 Ah, how you doing? Gordo, the techs are here. Another exciting episode of Hibachi Talk. I'm here with my good old buddy, the Fundmeister, or Muddy Bagsmauer. I can't figure out which one to use it. Riggs Mauer, nice to see you here. We have our guest, Larry J. Smith. Hey, Gordo. Jerome, nice to see you. Larry Jerome Smith. We have, we collectively have 100 years in healthcare. So we're going to talk about healthcare today, big data and things like that. So please, grab yourself a libation, pull up a chair and join us right now. So we got a lot to cover in 28 minutes. So we're going to move real quickly. We usually introduce our guests and we're going to spend like maybe a minute on that. A little bit of your background where you went to school and then a little bit while you got into healthcare and then we'll move forward with the first thing on big data. Okay. Larry Smith, I went to William & Mary undergraduate in Virginia and then got an MBA at Golden Gate University in San Francisco. And I got into healthcare because I'm from Tennessee. And in Nashville, you have country music, religious publishing and healthcare. And so when I went to move back to Nashville, I decided country music and religious publishing were not my thing. So I got into healthcare. And it was exciting because if they had a new program, just as I got into healthcare, it called Medicare. Which you're now collecting. Yeah, exactly. So yeah, so that's why I got into healthcare and stayed in it ever since. Ever since. And for the interest of our audience is that Mr. Mauer, Moneybags Mauer and Mr. Smith have worked together for many a year at many of a healthcare facility. That's right. Since about 1970s. Since the late 70s. I'll just leave it at that. So that's how I met these guys. We're going to do a couple of things. We're going to move fast because this should be an hour show. We're going to talk about big data in healthcare. We're not going to give you the medical side. We're going to give it to you from the back of the house side. And then we're going to talk about Obamacare in the second half. But we're not going to talk about good or bad about Obamacare. We're just going to talk about Obamacare. But first, I usually do a little bit of a rant. So this is just a heads up for people. You're going to see this letter coming to you in the mail. It'll be either pink or green. Larry's colored blinds, we wouldn't know. And it looks like it's an official document from the government about your car. Your maintenance program in your car. And they're showing up all over. So this is not an email. This is physical mail. This is just a scam. Throw it away. Don't even worry about calling them. It comes from Plano, Texas. If you want to learn more about it, just go online and just Google the name that's in there and you'll see what it's all about. But just ignore it. Throw it away. Don't even have to deal with it. It sounds very threatening and they come in all different forms. And I've gotten one. And Gordon, you're absolutely right on that. My friend got one and he doesn't even own a car. There you go. So how's that? Okay, so there's big data for you. We're going to talk about big data. So we're talking about healthcare, you know, big data and what goes on. So you've been in this for a long time. Pre-email, those kinds of things. So give us some of your thoughts on where it has been and where it kind of had now. And you've got some interesting stories. What's interesting is I came to be employed at Queens in 1982. And I remember one of the big things that I had to convince the board of that it was safe to bring a PC at Queens. I was there. Thank you for the support. Because the board was concerned that a PC had no control and they just didn't know what was going to go on. So when Gordon and I and I think Rick was there at that point, we brought the first PC to Queens which is a big deal. Because prior to that, the departmental financial reports were handwritten and sent out to folks. Remember you brought the first fax machine into? Oh, I forgot about that. It couldn't put it next to your desk. So now, over the years it's been amazing what's happened and the things that you can now accomplish. And I think Hawaii is very lucky in that at least the three big healthcare organizations in the state are all on one very sophisticated computer system. And who are the three? There are basically Queens, Hawaii Pacific Health and Kaiser. They're all in the same system and that system can actually more or less talk to each other. And so the great thing if you're a patient and you walk into one of those three entities, your physician can go in and not only see the information from that particular entity, but if you had been a Kaiser patient but then had a procedure at Queens, your physician can actually go in and see what happened to you at the Queens emergency room from Kaiser. So the ability to collect data and use data is unbelievable compared to where we were in the 80s and 90s. Yeah, but what about, go ahead. It's also that we think of just Queens or HPH, Kapi Elani, but it's the hospitals within those systems can share that as well. Is that right? Yes. Just checking. They are. Beyond the hospitals, what about the physicians, the physician groups, the insurance agency entities and so on? How does those work? I think that's all over the place. I think the physician groups that are affiliated with are employed by the three big systems. They can definitely use that information and get the information. I think the challenge in Hawaii and other places where you still have a lot of independent physicians is they can access the information that's in, for example, the Queens system. But unfortunately, the Queens Kaiser and Hawaii Pacific Health systems can't necessarily access what is in that community physician's data if it's not electronic. It's not tied to that particular hospital. Correct. That provider, because it may be that this group is tied to Kaiser, but then Queens can't get to that particular piece of information because of some business relationship. Actually, you