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: Welcome back once again to the outcomes rocket podcast where we chat with today’s most successful and inspiring health leaders. I thank you for tuning in again and I welcome you to go to outcomes.health/reviews where you add rate and review our podcast and especially today because the guest that we have today, our outstanding guests. He is a major contributor to Health. His name is Steve Sisko. He is a health data technology and services servant. He’s been in the game for over two decades assisting healthcare payers risk bearing provider organizations and software vendors to define, create, deploy and transform their software platforms products and technology ecosystems. He’s got extensive knowledge across many I.T. services as well as health services. He also runs the blog called the shimcode.com blog. It’s health care data technology and services blog where he posts a lot of his predictions lists on what he believes are relevant to today’s health I.T. environment. So with that being said he also does so much more so I want to open up the microphone to Steve to fill in any of the blanks that intro. It’s a pleasure to have you.
: Hey Saul Thanks for having me too. I hate to say like actually about 35 years in I.T.. But you’re right the last 20+ years. Yeah three decades right. Yeah. I’m a young 57. You know I got four kids so they keep me young. So I’ve been in the health care I.T. and services in various capacities for about 23-24 years I started in 93. You know I’ve got a long history on social media and that’s really helped me make a lot of connections, connecting with people I can lean on meeting new people such as yourself and also people that I can reach out to help out. You know when I need a boost. There’s no better feeling than being able to help other people out with no strings attached so that’s a little bit about my history.
: Hey now that’s really interesting Steve and we’ve had a chance to connect that couple of times and you definitely have an interesting story right, entrepreneur where your company sold it and have stayed in the game since all in health. What got you interested in health to begin with.
: Well to a certain degree sort of luck I suppose you know where preparation meets opportunity. But I had been working commercial paper trading for Chicago bank in the early 90s and people that remember 1991 was sort of one of the recession heroes. I got a call out of the blue from a company that was one of the first radiology benefits management firms actually Medicon at the time yeah. They’re now AIM’s specialty health and yes so I was working for them seven days after they called me.
: Yeah. So.
: Move fast.
Well it’s funny because all my best opportunities and I think this goes probably for a lot of people come when you’re not looking for them. But back then when I started with them you know they had 14 employees and 18 months later they had 300 plus. And I was the I was hired as the I.T. director with one contract land guy. But anyhow total immersion back than yeah. Back then the health care system you know was was all about managed care people that renumber you know the 90s and there weren’t a lot of tools and core systems out there. Back then at least affordable ones. So coming up on 24 years later we’ve come a long way.
: That’s for sure. Longway in technology and policy and definitely and most providers are doing so. Steve you’ve got the history and that’s really interesting because you put up some some really interesting less listeners if you haven’t had a chance go to shimcode.com That’s where Steve puts together his lists on collections of data and technology and other things are relevant to health. So if you haven’t had a chance to check that out. So Steve you gather a lot of pertinent information for health leaders today out of all of it. What would you say needs to be top of mind for health leaders today?
: Yeah well this is certainly the time of year where all these top of mind things come. You know you mentioned this list of lists that I have out there. But HIMMS is coming up and you know it’s conference season but you know keeping in mind that I’m largely on the risk side you know the health plan side sole financial administration quality and measurement are my areas of focus. But I’ve also had a few years on your provider side you know so things like clinical services order entry procedures precision medicine that I don’t have a lot of background in those. But what I would say one of the top things is hands down social determinants of health I’d like to say block change so I’ll say it everyone wants their work done that in bitcoin right. So right now my kids buying bitcoin on his credit card. Oh ok so working. You know I think social determinants of health. You know I mean I’ve been really working on that as my side hustle for a while. And I could share more about that if anyone’s interested. But you know I think social determinants of health and also the idea of analytics and our group everything into analytics you know artificial intelligence, natural language processing all these things but basically tools and methods to help gain insight. You know we’ve got all this data now we’ve got all this need but we need the insight both you know predictive and prescriptive not just retrospective like we’ve traditionally had. So particularly in the area of leveraging unstructured and semi structured data. So and actually that sort of fits back into my idea that social determinants of health are a hot topic and that really spans not just just the you know the health plans and the employer groups and the sponsors or the payers but also the providers and then really outside of that areas of service provision that are not typically associated with medical procedures per se. If you can’t get to the doctor’s office because you don’t have a ride that’s not a medical issue per se but it’s certainly going to impact your health care outcomes and if you don’t refill your prescription for whatever reason you can’t afford to copay you can’t get a ride to pick them up. You’re confused about when you needed to do that. These are all things that fall into the realm of social determinants of health so I’m convinced that this is an area everyone needs to focus on.
