OSP Q&A on Digital Health Technology

Nick:

Hi, I’m Nick from OSP, and welcome to our live question and answer session. With John, our vice president of technology for OSP Labs. John, would you like to introduce me? 

John:

Sure, first of all, I’m here in overcast Santa Monica, so welcome, Nick is in New York City. So from coast to coast, we hope to answer all your questions today. So has 47 years of experience in advanced information technology, including 20 years in clinical solution, ranging from bioinformatics, biomedical research to machine learning for the pharmaceutical vaccine, infectious disease research, major clinical institution, and a high tech major computer organization. So in collaboration with Nick, what I’ve enjoyed, he has both the industry experience and the health care and the science behind advanced technology, which we need today. In my own experience, I’ve got 30 years’ experience in deploying advanced technologies, typically to transform businesses and make them more efficient and better for the employees, for their clients. And I always, as VP of technology, often lead a conversation between our teams of experts, including Nick and our clients in health care technology or health care services. And our clients are in both arenas. So there is a lot of extensive range of needs which we’re going to talk about today. 

Nick:

John, thank you. And so let me start us off and say in our last webinar or our series of webinars, we spoke about different digital health technologies and strategies that we’re currently transforming the healthcare industry, as well as some of the current issues that have that became the catalyst for using digital technologies and supported telehealth like covid-19. But with that said, when I say transforming the healthcare industry and changing patient experiences, and positively impacting patient outcomes, so many questions came up about digital health. So today, we are here to start answering some of these questions. Thank you, John. 

John:

Sure, I mean, I just wanted to add it’s evident to everyone a covid-19 has pushed us and accelerated the movement towards technology adoption. It highlighted the need and benefit and challenges of implementing digital health technology and meant patients wanted more. They can be served from home. And of course, doctors can now spend their time more efficiently. So there is a need both from the healthcare industry and the general population. Their mindset has changed now, and they understand the advantage of it. So, of course, a government and other regulations have come to help us. Many changes, new rules were introduced to solve the challenge and that traditional health system consults. And now, we are moving to a new, more patient-centric innovation. 

Nick:

Yeah, John. Therefore, this transformation will meet or have already met many new things, new learnings, further questions continually being asked, and even more advanced innovation in the digital technology arena, supporting clinical. So let’s start our questions, John.

John:

Yeah, so, and by the way, we’ve got to start with a question sent to us for everyone attending today, and then we’re going to make sure to reserve time for additional questions that you can post. And then we’ll ask as much as we can. We’re going to try to answer everything. Some of the obvious questions, the more general questions, and then more detailed on the technical side are that we all know digital health is growing, and Mobile health applications are starting to replace traditional way-based systems. Now, how can we help patients but also health care staff to adapt? 

Nick:

Well, John, that’s a fascinating and also critical question, because based upon my experience, you may have the most advanced technology out there across different types of industries for other products, but without taking into account the customer or users of these systems and where you must mitigate such issues and provide training and insights into how to use the technology, as well as even to make the technology simple from their perspective, without changing the underlying advanced technology. So how we could help patients as well as clinical staff is in our capability. We need those technologies to make the system simpler from their perspective. In other words, let me give you an example. A user interface, say to enter specific patient data, is the patient comes into triage. We should not make the user interface so complicated where we’re trying to make that nurse into a computer engineer, but rather, it’s simplified. The right questions are being asked in terms of what the nurse needs to be answered, and so, therefore, that is one way. And I would also take that same approach to consumers, patients from a user interface slash interaction, keep it simplified, remember, mainly. It’s true for clinical staff, but more so for consumers slash patients because different levels of patients are using these technologies and value based digital health specific to consumer slash patients, different types of patients in terms of education, in terms of reasoning, etc.. 

Nick:

So it’s very important, like we used to say in IBM, keep it simple, keep it simple and to the point. So that’s number one from the UI for both clinical staff as well as consumer patients. The other way, the second approach is mitigated through. Online training, like you see several YouTube videos that will help immerse you into new technology, things like that, and going back to the take to the digital health technologies you release, supplying some sort of intuitive wizard or some sort of help. That’s not one game to text, but it guides the person as a personal adviser, not necessarily a personal assistant, to get where they need to get to use it. And so to me, there are two approaches. Thank you. 

