a job. Often, it’s, it’s the other way around, right? Once you give them a home base, then they’re able to, they’re able to, you know, get up at the at the same time and to be more consistent. And then and then it’s a it’s a cycle that then just repeats positively instead of negatively. And so same thing with, with psychic psychiatric, with, you know, patients with behavioral psychiatric problems. How can we convince people that it’s safe for the patient, it’s safe for the community around where that where that institution is, and show Hey, long term, this is much better for society. And for those of you with with minimal, humanistic feelings, hey, this is long term gonna save you money, we don’t need to be taking your tax money to, to fix a problem that doesn’t exist, because we prevented it in the first place.
Nick van Terheyden
Yeah, and I hate to be the rubber band that I keep snapping on my wrist and go back to COVID. But if we thought that the issues of psychiatric problems, loneliness, depression with that before, I don’t think there’s a single statistical data point that I’ve seen that suggests that COVID made all that better, and you know, things are going to improve, it’s made things significantly worse. So we have a bigger problem to deal with people that are in isolation. Are there any components you think, to technology that might be able to help that you think there’s a technology part of the fix?
Craig Joseph
Well, technology usually plays a role. But I would say it’s probably a minor role, right? We’ve certainly leverage the technology as much as we can to when we’re on lockdown, to have you know, video visits, both with our physicians and with one another. And so, you know, from that standpoint, and think about before we had, you know, if this would have happened in the in the 70s. Or the 80s, before we really had internet, the only way if we’re on lockdown for months to see friends and relatives would be not there’d be no way it would simply be having a telephone call. And so we had the video ability, and we had, you know, social networks and and other things to help us yet despite that, and that’s a little things that technology can bring us, as you say, everything’s gotten worse because of because of COVID. And, and it’s not, of course, COVID itself. It’s not the it’s what is brought along with it. So no, I don’t I don’t suspect that there’s much technology more than what we’ve already leveraged and that and I’m sure it’s made a big difference. But the Gulf is so wide that you’re never going to solve that with with a technological solution,
Nick van Terheyden
right. And the inequity that typically exists is even more prevalent in that particular population, their ability to access so this is really boots on the ground kind of approach. I think one of the most positive things is It was something that I wish I, I certainly thought of, and wanted to do myself if I was going to be remembered for something, this would have been it. And I was in a city and it was essentially a not a camper van, but those big Arby’s Those are the words. And they have set this up as a shower system for the homeless, and they drove around and provided shower, clean clothes for the community, they would come in flamin hot water, allow them and, you know, I don’t think there’s a time I don’t get into a shower and go, I’m eternally grateful that I have access to this. It’s simple things. I mean, I feel like these small steps could make a big difference. Accommodation would be a big one, although that maybe isn’t an incremental step. But it could be I mean, just imagine giving somebody somewhere to live that they know is theirs, giving them enough support infrastructure. So troubling issue, but you know, it’s not going to go away,
Craig Joseph
hey, an incremental step is thinking of useful to the person that essentially attacked you as someone’s son or brother. All right. That’s an incremental step. I think I like that. I
Nick van Terheyden
think that’s, you know, if I was gonna leave people with something, it’s exactly that I, you know, they did the folks that you want to call the police. I said, No, I did warn everybody that I was walking back on the way just to say, look, keep an eye out, but I’m sure it disappeared into the shadows somewhere. I wanted to help. I just didn’t know how to I think that’s the other thing is frustration. So anyway, as usual, we’ve run out of time. Interesting to be here at hims. I think, certainly a different experience. I’ve seen some positives, I would say that my capacity to recognize people at a distance with just their eyes is zero. I’m hopeless at it. So if I walk past you and ignored you, that’s why some people do spot me because I look like Gordon Ramsay apparently, and they spot the hair. How about you? Have you had any good experiences?
Craig Joseph
No, I’ve, most people are better at recognizing me than I am of them, as you said. And I thought you were Gordon Ramsay. That’s why I agreed to do this talk. So
Nick van Terheyden
I feel you’re not embarrassed. Craig, as usual, thanks very much for joining me. It’s always a pleasure. Thank you. Thanks for joining me today. Do you have any better ideas? Or have you found a small incremental change that’s brought about a big improvement in your world? Let’s continue the conversation on our hashtag the incrementalist or share with me at Dr. Nick one on Twitter. You can find more information about the show on our program page at healthcare now radio.com. and tune in next time to hear my discussions with leaders and innovators from around the globe who’ve revolutionized their space by using small incremental improvements to achieve their moonshot. I’m Dr. Nick the incrementalist and I’m starting a revolution through evolution.