can, if they're all in the same system and so kind of whether the three hospitals want to play together or not, you can get the data. The challenge that you have if you have a hospital system that's on another computer program, not the same as a big three, there you have, but it's pretty easy, you would have Queens would go to that other system and say, for example, the state hospital system. Queens could go to the state hospital system and work out an agreement and so if technologically you could do it, then Queens information would even be available at that hospital in Hilo, for example. What's really nice is the system that the three systems are on, the computer system, the three hospital systems are on is like the biggest system in the United States. If you're on vacation and you get sick and go to UCSF or you get sick and go to Mass General or wherever, that information from that visit, the emergency room visit you had in Chicago would be available for your primary care physician in Queens and vice-versa, if you walk in the emergency room of a hospital that's on that system, they can pull up your full medical records from Queens. Now, do they have to have some kind of contractual agreement to do that? As long as it's in the same as long as you're on the same vendor platform, then that's free game. So that's the thing that's for our viewers is the multiple software providers of healthcare systems financial, so on. If they're all on the same, it's easier to move the data around. But if they're competitive, it's called on the one big system which is called Care Everywhere. With a couple of my physicians here I've explained it when I'm having my physical exam how you go on to Care Everywhere and go on to this application and then that physician can pull up my old medical record lab results and so forth from the Seattle hospital. So that Care Everywhere is a website? Is it a portal? You can go in and you can see as long as it's in that system and for example even it could be on another one of the major systems if there's been an agreement between Queens and like that other major system. And the other major systems. So Queens could go to another system in the state that's on a different computer platform and reach an agreement and then if technologically they can do it. So if you were in the emergency room in Hilo and then you come back to your primary care physician at Queens or at Straub and you said I was just in Hilo and your primary physician can go in and look at the lab results and look at the physician's summary of what the physician wrote up from the emergency room in Hilo. And that's assuming that the state because you mentioned the big three but you didn't mention the state hospital system. So if we didn't mention the state hospital system I wonder why. Because I don't know. And guess what, neither do they. I've never been to get my job back at this government and it ain't going to happen. Hilo is a state hospital. Maui is going to move to Kaiser. So when they come up on the Kaiser platform then the information from Maui Memorial will be available or if you think about it it'll probably take a couple years for it to happen. So you go on vacation in Maui and something happens and you show up in the Maui Memorial emergency room that emergency room physician can pull up all of your records from straw for example. All the lab results everything. And so from a clinical standpoint it's just fantastic that you can go and this one particular vendor is probably 40-50% market share of large hospital systems in the United States. So when you're traveling so if you are sick and you're in San Francisco the UC system or the the other the Sutter they're all on that same system. So you can walk into an emergency room and I think sometimes because the doctors don't necessarily know it is you have to insist you say look I'm a patient at Straub and you can access my Straub records before you start doing things to me here in this emergency room or Palo Alto. So that's pretty damn cool. It's really from when we were doing this in the 80s that's come a long way. But what about finance? What about the economics of this? I mean now that you've got all this going on and you money bags this is going to be salivating. So you've got to be able to look at the dollars a lot better too and analyze the treatment of care and the cost of care. Well and I think we both come out on the financial side. But the great thing about that is is that physicians the caregivers, physicians nurses and other caregivers know what our unique healthcare history has been. And so they don't have to guess as to what it if they don't know me they don't have to guess as to what it might have been. If I'm in an ER they can get to my medical history and they know how to provide the care specific with what my history is. What your history is. So that means that they can treat me faster and better and quicker and that's going to keep the cost down. But I think the other thing here and Larry talked about if I go to an ER that's not at home then not only should I be saying to the ER physician or care team you got to go get to my medical record but my significant other who I'm probably traveling with can also know that and can make that demand or make people aware as well. It's important from an economic standpoint is you go in some place and that doctor is going to want to alter every lab procedure radiology that can ever happen you go wait a minute I just saw my PCP and had lab work drawn two weeks ago in Hawaii and they can go into the system in their emergency room in Palo Alto and see all those lab results. And pull up your lab results and the blood works and all of those things. Which is good for them because they have lab work in Palo Alto but they can sit there and say there's nothing wrong with these results it's kind of weird but you had the same results two weeks ago or this PSA is way off the scale versus where you were a week ago. So to me I'm a finance guy but the clinical capabilities that you have now with technology is fairly unbelievable. That's