John:

And I would like to add that having the right dashboard for the right audience is simplified to the maximum so that it is a different dashboard for the patient and for the doctors, for the nursing staff and some of them to open the hospital administrator. They each need to have it simplified for them. And in a way, he is. A second question to ask is how automation will help clinics who follow currently traditional paper-based systems? 

Nick:

Well, automation will help clinics reduce the cycle time it takes, like, for instance, to get lab results back, mainly you take many clinical institutions. They will send people to labs for all sorts of testing, like Quest Diagnostics or ACM. Through integration and smart workflow automation, they could reduce the cycle time it takes to get the answers back. So doctors can then reduce the cycle time it takes to resolve a patient’s problems. And so automation. You have to think of automation across all industries, but mainly clinical, as being smart. Let me use a term that we employ in the computer industry or orchestrated workflow, meaning orchestrated, meaning that it’s smart. It’s based upon business logic, which drives the points of integration. And with that also, validation of response is coming back. But Healthcare automation in itself, as I explained, will help reduce cycle times it takes to get the answers to the patient, get them to see the specialist that they need, and also help with billing issues, et cetera. 

John:

OK, now, before getting into a more detailed question, one last one of a general nature, and there’s so much to talk about, but let’s keep it short for now, and there will be more. It’s about the patient experience we have seen to believe, and many professionals in the healthcare industry have agreed that that patient experience matters a lot. He’s going to make this entire process work better. Can you tell us more about you and experience, Nick? 

Nick:

Oh, yes. Until nineteen ninety-nine, when I was working for Lockheed Martin, we had secured a major account, and I was the chief architect systems architect for the national health care system or service in Britain. And the focus of the major focus was on implementing customer relationship management, not just the software but also best practices. So I remember if this was an eye-opener. Being put forth by their representatives and in the national health care service, we see patients as consumers, so we need to establish good relations. Still, we also need to be proactive in the data mine. This is where analytics comes into data-mine. What, in fact, types of services, how can we expedite and predict or try to be at the forefront of providing these services? This, in itself, will add to a very welcomed and satisfying patient experience. And so that was denial because, in the states, patients were patients. If you said consumers or customers, that was that used to leave question marks. Well, what are you trying to convey? And the last thing about patient experience, you have to take that also into now with digital health technologies, mobile applications, again, everything goes back to the user interface, and the functionality that’s architected and designed underneath that user interface has to be very technologically advanced and complex while ensuring that the user interface is simple. And it’s to the point. So that addresses user experience, right?

John:

Absolutely. I mean, I can shape myself as a patient. I’ve been going to the same office of doctors in Santa Monica. With the advent of a. Large organization, just buying out a whole bunch of practices and then implementing digitization, maybe in a way that was not always the best in the beginning. It’s made me want to look for a new provider. So really, the providers who really pay attention to how to interact with the patients are really going to have an advantage in this new world. So let’s get on to some more technical questions we were given by some of you. The first one is, what are all the different scenarios to be used to get patient documents via nominal or alternate flow? 

Nick:

OK, OK, well, thank you. In these cases, when we speak of wild scenarios, I’m using the term use cases, nominal versus alternate. You can apply it to any industry, so basically what we’re talking about, if then else logic or Boolean logic, but the first one. Well, let me start with Altona. So the scenario slash use cases to retrieve patient documents by an alternative flow refers to an optional flow that allocates sorry that allows the documents to be obtained by a secondary source—for example, a governmental request. For example, if you were to make, say, a relative or close friend is a person who could obtain your health records when you could not ask for whatever reason. So, in this case, there are no privacy consent directives for the patient, and only the organizational get in under the or the clinical, organizational rules and. Juror as well as jurisdiction, meaning state, local, state and federal laws, the next one nominal refers to patient documents by a regular flow, which is what copies of your medical records requested for any other reason by you or someone whom you’ve authorized, have access to your medical records or any other supporting documentation. So that’s the difference between nominal versus alternate flow.

John:

OK, another question, this is a bit technical, but hopefully, some of you will find it relevant. What is the use of an asynchronous request in the Iti 55, Iti 38, and 39 standards? 

Nick:

OK, John, thank you.

Nick:

And as you know, I gave you a write-up, so I will pick specific answers to answer these questions without getting into the technical aspects. So when we speak of these standards, we’re talking about the NHIN Patient Discovery Web Service Interface Specification, which was adopted by the Cross Gateway Patient Discovery transaction, which is Iti- 55 is the protocol, the network protocol for patient discovery. So these modes and their expected use, for example, you have demographic query and feed, you have where both the demographics and patient identifier used by the initiating any child is included in the request of the second one would be only the demographics of the patient are included in the request, and the initiating the child does not have or does not specify patient identifier. So that’s the second or review of this standard iti-55. The third one is their shared national patient identifier Query/Speed, only a shared national identifier specified in the request. So the use of this model will be deferred until the user until a clear use case is presented. So again, this was somewhat technical. So that answers the question. Fifty-five. Let’s go to iti-36. And keep in mind this is a quote. We’re talking about the patient discovery web service interface specification adopted by again, cross Gateway Patient Discovery Transaction, Iti -55 now for Iti – 38. It’s a cross gateway query filed documents request to respond to a query for the patient’s document entries. 

Nick:

I’ll leave it at that again, we’re getting into network engineering.

Nick:

Relative to the clinical community’s standards, last one, initiating gateway sends a cross gateway to retrieve, that’s a message according to Standard thirty-nine requests to the responding gateway to retrieve documents. The request includes the form the repository community decides if the responding gateway. 

Nick:

Let me give you an example of the last one. Those that use APIC no, that is their EMR system. They have a clearinghouse where EPIK, like customers, can share HL seven records and other pertinent medical records. Then there are like, for instance, open clearinghouses like the Sequoia project. And so the third one. 

Nick:

Suits that sort of scenario, John, forgive me for being too controlling and. 

John:

Indeed, we can forward information and or links to find further information for yourself for some people to know more. Another question was, how does authentication work between two different implementers to exchange patient data? 

Nick:

OK. Let me read this, and then I’ll give an example, so digital authentication is the process of determining the validity of one or more authenticated users to claim a digital identity relative to the medical records being sought after between one or more entities, for example, a clear plan to ensure governmentally, etc.. So let me take a step back. OK.

Nick:

So authentication in the IT world that conjures up that capability, Eldad is a technology whereby it will authenticate. McMutrie rally is currently employed full time by clinical institution X Niks Rowe, a bioinformatics scientist, data scientist, etc.. Now, if I’m dealing with another clinical institution, what would be set up is a hybrid of an L capability. In other words, you would have I would give that second clinic access to an album capability that was outside my firewall, which had my medical credentialing and other people’s meaning outside the firewall. So this other implementer could not get behind the firewall, but on the production side and vice versa on his or her side. So that’s how I would deploy authentication to have access to records. Thank you, John. 

John:

Now that the next one, I know the answer is fairly complex and complex schematics, I’m not sure if you want to talk about it; maybe we can send it to people interested. What should be the application architecture to manage multiple initiating or responding gateway for each home community idea? 

Nick:

OK, and yes, we can post a series of models for your reference, but let me just start this off and say this information is available. Through government and academia and through major clinical institutions that usually have research arms or they or it’s a teaching hospital and or standards out there. And so I’m referencing the IAEA, IT Infrastructure Technical Framework Supplement, for example, cross-community document, reliable interchange. So when we talk about the community being clinical, one community being clinical to the community, see clinical three, three separate entities. 

Nick:

We’re talking about establishing a federated network architecture whereby through that infrastructure and deploying gateways and, of course, reverse proxies outside of their firewalls, I can’t communicate. 

Nick:

And what I’m thinking about is the Federated Communities with a process flow diagram. So we could get very technical. But again, there are standards out there, very detailed, not conceptional, that you would have a starting point to define what your federated architecture basically would be, your federated network. Architecture would be as well as you know, you may have Federated Applications data repositories. So I just want to mention that I have a paragraph. We could post the standard again, and we could post my right up to that standard. Thank you, John. 

John:

We will do this on our website. Here’s another question. What are all the possible ways for home, home care service providers, agencies to verify caregiver visit hours before submitting the claims to clearinghouses? 

Nick:

OK, well, the industry has historically been dependent on each payer’s specific paper plane format today—electronic billing. I would refer to it as e-commerce is more standardized among payers, with many agencies now billing using the eight thirty-seven or eight thirty-seven I Electronic Data Interchange EDI. 

Nick:

Such an electronic data interchange. 

Nick:

They’re not leveraging the Internet like e-commerce would win SBX; now, they have an established private network using EDI electronic data interchange. You have this concept of valuated systems being set up at multiple sites. And so claims are submitted earlier through a clearinghouse. These clinical institutions that have an EDI infrastructure internally have a clearinghouse outside of their firewalls to exchange payment medical billing information, which can then be consumed by clinical institution one. It hits their reverse proxy and is accepted and processed through their EDI Claim Claim Forms network. 

Nick:

So although the industry is still dealing with the lack of across the board interoperability, keyword, and clinical, there should be greater efficiencies. And one state aggregators of Medicaid data come online. Many states providing Medicaid services use data aggregators to collect verified visit data from home care providers or claims processing.

Nick:

So I will stop there. But add one more key point. Everyone knows about seven messages, and everybody knows that a clinical institution may receive up to five to seven or eight million a week on an average basis. And so you take the state of New York, the state of New York is divided into six private regional bodies that share these seven messages. And then there’s a state body, but then there’s a federal body called Fabs. So if you multiply that by forty-nine other states and I believe even the Canadian provinces, you’ll have a lot of traffic. That’s why we have these clearinghouses. And that’s why I believe they use a proprietary network approach, call it e-commerce for four billion, which is electronic data interchange. It’s been around since the 70s. Thank you, John. 

John:

So here’s simple, and thank you, Nick. Here’s a relatively simple question. How to manage the claim for patients who have more than one insurance active on the same service date?

Nick:

OK, well, under the coordination of benefits, in many group plans, your secondary insurer can cover what your primary insurer does not. So basically, like in the case of my wife and me, our vision plan. 

Nick:

Believe we have VCP, so that’s our primary. And if it’s three hundred dollars per visit. There may be twenty-five dollars left over, so then my wife’s secondary insurance would kick in and cover it. So basically, that is what it’s stating that needs to be set up with the vendors. And, of course, you have to ensure the vendors are within the network or not. To close this out, often benefits are only covered up to a certain percentage and up to a max amount per year. Again, it depends upon your provider. That also depends on the vendor you’re dealing with that deals with your provider, your insurance company. So basically, with two plans, you can end up recouping 100 percent of your out of pocket. And I know my wife and I have been very successful like other couples. Thank thank you. 

Nick:

Thanks. What is Cure’s Act 2021? What point does it cover from the data handling point of view? 

Nick:

OK, well, I have two quick bullets. The Twenty-First Century Cures Act. That’s precisely what it is. Besides this acronym, it was signed into law on December 13, 2016, is designed to help accelerate medical product development and bring innovations and advances to patients who need them faster and more efficiently. 

Nick:

So when you look at this. And you look at how negative scenarios like COVID19 moved digital health challenges and new innovative technologies into the limelight. This law does help. Does it also help with the fact that a year ago, President Trump signed a bill, or was it an executive order? I can’t remember that. It says I believe it was coined the right to try. So if you have a terminal disease. You have the right to try even an experimental drug or treatment.

Nick:

So this law helps this law is this act, rather, has helped set a precedent and the last point I like to make rules mark the most expensive health care data sharing with the ability to manage their health care the same way they manage their finances, travel, and health information networks. 

Nick:

When you look at this, this act also expedited the sharing of health care records. Quicker, faster. That’s why you had many clearinghouses. That’s why I went to the scenario that I just stated about New York State. And so this 20th century, this 21st Century Cures Act has been the catalyst for many changes supported by these negative occurrences like covid-19. 