: Absolutely and define a hot topic that came up before Steve. Yeah I mean why don’t you talk to us a little bit about how your side hustle is leading to maybe implementing some.
: Okay so I travelled a lot for years and in fact about two years ago this coming May I was up in Portland for about close to six years straight. I mean very little time back here in a suburb of Phoenix where I live but I had a lot of downtime in the evenings in the weekends because I would always come home because of the overhead. So one of the things I worked on was a tool and continuing to work on this idea of measuring functional status of individuals so we can’t measure we can’t determine outcomes if we can’t define the metrics and the measures that are available to help us measure those outcomes or results. So there’s a lot more than just again the physical procedural aspects but you know you have what’s your environment like what are your support relationships what are your the products and the technologies that are available to you. What are you do you live in a food desert. So historically I’ve been involved with diagnosis codes that was actually to start my first foray into blogging was ICD 10 and because that’s what I was working at the time so of course I write about what I’m interested in. So social determinants of health need to be measured and there’s no standard way of measuring these things so we have to. Everyone talks about population health but what’s a population a population is a a group of individuals. So you have the roll up from the bottom. So what I’ve been working on there’s actually a standard set of classification of functionality in disability it’s going to be big with ICD 11 yes. So this is something that you know I have a strong background in I.T. and product management, data modeling, design specifications requirements, so I’ve been working on a complete set of what I envision as a way that companies could jumpstart their measurement and outcomes measurement needs with a tool so actually a set of API used to be clear and you know I’ve been working on this on and off and this scary at once I should say the exciting thing and somewhat scary, depressing thing is. 90% of people are talking about this and historically I’ve always sort of been you know this sounds sort of probably put myself on the back here and it hurts to do that but I’ve seen things a few years in advance of when they happen or widespread deployed I should say. So I’m convinced that this idea of measuring social determinants of health where we take a baseline as to people’s functionality across a whole range of aspects not just physical or or mental or behavioral but they’re living in their social networks are really big things like that so I’m pretty excited about it and I’m at a point where I identified a lot of the patent and the other legal and licensing and you know I just I’m trying to develop a set of API that might be used by a wide range of systems be they health plan, or provider or vendor or whatever. So there’s a couple of firms out there that specialize in API you know pockit doc and no eligible API and a couple of these other companies so I think this idea of provide an API is sort of a flexible approach where I can pivot if things change.
: Yeah. That’s pretty cool. And without a doubt listeners we have an array of things that in health do not have a standard measurement. And like Steve’s mentioning to us social determinants of health are one of them it can be a big lever to improve outcomes. Just recently we had a guest, Justin Barad. Dr Justin Barad talked to us about standardization needs for orthopedic and cardiac surgeons right using VR for that. What else is out there, listeners that is not standardized yet and what could you do to use technology or just process to help with the standardization of that? Steve, really really super interesting.
: Yeah and you know I’ve always had this idea that the government got to completely bass ackwards with the giant meaningful use. You know they had everyone put in the software in advance of actually defining the standards and the use cases and the communication protocols so you know certainly you know fire the h all seven standard and use cases are really important because one of the areas I’ve spent a lot of time in and you know my LinkedIn profile sort of bears this up is integration and interfaces so oh yeah you know you’ve seen one standard, you’re seeing one standard because everyone codes them therefore and everyone uses this segment or this loop to put something different and so being able to sort of reduce the variability among the so-called standards is really important.
: Absolutely. And in your vision Steve can you share with the listeners a way that standardizing social determinants of health would improve outcomes.
: Yeah well OK so so we have to measure things I mean what’s an outcome really it’s the difference between a baseline or one stake in the ground and then the second stake in the ground and hopefully that second stake in the ground is in a positive forward manner but not always right. So the idea is is that we have assessments of people some of these assessments I can assess someone without them ever knowing it. Right. I mean this is unfortunately well fortunately and unfortunately very common. We know what people buy we know where people go we can infer things from their activities and that but what we need to do is there is you know four or five major areas of these you know body functions of course is one. But then what are their activities and what do they participate in and what do they do. Right. They’re a long distance runner who just eat great food and goes to church every day or something right oh they’re going to live forever right. But they’re a crack addict who who is in a box and drinks Jack for breakfast right. Well they might not live so long. All right. So there’s these activities and participation. So which are of course influenced by environmental factors and which include not just your current environment but your historical environment. And then you have body structures and things that are different in body function. So then you could go in there and take measurements where people lie. So these will be prioritized based on individuals or populations. But then you go in and this system that’s actually out there and I’m sort of hesitant to actually tip this. But anyone who’s listened this far can easily determine what I’m talking about. But it’s been out there since like 2011-2012. And what I’m saying is is the new release of the International Classification of Diseases ICD 11 is going to incorporate a lot of this stuff. So but what I’m thinking is is that we need to have a separate set or some complementary set that companies can use to measure things. So when when they bring on a new member they have an employee they do an assessment and then they work with their person to determine okay you know where you live. What do you need help and what would make your life better? You know do you need some sort of legal services? Do you need some sort of education and training? Do you need certain types of vitamins or food or this or that. So I think being able to codify things people get upset Oh you can code everything and S.P. t’s are a billing system not a medical system I get that you know ICD codes. Does the diagnosis codes are billing and use for that kind of stuff. Yeah to a certain degree they are but not always and that’s what we have. So I think some new way or some complimentary way of being able to measure people’s life situation because we all have I mean we all and this stuff some of this stuff is fixed and it’s a one time thing and they can go up and down some of it’s variable. We moved into neighborhoods. Things happen. We have deaths in the family we have. We win lotteries that change things all kinds of stuff comes around to impact our our well-being and the social determinants health of health are critical they really are.