pretty amazing. This first half of the show is done so we're going to come back and talk about Obamacare not the pros and cons but just about how it works. I've got Rick's Mauer Moneybag's Mauer in finance Larry Smith expert in healthcare not from the patient care side from the big data side and the finance side and knowing that and he got Gorda the tech star who just hangs out here once in a while. Anyway I've got to go to Lula, we'll get Angus he's got a great gadget I decided it was awesome and we'll be back in a minute. My name is John Waihe and I used to be a part of all the things that you might be angry at. I served in government here and may have made decisions that affects you so I want to invite you in I want to invite you in to Talk Story with me and some very special guests every other Monday here at Talk Story with John Waihe come on in, join us, express your opinion learn more about your state and then do something about it Aloha. Okay so I'm Crystal if you haven't tuned into Talk before you better do it because you're missing out on all the information we talk about sex, we talk about religion we talk about everything and nothing so we've got two gentlemen here going to validate that right Greg Kinkley and Roy Chu the important sense of talking about these issues it's very important, it's due I think expressing ideas and exchanging ideas that we come to a better understanding of the world and each other and without that we live in ignorance and fear and fear is based on ignorance Amen. What more could I say than that? Something in Yiddish I think Roy, Roy, come listen to Quok Talk, Tuesday mornings Aloha, how you doing? It's Angus McTag here I'm not Angus McTag, I'm Angus McGadget whatever I am, I get all messed up here Mr. Rowley, nice to see you Well it's good to see you again Angus And to our viewers everyone welcome back and we'd like to let you know that Angus has got a real good gadget that he wants to talk about monitoring the UV Yeah monitoring the UV because you and Scotland, we don't have the UV You know what the sun is in Scotland unidentified flying object I mean Larry, we fought against you at 1432 That's right I didn't even listen, look up on it You know what, we beat you It's the only time That's why I came here Anyway, you know, I got a big concern about getting sunburned I was concerned So I found this great new device It's a bikini monitor So I got a new job down at Waikiki I'm going to be at Waikiki with the UV Smart Fabric Bikini Monitor I like the way they place it I have to get down on my knees to look but that's okay, I didn't have any knees I'll be watching for this but actually this is not a real gadget and I think it's a really cool thing so tourists should come everyone should go get yourself a UV bikini monitor and I'll be there, I only charge $1 for every peak Anyway, that's it That's it for my gadget of the week and as I said in every segment I'll see you in Area B below Ha! Alrighty, well thanks very much Angus and you know, I think that Angus is probably the first Beach Boy Scotsman that we have down at Waikiki Yeah, it could be and the last Anyway So we're back I got Rick's money bags my hour and Larry, I got a nickname for you We'll come up with something for sure Obamacare and we're not going to go whether it's good or bad or whatever but it's just like how it works to try to get an understanding of or how it doesn't work and so on and one of my first comments was Hawaii didn't need Obamacare Why did we do Obamacare in Hawaii? We had pre-made health Exactly, I mean what's amazing because when Obamacare was unfolding and actually before that there was Hillary care in the early 90s and as both of those things were being discussed I was scratching my head because I was sitting there going Hawaii we've already got this the pre-paid health act which I guess was in the late 70s was unbelievable and it's doing what Obamacare is trying to do Yeah and I'm always knocking government and this is one where I will complement Hawaii is that and it evolves over time it's a really amazing system, it's excellent and so that's what was interesting and especially when Obamacare rolled out and it was a big deal in a lot of states the good thing is I could think back about how did they do it in the pre-paid health act and so I could understand it and people around me that I work with that didn't know the pre-paid health act was scratching their heads about how was this working and I would sit there going okay how did it work in Hawaii how did you do it and it was very consistent as a rule and so yeah Hawaii already had it and it's too bad that the feds couldn't just say we're going to take the pre-paid health act and more or less expand it nationally but I think as people point out getting something passed was such a difficult thing and there were so many compromises made that a lot of things were compromised to get something going so it's what we did don't destroy the good for the perfect or something like that so it was the best and I think what people realize and as our current president now understands healthcare is very complex and it's very difficult to understand and so Obama was the best you could do at the time when you got the votes and you got something done but we spent a hundred million dollars on a system that we tore down in Hawaii that we didn't meet yeah that's and I think that's one of the things and it's not only Obamacare but it's healthcare in general which we always have to remember I think because I've moved around the country healthcare in every state and even in every city is different and so what a statement you can make about Honolulu definitely doesn't fit in Birmingham or in California versus Chicago and this is because of why I mean you talked about this earlier blue red kind of thing and yeah my simple way of looking at it is it almost breaks down how healthcare works and the impact of Obamacare is impacted by whether you were traditionally like you were a blue state or you were a red state so for example a blue state is really talking about the extent