John:

Thanks, Nick.

John:

Now, what are the different ways that can be employed to recover a balance payment from patients? OK, well, this is becoming a challenge for many, many practices in hospitals. 

John:

And, of course, from the patient’s point of view, sometimes the medical billing is so complicated they don’t even know what they hold to whom they might contest and go, what the heck am I paying, and why am I paying it? Too often, the information is missing. 

Nick:

Exactly. Exactly. Too often, there’s been mistakes in billing. Oh, I take this, but I received the same bill. So to answer that one, use appointment reminders to bill payment, so if you have an appointment up and coming and say, you know, a balance from whatever services provided before by your clinic. 

Nick:

You may receive it.

Nick:

For instance, a problem in your appointment might be Guthrie, who’s my provider in upstate New York, would send me a text message. Hey, Nick, do you have an appointment two days from now? 

Nick:

And then you can include oh, by the way, don’t forget about this remaining balance. Just to give me an example. The second one is to be transparent with patients about prices

Nick:

This coincides with President Trump has stated that clinical facilities, medical facilities should be published. Their prices are, so you’re not paying two hundred dollars per aspirin. They should publish that this would make clinical institutions more financially efficient or solvent, but this would also help our patients, our consumers. The third one is purchasing a medical billing management software system. This is what several clinical institutions, a small minority, particularly if they’re smaller, like in rural semi-rural areas, represent a bonafide building management software system that would have accountability, maybe age bills every 30 say, hey, OK, it’s thirty-one days. We’ve seen the sun. We need to send another notice out. So it has the right billing management software system. And in many cases, if your EMR or our system, whatever term you want to use, does not support a robust medical billing management system, it’s OK to look at a third party. 

Nick:

I highly suggest that the fourth one is to collect payments, give patients the capability to submit through a secure portal HDB. Next, give patients the benefit of the doubt, in other words. Do not assume that they’re trying to escape payment simultaneously; it’s your responsibility to remind them and keep reminding them in a consistent but proper and respectful manner. 

Nick:

No. One, to use a collection agency that’s always tough. It’s up to what the CFO for the clinical agency would set in place. So it goes back to business rules. Yes, collection agencies are good, but keep in mind they keep a certain percentage. I’ve seen many clinical institutions, particularly where they have urgent care and these offsite seven by twenty-four locations; they will offer payment plans. 

Nick:

Even clinical institutions without these offsite facilities do offer payment plans. 

Nick:

The last one is trained staff to prompt payment. What does that mean when you go for your appointment when you arrive for your appointment, rather? And the first thing they say, oh, you have a co-payment of 20 or 30 dollars. Right. If there is an overdue balance. 

Nick:

In a politically correct but sensitive way reminder. And also direct them. Well, maybe, you should consider this payment plan that we have considered your circumstances. I mean, when you look at people who have been laid off, they’ve lost their jobs or health insurance due to COVID. I think it’s the right thing to do. Thank you, John. 

John:

Thank you. Thank you. This was very thoughtful. It’s important, of course, because after all their business is run, their staff pay, and it’s important to get paid and be sensitive to patients.

John:

At the same time, you need to keep your business going so you can have more public. 

John:

Here’s an interesting question. How do you integrate with Labor, America, and the Quest to get patient lab information?

Nick:

OK, while Quest, they were referring to Quest Diagnostics. Let me just say this. So this question is very specific to get patient lab information. Well, first of all, there’s proprietary electronic data interchange capabilities where I’m not leveraging the Internet. It’s a point. I had my infrastructure set up to facilitate the integration of patient information, lab information rather. Then there’s also the client maintained FTP server with FTP software. But if you’re going to do this, make sure you use an SSL secure player and use encrypted keys. The other point, if secure protocols are not used, data files must be encrypted. Let me make a very, very critical point. Layers of security, you can’t do enough in terms of layers of security when you consider the sequel Injection Attack. Now we’re in the cloud and are supposed to deploy neural networks and reverse proxies to trap these intrusions with rejection attacks. Not only should you use it. Protocols, secure protocols like a cheekier soccer player, but you should always encrypt the data; the data should be encrypted. Make sure you have them; for example, there’s decryption software. 

Nick:

Yes. Mind security certificate or public key, but never take either one. And if you have your proprietary infrastructure for communicating lab information back and forth, meaning you have electronic data interchange locked it down, too. So that’s my word of wisdom for nine because I had learned this, and I had many stories to say. But it’s not time now. 

John:

Thank you. Next, we were trying to keep our answers short to get to questions that are coming in. Here’s another one. How do you integrate with CVS to get patient pharmacy information? 

Nick:

Well, as you know, their standard industry protocols. Let’s take a look. There is the Internet. Well, what do I mean by the Internet? You have. Open APIs that can be exposed, I know what CBS, which they owned, Aetna Insurance Company, basically have many cloud deployments, public cloud deployments, and you could deploy.

Nick:

A rest API to call to any open API that they expose for patients or vendors, et cetera. So that’s one thing. Then there’s the traditional middleware technology. There are MICRO services. 

Nick:

This is pretty much it out there. It’s out there for integration and healthcare interoperability. And then also the last thing, when you look at it. When you look at deploying integrated networks externally while leveraging the Internet, say, your clinical facility has multiple sites. These standards come in very handy. Also, using service buses like a ramp to be used in prior medical myth ensures it’s integrated to like a patient index capability similar to an album. I’m thinking of IBM’s MPI capability for identifying patients. Sure, sure. 

John:

So there is another question, and then we’ll jump quickly to Q&A. What kind of ability do a company have, including us when we. We speak to two different clients, and they have needs, for example, for wearable devices, wearable devices are going to be used more and more, and they’re going to require other kinds of readings to be acquired. At the same time, the wearer is active and then aggregated with disparate data coming from different places to then start making sense of what’s happening in a room where they are. And so, how do we work with them to do research and then apply machine learning to predict certain events based on aggregated data? Because now we have data that can come from so many places and the best use of it. And it could be complex. 

Nick:

Well, OK. And I’ll try to answer it within two minutes. I get to do a whole lecture on this. But let me, but let me cut to the chase. What we at OSP provide is foremost as we talk about alphanumeric data in a multivariate type of content. I use that term to describe static, dynamic documents, images like radiology. So that’s why it’s a multivariate quote, the content of courses alphanumeric. With all the digital capabilities to remotely gather data from customers and share it via mobile applications, the first thing we do is over speed and emphasize enterprise architecture. And a key part of that is the digital enterprise architecture subset of that which equates to what, Internet of things? These remote devices are not only, but I need to integrate with my infrastructure, whether in the cloud or on-premise or both. So we’re AI comes in very heavily by deploying, by using this architecture, the digital architecture enterprise, which is a subset of the overall organizational enterprise architecture, I am looking to see for the establishment of computational clusters. Or I could center gate like alphanumeric data and multi-variant type of content by maybe a specific category, like in clinical, there are 14 medical domains. Then from there, I could use map-reduce and still abide by my rules, let’s say, for understanding the information. But instead of having the rules-driven, having the deep learning algorithms, not machine learning algorithms, but I’m talking about machine deep learning algorithms that will mind that would do the analysis that will look at the combinations. 

Nick:

Let’s take, let’s take medications. As one of the 14 clinical domains, it will look for certain commonalities in relationships between a specific medication and the byproducts of providing this medication and related symptoms if I use another medication, etc.. So machine learning has many different capabilities. And for myself, using it in biomedical research has been very helpful in developing predictive models and doing causal analysis before a problem happens. This is when I develop the root cause sorry pattern of classification for a specific problem which I’ve identified the root cause. But now. I have one or more other patterns of self remediation, meaning correction. So the data about the alphanumeric data and its related multivariate type of content per copy per computational cluster, it’s constantly metamorphosis thinking. It’s critical reasoning, critical, analytical ability. I’m saying that cognitive ability, those to think not just store and interpret, but now create new insights for you. And the more humans it interacts with your analytical engines, the more powerful it’s capability as a human brain to think. And in this case, we’re talking about recurrent neural networks, even though there are other neural networks

John:

So thanks, Nick. And this is a big, big project, of course. And if any of you have any further questions, you know, please send them to us. And if we cannot address it now, please contact us for one on one conversation between our teams. But let me for now, and of course, machine learning can be applied to a different use, whether it’s mobile devices, information coming from different places can also be applied to two to medical billing systems and practice management systems and on and on. So let me start sharing some questions. Here’s the first one. There will be a lot so we can start answering quickly. And obviously, some of them will require more follow up. So here’s someone who says we are an audio-video integration company and we build conference rooms. One of the ways we have responded to the pandemic is we’ve rolled out touch-free conferencing. So what are some of the other covid influences technology in health care?

John:

And we hear of so many. But any thoughts on how to answer this? Let me just take a look at that one bit of our conference. One of the ways we have covid-19 new technology rolled out that touch-free. 

Nick:

What are some of the corporate 19 influence technologies now in health care? That is a little. Let me just let me answer it this way. So, in the same way, we’re using video conferencing; your question is, what are some of the technologies used in light of what we’re facing, which is this pandemic? And it would also be the ability to whiteboard between physicians. They’re working on this specific problem and the ability to share labs, radiology, and the ability to have mobile applications that can be tax-free through natural language processing. That question is a loaded question. Sure. And the way that. 

John:

Yeah, I just would like to add it’s so wide. There is a webinar we did recently about remote patient monitoring. That’s also a huge area. And a lot of details were shared on different kinds of tools and things that are possible to reach into senior homes, home care, remote patient monitoring. And these are a lot of different ways in which there is more safety also for the patient. Not only do they get care remotely or, you know, but health care workers or doctors can also be alerted if there is a problem. They also don’t have to get on the bus, to get in a car waiting in line for hours to see someone. 

John:

There is so much that is being done. So as a follow-up, we’re going to repost a couple of webs, you know, we had where we addressed this topic with all kinds of technology coming out. And we have a lot of creativity at play right now. Going to be helpful, not just for covid-19, but going forward for patient care in a much more thoughtful and powerful way. 

Nick:

Yeah, and no, I was going to go ahead. Sure. Sure. I was going to add to this. Suppose you’re working with a client of your first. In that case, I go back to enterprise architecture in the digital enterprise architecture critical subset, particularly when we talk of the Internet of Things. This way, you could identify and know exactly what needs to be integrated and what they may have done. 

John:

Yeah, well, there is a related question, which is a good one. With all the data in the cloud today and digital health applications, Tenet health, remote patient monitoring devices, and wearable devices pose a risk to data privacy and leaks? And we know it does. And then the second part of the question is you mentioned encryption is key. Is there a possibility to keep our data 100 percent safe? 

Nick:

Well, OK, to answer your questions, let me start with the latter part. Yes, one hundred percent safe or let me say ninety-nine. Nine-tenths, OK, because as much as people like us get smarter, the criminal part also gets smarter. They keep pace. But encryption is very critical. Let me also give you just a very. Please, John, cut me off if I longan after one minute, but basically in a clinical institution, what I’ve advised them to do is to. Set up in their DMZ access public zone, a set of reverse proxies and armies, they would be clustered with a recurrent series of neural networks, and so from the DMZ Public Access Zone, you drop back to the DMZ access private zone. Same thing, set of reverse proxies set up a real current artificial neural network. Now. If a sequel injection attack can penetrate the DMZ public zone and get into the private zone. You have fallbacks because there’s this quote, smart firewalls built on neural networks that will not only capture it and attempt to interpret it, develop a pattern of resolution when it sees certain patterns. 

Nick:

Think of cryptography and notice how two layers of DMZ access public and DMZ ex-private zones. Now you drop behind the firewall, either your production as well as non-production systems. You set up a series of reverse proxies against each layer, the UI layer business, the layer, the application layer, and data layer. Because you want fallback, you want to tramp, tramp, tramp. So the bypasses, you’re going to have another way of trapping it. 

Nick:

So yes. One hundred percent secure now in the cloud. When you say you have a cloud provider client with two separate cloud providers, that same approach is taken. So yes, I would say ninety-nine, nine, 10. OK, and the other part with all the cloud data is digital health applications like telehealth. The answer is yes, remote patient monitoring devices are wearable. OK, it doesn’t pose a risk to data privacy and leaks. Why? Because the technology is so advanced. 

Nick:

If you remember when the FBI was trying to order Apple to please give me encryption, that embedded software, they said no. Again, advances in technology and the cloud it stops also takes a very serious emphasis, more and more social and security and network protocols. 

John:

Thank you. And of course, the obvious is whatever devices you decide to implement; you need to confirm what kind of security they are providing and fit within your architecture

John:

I see another question here about cash pay like health plans and eliminate the prospect of a balanced bill. And apparently, many new self-insured plans treat patients in-network and out of network doctors the same. And there is an emerging use of cash payment for care. And it’s using Parra’s health care reimbursement account so that consumer portability of health plans will be more possible to do. 

John:

I’m not sure how much you know about this. 

Nick:

Oh, yes. Well, you take a look at health care, the HRH, the health care reimbursement accounts; most people have them, particularly if you have a family. When my children were young, my wife would put away X number of dollars per year, but you had to use it by the end of the year, or the state would take the money. OK, so now we’re talking about well, what about cash payments? OK. Yes. You could use cash payments to pay a provider. But that money as long as you had the receipt. That receipt can be applied. Be certain of the exact amount that you have in your reimbursement and your HRA, so I don’t see a problem with cash payments whatsoever to provide. 

John:

If anybody has questioned the most efficient way, there is a Q and Q and a tab at the Zoom video’s bottom. And if you click on it, you can answer your question there.

John:

If you enter your question differently, is that something you can technik? 

Nick:

Yes, we only have a wait. We have another one that came in. Brian Smith, do you think digital health will grow, and patients will adapt to it and. Oh, yes. Yes. Let me make this clear, concise point. Let’s take baby boomers, which I’m a baby boomer, about maybe 50 to 60 percent of us are computer savvy. We’ve been in the field. We grew up with IBM, and so on. But the vast majority, about 90 percent, are better equipped to use digital technologies than me, the X generation, and even the millennial generation. I mean, by using these different systems that we understand that if the push button doesn’t work, OK, we understand critically how to troubleshoot at a high level instead of just, you know. Oh, wait, wait. This application doesn’t work, OK, this is not to say that the younger generations after the baby boomers do not. Still, it’s been adopted for digital health and its ability to reach rural communities. It’s why telehealth has grown so much. And of course, covid-19 and other factors like Obamacare are moved. This whole concept of telehealth helps diagnose patients, help prescribe, and establish relationships not only for the medical area, but I mean the medical arena for medical treatment. But when you look at the devastating effect of covid-19 on the economics and the amount of depression that many people are going through with losing their livelihoods and so on, that whole area of medicine. Mental health has been lifted very heavily to help people who need help again, particularly in those rural areas, because since Obamacare, many institutions have been bad, good, or different. They’ve consolidated. There are like conglomerate’s right now, and many local hospitals closed. Many practitioners retired or became part of a big conglomerate. So it is qwant. So they can also move telehealth and other ways. Like, for instance, when you need contact lenses or medication, you can get them through the US mail, whatever, or carrier. 

John:

So yeah, I’ve experienced that living even in a big city, the outskirts of Los Angeles cinematic. I found that even large institutions, you know, have cut back on staff. You know, they have to be more efficient because the cost of some of the things that they’ve had to do is so much. In any case, the time is up. Thank you very much for joining us today. We try to answer as many questions as possible. Are we going to do this again? So please feel free to check our website, osplabs.com, to learn more about not just us. Still, we provide information on what the healthcare industry is doing as a whole and certainly feel free to subscribe to receive updates and invitations to other webinars we plan to have. So so again, thank you very much and thank you to everyone who attended, especially those who sent us questions. And we look forward to collaborating and communicating more now and in the future. So thank you very much. 

John:

Thank you. Thank you, Nick. Take care.