: Steve. Really great insights that you’ve made here. You know a couple of weeks ago we had a guest Matt Park is from Dacadoo. You guys go outcomesrocket.health/park works with this company at Zurich Dacadoo. And they measure they have a health score. So they use body, mind and lifestyle. They could bring in the Steve component and do social determinants of health to come up with something really interesting.
: Yeah there are some companies out there you know and I’ve heard of this Dacadoo you know our healthify, here in Phoenix. There’s a number of firms out there that are entering and living in this space. But my idea is is that there’s really no one firm that’s going to do it all because it’s really a combination and it takes a village. As much as I am all for the individual and and self-reliance. Yeah sometimes it takes a village. OK so let’s deal with that let’s use that village. So I think that some sort of a means of allowing multiple different parties to contribute and to share their role and individual and a population’s health. But being able to collect it on a longitudinal holistic basis not just my little vertical slice.
: No totally makes a lot of sense and a great share definitely stimulating thoughts that you’ve got going on here. Steve and now I’m excited that you’re sharing it with our listeners. So give us an example of a time when you had a setback or fail and what you got out of that moment.
: Only one?
: We just have time for one.
: No man, I’ve had you know I’ve had a lot of instances where I let my pride and the opinion or comments of others get in the way of fully completing a project or deliverable you know you’ll you’ll get comments from senior people who might not really understand the opportunity or naysayers. I let them get to me and I an attitude so I’ll show you I’m not going to finish this right. So I pretty much gave up on correctly or you know adequately finishing a project just because someone or me. And it ultimately it reflected poorly on me and maybe that’s what their goal was and I help them succeed. So you know I’ve had 30 something years trust me I’ve had a lot of mistakes. I mean one of the scary or funny ones are most costly ones I ever did a sort of hate the repeat this but when I was just starting in IT, I was working for the Czechoslovak Society of America in Chicago. It was fraternal organization but anyhow I wrote some software and I swapped the previous and the current values in these certificates that they sent out for paid up life insurance and it costs about 100 grand. And they sent them out and then I discovered the error. No one knew.
: Oh boy.
: And I had to come in and tell the people that this happened and it just so happened that about half of them are right because the previous and the current values were the same but nonetheless they had to redo it and it was a big deal. So anyhow you know. So that was an instance where I had to own up to something at a young age. And I did so anyhow.
: And so what pearl would you take out of that. Right. You know you mentioned a lot of really interesting things if you had to leave the listeners with one pearl out of your experience what would it be.
: Well follow through to the end and sort of along that lines. Perfectionism is very costly. I got a senior V.P. of a vendor that works with a client of mine that I’m on the phone a lot with is always saying perfectionism is the enemy of good enough or something to that effect. So definitely follow through but avoid being a perfectionist. You’ll get to the end a lot faster.
: I love it. Steve what a great message. So many of us care so deeply about the things that we do. But in the end we got a ship at the end, we have to ship our idea, our product, or service. Otherwise it won’t touch the people that we want to touch.
: Great share Steve. Tell us a little bit about an exciting project or focus that you’re working on.
: Well I mentioned the social determinants of health. So there’s that you know that’s self funded and a side hustle and that’s just sort of you know out there. But one of the things is I’m creating right now I’m creating a set of for blog post series that each series will have about four to six posts so you know about 20 to 30 posts. And right now I’m at about post number eight and they cover the topics of opportunities in healthcare in 2018 and beyond. Primary areas of digital transformation and health healthcare. One of them is about a specific engagement advisory engagement methodology that this client offers and then just a series on digital transformation ideas in general not necessarily healthcare so. So I’ve got this blog post series I started out thinking 6-700 words a post. My last post that I finished yesterday was twenty five hundred. Although long form posts are good I guess for cases so I’ve got that so I’m writing a lot. I’ve also recently which was sort of on what it’s over is I was helping a medical a real estate firm with collecting data on the earnings of the doctors and the special lists and other vendors within those facilities. So gathering up different sources of data and then trying to assess OK what’s the viability of this building based on its occupants and the money they’re making based on publicly available data. So that was pretty interesting a little bit outside of my recent experience but also right in line with my detailed knowledge of healthcare data. And then of course my technical abilities to map and design.