you had unionization so you had strong labor unions and also that you have a high tech economy so I just moved here from Washington state so Washington state is heavily unionized and the big employers are very high tech where they have to provide extremely good healthcare benefits to attract the smartest young kids in the United States to come to Washington with miserable weather where sun is an unidentified flying object same as skyline so what happens is if you look at those states and what Obamacare did is Obamacare improved benefits so you have a standard level of benefits so it's like the kids up to 26 are covered it's pre-existing conditions are covered so there was an expansion of benefits there's one piece of it the second piece was it was an expansion of Medicaid which is healthcare for the poor Medicaid healthcare for the poor then it was coming up with the Obamacare plans which were for people that weren't that poor but were required to have health insurance and so what happens is if you look at the blue states like Washington state where I worked so everybody liked the extension of benefits because that helped on Obamacare plans most people already had either through their labor union or through the fact that their employer like Microsoft wanted to give unbelievably good benefits to attract the brightest and the best to Washington state so that wasn't such a big deal for us what was a big deal is you had poor people that didn't have coverage and so the hospital where I worked was a very blue color slightly on the poor side and we went from having 10% of our patients with no insurance coverage to having 1% so when you talk about Obamacare for a lot of the blue states what it really means is that the more poor people were able to get insurance coverage which is a good thing and over time if you have preventive care and so forth they're not going to use more health care benefits in the future then you've got the red states so then you get to the red states which is much more complex because you had a lot of people that didn't have insurance even though they were employed this is the Republican states the ones that were anti Obamacare Texas they were employed but either they had really bad insurance or they were farmers or they had no insurance and so all of a sudden they were required to join one of these Obamacare plans so one of the things that happened just because say you're a red state guy but you might have some kind of insurance but your insurance was horrible coverage so all of a sudden you're required to join an Obamacare plan well the Obamacare plan had much better coverage so guess what it's going to cost you more money and the other part of it which gets into how insurance companies work is the Obamacare limited the the variation in insurance premium so that younger people tended to pay more and older people tended to pay less and so what you did is you kind of messed up the historic insurance economics that everyone had been used to so why the insurance companies didn't like it that's why some of them are doing quite well because they have a certain computer system that knows how to to give you a bad time give you good data and so Obamacare is interesting because who you talk to thinks things in sliced bread or you think it's awful because all of a sudden you as a young person in Texas are having to pay a higher premium because it's covering something like well baby care or it's covering deliveries when maybe the health insurance you had before didn't cover that and so that's why there are varying opinions about Obamacare although it seems like now people once they got used to the fact that kids under 26 could stay on the parent's policy and you didn't have to worry about pre-existing condition all the people that maybe didn't like it to start with but all of a sudden are now beneficiaries of some of those extended benefits are now saying wait a minute don't take this away because now that we have it we really like it now and part of this is that the people who like it really like it in the states is the federal government is picking up most of the increased cost but the federal government is you and me that's our tax dollars but at least you're at the state capitol in Olympia in Washington state you love it because more people are covered and you're not paying for it out of the state budget it's coming from the federal government so that's what's going on with it and as our president has figured out completely dumping it and are coming up with something else is kind of hard yeah no kidding but you said something earlier we had an earlier discussion why not just adopt the Hawaii prepaid health care system wish they had the Hawaii plan is a great plan and like I say as we were sitting here I was sitting helping my hospital figure out how we were going to deal with Obamacare and I'm thinking about how the prepaid health plan worked it just stood and it made sense there were times when Obamacare is not exactly like that because Obamacare will expand and medicate yeah it was great which is good at our hospital we had a very large immigrant population and what happened was that effectively you could get coverage almost anyone who came in the hospital could get coverage like a visitor a real visitor from a foreign country so guess what I told you this thing could go fast we were actually out of time so our guests do not go unrewarded they get an autographed solo copy you get 115 in the series these are going for like bitcoin on the web for sure so this is for you Larry and also I got to make an announcement that this is our last show on Fridays on Wednesdays at 2 so we're now going to be starting next week Wednesdays at 2 on ThinkTech no longer on Friday I'm going to cut into my whole plan and everything and how I have to do things but anyway that's what it will be but we'll have the same exciting guests and the same exciting co-hosts with all the money in the world and hey Bajitaka will just continue to be what it is and like we say at the end of every show we talked about this early see you everyone