: Yeah super interesting. You’re always doing some cool stuff and it’s interesting. Lessner it doesn’t matter what avenue you take toward helping improve health. You can always find a way to leverage your talents to give to this. You know we had a guest Gavin Teo talked about health care so big. It’s not really a vertical, it’s an economy with…
: Right, Steve.
: Right spot for everyone.
: Yes. So there is a spot for everybody. Every talent. Steve let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine. The 101 of Steve. Oh yeah. And so what we’re going to do is talk about what you believe will take to be successful medicine. I got four questions and followed by a book and a podcast that you recommend to the listeners.
: OK. Yeah.
: All right. What’s the best way to improve health outcomes?
: Well define exactly what your outcome is and how you’ll measure it. Because if you don’t know you know what it is how are you going to measure it. Keep things short and simple don’t over-engineer.
: What is the biggest mistake or pitfall to avoid?
: Well I just mentioned it earlier. I mean avoid being a perfectionist you know. And also along that line, not letting your pride or your ownership of an idea or external largely oftentimes uninformed people or sometimes people with a hidden agenda get you down or distract you. The old saying write don’t let people interrupt you while you’re doing the people that say you can’t do it while you’re doing it. Don’t let them interrupt you.
: How do you stay relevant as an organization despite constant change?
: Well I’m pretty much a one man band with some resources I use. And I can’t speak for my clients but I try to stay relevant number one by reading you know voraciously. By participating in social media. By attending lots of webinars multitasking at times watch and listen to the Web in our time writing something. Real life events like the HIMMS conference two weeks from today. Eyup Insitute regional events HIMMS chapters things like that. And again I do a lot of writing and blogging so you have to research and read and put your thoughts down and putting your thoughts down definitely helps you thinking through.
: What’s one area of focus that should drive everything in a health organization?
: Well services management. I think you know we have products and a lot of times those products aren’t deployed right. They aren’t leverage configured implemented sharing information freely not holding it back which hasn’t always served me well but nonetheless it’s the real me. So you got what you hear.
: Absolutely. And what would you say a book and a podcast you recommend the listener, Steve.
: Yeah you know this is corny but I really like to Think and grow rich by Napoleon Hill. I read that my late teens my mother in law recommended it and it has a lot of practical advice so I guess what some people might think some spiritual or higher power advice. But you know I’ve also recently read a book called Social Selling Techniques something about techniques for influencing buyers or something but social selling it’s by a guy named Hughson Reynolds. But it gave me a lot of good insight into the idea of the changing channels and landscape through selling and then podcasting. There’s a lot of great health care podcasts but I got to tell you I think Joe Rogan you know if you know who he is yeah I like Joe Rogan’s podcast very informative very practical just very practical as you know. And just like no bullshit. And if you’re offended by it then you probably have something wrong with you. I think though whatever.
: Love it. Listeners go to the outcomesrocket.health/sisko it’s Steve’s his last name. You’re going to find all the show notes, as well as links to the things that we’ve talked about with Steve, things to his blog as well as some of the pearls that he offered including the books and the link to Joe Rogan’s podcast. Steve, this has been awesome. Can you just share one closing thought and then a best place where the listeners can get a hold of you?
: You know do things you enjoy. Even if it means doing it for free sometimes to use a gambling term on the column you’ll always be rewarded one way or another. Yeah. So you know I’m on Twitter as @shimcode you can check out my blog which you mentioned. And you know you can reach me at email@example.com and I don’t really hide or block things out so if you’re happy with me or if you’re upset with me or if you’re different you know where to reach me.
: Outstanding. Steve, it’s been fun to have you on. I always enjoy having a conversation I’m glad the listeners will be able this time. So appreciate you taking the time to do it.
: Great. My pleasure. Thanks for having me.
Thanks for tuning into the outcomes rocket podcast if you want the show notes, inspiration, transcripts and everything that we talked about on this episode. Just go to outcomesrocket.health. And again don’t forget to check out the amazing Healthcare Thinkathon where we could get together took form the blueprint for the future of healthcare. You can find more information on that and how to get involved in our theme which is implementation is innovation. Just go to outcomesrocket.health/conference that’s outcomesrocket.health/conference be one of the 200 that will participate. Looking forward to seeing you there.
Best Way to Contact Steve: