The Dish on Health IT

In this episode of The Dish on Health IT, host Tony Schueth and payer interoperability expert Kendra Obrist sit down with Rob Alger, SVP of Health Plan Technology at Kaiser Permanente, for a candid and sweeping conversation about payer interoperability, AI, FHIR, and the realities of health IT innovation at scale.Rob kicks things off by discussing Kaiser Permanente's unique care and coverage model, highlighting how it streamlines internal coordination and shapes investment priorities. He notes that, unlike many other health plans, Kaiser's vertically integrated structure allows for fewer administrative hurdles, particularly in areas like prior authorization.The conversation then turns to CMS-0057. While Rob acknowledges Kaiser must comply like everyone else, the regulation presents less of a lift for them due to their internal alignment. That said, both he and Kendra agree: the success of any interoperability initiative hinges on provider adoption, and that remains uncertain.Looking ahead to 2025, Rob shares Kaiser's strategic focus on simplifying healthcare experiences, especially by leveraging AI to remove friction from both clinical and administrative processes. One standout example is their ambient listening tool from Abridge, now rolled out across 40 hospitals and 600 medical offices, which is allowing clinicians to focus more on patients than keyboards. It's one of the fastest clinical tech adoptions Rob's ever seen.Naturally, the discussion shifts to FHIR. Rob puts it plainly: “FHIR is non-negotiable.” Regulatory mandates have solidified its role, but he wonders whether the industry will eventually want to use FHIR or continue reacting to policy. Kendra and Tony weigh in, noting signs of growing pull once organizations recognize the potential. They agree that multi-stakeholder efforts like Da Vinci Project and FHIR at Scale Taskforce (FAST) are helping to build real-world traction by solving for shared use cases.When asked why Kaiser stays engaged in these initiatives, Rob makes it clear it's about shaping standards early, staying ahead of the curve, and making smarter, future-proof decisions, especially when it comes to vendor selection.The episode then revisits AI, with Rob outlining Kaiser's guiding principles: human in the loop, bias mitigation, and responsible governance. He explains that while Kaiser isn't trying to build every tool themselves, they aim to be excellent adopters, using AI to free up clinicians and call center reps to operate at the top of their license. It's less about chatbots and more about smarter workflows, ambient data capture, and preserving session context across modalities.Data quality surfaces as a recurring theme. Kendra highlights increasing payer interest in tackling inconsistency and fragmentation. Rob acknowledges Kaiser has an edge due to its standardized EHR system, but insists no one is immune to the challenges, especially when AI is in the mix. As he puts it, “If your data's not clean, you're not going anywhere.”As a member of the Council for Affordable Quality Healthcare (CAQH) board, Rob brings a unique perspective on industry-wide infrastructure and collaboration. He explains that CAQH, originally formed by major health plans to tackle non-competitive operational challenges, has evolved into a key player in both standards development and practical solutions like coordination of benefits and provider directories. That dual focus—advocacy and action—resonates throughout the conversation, especially as Rob underscores the importance of shared investments in foundational infrastructure that lift the entire industry.The discussion then touches more specifically on directories and the potential of shared infrastructure for non-competitive areas of healthcare. Rob emphasizes that while payers care deeply about directory accuracy, the solution likely involves more human accountability than tech alone.In closing, the trio shares their perspectives on under-discussed industry challenges. Rob flags cybersecurity as a growing threat, especially in light of recent ransomware attacks. Kendra and Tony shine a light on consent and pharmacy interoperability, two areas that, while not headline-grabbing, could unlock major gains in care coordination and equity.Rob's parting call to action? It's time for the industry to align on clinical policy. Competing on utilization rules isn't sustainable, and getting consensus on what's appropriate care could help streamline prior auth and improve patient trust.Kendra wraps by urging payers to suspend disbelief and start planning for a world where APIs and data exchange work as intended. Dream a little, and then build accordingly. 

In this special HIMSS25 recap episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by co-hosts Brian Bamberger, POCP's Life Sciences Lead, and Vanessa Candelora, Senior Consultant and Program Manager of the HL7 Gravity Project. Together, they break down the biggest themes from the conference, covering interoperability, artificial intelligence (AI), FHIR adoption, and the growing focus on improving data quality in healthcare innovation.HIMSS25 once again proved to be a crucial gathering of healthcare leaders, vendors, and policymakers, drawing nearly 28,000 attendees. Vanessa notes the continued focus on interoperability and trust, with a clear divide between experienced stakeholders refining their strategies and newcomers trying to grasp the fundamentals of FHIR. Brian, a HIMSS veteran, points out that first-time attendees often struggle with the complexity of both the conference itself and the discussions around health IT's latest advancements, particularly AI and its real-world applications.To add perspectives from the conference floor, Tony introduces a series of interviews with HIMSS25 attendees and industry leaders, including Anna Taylor, Associate Vice President, Population Health and Value-Based Care of MultiCare, Erin Weber, Chief Policy & Research Officer, CAQH, Mariann Yeager, CEO, The Sequoia Project, Matthew Holt, Founder/Writer of The Health Care Blog, and Lynne Nowak, Chief Data and Analytics Officer. Each interview provides insights into the real-world implementation of interoperability and FHIR, the evolving use of AI, and how data privacy and governance are shaping health IT strategy.FHIR adoption was one of the topics covered in the interviews. Some, like Mariann Yeager and Erin Weber, expressed optimism about FHIR's expanding role in clinical data exchange, while others, such as Anna Taylor, highlighted persistent scalability challenges and limited adoption for administrative functions like prior authorization. Matthew Holt offered a broader view on data exchange, arguing that while data mobility has improved, the real challenge is how organizations actually use and integrate that information. Vanessa underscores that while FHIR is gaining traction globally, large-scale implementation remains a work in progress. The panel agrees that translating theoretical frameworks into real-world adoption is the next crucial step.AI was another dominant topic, with a mix of enthusiasm and skepticism surrounding its potential. The HIMSS interviewees discuss AI's growing role in streamlining administrative workflows, summarizing patient records, and enabling ambient listening for clinical documentation. However, as Brian bluntly puts it, the “magic” of AI is still far from reality—many tools promise seamless EHR integration but lack the ability to write back into clinical systems, requiring manual intervention. Lynne Nowak and others emphasized that AI's effectiveness is directly tied to data quality—bad inputs will only lead to bad outputs. The consensus? AI has real potential to enhance workflows but cannot replace clinicians, and health IT leaders must focus on governance, usability, and ensuring AI supports, rather than replaces, human decision-making.As the conversation wraps up, Vanessa highlights the critical role of policy and strategic innovation in shaping the next wave of health IT progress. With new regulatory shifts and uncertainty around TEFCA, organizations must stay agile while ensuring that patient privacy, data integrity, and consent management remain top priorities. Brian brings the discussion back to life sciences, stressing the importance of leveraging patient insights and real-world data to drive treatment adherence and improve outcomes.HIMSS25 reinforced that while FHIR, AI, and interoperability remain hot topics, the industry is now at a critical inflection point—shifting from theory to execution. Organizations must filter out hype, focus on data quality, and build scalable solutions that improve both clinical and administrative functions.For those who couldn't attend HIMSS25 or want a deeper dive into what's next for health IT, this episode provides a comprehensive breakdown of the major takeaways. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or your preferred platform. The podcast is also available on HealthcareNOW Radio. Full video versions are also available on POCP's YouTube channel. As always, health IT is a dish best served hot. 

In this episode of The Dish on Health IT, host Tony Schueth leads an engaging discussion on pharmacy interoperability, a topic at the center of a recently published POCP white paper funded by the NCPDP Foundation and supported by Surescripts. Joining Tony as guests are, John Hill, Executive Director of the NCPDP Foundation, and Larry King, Director of Intelligent Prescribing at Surescripts, to unpack the white paper's findings and explore the future of pharmacy's role in patient care.The conversation begins with Tony laying the foundation for the discussion by defining pharmacy interoperability as the seamless, bi-directional exchange of health information between pharmacy care settings and the broader healthcare ecosystem. This connectivity ensures that data flows effortlessly without adding complexity to the workflows of pharmacists or other providers. Tony highlights the POCP white paper, which outlines critical opportunities and challenges in achieving this vision. The document calls for leveraging standards and technology to integrate pharmacists as key contributors to care teams, addressing  medication management and broader clinical services.John Hill and Larry King bring their unique perspectives to the conversation. John shares insights into how the NCPDP Foundation is focused on grants that expand the pharmacist's role, improve patient safety, and enhance access to care. He emphasizes that the white paper marks a pivotal step toward identifying gaps in interoperability and opportunities to engage pharmacists more fully in patient care. Larry draws from his experiences as a pharmacist and industry leader, highlighting the complexity of patient needs and the roadblocks that prevent pharmacists from working to the highest and best purpose of their license. Both guests underscore the need for workflow-friendly solutions to reduce administrative burdens and allow pharmacists to spend more time on meaningful, patient-centered work.The discussion delves into the growing role of pharmacists, who are increasingly stepping beyond dispensing medications to provide direct patient care services, including immunizations, chronic disease management, and comprehensive medication reviews. Tony and his guests agree that pharmacies are uniquely positioned to fill gaps in care, especially in underserved areas, and to offload basic services from overburdened primary care practices. However, for pharmacies to step into this larger role, significant progress is needed in interoperability, reimbursement models, and technology adoption.A key focus of the conversation is the critical role of standards in enabling interoperability. John elaborates on how NCPDP works to ensure data can be exchanged seamlessly, highlighting their collaboration with HL7 on standards like the eCare Plan. He explains that standards not only ensure data consistency across systems but also reduce the burden on users by integrating into existing workflows. Larry adds that Surescripts' efforts to implement interoperable solutions, such as Qualified Health Information Networks (QHINs) under TEFCA, demonstrate the potential of standards to create a nationwide framework for secure data exchange.The guests also discussed the importance of using sustainable financial models to incentivize investment in interoperability. Larry points out that while there are some reimbursement programs for clinical services, inconsistencies remain a significant barrier. Both guests stress that the industry must develop scalable payment models that align with pharmacists' expanded roles and address the technology investments required to connect pharmacy systems with the broader care continuum.Emerging technologies like AI are also prominently featured in the discussion. Larry shares how Surescripts is leveraging AI for tasks like parsing patient instructions and monitoring network activity for compliance issues. John highlights NCPDP's efforts to explore how AI can support standards adoption and governance. Both agree that while AI offers enormous potential to optimize pharmacy workflows and enhance clinical insights, it must be implemented cautiously, with safety and security as top priorities.As the episode nears its conclusion, the guests reflect on the ideal future state of pharmacy interoperability. Larry envisions a world where patients experience seamless care, with providers and pharmacists having immediate access to comprehensive, accurate health information. This would eliminate redundant data collection, reduce errors, and enable faster, more informed decision-making. John echoes this vision, emphasizing that interoperability can empower pharmacists to operate at the top of their licenses, improving patient outcomes and addressing provider shortages.Tony closes the discussion by encouraging listeners to take actionable steps, such as engaging with workgroups like NCPDP's Work Group 20, reviewing the POCP white paper, and participating in industry initiatives that drive interoperability forward. John and Larry emphasize the urgency of acting now, describing this as a once-in-a-generation opportunity to create lasting change in healthcare delivery.For more insights and resources, including links to the white paper and details on key industry initiatives, check the episode summary. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or Healthcare Now Radio to stay informed. Let's continue the journey toward a more connected and efficient healthcare system—because health IT is a dish best served hot!Reference Links: POCP Pharmacy Interoperability Whitepaper: https://info.pocp.com/pharmacy-interoperability-whitepaper NCPDP Foundation abridged results report: https://ncpdpfoundation.org/pdf/PharmacyInteroperability_AbridgedResults.pdf  NCPDP Foundation website (for grant proposals in connection with the CTA of future opportunities for grants): https://ncpdpfoundation.org/home.aspx  NCPDP Standards website (for encouraging involvement/collaboration in WGs in connection with the CTA of getting involved/supporting the mission): https://standards.ncpdp.org/  Surescripts Blog, "Ready for Action: Advancing Pharmacy Interoperability": Preparing Pharmacy with Technology to Participate in Healthcare Interoperability | Surescripts  

In this episode of The Dish on Health IT, Host Tony Schueth, CEO of Point-of-Care Partners (POCP) and Co-host, Kendra Obrist, Payer Strategy Senior Consultant with POCP, welcome Anthony Murray, Chief Information Officer of MRO, to tackle one of health IT's most pressing topics: payer-provider data exchange and interoperability.The discussion begins with introductions and a light-hearted acknowledgment of the traditional friction between payers and providers. Anthony shares his journey from pharmaceutical work to leading MRO's efforts in clinical data exchange. He emphasizes the enduring challenges in interoperability, including siloed systems and the complexities of real-time data sharing.The conversation then shifts to the evolving patient-centric approach. Anthony and Kendra explore how technology like patient portals has improved engagement but highlight gaps in bidirectional data exchange. They dive into the payer-provider dichotomy, with Kendra explaining how payers are shifting their mindset to view data holistically as patient data rather than isolated categories like claims or provider information.Later, the trio examines successful payer-provider collaborations, such as Anthony's example of a client achieving a 63% improvement in quality scores through seamless digital connectivity. They also spotlight the Da Vinci Project and other initiatives driving innovation in the space.The regulatory landscape takes center stage with a discussion of the CMS-0057 rule, which aims to streamline prior authorization and bolster interoperability. Both Anthony and Kendra share candid views on the challenges of implementing these changes and the opportunities they present for strategic advantage.Closing on a forward-looking note, Anthony calls for active industry participation in shaping health IT's future, urging stakeholders to engage in accelerators and public comment opportunities. Kendra envisions a healthcare system that embraces real-time digital experiences, aligning with the expectations of younger generations.Tune in for actionable insights and spirited dialogue about the future of health IT and interoperability!Key Themes:Challenges in payer-provider data exchangeOpportunities in patient-centric interoperabilityRegulatory impacts, including CMS 0057Examples of successful collaborations driving innovationStrategic shifts in viewing data holisticallyListen now to explore how collaboration, technology, and regulation are reshaping health IT! Find us on Apple Podcasts, Spotify, and Healthcare Now Radio, or watch on the POCP YouTube channel. Don't forget, health IT is a dish best served hot! 

In this lively recap of the HLTH 2024 conference in Las Vegas, The Dish on Health IT dives deep into the event's biggest topics with host Tony Schueth, CEO of Point-of-Care Partners, and guest co-host Seth Joseph, Managing Director of Summit Health and contributor to Forbes.com. Known for its forward-looking focus on healthcare innovation, HLTH 2024 was packed with discussions on artificial intelligence, data interoperability, data security, and the emerging technologies shaping the industry.Tony and Seth kick off the episode by reflecting on HLTH's unique vibe, contrasting it with other industry events like HIMSS. They offer honest reactions to the glitzy atmosphere and networking opportunities that HLTH provides and discuss how its “futuristic” focus is a magnet for healthcare investors, entrepreneurs, and thought leaders. Seth provides a candid look at the range of perspectives on AI in healthcare. While excitement around generative AI applications remains high, he notes a growing willingness to challenge its real-world impact and value, marking a shift from last year's unbridled enthusiasm to more cautious optimism. Tony echoes this sentiment, observing that AI and other tech innovations will only prove their worth when they meaningfully improve patient care and operational efficiency.Throughout the episode, Tony shares exclusive clips from his one-on-one interviews with several key industry leaders who each offer unique insights into the conference themes and the road ahead for health IT. The interviews include:Bevey Miner, EVP of Consensus – Bevey shares her views on HLTH as a stage for innovation and the importance of collaboration in advancing health IT solutions.Frank Harvey, CEO of Surescripts – Frank discusses the critical role of data and interoperability in healthcare, and how AI could streamline data exchange and improve patient outcomes while noting the limitations of isolated “point solutions” that need a more holistic approach.Tim Pletcher, CEO of MiHIN – Tim emphasizes the importance of regulatory compliance, particularly with TEFCA, HTI-1 and HTI-2, as well as the need to build trust across state lines to enhance data-sharing frameworks.Charlie Harp, CEO of Clinical Architecture – Charlie dives into the challenges of data quality and the vital role of accurate, clean data in effective AI applications.Brian Anderson, MD, CEO of CHAI – Brian brings a thoughtful perspective on responsible AI use in healthcare, stressing the need for realistic expectations and industry-wide collaboration to ensure AI's impact matches its promise.Tony and Seth revisit the recurring theme of interoperability, an area of focus for POCP. They discuss its complex challenges and how data standards and regulatory shifts are beginning to create a more integrated system. Highlighting Blue Shield of California's partnership with Salesforce on prior authorization as a standout announcement, Tony notes the significance of innovations that simplify administrative burdens on providers and reduce care delays for patients.The episode wraps up with Tony and Seth's thoughts on HLTH's atmosphere, especially the mixed reactions from attendees about the conference's glitzy setup. While some question the balance between style and substance, Tony appreciates the energy and enthusiasm HLTH brings to healthcare, believing it encourages important investment and public interest in health IT. Seth offers a dose of realism, pointing out that while glitz can attract attention and funding, the true test will be in the hard work and strategic planning needed to implement these innovations at scale.For those eager to hear about the latest in healthcare innovation, this episode delivers a nuanced take on HLTH 2024, blending high-level industry insights with grounded observations on where health IT is—and isn't—making an impact.

In this episode of The Dish on Health IT, Tony Schueth, CEO of Point-of-Care Partners, and Kim Boyd, Regulatory Resource Center Lead, are joined by Pam Schweitzer, former Assistant Surgeon General of the United States and current Chair of the NCPDP Foundation Board of Trustees. Together, they deliver an in-depth discussion on critical topics impacting the health IT landscape, including interoperability, public health data modernization, and evolving healthcare regulations.The episode begins with introductions from Tony and Kim, highlighting Pam's extensive career in healthcare, ranging from her leadership roles in the Indian Health Service and the Veterans Affairs (VA) system to her current position as chair of the NCPDP Foundation. Pam reflects on her experience overseeing the transition from paper to electronic health records and how this complex shift required the coordination of multiple healthcare departments, including radiology and labs.Pam shares her insights into how policy changes, such as CMS 0057 and the HTI-2 proposed rule, are shaping the future of healthcare interoperability. The trio discusses how these regulations, aimed at improving data sharing between payers, providers, and public health systems, will ultimately drive real-time data exchange. They also emphasize the importance of infrastructure, standards, and innovation to support these efforts.As the discussion moves forward, Pam talks about her work on public health initiatives, particularly around pharmacy interoperability, maternal health, and the broader impacts of nutrition and food supply on community health. Kim and Pam also explore the evolving role of pharmacists in public health, especially in rural areas where they often serve as the primary healthcare providers.The conversation includes key steps for modernizing public health data systems, such as addressing the data silos between healthcare and public health systems. Pam emphasizes the need for greater collaboration and data sharing to enable a more effective public health response, especially during crises like pandemics or natural disasters.Pam, Kim, and Tony also touch on the role of the Trusted Exchange Framework and Common Agreement (TEFCA) in promoting data fluidity and expanding the integration of pharmacists and other healthcare stakeholders into the broader healthcare ecosystem.The episode wraps up with Pam expressing her optimism for the future of health IT and public health interoperability, while stressing the importance of ongoing collaboration between stakeholders, from policymakers to healthcare technology vendors. Kim adds that the evolution of pharmacy practice and regulatory changes are driving significant improvements in patient care and medication management.Listeners can tune in for a deep dive into the intersections of health IT policy, pharmacy standards, and public health modernization, with practical insights from leaders in the field. This episode is a must-listen for those interested in healthcare interoperability, the impact of CMS and ONC policies, and the future of public health and pharmacy integration.Catch the full episode on your preferred podcast platform, including Apple Podcasts, Spotify, and Healthcare Now Radio, or watch the video version on YouTube.Other resources you may be interested in:Healthy People 2030 – Data and Information Systemshttps://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructurePublic Health Infrastructure - Healthy People 2030 | health.govhttps://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructureStrategies for Public Health Interoperability | PHDI | CDChttps://www.cdc.gov/data-interoperability/php/public-health-strategy/index.htmlMarch 27, 2024 – Draft 2024-2030 Federal Health IT Strategic Planhttps://www.healthit.gov/sites/default/files/page/2024-03/Draft_2024-2030_Federal_Health_IT_Strategic_%20Plan.pdf2023 – Infrastructure for Scaling and Spreading Whole Health – Health Informaticshttps://www.nationalacademies.org/our-work/transforming-health-care-to-create-whole-health-strategies-to-assess-scale-and-spread-the-whole-person-approach-to-health 

Welcome to "The Dish on Health IT," a podcast brought to you by Point-of-Care Partners, a leading health IT consultancy. Each episode features a rotating panel of senior consultants and guests who discuss trends and innovations in health IT, providing insights and recommendations to help organizations leverage advances to solve their business problems.In this episode, POCP hosts Tony Schueth, CEO of Point-of-Care Partners, and Pooja Babbrah, PBM and Pharmacy Lead, are joined by Shivani Patel, Executive Vice President of Patient Access Operations and Technology Solutions at Asembia. Together, they delve into key topics including specialty prescribing, pharmacy interoperability, TEFCA, and consent management, highlighting how technology, policy, and process improvements can drive positive changes in healthcare.The conversation kicks off with an introduction to specialty prescribing. Shivani explains that specialty prescribing involves treatments that are typically more complex than standard prescriptions due to factors like high cost, special storage requirements, and adherence challenges. She points out the logistical gaps and barriers in the specialty space, such as prior authorizations and communication challenges between stakeholders. Pooja adds that the lack of a standardized definition for specialty medications further complicates the process, leading to delays and confusion.Moving on to pharmacy interoperability, Pooja describes it as the ability to share clinical data between pharmacists, providers, and other stakeholders. She emphasizes the importance of providing pharmacists with the right information they need, instead of overwhelming them with excessive data. For instance, pharmacists should not have to sift through 500 pages of patient records to find relevant information. Instead, they need targeted, pertinent data to improve patient care and streamline processes.The discussion then shifts to TEFCA (Trusted Exchange Framework and Common Agreement), which aims to fill information gaps in the healthcare system by setting standards for data exchange. Shivani and Pooja discuss how TEFCA can enhance transparency and interoperability, helping pharmacists and other stakeholders' access and share necessary patient information more efficiently. Shivani notes the potential of TEFCA to establish a universal patient identifier, which could significantly improve data sharing and patient care coordination.Consent management is another crucial topic covered in this episode. Effective consent management is essential for pharmacy interoperability and ensuring patients' privacy and data security. Shivani and Pooja explore how consent management can be improved to make the sharing of patient information more seamless and secure. They emphasize the need for standardized consent processes that allow patients to control their data while ensuring that relevant information is accessible to healthcare providers.Throughout the episode, the panel highlights the role of technology in improving the prescription journey. Shivani discusses how Asembia uses technology to support the industry by connecting stakeholders and providing tools to manage patient care better. This includes everything from prior authorizations to benefit checks and copay cards. Pooja underscores the importance of industry collaboration and transparency to create standardized solutions that benefit all stakeholders.Towards the end of the episode, Shivani shares insights about the Asembia Summit, an annual event that gathers industry stakeholders to discuss trends and innovations in specialty pharmacy. She invites listeners to attend AXS25, the next Asembia Summit, which will take place from April 27th to May 1st, 2025, at the Wynn Las Vegas. The event offers a premier forum for learning, networking, and exploring the latest advancements in the industry.Tune in to this episode to gain a deeper understanding of the complexities of specialty prescribing, the importance of pharmacy interoperability, and how collaborative efforts in technology, policy, and process can enhance healthcare delivery. Don't miss the insights shared by industry stakeholders on why they attend the Asembia Summit each year. For more information and to suggest future topics, email us at podcast@pocp.com or tweet us at @POCPHIT.

The special episode of The Dish on Health IT episode provides insights and coverage from the recent HIMSS24 conference. Hosts Pooja Babbrah, the PBM and Pharmacy Lead and Jocelyn Keegan, Payer/Practice Lead with Point-of-Care Partners dig into their observation from HIMSS24 before reacting to stakeholder interviews from the floor of the Interoperability Showcase on topics ranging from the impact of the final CMS interoperability & prior authorization, benefits of API adoption and pharmacy interoperability opens with a montage of HIMSS24 attendees. --NOTE: The sound quality of the kiosk interviews is not ideal. If you prefer, you can watch this episode on video for close captioning of the kiosk interviews--The episode opens with a montage of HIMSS24 attendees sharing what they find valuable about attending HIMSS. Pooja Babbrah then opens the episode explaining that she and co-host Jocelyn Keegan share their key takeaways and insights from the biggest health technology conference in the industry. Jocelyn started the conversation off by sharing her observation that the work over the last 15 years to forge scalable connections to improve data fluidity has been fruitful and reached a tipping point. Importantly, the conversations we heard at HIMSS24 showed an acknowledgment as important as data fluidity is the content of what we are exchanging, and that data quality is just as important. Jocelyn then shared her second observation which is that we need to build a skillset and pool of resources who can do the next phase of work that is needed. She shared that when she worked in the financial industry which was at the time transitioning to interoperability and automation, they had to hire and develop the critical thinkers needed to think through how to best leverage technology, approach change management and do the abstractions needed to be successful. Health IT is at a similar place; we probably need more clinical informaticists because how we use technology in clinical workflows is extremely important, but we also need operational experts to help pull through how shifts in one workflow should get pulled through in others. She went on to say that we need people understand data mapping and why clean data is so important. Pooja thanked Jocelyn for her insights before sharing her own. She mentioned that she heard talk about whether ViVE and HIMSS could both survive because they occur so close together, and are big investments for companies to make to attend or exhibit. She shared that her view is that they are different enough in programmatic and attendance mix that she believes they both have value and will survive. Adding to Jocelyn's point about data quality, Pooja added that data governance and sending the right data to the right people at the right time versus just sending a data tsunami. Pooja continued by adding that it's also important to meet people where they are. This was clear at the post-acute care listening session. Some care facilities are not yet FHIR-enabled, some can send data via FHIR but perhaps are not yet API-enabled, how can we meet those facilities where they are even if they aren't using cutting-edge technology? Most stakeholders are going to be somewhere on a spectrum of tech adoption. We need to be flexible in how we do things. Pooja went on to say that another observation is that the importance of consent management will continue to grow, and that real work is starting to be done to figure out what patient-centered consent management might look like. We need to be able to exchange the right data at the right time with the right people, but we need to ensure we have the right consent to go along with it. Pooja mentioned some industry initiatives on consent including the HL7 FHIR at Scale Taskforce Accelerator, which has launched a new consent project. Public meetings for the FAST Consent project have launched and will be held regularly. A consent learning lab was held at HIMSS24 for the second year in a row. Pooja expressed that she attended both last year's and this year's events and she could feel a shift including the presence of regulators who were in the room. She explained that the conversation focused on actual work and progress being made in California and Florida as well as a huge focus on the role of consent in connecting health data and human services data.Next Pooja and Jocelyn listened and reacted to stakeholders who stopped by the POCP Kiosk in the Interoperability showcase to give their perspectives on the final CMS prior authorization & interoperability rule, API adoption, and pharmacy interoperability. Interviewees at the kiosk included:Colin Banas, Chief Medical Officer for DrFirst, shared insights on medication management and prior authorization.Polina Vaserman, Vice President of product Management with MHK, discussed the complexities and proposed improvements in prior authorization final rule.Lathe Bigler, Vice President of Clinical Network Services at First Databank provided perspectives on leveraging FHIR APIs for improving price transparency and patient care.Lenel James, Business Lead - Health Information Exchange & Innovation, Blue Cross Blue Shield Association, highlighted the use of FHIR APIs to enhance data accessibility for all stakeholders, including patients, payers, and providers, underscoring the importance of making healthcare data available across the care continuum to improve service delivery and care coordination.Melanie Marcus, Chief Marketing and Customer Experience Officer at Surescripts highlighted the role of pharmacies in expanding care access and the necessity for interoperability and policy support.Kathryn Ayers Wickenhauser, Sr. Director of Community Strategy at DirectTrust discusses the critical role of pharmacists in delivering care and the role of Direct Messaging can play in supporting this work. Themes from the interviews and host response include: CMS Interoperability and Prior Authorization: There has been broad acknowledgment of the positive progress this final rule will make towards enhancing interoperability and refining the prior authorization processes is widespread, with some hoping for additional policies to go even further.Healthcare Ecosystem and CMS Policies: The industry acknowledges the complexities of medications requiring prior authorization. There's an expectation for CMS to broaden its research and policy scope to include specialty medications, recognizing their critical importance.Impact of Technology and Innovation: The importance of adopting standards like FHIR for improving healthcare interoperability is emphasized. Leveraging technology and standard adherence is highlighted as crucial for enabling effective communication among healthcare stakeholders, reducing administrative burdens, and improving patient care quality.Pharmacy's Essential Role: Pharmacies are spotlighted as key to healthcare delivery, especially in underserved areas. There's strong advocacy for improved pharmacy interoperability and integration into the care team, stressing the need for policies, payment reforms, and access to health information to support their expanded role.Using Existing Technologies: The discussions promote the practical use of existing technologies and workflows to address healthcare delivery challenges effectively. This pragmatic approach centers on solving immediate patient care and business problems with available tools and sharing successful industry practices to foster broader adoption.Future Directions and Collective Engagement: A desire for ongoing engagement with health IT innovations, with a focus on interoperability, is clear in future industry events. The importance of collaborative efforts within the community and across the industry is underscored as critical for driving advancements in health IT and interoperability.After Pooja and Jocelyn listened and reacted to the interviews, Pooja shifted to close out the episode. She took a moment to reflect on the rich dialogue and insights shared by professionals across the healthcare ecosystem. She acknowledged the collective and collaborative effort that is fundamental to advancing health IT, underscoring the critical role of technology, the growing importance of pharmacies in the healthcare delivery ecosystem, and the collective anticipation for the evolution of policies concerning specialty medications and the work toward a better way to manage consent. With a nod to the resilience and spirit of innovation that defines the HIMSS conference, Pooja expressed gratitude for the contributions of all speakers and participants, celebrating another successful year of sharing, learning, and collaborating. Looking ahead with optimism, she voiced enthusiasm for the next HIMSS, where the community will reconvene to delve deeper into healthcare's pressing issues, explore new advancements, and foster further collaborations that promise to shape the future of health IT.

In this episode of The Dish on Health IT Podcast, hosted by Tony Schueth, CEO of Point-of-Care Partners, the evolving role of pharmacists in the healthcare ecosystem is explored. Tony introduces the episode by highlighting Point-of-Care Partners as a health IT consultancy known for its deep expertise and trusted, objective perspective. He is joined by co-host Pooja Babbrah, a recognized expert in pharmacy standards and interoperability, and special guest Bob Katter, President of First Databank (FDB).The conversation begins with an exploration of the increasing number of clinical services offered in pharmacy settings and how technology can enhance pharmacists' ability to operate at the top of their license. The importance of integrating pharmacists more significantly into the care team, especially to improve access to care in rural areas and support patient health outcomes, is emphasized.Bob Katter shares insights into his journey in health IT and pharmacy sectors, reflecting on the significant advancements in electronic prescribing and the adoption of electronic health records (EHRs) since the early 2000s. He also acknowledges the challenges and opportunities that lie ahead.The episode delves into the transformative role of pharmacists during the COVID-19 pandemic, highlighting their contributions to administering vaccines and treatments. Bob notes the legislative and regulatory changes at both state and federal levels that are expanding pharmacists' scope of practice, allowing them to take on more responsibilities traditionally reserved for physicians.Bob discusses FDB's partnerships and initiatives aimed at supporting pharmacists in their expanding roles, including a project with a major pharmacy retailer focusing on drug utilization review (DUR) processes. He shares observations from his visits to pharmacies, noting how pharmacists are increasingly involved in direct patient care beyond their traditional dispensing duties.Furthermore, the episode touches on international perspectives, mentioning Canada's "minor ailments" program that allows pharmacists to diagnose, treat, and prescribe for certain conditions. This program is highlighted as an example of leveraging pharmacists' skills to address physician shortages and improve patient access to care.The conversation pivots towards the role of standards development organizations like the National Council for Prescription Drug Programs (NCPDP) and Health Level Seven International (HL7) in supporting the expanding clinical services provided by pharmacists. Bob Katter acknowledges the importance of these organizations while emphasizing the need for cooperation among industry players to utilize these standards effectively. Pooja Babbrah highlights innovative efforts, such as work group 20 at NCPDP, which focuses on care coordination and the potential for expanding the use of existing standards to include pharmacists in key patient care transitions, such as Admit, Discharge, Transfer (ADT) notifications.The discussion then explores the application of artificial intelligence (AI) in healthcare, with a particular focus on FDB's initiatives. Bob Katter details how FDB leverages AI, including natural language processing (NLP) and generative AI, to enhance data curation, improve existing solutions, and collaborate with customers on developing new solutions to longstanding industry challenges. He underscores the potential of AI to streamline processes such as medication reconciliation and the authorization of specialty medications.Pooja Babbrah expresses enthusiasm for the innovative use of AI in specialty medication automation and enrollment, emphasizing the importance of reducing the time it takes for patients to access necessary treatments. She mentions recent regulatory developments and the ongoing challenges in automating prior authorization for specialty medications due to their complexity and the dual coverage under pharmacy and medical benefits.The podcast concludes with an invitation for any final messages or calls to action for the industry, emphasizing the collective vision and efforts towards automating and improving the delivery of healthcare services, particularly in the specialty medication domain. The dialogue throughout the episode reflects a shared commitment to leveraging technology and collaboration to enhance pharmacists' roles, improve patient care, and address the systemic challenges facing the healthcare industry.In the final moments of the podcast, Bob Katter expresses his enthusiasm for the future of healthcare and encourages those at the beginning of their careers to consider the immense opportunities within the industry. He reflects on the significant advancements already made, such as nearly universal EHR adoption and electronic prescribing, but emphasizes that the greatest impacts for caregivers and patients are still on the horizon. Katter points to the rapid development of clinical science, including pharmacogenomics, and technological innovations like AI and cloud computing as driving forces behind these future advancements.Pooja Babbrah shares this excitement, reminiscing about the early days of e-prescribing and looking forward to the next wave of innovation. She highlights the potential for pharmacists to practice at the top of their license, the reduction of burdens on pharmacists, and the integration of pharmacists into the care team as key areas of opportunity. Both Katter and Babbrah view the current moment as a new beginning for the industry, akin to the excitement surrounding the initial push for e-prescribing, but now with even greater potential for innovation and improvement in patient care.The podcast concludes with a thank you to the guests and a reminder to listeners about where they can find episodes of The Dish on Health IT, signaling an optimistic outlook on the future of health IT and its capacity to enhance healthcare delivery and outcomes.Stakeholders interested in monitoring state laws related to advance pharmacy practice can explore the POCP Regulatory Resource Center's Pharmacist Advanced Practice Subscription as well as other subscription services. Other Reference Links: https://www.fdbhealth.com/about-us/press-releases/2022-08-25-fdb-launches-fdb-navigohttps://www.fdbhealth.com/about-us/press-releases/2022-03-15-fdb-launches-fdb-vela--a-new-eprescribing-network-to-deliver-greater-choice-and-value

Point-of-Care Partners (POCP) Dish on Health IT hosts, Pooja Babbrah and Jocelyn Keegan welcome special guest Laura McCrary, President and CEO (Chief Executive Officer) of KONZA National Network. KONZA was recently designated as one of the first five Qualified Health Information Networks, or QHINS (Qualified Health Information Networks), to participate in the Trusted Exchange Framework and Common Agreement (TEFCA)Laura McCrary speaks with hosts about: Why KONZA pursued QHIN statusInsight into the QHIN processHow KONZA's status as a Health Information network since 2010 forms their approach as a QHINKONZA's initial Membership mix, and What's new or surprising in the TEFCA Common Agreement version twoBefore digging into the meat of the episode, Jocelyn Keegan introduced herself briefly as the payer practice lead at POCP, program manager of HL7 Da Vinci Project and devotee to positive change building and getting stuff done in healthcare IT. She added that her focus at POCP is on interoperability, prior authorization and the convergence of where technology, strategy, product development and standards come together.Jocelyn ended her introduction by saying that she has had the honor of seeing Laura McCrary present on several occasions and that her pragmatic approach is refreshing and that she is looking forward to hearing how KONZA will be building on their already vibrant HIE (Health Information Exchange) footprint as a QHIN. Next Laura introduced herself sharing that she has been working on interoperability strategy in Kansas and then expanding to nationwide over the last 4 decades. She started her career as a special education history teacher. Early in her career she realized that while these children were in her care, she should have some basic information about medications or conditions so she could be informed and able to ensure everyone was well cared for. Of course, nobody shared medical records with teachers and parents didn't have access to their kid's patient records either. Making sure special education teachers or at the very least the school nurse could access necessary clinical information at the point of care became a passion of hers which led to an early success in her career which was working with the University of Kansas Medical Center setting up one of the first telemedicine programs in the public-school systems. Because of this work, since the early 2000's, elementary kids in Kansas City, KS inner-city public-school systems have had access to basic health and telemedicine services. The telemedicine project helped Laura realize that technology really could bridge access gaps if we built and employed a robust technology infrastructure.When asked about KONZA's mission and reasons for becoming a QHIN, Laura shared that the name “KONZA” is named after a Kansas prairie that is one of the most beautiful prairies in the nation. The way KONZA originated in Kansas around 2010 is a bit different than how other HIEs started. Most states at that time received federal funding through the American Recovery and Reinvestment Act to establish health information exchanges.Kansas was different in that instead of standing up a state-sponsored exchange, they actually encouraged a private-public partnership and opened the floor for any organization who wanted to do business as a health information exchange in Kansas could so as long as they meet a set of very rigorous accreditation requirements, which included some pretty innovative ideas for that time.For example, one of the things that was required was that the health information exchange needed to share all information with patients. As early as 2012, Kansas HIEs were required to have a personal health record for patients where they could access any data that was in the health information exchange. QHINS must also do this by offering “individual access services” and KONZA has already been doing this for over a decade. In addition to sharing data with patients, Kansas also required data sharing of HIPAA (Health Insurance Portability and Accountability) approved treatment, payment, and healthcare operations data with payers as it relates to their members.  Laura continued by sharing that today, 4 exchanges do business in Kansas, and they all work together as well as connect to other exchanges. KONZA also expanded to be able to serve patients across state lines as Kansas residents cross over into Missouri quite often to consume healthcare. Because of this history and background, Laura shared that becoming a QHIN was a natural progression and a way to support their mission to make sure all participants have access to their own or their patient's data. Pooja asked Laura about the process of becoming a QHIN. Pooja acknowledged the stringent requirements for QHINs and mentioned challenges discussed at the ONC Annual meeting in December.Laura shared KONZA's experience, saying they initially thought it would be like Kansas certification requirements. However, the application process involved demonstrating sustainability, financial viability, high trust certification for security, and proper information sharing using IHE protocols. KONZA became a candidate QHIN in February of the previous year, requiring the development of a project plan addressing technology conformance testing and demonstrating business viability.Laura emphasized the challenge of meeting high-level requirements, including safety, security, project management, and board governance. Notably, QHINs must have 51% of their Board of Directors as members, ensuring those participating in the network make decisions about the business model. KONZA reached 49% and welcomed a new member from a public health organization in January. The ongoing process involves meeting the remaining requirements to become a fully certified QHIN.Laura said the process of becoming a QHIN is a continuous work in progress. While they successfully crossed the finish line and are in production, she emphasized the need for ongoing changes to advance interoperability and data sharing. Laura highlighted the importance of QHINs working together as colleagues and federal leadership setting expectations for the national network. After four decades of working on the project, she expressed great satisfaction with the current state of progress.Pooja inquired about the impact of the diverse functional areas of the first group of QHIN designees on their operations. She expressed curiosity on behalf of Point of Care Partners, highlighting KONZA's background as a health information exchange in Kansas and seeking insights into how this background influenced KONZA's role as a QHIN.Laura responded by emphasizing the significance of diversity among QHINs as a valuable asset. She expressed excitement about the potential for innovative solutions to emerge from the diverse backgrounds of QHINs, enabling a departure from a one-size-fits-all approach. Laura expected the development of exciting and innovative solutions unique to each QHIN's diverse background.Pooja then invited Jocelyn to share her thoughts. Jocelyn expressed appreciation for Laura's insights, noting that knowing more about Laura's background made sense. She highlighted the importance of Laura's background in approaching long-term transformation. Jocelyn commended the incremental progress and permanent change advocated in the industry, aligning with Laura's pragmatic approach.Jocelyn acknowledged the mix of QHINs as fascinating and emphasized the importance of meeting people where they are. She recognized the relay race nature of the journey, with December marking the start of a new phase. Jocelyn predicted the challenge of creating compelling business cases and exploring the evolving business model for QHINs. She expressed interest in seeing the progress reports as end users transition from the HIE world to the TEFCA world.Laura emphasized the importance of KONZA serving as the QHIN for Health Information Exchanges (HIEs) and growing out of the HIE space. She expressed the belief that onboarding HIEs to their QHIN is crucial for expanding access to a broader set of data, benefiting patient care. Laura highlighted the critical role HIEs play in meeting the healthcare needs of communities, states, and regions.To ease this onboarding process, KONZA actively reached out to HIEs. Laura shared her personal commitment by mentioning that she had personally spoken with every HIE in the last six months. Additionally, KONZA planned to initiate HIE office hours to engage with HIEs and discuss the onboarding process to the QHIN. Laura conveyed a strong sense of responsibility, stating that if HIEs were not successfully onboarded to QHINs, she would personally feel like they had failed. She recognized the significant value and commitment HIEs have provided to their communities and stressed the importance of building upon their established connections and capabilities.Jocelyn initiated a discussion on expanding endpoints and the role of payers in TEFCA. She acknowledged Laura's insight into the base requirement in Kansas that involved having payers at the table, filling gaps in understanding about payer participation in national programs. Jocelyn expressed interest in understanding the implications of active payer participation, especially with recent rules requiring payers to provide data to providers.Laura provided a comprehensive response, highlighting the common inclusion of payers in HIE networks and the evolving landscape outlined in TEFCA requirements. She emphasized that recent rules, including prior authorization, point towards increased payer participation in the QHIN model. Laura praised ONC's efforts and leadership, acknowledging the challenge of absorbing the vast amount of information released.Laura discussed the significance of two specific SOPs (Standard Operating Procedure) dropped on Friday related to delegation of authority and healthcare operations. She encouraged stakeholders to focus on these documents, emphasizing the critical role they play in bringing clinical and claims data together. Laura outlined the historical challenge of integrating clinical and claims data, noting that TEFCA offers an opportunity to bridge this gap.Notably, Laura highlighted the requirement for payers participating in the QHIN model to provide adjudicated claims. She acknowledged that while this transformation may take time, conversations with payers indicated openness to sharing crucial data that providers might not have. Laura expressed excitement about the groundwork laid in the SOPs, anticipating an amazing transformation in healthcare. She encouraged innovative companies to explore the delegation of authority, foreseeing its profound impact on healthcare transformation.Pooja highlighted the collaboration between CMS and ONC in recent rule drops and mentioned the inclusion of FHIR (Fast Healthcare Interoperability Resource) in the latest regulations. Jocelyn asked for comments on this, pointing out varying levels of maturity in QHINs' FHIR programs. She emphasized the shift towards API (Application Programming Interface) and codified data over documents, aiming for automation and reducing human involvement. Jocelyn expressed interest in Laura's perspective, considering the existing collaborations and partnerships.Laura explained the importance of EHRs (Electronic Health Records) being FHIR-enabled for effective data sharing with QHINs. She clarified that while QHINs can be FHIR-enabled, the critical factor is whether EHR vendors support FHIR. Laura highlighted the necessity for EHR systems to have FHIR endpoints and publish them in the RCE (Recognized Coordinating Entity) directory for effective data retrieval. She stressed that both FHIR endpoints and resources are crucial for successful data exchange. Regarding facilitated FHIR, Laura expressed excitement about its implementation by the end of Q1. She mentioned the role of facilitated FHIR in responding to payers and highlighted the importance of the healthcare operations SOP. Laura also discussed the bulk FHIR initiative by NCQA, expressing enthusiasm for participation. She emphasized the significance of FHIR in sharing minimum necessary data, addressing the challenges posed by lengthy patient care documents. Laura underscored FHIR's role in providing relevant information to physicians and caregivers based on their specific needs.Pooja, the host, moves to the closing segment, asking cohost Jocelyn and guest Laura for final messages or calls to action. Jocelyn commends Laura on FHIR progress and highlights the importance of maturity and bulk FHIR for automation. She mentions an upcoming Da Vinci Community Roundtable discussion on the clinical data exchange FHIR guide and encourages engagement with Laura for early participation in payer use cases.Laura emphasized the profound opportunities with QHINs, including potential in public health and COVID response. Laura invites those interested in discussing the future of healthcare data and transforming patient care to reach out via LinkedIn, email, or to call her. Pooja expressed gratitude to guest, Laura McCrary for joining The Dish on Health IT and to listeners for tuning in. 

Thank you for tuning into The Dish on Health IT's 2023 end-of-year recap. Point-of-Care Partners' (POCP) subject matter experts, including, Pooja Babbrah, Pharmacy and PBM Practice Lead; Jocelyn Keegan, Payer Provider Practice Lead; and Kim Boyd, Regulatory Resource Center Lead, gathered to discuss their top 3 health IT milestones for 2023 and their expectations for 2024. They also delved into the highly anticipated final version of the Interop 3, focused on advancing interoperability and improving prior authorization rules. Offering insights and advice, they guided listeners on approaching the initial review of this significant final rule. Point-of-Care Partners extends warm holiday wishes and a Happy New Year to all. Host, Pooja Babbrah kicked off the episode informing listeners that this episode will be a special format. POCP has subject matter experts galore so this episode will bring together a small group of POCPers to look back at 2023, discuss what 2024 will have in store and talk a bit about the anticipated final Interop 3 rule.Cohosts Jocelyn Keegan, recently honored as the DirectTrust Interoperability Hero, and Kim Boyd, a contributor steeped in policy knowledge and serving as POCP's Regulatory Resource Center Lead, introduced themselves before the trio transitioned to the main discussion.They contemplated a format for the day, aiming to dedicate the first half of the conversation to a round-robin, where each would share their personal top three events or trends from 2023. Pooja referenced the HIT Perspectives 2023 trends article, outlining POCP's collective trends. However, today's discussion allowed each participant to present their individual lists before delving into the much-anticipated final rule.Top of FormKim initiated the round robin by expressing that her top priority is healthcare interoperability, acknowledging its vast scope emerging from the 21st Century Cures Act and beyond. Within this expansive interoperability landscape, she highlighted the advancements within the FHIR community, predicting a swifter adoption of FHIR than previously witnessed. Her second ranking milestone revolves around artificial intelligence and machine learning, particularly their rapid uptake and integration into policy. Kim anticipated a more robust policy oversight of AI in the future. Her third notable milestone encompasses telehealth and telepharmacy, noting that the COVID-19 pandemic significantly increased patient reliance on remote visits for healthcare.Jocelyn followed, emphasizing that her list complemented Kim's perspective, offering a different angle. Her primary inclusion highlighted the industry's transition into implementation mode in 2023, witnessing real-world progress and widespread adoption of FHIR at scale.Jocelyn provided examples supporting these observations. The first involves the reaction to the proposed attachments rule, released alongside the prior authorization proposed rule. While many organizations expressed their belief that attachments might not be crucial for future progress, the responses to the Interop 3 proposed rule were predominantly positive.Her second HIT milestone relates to AI but primarily focuses on acknowledging and addressing the baked-in bias potentially inherent in AI and other advanced technologies. She highlighted the steps included in the HTI-1 proposed rule, aiming to mitigate bias and initiate discussions on ensuring the unintentional disruption of the path towards equity.Jocelyn's third milestone centers on TEFCA, highlighting the progress made and the anticipated clarification expected in 2024 regarding its scope and limitations.She connected TEFCA back to the first topic, emphasizing the necessity for alignment between the TEFCA infrastructure, rule framework, and the emerging API world. There have been ongoing discussions and industry feedback stressing the need for better alignment between the FHIR roadmap and the TEFCA roadmap as the industry shifts towards more real-time interactions.Finally, Pooja presented her list, with pharmacy interoperability holding the top spot as her absolute milestone. She expressed her honor in participating in the HITAC Pharmacy Interoperability Task Force, emphasizing POCP's long-standing advocacy for integrating pharmacists into continuity of care discussions. She highlighted the importance of this focus in bridging access gaps, facilitating genomics testing, and building momentum for sharing data with pharmacists. This includes ensuring their access to patient records and their ability to share data with the broader care team, a significant development.Her second and third priorities revolved around emerging trends in pharmacy with broader implications. Second on her list was Pharmacogenomics, involving genetic testing to discern the effectiveness or ineffectiveness of certain medications for specific patients. Pooja's third priority was digital therapeutics, an area where POCP has already made strides. She noted the growing emphasis, not only for pharmacies in understanding how to administer these therapeutics but also for payers in determining coverage policies.The discussion then pivoted to sharing reactions and perspectives on each other's lists. Kim expressed her delight in hearing pharmacy interoperability as Pooja's top priority. She highlighted the dichotomy within the healthcare ecosystem, emphasizing the divide between pharmacy services and NCPDP standards on one side, and clinical services with HL7 standards, including FHIR, on the other. Kim noted the increasing convergence between these realms, particularly with enhanced collaboration between NCPDP and HL7. She anticipated continued advancements in NCPDP concerning pharmacogenomics, digital therapeutics, social determinants, and the flow of relevant health data.When questioned, Jocelyn emphasized the criticality of integrating pharmacy into data flow and recognizing pharmacists as integral members of the care team. She stressed the impact of provider shortages in recent engagements with the US healthcare system.Jocelyn echoed Kim's perspective on the alignment of pharmacy and clinical standards, emphasizing their collaborative synergy rather than competition. She emphasized the need to ensure the right patient data reaches the appropriate care team members, including pharmacists, at the opportune moment, asserting that this alignment significantly enhances patient care.Jocelyn highlighted that technology is designed to facilitate transitioning from one standard to another. She emphasized the increasing significance of robust data exchange, particularly the exchange of quality data, between payers and pharmacies as the industry transitions towards value-based care.Agreeing with Jocelyn, Pooja explained the challenges in integrating pharmacists into value-based care contracts consistently. However, she noted that as data exchange between pharmacies, other healthcare settings, and payers improves, barriers diminish. Pooja underscored the broader benefits of enhancing pharmacy interoperability, emphasizing advantages not only for pharmacists but also for providers and payers.Highlighting the pivotal role of pharmacists, Pooja stressed their potential as invaluable resources for gathering social determinants of health data. She emphasized their significance in care delivery, identifying patient needs, and facilitating connections with community services. Given the frequency of pharmacist-patient interactions, she emphasized the criticality of collecting and sharing this information with the broader provider team.The conversation then shifted to the Interop 3 – Advancing Interoperability and Improving Prior Authorization rule, expected to be released by the end of 2023 or early 2024. Kim initiated the discussion, focusing primarily on the prior authorization aspect of the rule, acknowledging its broader scope.Kim emphasized the crucial need to establish transparency and automation to address the delays in treatment caused by prior authorization or impeding patients' understanding of their coverage when a PA is not approved. The rule encompasses various APIs facilitating exchanges among payers, providers, and patients, utilizing the Da Vinci implementation guides.Regarding industry feedback on the proposed Interop 3 rules, Kim highlighted the notably high volume of comments, predominantly expressing overwhelming positivity. Approximately 68% of the comments agreed with the rule's intent. Although some HIPAA-related concerns were expressed, very few disagreed with the rule overall, which was intriguing given its extensive scope. Providers consistently voiced their desire for a more efficient prior authorization process, advocating for faster turnaround times and increased transparency regarding reasons for denial.Kim underscored the significance of the inclusion of the patient access API, stressing its value for all individuals as patients. She emphasized the importance of augmented access and transparency, not only concerning clinical information like test results but also regarding payer information related to coverage and reasons for prior authorization denial.Jocelyn aligned with Kim's overall assessment and expressed disappointment over the proposed rules' omission of automation for specialty medications or treatments covered under the medical benefit. She highlighted this overlooked area, expressing disappointment at its continued exclusion.One thing that brought Jocelyn immense satisfaction was the inclusion and acknowledgment of the Da Vinci Guides' role, which significantly boosted morale. There has been noticeable maturity and widespread adoption of Da Vinci guides this year.Jocelyn expressed surprise at the absence of staggered deadlines in the proposed Interop 3 rule. From the Da Vinci community perspective, strong opinions have been consistently voiced to all HHS colleagues—ONC and CMS—over the past couple of years, emphasizing the importance of promoting gradual progress rather than imposing substantial leaps. Hence, the alignment of everything with the 2026 deadline was quite unexpected.Pooja expressed her appreciation for Jocelyn's mention of the absence of specialty medication. She highlighted the stakeholders' growing interest in addressing specialty automation. Notably, many specialty medications require prior authorization, making it surprising that a proposed rule focused on prior authorization didn't include items covered under the medical benefit, such as specialty medications.The discussion shifted towards offering advice to listeners on how to approach their initial review of the final rule when it's released. Pooja inquired if there were any specific strategies to consider. Jocelyn openly admitted that she would start her review by performing a search using control + F for the words "Da Vinci" before delving into noting the specific IGs named and understanding the timeline. Additionally, she highly recommended reviewers commence with the rule's introduction, as it sets the expected scope for the details.Kim humorously mentioned her plan to break out the eggnog before diving into the review, expressing eagerness due to its overdue nature. She echoed Jocelyn's emphasis on paying special attention to standards requirements, specifications, and particularly the timelines. She's curious if any staggering will be introduced.Kim highlighted her interest in uncovering any mentions of TEFCA and seeking details regarding prior authorization. Anticipating stakeholders' keenness for the timeline, she pondered how organizations less proactive in their approach might adjust their interoperability roadmaps.The trio acknowledged the waiting game as they anticipated the final rule, expecting it to drop within a week or a few weeks. In closing the episode, they shifted focus to their expectations for progress in 2024, sharing their final thoughts.Expressing gratitude, Jocelyn thanked Pooja, Kim, and all the dedicated Da Vinci members committed to transforming healthcare. She emphasized the privilege of their work and the influential role they play in driving industry progress forward.Continuing, Jocelyn emphasized the importance of stakeholders having a plan in place, having selected partners, and scoped out project requirements, considering the multiple requirements in proposed rules like HTI-1 or disincentives related to information blocking. With policy activity accumulating, starting work becomes increasingly challenging if stakeholders haven't initiated their projects.She highlighted that interoperability and emerging policies transcend mere technology, impacting fundamental business transformation. It's about establishing collaborative frameworks with partners, providers, suppliers, pharmacies, and community members.Recognizing the learning curve, Jocelyn stressed the need to leverage collective experience, emphasizing the necessity of investing in building skilled professionals for this transformative journey.Additionally, Jocelyn pointed out the considerable activity at the state level, highlighting states like Washington, California, and Utah potentially setting more aggressive deadlines than anticipated by CMS.Kim contributed by mentioning the Office of the National Coordinator's rule-making efforts around certification. Specifically, she referenced the FY2025 rule encompassing real-time prescription benefit and the new SCRIPT standard, particularly pertinent to pharmacy interoperability.Agreeing with Jocelyn's state-level observation, Kim highlighted a Wisconsin Bill allocating $500,000 annually to drive the adoption of real-time prescription benefit tools. States like Wisconsin actively support moving patient empowerment solutions forward where progress has been slower.In 2024, increased AI-related policy activity is expected, not only at the federal level but also within certain states as they unveil details regarding the integration of artificial intelligence in healthcare. Privacy and security will be pivotal aspects of these developments. TEFCA's prominence, especially in the initial six months of 2024, cannot be overstated.POCP houses experts deeply entrenched in these areas, dedicating their days to aiding organizations in navigating the landscape, aligning strategies with competitive trends and policy shifts, as they are intrinsically intertwined. Further industry consolidations are anticipated, influencing healthcare interoperability and patient care delivery.Looking ahead, there's a breadth of promising developments on the horizon, but staying abreast of these changes requires daily vigilance—a facet in which we aim to empower and assist. Pooja echoed these sentiments about 2024, emphasizing the significance of pharmacy interoperability.She highlighted the recent recommendations from high-tech quarters, advocating for pharmacy inclusion at the table. Pooja referenced the Sequoia annual conference, where the importance of not overlooking pharmacists was underscored. She hinted at discussions swirling around the potential formation of a pharmacy workgroup under the Sequoia project.The recommendations stemming from the HITAC pharmacy interoperability task force aimed to unite stakeholders and emphasize various focal points in the field.Reflecting on 2024, Pooja's closing thoughts emphasized the importance of collaboration. Encouraging individuals with substantial pharmacy knowledge and hands-on experience in operability to step up and contribute, she urged for their active involvement to ensure the comprehensive inclusion of this expertise.Closing the episode, Pooja extended her gratitude to her esteemed colleagues, Jocelyn Keegan and Kim Boyd, and expressed sincere appreciation to the audience for their unwavering support of The Dish on Health IT, underscoring its immense value to everyone involved.

The podcast "The Dish on Health IT" is brought to you by Point-of-Care Partners, a distinguished health IT consultancy. In the opening minutes of the episode, the hosts, Pooja Babbrah and Jocelyn Keegan, set the stage for a dynamic conversation focused on the HL7 Da Vinci Project and its real-world implementation results.Introducing their guests, they warmly welcome Anna Taylor, Associate Vice President of Population Health and Value-Based Care at MultiCare, and Heidi Kriz, Director of Medical Policy and Medical Management at Regence. Both guests are not only accomplished professionals but also members of the HL7 Da Vinci Project, where they play pivotal roles as early implementers of the Da Vinci Fast Healthcare Interoperability Resource (FHIR) Implementation Guides.The hosts underscore the key themes of the episode, which revolve around sharing insights from early implementation projects, understanding the tangible benefits and returns on investment, and exploring how their experiences in the Pacific Northwest can serve as a model for nationwide FHIR adoption.As the hosts and guests delve into the discussion, they shed light on the core issues they are working to address. Heidi Kriz highlights the existing silos in healthcare, where payers and providers often work independently, using different data standards and requiring access to multiple portals. They recognize the need to promote a common language and reduce the administrative burden of healthcare processes. A major area of concern is prior authorization, which often leads to delays in care. Their aim is to make the process more transparent and incorporate it into the provider's workflow, thereby automating several steps that currently require manual intervention.Anna Taylor supplements this perspective, emphasizing that their goal is to find a many-to-many solution that involves multiple stakeholders. With thousands of members to care for and thousands of providers to collaborate with in the MultiCare Connected Care ACO. To navigate the complexities of these relationships, they aim to streamline data administration, allowing more resources to be devoted to direct patient care. Open standard APIs, like FHIR, play a pivotal role in this quest for a comprehensive, interoperable solution.Jocelyn Keegan highlights the significance of implementation guides within the Da Vinci Project. She underscores the importance of repeatability and the need to get information to where it's needed, thus improving overall efficiency and user experience.The hosts and guests underline the role of collaboration as the linchpin of their endeavors. They emphasize the necessity of involving diverse stakeholders, including providers, patients, community organizations, and other contributors to the healthcare ecosystem. The objective is to create a harmonious and collaborative environment that benefits all parties involved.Heidi Kriz shares the story of how Regence, from a business perspective, became engaged in the Da Vinci Project. The organization's CEO and leadership recognized the need to enhance the member's experience, particularly regarding the prior authorization process. This realization prompted a series of discussions and plans to implement collaborative, interoperable solutions.In the early moments of this podcast, the stage is set for a conversation that promises to explore healthcare's complexities, emphasize the role of collaboration, and advocate for interoperability. The guests, Anna Taylor and Heidi Kriz, offer valuable insights from both the provider and payer perspectives. They highlight the need for automation, standardized processes, and the creation of a seamless healthcare ecosystem, ultimately aiming to enhance the patient experience and streamline administrative tasks.When asked about key insights or any “aha!” moments.  Heidi shares that it was realizing the power of collaboration between a payer and a provider. The ability to come together to solve complex healthcare transactions and streamline processes marked a profound shift in their approach. The synergy between MultiCare and Regence in tackling a common goal was a testament to the potential of collaboration in the healthcare ecosystem.Heidi's second aha moment came when they went live in October 2022. After years of hard work and dedication, seeing their vision become a reality was truly amazing. The initial results were already impressive, but Heidi recognized that they were just scratching the surface of what could be achieved in terms of process automation and instant information delivery.She also highlighted the importance of involving patients in the process. The ability to provide timely information to both providers and members, enabling them to make the best decisions for their care, was a transformative idea.Another valuable lesson for Heidi was the necessity of embracing failure as part of the innovation journey. Adapting and making changes based on feedback and evolving needs was crucial, even if it meant not getting everything right the first time.As for Anna, her aha moment was realizing that the combination of a business-centered approach and the right technology expertise was key to success. It wasn't a matter of choosing between one or the other; both were essential. This perspective underscored the importance of collaboration between these two aspects of healthcare organizations.Anna also shared the concept of the "magic button," where providers found immense value in a simplified, streamlined process. The idea of having a single point of access to manage transactions and receive instant responses became a game-changer, simplifying the lives of providers and driving home the importance of automation.Both Anna and Heidi spoke about the remarkable return on investment they experienced. Anna cited the Data Exchange for Quality Measures (DEQM) implementation, where they saw immediate returns by closing quality gaps and receiving financial incentives. The investment in developing these open standard APIs proved to be worthwhile, not only in terms of financial gains but also in making providers' lives easier.The discussion revealed that the journey to healthcare transformation through initiatives like the Da Vinci Project is challenging but entirely feasible. Success hinges on a combination of collaboration, transparency, and a willingness to embrace change. The ability to iterate and adapt is essential, and organizations that strategically invest in these initiatives will position themselves for long-term success in the evolving healthcare landscape.In this podcast segment, Anna Taylor and Heidi Kriz discuss their experiences and insights regarding healthcare interoperability and the impact of open standards and APIs in the healthcare industry.Anna emphasizes the importance of embracing open standards and APIs, highlighting their potential to transform the healthcare landscape. She encourages organizations to take a close look at their current processes, especially if they are spending a significant amount of time and money on old-fashioned ETL (Extract, Transform, Load) packages. By adopting open standards and APIs, they can free up their employees' capacity, transform their culture, and ultimately improve healthcare.Heidi adds that the risk of not adopting these technologies is greater than taking the leap. She cites the staggering amount of money wasted due to the lack of open standards in healthcare and emphasizes the potential for financial savings and enhanced patient care through interoperability. She also stresses that putting patients and people at the core of healthcare is vital.Both Anna and Heidi underscore the importance of community collaboration, particularly through organizations like Da Vinci, which provide resources and support for implementing open standards and APIs. They encourage organizations to start small, focus on foundational changes, and build a culture of transparency and collaboration.As they conclude, they invite more providers and partners to share their success stories and experiences, urging the community to come forward and tell their stories to inspire and educate others.In summary, Anna and Heidi emphasize the transformative power of open standards and APIs in healthcare, the necessity of community collaboration, and the need to embrace change to improve healthcare for all. The discussion also highlights the significant impact these technologies can have on productivity, transparency, and patient care in the healthcare industry.Learn more about this and other Da Vinci Project Implementations: Da Vinci Roundtable Presentations: https://confluence.hl7.org/display/DVP/Da+Vinci+Video+PresentationsCMS Presentation: Catching FHIR: Lessons Learned from Achieving the First Prior Authorization Automation via HL7® FHIR® - https://www.cms.gov/files/document/hiig-august-2023-isc-speaker-slides.pdfFierce Healthcare Article: https://www.fiercehealthcare.com/payers/regence-multicare-team-fhir-enabled-prior-authorizationRevcycle Intelligence: https://revcycleintelligence.com/features/how-a-better-prior-authorization-process-is-rising-from-fhir News Coverage:KLAS Points of Light Award: https://www.mcg.com/client-resources/news-item/mcg-regence-multicare-klas-points-of-light-award/ 

In the latest episode of "The Dish on Health IT," brought to you by Point-of-Care Partners, a riveting conversation unfolds as the hosts, Pooja Babbrah and Jocelyn Keegan, welcome a distinguished panel of guests from the National Council for Prescription Drug Programs (NCPDP). The episode begins with warm introductions, setting the stage for an in-depth exploration of the cutting-edge developments and innovations in the realm of Health IT.They kicked off the episode by introducing themselves, shedding light on their roles and professional backgrounds. Jocelyn Keegan shared her primary focus on payer-provider collaboration and prior authorization, setting the context for the exciting discussions to come.The spotlight then shifted to their esteemed guests from NCPDP, including Lee Ann Stember, President and CEO, John Hill, COO and Foundation Executive Director, and Christian Tadrus, Vice Chair of the NCPDP Board of Trustees. Each guest provided a brief glimpse into their professional activities, highlighting their significant contributions to the healthcare landscape.Lee Ann Stember, serving as the President and CEO of NCPDP for the last 43 years, is recognized as a leading figure in the healthcare standards development landscape. Her dedication and unwavering commitment to enhancing patient care and healthcare efficiency through enhanced pharmacy standards and workflows. John Hill, the Chief Operating Officer of NCPDP and Foundation Executive Director brings a wealth of experience and insight to the table. John's multifaceted role in managing NCPDP's operations and spearheading the Foundation's efforts demonstrates his commitment to driving positive change in healthcare. His role as a pivotal liaison between NCPDP and various stakeholders underscores his dedication to fostering collaboration for the betterment of healthcare systems.Christian Tadrus, the Vice Chair of the NCPDP Board of Trustees, is an instrumental leader in the organization's strategic initiatives. As a key player in the coordination of care and innovation workgroup, Christian is at the forefront of efforts to bridge the gap between pharmacists and other healthcare stakeholders. His deep understanding of the evolving role of pharmacists in healthcare positions him as a thought leader in driving healthcare interoperability and innovation.The conversation shifted to the topics of the day and the guest were asked to elucidate NCPDP's mission and its remarkable milestone accomplishments. Lee Ann eloquently explained NCPDP's role as an accredited standards development organization, driving healthcare interoperability and ushering in a new era of efficient healthcare solutions.One of the key highlights of the episode was the discussion surrounding the National Facilitator Model pilot. This groundbreaking initiative is designed to provide real-time prescription testing and immunization data, revolutionizing public health and care coordination. The hosts and guests underscored how this model could streamline healthcare processes, enhance patient outcomes, and elevate overall efficiency. Read the research findings from Phase 1 of NCPDP's National Facilitator Model Pilot:  https://ncpdpfoundation.org/pdf/NationalFacilitatorModel_Phase1_Report.pdfA significant theme that permeated the conversation was the evolving role of pharmacists in healthcare, especially during the pandemic. Pharmacists have taken on an expanded role in clinical services, including administering tests, treatments, and immunizations. This paradigm shift underscores the critical need for healthcare interoperability.The episode also unveiled a new workgroup, the Coordination of Care and Innovation (CoCI), which aims to bridge the gap between pharmacists and other healthcare stakeholders. The objective is to ensure that standards are aligned to support the evolving role of pharmacists in patient care. Watch this video for an overview of NCPDP's new CoCI, Work Group 20. https://rebrand.ly/NCPDP-WG20-mem00In conclusion, this captivating episode of "The Dish on Health IT" offered a comprehensive overview of NCPDP's mission, milestones, and innovative endeavors. The National Facilitator Model pilot emerged as a beacon of promise for healthcare efficiency, while the evolving role of pharmacists highlighted the need for robust healthcare interoperability. The introduction of the Coordination of Care and Innovation workgroup symbolizes a pivotal step in unifying healthcare stakeholders. The key takeaways and calls to action include supporting NCPDP's three-year plan, emphasizing interoperability, health equity, and public health, and encouraging collaboration to drive positive changes in healthcare delivery. Learn more about NCPDP's Work: Phase 1 Research Findings, NCPDP's National Facilitator Model: Pilot:  https://ncpdpfoundation.org/pdf/NationalFacilitatorModel_Phase1_Report.pdfUniversal Patient Identifier (UPI), powered by Experian Health's Universal Identity Manager (UIM) and NCPDP Standards™: https://ncpdp.org/upi.aspxCoCI, WG20 Overview Video: https://rebrand.ly/NCPDP-WG20-mem00NCPDP Work Group Meetings and Events: https://www.ncpdp.org/Events-Calendar.aspx   

On this episode of "The Dish on Health IT," hosted by Ken Kleinberg and Jocelyn Keegan from Point-of-Care Partners (POCP), healthcare technology enthusiasts were treated to an engaging discussion with a special guest, Alice O'Carroll, Interoperability Product Manager at Florida Blue.  Ken Kleinberg, the senior consultant and innovation lead at POCP, kickstarted the episode by extending a warm welcome to listeners, emphasizing POCP's pivotal role as trusted and independent health IT consultants. He expressed their unwavering dedication to uncovering the latest healthcare technology news and milestones.The episode promised an illuminating exploration of some of healthcare's most significant challenges and opportunities from a payer perspective including:• CMS MANDATES IN HEALTH IT: Ken introduced the episode by shedding light on the far-reaching impact of CMS mandates and other policy initiatives within the healthcare technology space. The hosts emphasized that merely adhering to regulations falls short; healthcare stakeholders must aspire to achieve more.• ARTIFICIAL INTELLIGENCE (AI) IN HEALTHCARE IT: The episode delved into the transformative potential of AI in healthcare but perhaps used in a more mundane way than expected.  • ENHANCING DATA QUALITY IN HEALTHCARE: The hosts underlined the paramount importance of elevating data quality standards within healthcare. They highlighted how this mission not only benefits healthcare providers and payers but also empowers patients and enhances overall healthcare outcomes.• PATIENT CONSENT MANAGEMENT IN DIGITAL HEALTH: Among the critical issues discussed was the management of patient consent not only across the ecosystem but also the need for the patient to be able to grant access to pieces of information and not their full record. Most importantly, patients need a way to revoke consent at any time. Consent is a challenge demanding immediate attention within healthcare technology.Alice O'Carroll's introduction was met with enthusiasm as she joined the podcast as a distinguished guest. She donned multiple hats, including her role as the Interoperability Product Manager at Florida Blue and her status as one of the champions of the HL7 Da Vinci Project—a remarkable collaborative initiative.  Alice passionately shared her personal dedication to healthcare interoperability, tracing her journey into the realm of interoperability mandates and their profound impact. She underscored the unique role of these mandates in reshaping the entire business model of health IT. She explained that she had a deep belief that interoperability can usher in meaningful change, benefiting not only patients but also all stakeholders in the healthcare ecosystem.At Florida Blue, Alice and her team stood at the forefront of CMS mandate compliance, actively participating in industry workgroups like Da Vinci to ensure alignment with industry standards and drive positive transformation.The discussion swiftly transitioned to the impact of policy developments, particularly CMS mandates, on payers in the healthcare technology landscape. Alice offered her perspective, tracing the lineage of mandates back to CMS's Meaningful Use initiative. She painted a vivid picture of a rapidly evolving regulatory landscape, touching upon mandates such as the transparency and coverage mandate and the no-surprises act. Alice emphasized the vital role of industry involvement in effectively influencing and navigating these transformative regulations.Ken questioned the philosophy of merely checking the regulatory box and explored why organizations, including Florida Blue, should invest additional time and resources in healthcare technology. Alice passionately responded, underlining that the healthcare technology industry's business model is undergoing a profound shift. She explained that compliance with mandates like USCDI creates opportunities, such as payer-to-payer data exchange, but real value emerges from leveraging data to benefit members, lower costs, and enhance quality.The trio ventured into the thrilling domain of artificial intelligence (AI) in healthcare technology. Ken and Jocelyn recognized the potential and challenges AI presents. Alice joined in, envisioning AI's role in transforming unstructured data into structured data, thus enhancing data quality and interoperability in healthcare technology.Alice and Jocelyn delved deeper into the pivotal topic of data quality, acknowledging the healthcare technology industry's historical shortcomings. Alice stressed the need for a universal standard and the challenges posed by unstructured data. She discussed how regulations accelerated data exchange but also emphasized the significance of data stewardship and accountability in healthcare technology.This dynamic conversation encapsulated these crucial healthcare technology themes, painting a vivid picture of an industry undergoing unprecedented transformation. As Ken, Jocelyn, and Alice shared their insights, they collectively illuminated a path forward—one where interoperability, data quality, AI and consent management converge to progress healthcare towards a more patient-centered approach.  The podcast culminated with a valuable reminder from Alice and Jocelyn for healthcare technology professionals to actively engage in industry workgroups and partake in the ongoing transformation of healthcare data sharing and interoperability. They championed a collaborative approach, where both business and IT partners collaborate effectively to navigate the evolving healthcare technology landscape.In closing, Ken expressed his gratitude to his guests, Jocelyn Keegan and Alice O'Carroll, for their passionate insights and engagement in the healthcare technology discussion. He also extended his thanks to the audience for tuning in and invited them to stay updated with future podcast episodes across various platforms as the dynamic field of health IT and healthcare technology continues to evolve.    

In this episode of The Dish on Health IT, hosts Pooja Babbrah and Jocelyn Keegan both leads at Point-of-Care Partners welcome Dr. Su Chen, program manager and clinical director of CodeX, and Michelle Galioto, deputy program manager of CodeX, to discuss the mission and scope of the CodeX community. CodeX is an HL7 FHIR Accelerator that advances clinical specialty terminology data standards to improve healthcare outcomes. Dr. Su Chen provided an overview of the CodeX community, highlighting that CodeX is a not-for-profit, member-driven community that aims to advance clinical specialty terminology data standards. CodeX began its work focused on cancer but has since expanded to genomics and cardiology. The idea behind CodeX is that if we can capture the right level of granular clinical data to support complex disease states, we can treat the patient in a more informed way as well as use the data to better understand what is working. Dr. Su Chen and Michele Galioto both have a clinical background which is somewhat uncommon for guests of this podcast. Both guests shared that their clinical experience and the understanding of the negative impact not having the right data at the point of care can have drove them both to get involved on the health IT standards and technology side of things. The perspective is that if clinical data can be collected and disseminated, real change and positive outcomes can be influenced. CodeX member population span across, provider organization, specialty societies, patient advocacy, regulators, life sciences, etc. They all came together to make strides in data collection and fluidity. The CodeX community brings together all these different perspectives, to really understand real-world pain points, requirements and what needs to be done to move the needle and really impact patient outcomes in a positive way. While CodeX is focused on standards development, it's more than that because we must pull it through to adoption. Host, Jocelyn Keegan, weighed in to echo the idea of FHIR Accelerator members generally, not just CodeX, coming together to make sure the real-world problems are accurately represented and that solutions are pulled through in testing and pilots before being adopted out in the wild is really what makes the FHIR Accelerators so special and that she sees the same passion being brought to bear in the HL7 Da Vinci Accelerator, even though it has a different focus. Dr. Su Chen recapped some of CodeX success stories sharing has had growing real-world traction and adoption in the last six to nine months and has started to have outcomes of real success in its pilots and use cases. She shared that CodeX has approximately ten use cases that span patient care, patient care coordination, public health research, payer processes, and more. Some of CodeX's more mature work can now be found live at real-world clinical care sites and the data being gathered is being leveraged in trials. There is also a trial matching pilot that is attempting to improve enrollment for clinical trials using standards to expand the pool of possible trial candidates outside of the trial site or the close network of physicians related to the trial. This expansion of the trial recruitment pool could help improve trial enrollment rates from 3-8-fold. One of the use cases to highlight is prior authorization in oncology work. This use case brings together a collection of interested parties, EHR, vendor health, IT groups, and payers to reduce the burden of prior authorization across the healthcare team to benefit the patient. CodeX is addressing real-world problems that can be solved, and the investment in MCODE by MITRE and the community to create the right pool of cancer and cancer terminology within the FHIR community is making things better than they are today. CodeX is also starting to see traction in the international community including Germany and Brazil. CodeX is being creative and learning from each other, cross accelerator, cross HL7, and time pieces together so that we can get to end goals faster. In doing so, CodeX is starting to see greater voices added to the table, starting to look at prior authorization, not just in cancer, but now in cardiovascular health or genomics.The episode closed out by our guests encouraging listeners to get engaged with FHIR if you haven't already. There are many policy requirements and there will be more to come so if get engaged with the FHIR community now. If listeners are interested in the work of CodeX in particular, they can engage with the work that CodeX is doing by joining as a member, attending public calls, and checking out the CodeX website. Clinicians are especially encouraged to get involved and offer their perspectives, but all are welcome. CodeX is a generous community that promotes its members' needs and collaborates with other accelerators, working groups, and standards organizations.

This episode of The Dish on Health IT features guest Kyle Kiser, CEO of Arrive Health, joined Point-of-Care Partners (POCP), hosts and health IT leaders Pooja Babbrah and Jocelyn Keegan to discuss price transparency and real-time pharmacy benefit (RTPB) check. They also discussed user centric design, optimizing adoption, and related policy and standards. To kick off the episode, Pooja Babbrah introduced herself as the host and Pharmacy PBM Lead with Point-of-Care Partners. Jocelyn Keegan then introduced herself as the POCP Payer Practice Lead. Pooja then asked Kyle Kiser to introduce himself where he explained he is the CEO of Arrive Health and has been with the company for almost 9 years. They then talked about the benefits of tools that allow for more visibility for providers and patients into coverage and price, as well as the key considerations when designing and rolling out new tools to optimize adoption and consistent use. They also discussed the role of policy and standards related to price transparency and RTPB.Kyle explained that Arrive Health is a company inspired by Dr. Kevin O'Brien's experience with his mother Lucy. When she came to Dr. O'Brien with an issue of out-of-pocket spending, using his expertise, he sought out ways to reduce her spend. This led to the creation of Arrive Health and the mantra “Lucy Up” which is a reminder of their mission to make sure patients can afford their medication. They focus on the patient-provider relationship, and their customers and partners are those looking to save money on their medications.The conversation shifted to focus on the vision and mission of a company that has been around since 2013. The focus from the beginning was to improve healthcare value by connecting patients and providers with the right information at the right time to drive the right decision. This conversation then shifted to price transparency and the policies that have been put in place to make it easier for patients to understand what they are paying for and how the industry can help to smooth out some of the pain points they face when it comes to affordability. The company is committed to its mission and is continuing to focus on the patient-provider relationship as the most leveraged opportunity in the value chain.The conversation then focused on the current state of making price more transparent in the healthcare industry. The group agreed that real-time benefit check has been a successful addition, offering a strong value proposition for providers, payers, and patients. They also acknowledged that there is still much work to be done on the medical benefit side. The group discussed the ever-increasing complexity of benefit carve outs and the ongoing challenge of validating patient identity and connecting with their benefit details at the granular level needed to really understand coverage and out of pocket costs. They then discussed the role of policy in raising the floor for the industry without boxing out innovation by making requirements too narrow or prescriptive.The conversation shifted to prior authorization and the work of Da Vinci Project on price cost transparency. The participants recognize the need to get pricing information to the payer and patient at the right time so that they can make decisions about their care that they can afford. Da Vinci's four guides allow for similar workflows to that of RTBC today due to the separation of activities on the medical side compared to a dispense event.

Ken Kleinberg, Innovation Lead, greeted guests and listeners explaining that The Dish on Health IT is a forum for Health IT innovators and catalysts to break down and discuss some of Health Its biggest news and most exciting milestones and that it is produced by Point-of-Care Partners (POCP) Health IT Consultants who work with stakeholders across the healthcare ecosystem. Viewed as an independent trusted party. Ken was joined on this podcast by co-host, Jocelyn Keegan, Payer Practice Lead. They welcomed this episode's guests who serve as co-chairs of the FHIR at Scale Task Force or FAST Deepak Sadagopan, Chief Operating Officer of Population Health with Providence, and Duncan Weatherston, CEO of Smile Digital Health joined the podcast to dig into what FAST is up to now that it's transitioned from an ONC initiative into an HL7 FHIR accelerator the importance of building a strong framework for a national FHIR infrastructure, why FHIR scalability is crucial and how coordination and collaboration across the FHIR Community are integral.Jocelyn Keegan briefly introduced herself explaining that FAST sprung out of the leaders within Da Vinci recognizing there were critical components needed for FHIR implementation to happen smoothly and at scale so all the great implementation guides coming out of Da Vinci and the other Accelerators can more easily be picked up and used. The work of FAST is truly foundational. Deepak introduced himself expressing how much of a pleasure it's been to work alongside Duncan and that he's looking forward to all the work they have in front of them. He explained that he is the Chief Operating Officer for Population Health with Providence Health System and that he has been actively engaged in the standard space and particularly as it relates to the adoption of FHIR for the past few years. He explained that advocating for standards in the value-based care space and following the path CMS has laid out is the North Star of much of his work. Deepak continued to say that in order to benefit the entire population a foundational infrastructure that supports scalable adoption of modern standards is needed. This will help reduce administrative burden and improve the patient experience. FAST's work really resonated with me because I see the work as helping solve not only industry challenges but specific challenges my own organization faces. Duncan then introduced himself saying that he shares Deepak's enthusiasm for the team that has been put together to support the FHIR and Scale Task Force. Adding that all the members are well informed and have a deep belief in the value of the FHIR proposition and are really interested in ensuring that all of the community have the tools they need to be able to participate effectively which is essentially the heart of what FAST is trying to do. Duncan shared that he has a background as an architect in healthcare since the late 90s. He went on to say that he has played roles across different aspects of healthcare like population health and primary care systems. He went on to explain that his interest in FAST was due to the synergies in mission between FAST and Smile Digital Health, the company he founded.He went on to say that he believes the API-driven approach to Health Care is the necessary bedrock for real transformation in care delivery. He compared the transformation in healthcare to the transformations in finance or music industries adding that healthcare is much more complex which is why having stakeholders bringing their various perspectives to the table is critical to solving healthcare's biggest challenges. He added that FAST has a long path ahead. Ken asked Duncan to share a little bit more about FAST's history and the current status of its work. Duncan explained that the FHIR is Scale Task Force started as an ONC-convened initiative with the goal to solve common implementation challenges by building on the work the industry had already started and identifying other gaps that needed to be addressed. FAST then transitioned into an HL7 FHIR Accelerator to continue its work as an independent body. Members include stakeholders like EHRs, payers, health systems, really the whole gamut. The focus is to establish consistency in the adoption model, adding that ideally all of us should be singing from the same songbook when it comes to how we interoperate in this sort of burgeoning API landscape. Ken expressed his appreciation of the concept of solving common challenges and creating a common adoption model for the FHIR Community. He then transitioned to asking Deepak to share examples of real-world challenges provider organizations like his face that the work of FAST would help to solve. Deepak responded by sharing a scenario related to the wide geographic area across the west coast that Providence serves. Quality measurement for any organization like Providence is incredibly important because if it isn't measured, it can't be addressed. This quality data must be collected across all affiliates and partners to support Accountable Care Organization (ACO) and other types of arrangements where Providence and its affiliates and partners are held accountable for quality and total cost of care for a defined set of populations. On its face, this may seem simple, however, when one considers that a region may have as many as 45 different affiliates using 23 different electronic health record systems, one sees that the data is still very siloed. He continued to explain that when attempting to measure the quality of care for 300 000 beneficiaries covered under different ACO arrangements and 10 different payers, creating one platform or dashboard for all quality data is incredibly challenging. He continued by asking listeners to imagine a state where it's possible to have one central dashboard that can be queried to bring up patient data indicating the associated payer organization, which provider organization is able to use APIs to deliver data related to this patient or the set of patients both in terms of claims and clinical data associated with all the organizations that know about that patient and have interacted with that patient before. This would dramatically simplify the effort required for system-wide quality measurement. Ken empathized with the challenges stakeholders face. He went on to say that FAST is focused on infrastructure and scalability that would address some of these challenges. To gain further clarity on FAST's work, Ken asked for either of the guests would like to expound on how FAST fits in with the other HL7 accelerators. Duncan explained that he sees FAST as an Accelerator for Accelerators. FAST is trying to fill the gaps and overcome barriers to scalable FHIR Solutions. In addition to the implementation guide development, FAST is coordinating and collaborating with other Accelerators and organizations to align the FHIR community on policy and approaches to issues and harmonize existing efforts. The FAST implementation guides address scalability challenges related to areas like identity, security, and intermediary access for a consistent way to proxy content backward and forwards and also a provider directory. The current set of FAST IGs is pretty fundamental to the infrastructure deployment we have in mind but more than that, FAST is exploring opportunities to work on other collaborative strategies to support the creation of capabilities to operate across different governance frameworks or accountability agreements. Ken asked Jocelyn to weigh in wearing her Da Vinci Program Manager hat. Jocelyn referenced back to the scenario Deepak shared saying that as stakeholders need to exchange data across thousands of providers, and hundreds of payers to support an endless number of different agreements, someone needs to look at the macro picture to figure out what foundation guides or work are needed. She went on to say that Providence as an organization, while complex, is innovative and mature and their early work can serve almost like an advanced team, feeling out the challenges others will face. She continued to explain that right now, finding out which organizations have a FHIR server live, is a very manual process. In a future scenario, stakeholders should be able to publish their endpoints to a directory and allow it to be discoverable without having to manually do anything. Jocelyn went on to say that she believes FHIR adoption is much higher than currently reported partly because it's impossible to get a realistic view of live servers without having an endpoint directory. The industry agrees that using these modern standards is important but if these foundational pieces aren't addressed, we won't be able to achieve the level of automation we're looking for. Deepak responded to what Jocelyn said by agreeing and offering that some tracking of partner organizations can share data is being done using excel spreadsheets. He added that problem number one is consistency in the adoption of standards. In an ideal world, every endpoint should communicate information such as which patients are covered under their particular ACO arrangement in the same way. Next, stakeholders don't want to have to develop 10 different connections and have 10 different ways to indicate payer and patient data or require manually checking 10 different organizations. A directory-type structure would help. There needs to be consistency in approach and consistency in the adoption of the standards and the scalability across these different endpoints. He explained that so far, we've been successful in solving it in small microcosms but it's nowhere near the level of scalability required.Ken, in follow-up, probed about what is meant by scalability. Duncan responded by saying that some may look at scalability as being able to handle a high volume of transactions or lots of lots of data flowing backward and forwards and of course once we're at scale we have to support that. He referred back to what Deepak pointed out that it's really important that organizations be able to reach out to hundreds or thousands of others and that everyone is doing it in the same way. The way FAST sees scalability as creating a consistent fashion in which every endpoint can have a reliable and predictable mechanism by which they can discover, relate, log in, transact, and retrieve information the same way every time. He went on to say that the problem stakeholders face today is that we live in this heterogeneous environment if an organization needs to work with providers, they have to work with each provider discreetly and then providers working with payers have to coordinate with each payer discreetly. He continued that it doesn't stop there, the problems of a heterogeneous environment extend to researchers trying to gather information, or really any stakeholder within the healthcare ecosystem will face the same set of issues. This is why it's important to deploy a scalable methodology for information exchange. Ken responded by saying that he understands the leveling aspect of being ableto get everybody in a consistent methodology at scale is incredibly important. He went on to say that it made him think of the different types of railroad tracks across different parts of the world or mobile phone networks, ATM networks or electrical standards. He shared that his daughter's traveling through Europe now and she has a whole bag full of different plugs for the different countries she's traveling to that she's going to face. He asked if one of those comparisons was apt for what is going on in healthcare or if there was another preferred analogy. Duncan responded by saying that he thinks those are good comparisons to a point but went on to say that the key thing to remember is that those power plugs work regardless of whether you're plugging in your laptop, a stove or your electric car. Each may have different connectors or run on different volts but the fundamental grid that supplies thatpower is consistent. The idea that we all have the same experiences is very important. One of the advantages that we see with the plug system is at least within broad regions, the plugs remain the same whether in Seattle or Miami the plug I the same. If traveling to London one might need an adapter, but no one will need to break out a toolkit to rewire a device and through trial and error and a little bit of smoke get everything working. He added that if everyone had to bring an electrician with them on vacation, electricians would be in way more demand than we could ever supply. That's where we find ourselves today Ken followed up by asking how FAST goes about creating these common solutions and common implementation models and then pulling them through to adoption. Duncan responded that currently FAST has four implementation guides that have gone through the rigorous and transparent standards development process. In addition to that kind of work, FAST working to bring the community to the table to talk about the problems that they're discovering with scalability and then expose those as potential collaborative pathways going forward. FAST does that through communication and staying in contact with the other Accelerators and other implementers and keeping our ears to the ground for opportunities to collaborate. Deepak added that he looks at FAST as essentially a shared service for all the other accelerators like if you think of all the other accelerators or as individual business units and FAST is a common service that supports each of these other accelerators in enablement and scaling the standards they are developing, that is what FAST is focused on. Jocelyn spoke up to agree and add that the cross-pollination FAST has brought into the HL7 community has been really powerful and has helped tighten those connections. She added that having worked on a number of the Accelerators over the last few years one can't discount the value of convening conversation discussing and brainstorming with peers on how to solve complex problems.Ken asked for thoughts on the Trusted Exchange Framework and Common Agreement or TEFCA. He mentioned that TEFCA recently announced a first wave of half a dozen organizations approved as the so-called qualified health information networks or QHINs. He added that while TEFCA isn't a FHIR-specific framework although there is a recently introduced FHIR road map with payload support as well as facilitated and brokered FHIR Exchange in the future Ken asked whether TEFCA is on the right track. Duncan responded by saying that the intent of TEFCA is admirable and I believe that their goals are very well aligned with what FAST is trying to accomplish in the FHIR community. He added that the critical piece is to ensure there is a consistent strategy and a consistent set of standards for all of the members and participants in the community to be able to share information whether exchanging as part of TEFCA or outside of TEFCA. He continued by adding that the most important point is to avoid divergent standards. Duncan share that in his view, the implementation of TEFCA must align with the standards implementation community or else stakeholder will have to continue operating in a heterogeneous environment and trying to figure out what rules apply within TEFCA that might be different from everywhere else. Deepak concurred with Duncan's point that avoiding divergence is the most important thing. He added that TEFCA is engaging with the FHIR community and soliciting feedback and he hopes to see more of that to lead to better alignment. He added that if we don't gain alignment now, it will be much more difficult to address the new issues introduced into the ecosystem.The group discussed the relationship between standards and policy and the interconnectedness between them. All agreed that policy continues to be a powerful lever to move the industry towards interoperability even if things don't move as quickly as everyone would like. Closing out the episode, Ken asked the guests to share any final messages or calls to action for the industry. Duncan responded by saying that the industry is in the process of transformation from a pre-internet to a post-internet model. He continued by saying that every organization has an opportunity to evaluate what can be learned and applied from other industries that have experienced massive transformations. The industry also needs to recognize that it is an information industry. He added that it sometimes feels like healthcare is stuck in a debate on whether it is a bricks-and-mortar industry or information. He added that in his view it is very clearly an information industry and the adoption of standards like FHIR allows data exchange directly point to point in a consistent fashion. He continued by recommending organizations evaluate their role in the community evaluate their use of information and figure out how they can become part of this transformational solution so that patients get the best care at the most affordable rate.Deepak added his voice saying that he has been in the interoperability space for over 20 years now and that the industry is in a really exciting place. The whole industry is more active and engaged in this space. So many are taking an interest in liberating data from electronic health records and really figuring out how to democratize the use of healthcare data to drive better care and outcomes for the populations we serve and that is incredibly exciting to see. He added that of course the industry can sometimes get caught up in short-term challenges but that leads to healthy debate that will allow us to end up in a spot that leads to better outcomes for the Patients. Jocelyn implored stakeholders to pay attention to the work being done and to come to the table and share the business problem they're trying to solve and what data they're trying to free or if they're already down the implementation path to participate in testing. She concluded by recognizing that FAST is looking to move the industry into the future with a practical approach. Ken closed out the episode by thanking the guests and his co-host and reminding listeners they can find the podcast on Apple podcast, Spotify or wherever you get your podcasts and to check out the POCP YouTube channel for videos of episodes. FAST will be speaking on March 22nd on an HL7 webinar. Register here. FAST will share a kiosk at ViVE in the InteropNow Pavilion and have a kiosk at HIMSS23 in the Interoperability Showcase. Reach out to FAST to learn more by emailing fast@hl7.org

Pooja Babbrah, Point-of-Care Partners Payer & PBM Lead kicked off the episode by acknowledging guest, Dr. Steven Lane, Chief Medical Officer with Health Gorilla and Point-of-Care Partners co-host, Jocelyn Keegan , Payer/Practice Lead and HL7 Da Vinci Project Program Manager. Pooja then outlined the discussion for this episode. The hosts talked with Dr. Lane about: Trusted Exchange Framework and Common Agreement (TEFCA)Information blocking…or rather information sharing, Dr. Lane's transition from being part of a large health system to joining the health IT company, Health Gorilla and the different perspectives on innovation and change that come with operating in these quite different organizations. The cycle of innovation and the role of policy. Before jumping into the discussion both Jocelyn and Dr. Lane introduced themselves and explained that over the years they have worked with each other several times through the HL7 FHIR (Fast Healthcare Interoperability Resources) Accelerators with Dr. Lane participating in the Da Vinci Project and Jocelyn serving as the program manager of Da Vinci. Today's hosts, Pooja, Jocelyn and the guest are all interoperability champions and share a passion for leveraging technology to improve healthcare. This episode's guest, Dr. Steven Lane, Chief Medical Officer of Health Gorilla, member of the Health Information Technology Advisory Committee (HITAC) and longtime advocate for interoperability identifies as being a clinician first and that role brought him into the health IT space. Dr. Lane shared that he started using an EHR (Electronic Health Record) back in 1989. Worked on EHR implementation during the 1990's and helped launch one of the first patient portals connected to an EHR back in 2001. He explained that he's had more of an opportunity to engage in health IT throughout his career than most primary care physicians. He explained that the importance of interoperability started to be a real focus starting in 2008 and he had the opportunity to work with HIEs (Health Information Exchanges) and then was invited to take part in an ONC (Office of the National Coordinator) taskforce and just continued to say yes to any the opportunities that have come his way so he could contribute to progressing interoperability. He continued to say that in his view if we're going to fix healthcare, we need to first focus on improving the health of our population. Second, improve the value of the healthcare being provided (reduced costs with optimal outcomes). Third, improve the overall experience of obtaining and delivering healthcare for the patients and for the providers, acknowledging that physician burnout is a real issue. Last, improving health equity. Pooja asked Dr. Lane to share a little more about the mission & vision of Health Gorilla to familiarize the audience.Dr. Lane explained that Health Gorilla started initially by addressing physician burden around lab orders and results. From there, they built a platform and started aggregating data they were exchanging and created a private HIE (Health Information Exchanges). They build a robust record service, master patient index, and then aggregate, normalize and de-dupe the records. The focus really being on data quality and utility. He compared the work to some of the regional HIEs, but Health Gorilla's audience is much broader. Health Gorilla made early connections with CommonWell, eHealth Exchange, Carequality framework – Epic Care Everywhere, with Direct messaging through 3rd party health information service providers (HISPs)Dr. Lane shared that what he found special about Health Gorilla is the commitment to innovation and bringing in more data types like social determinants of health or data from wearables. Pooja then asked Dr. Lane to share his view of TEFCA and why Health Gorilla decided to apply to become QHIN (Qualified Health Information Networks)?Dr. Lane described the history of TEFCA, the initial idea for it being included in the 21st Century Cures legislation. He recalled that while interoperability had been a major focus of policymakers and the industry, providers and other stakeholders were still voicing frustration that they still couldn't access the data they needed. The idea of TEFCA was for it to be an onramp to support all kinds of interoperability, data exchange and use cases. He expressed that he has had to learn patience as things in health IT never move as quickly as one might want. Dr. Lane went on to convey that early on after the announcement of TEFCA, Health Gorilla came out with a public commitment to apply to be a QHIN and be part of a diverse community of regional and national private and not-for-profit entities. He continued that becoming a QHIN for a private company is a big deal. They are inviting government oversight and commit to robust governance, state-of-the-art privacy, security and compliance practices. Health Gorilla is committed to supporting a broad range of cases and user communities like:Health Data UtilityPublic HealthCommunity based social servicesPayer-providerIndividual Access ServiceQHINs (Qualified Health Information Networks) will pursue multiple architectural approaches. Health Gorilla will be a data aggregator and platform. Health Gorilla will leverage TEFCA exchange as they do current HIN (health information networks) exchange to continue to build their secure cloud-based repository of health data with the goal to become the nation's largest and most secure repository of high quality, high utility health data.Dr. Lane likened his vision of the role of a QHIN to that of a dance studio operator. He went on to explain that a dance studio operator creates a safe supportive space for people to come to dance. Different types of people - individuals or groups. Different types of dances – flamenco, ballet, private party. Everyone is invited to creatively use the space within specified constraints to ensure safety and privacy. Pooja followed up to clarify whether Dr. Lane likened becoming a QHIN as more opportunity for innovation. Dr. Lane said that absolutely it does. He explained that TEFCA is supplying a framework or single on-ramp and allows for more innovation in various use cases from treatment to payment and operations to public health. Pooja asked Dr. Lane to talk about TEFCA and FHIR. She explained that there has been some feedback in the industry voicing concern that even with the TEFCA FHIR roadmap there isn't enough alignment between TEFCA and the FHIR community. Dr. Lane responded that many were disappointed that when TEFCA was originally announced there was no mention of FHIR at all but since then the TEFCA FHIR Roadmap was published. Some may not be satisfied with the current roadmap but it's a good step in the right direction.Related to the TEFCA FHIR Implementation guide, Dr. Lane summarized some of the responses explaining that there were 16 commenters – Provider organizations, EHR and other HIT (Health Information Technology) vendors, public health departments, HL7, DirectTrust, HISPs, and othersSome commenters called out the challenges of scale especially around registering and managing endpoints. Others pointed out the need to leverage and align with other work in the FHIR community. Others still pointed out the need to clarify the priority between developing to IHE (Integrating the Healthcare Enterprise) document vs. FHIR exchange for specific use cases.Dr. Lane went on to point out that there has been concerns about “if we build it will they come” but the number of QHIN applicants and the engagement seen with the comments submitted are a great sign that people are engaged with TEFCA.Pooja asked Jocelyn to chime in and share what she is hearing from the FHIR Accelerator community related to TEFCA and FHIR? Jocelyn agreed with Dr. Lane about seeing the level of engagement being a great sign. She added that there is starting to be a little bit of a cultural shift related to thinking about data outside of clinical data and how to use data to support billing, operations and more and how to use FHIR to do some of those things. Jocelyn explained that we're starting to see a lot more traction. After attending the Carequality, Sequoia and eHealth Exchange meetings in DC in December and hearing the cacophony of voices talking about how to make TEFCA a reality and leverage FHIR was amazing. From a community perspective, Jocelyn explained that she is hearing a lot of positive feedback after seeing more real alignment happening with TEFCA and the FHIR community and there seems to be a feeling there is more of an openness akin to what happens in the standards development communities which was a needed next step. Jocelyn went on to say that in the near future the industry will need the volunteers to help pilot some of this work and prove we can move beyond point to point and settle the trust issue through these networks. What will be critical is technology meeting us where we are and solving real business challenges. Ultimately, while documents will continue to be part of certain transactions we really have to strive to get to codified data to get to the level of automation the industry needs. Dr. Lane seconded the notion of piloting now and not waiting until policy deadlines are looming. This is the time test, pilot and work out the bugs. Pooja remarked that it will be interesting to see how Sequoia as the Recognized Coordinating Entity (RCE) of TEFCA decides to engage more closely or not with the Accelerators, specifically FHIR at Scale Taskforce. Then Pooja asked Dr. Lane to discuss the huge transition from working for Sutter health, a huge health system to working with a health IT company. Pooja asked him to explain the different approaches to innovation he's noticed. Dr. Lane acknowledged that it is a big challenge to change the course of the huge ship that is healthcare. Things have evolved over the last 100 years or so resulting in the way healthcare is delivered today and it can be hard to change. Many providers may be resistant to change but then you have big disrupters like telehealth and other innovations that force that change. Dr. Lane explained that he has personally been deeply passionate about health IT and being innovative but for many years, he was the only provider in the room for years. That's starting to shift but if the industry wants to see more engagement and willingness to change by providers, there needs to be the right incentives. The most efficient way to innovate is to have all parties at the table with representation to make sure the work being done is solving the right problems. Dr. Lane expressed that he's been at this for 20-30 years and he has recognized the improvement in the process for standards development, policy changes and innovation with people thinking about how we can do this in a coordinated and repeatable way to gain efficiencies. From a policy perspective, Dr. Lane explained, there will always be a need for carrots and sticks. Pooja then asked Jocelyn to share her perspective on the health systems that are members of Da Vinci and whether there are common attributes/factors that lead some systems to be more open to engaging with standards development and FHIR adoption?Jocelyn shared that before she jumps in she wants to point out that CMS (Centers for Medicare and Medicaid Services) has done a lot over the last decade to move the policy levers shifting the industry from a pay for service to a value-based care. This shift will require real-time interaction from a 60-90-day lag in information in provider systems. Health systems likely to be at the standards development table have recognized this shift to real-time exchange and own and master their own data. Jocelyn explained that one of the big attributes she's seen in health systems who are more engaged in standards development are those that area a little further along in the value-based care journey and have strong partner relationships. A second attribute is having a willingness to go first and help prod their partners to move a little faster. Jocelyn went on to say that it isn't just the big health systems that can engage, APIs will help level the playing field and enable smaller systems to operate more efficiently. She went on to say that sometimes all it takes is an individual with a passion like Dr. Lane to volunteer, come to the table and be willing to speak up and share the challenges they are facing during use case development. Standards development isn't just for big health systems to participate and represent providers, it isn't just for developers and implementers. For valuable work to be done the standards development process needs to understand the real-world problems that need to be solved. There is space for providers, pharmacists, grad students, really anyone in the ecosystem. Pooja made the point that this discussion is really about innovation, there is a role for and intersection of policy and standards development and the importance of stakeholder engagement and participation in these areas. She asked Dr. Lane to share his view of the policy role in innovation. Dr. Lane responded by saying that Jocelyn had it right when she talked about the importance of having different perspectives represented, especially when creating the initial use cases. Dr. Lane went on to say that in his role on HITAC and working on USCDI (United States Core Data for Interoperability). After the first version, other stakeholders were invited to the table to contribute and provide feedback and now there is a repeatable process that is done to update USCDI annually. He added that HL7 has been invited in as well and there is coordination there to ensure implementation guides reflect the latest coming version of USCDI. Pooja responded by saying that policy is really important in moving the industry forward but there is also a solid connection between standards development and policy and that in her role as chair of the NCPDP board, she may be biased, but feels organizations who don't participate in standards development are really missing a big opportunity. HL7 and NCPDP see the value of coordinating and working together and CMS and ONC have made it clear through their roadmaps that standards will be named in coming policy so why not come to the table and make sure your organizational interests are being represented while also working to solve the big, complex issues in healthcare? Pooja then shifted the conversation mentioning that as we close out, we like to ask our guests if they have any final message or calls to action, they want to send to the industry?Dr. Lane responded by saying that he sees TEFCA as a once in a decade opportunity to really take nationwide interoperability to the next level. Right now, the general public probably has no idea what TEFCA is and that there should probably be more of a nationwide, public discourse and awareness so people can move towards it versus being dragged along. Pooja then asked Jocelyn for any concluding thoughts or calls to action she would like to send out. Jocelyn expressed her agreement with Steven, what are you doing to advance us as an industry, we're all consumers of this data and ecosystem. She added that we are at an unprecedented time when the industry is leading and CMS and ONC are playing a critical role in alignment. The standards version advancement process (SVAP) is a notable example of CMS and ONC listening to the industry. They are no longer putting a ceiling on the level of advancement and progress the industry can make but rather focusing on establishing a floor. Jocelyn reiterated her encouragement of organizations and individuals to come and participate in the standards development process and give voice to your challenges so the industry can solve real problems. Pooja thanked cohost and interop expert Jocelyn Keegan and the well-informed guest, Dr. Steven Lane from Health Gorilla And thanks to our audience for tuning in! A friendly reminder to new listeners that you can find us on Apple Podcast, Spotify or whatever platform you use to pick up your podcasts, including HealthcareNOW Radio and the Podcast Channel. We also post videos of our podcast episodes, sometimes longer versions, on the POCP YouTube channel. And don't forget, Health IT is a dish best served Hot!

Pooja Babbrah, Pharmacy & PBM lead with Point-of-Care Partners (POCP), NCPDP Board of Trustees Chair, and host of The Dish on Health IT kicked off the episode. This last episode of 2022 featuring POCP Regulatory Resource lead, Kim Boyd and Payer & Provider Practice Lead and Da Vinci Program Manager, Jocelyn Keegancame together to break down all the big things that have happened in 2022 and what we expect for 2023. Pooja explained that while this episode's discussion will primarily be policy related, the panelists will also talk about some of the real progress being made in the standards world and the interconnectedness between federal and state health IT policy and legislation and between standards and policy, and what it means to the industry. Pooja asked Jocelyn and Kim to briefly introduce themselves and to tell the audience what topics they are most excited about discussing. Jocelyn introduced herself as the POCP payer practice lead, devoted to positive change and building/getting stuff done. She went on to say that her focus at POCP is on interoperability, prior authorizations, and the convergence of tech, standards, and product strategy. She explained that she has spent her career moving people and organizations towards APIs, unleashing data for their highest, best-purpose uses. She expressed that she couldn't be more excited about where we've been this year and the precipice of where we are headed next year.Kim expressed that it's always a pleasure convening with Pooja and Jocelyn to discuss the exciting world of health IT.  She went on to share her background which has spanned medical and pharmacy operations and implementations, with years of policy, industry, and standards development work on ePA, cost transparency, ePrescribing, and taking what she learned in these areas to work with policymakers on smart policies to advance interoperability and patient care.  Kim stated that it has been an exciting year leading POCP's Regulatory Resource Center and that so much is happening in the state and federal regulatory spaces that ties to the innovations and acceleration the industry has been experiencing in health care.   Pooja thanked them both for their introductions and then dug into the discussion by asking each of them to share the biggest Health IT highlights of 2022. Kim explained that four things really stand out in 2022:the requirements of the transparency in coverage and no surprises act going into effect and the various provisions requiring data and cost transparency and giving patients and their care teams access to information that will help them make informed decisions.  Many in the industry have been clamoring for transparency of this type for some time.The incredible work happening to advance interoperability via the SDOs and Accelerators, like HL7 Da Vinci, CodeX, FAST, and NCPDP's Pharmacy Technology and Innovations group. how Federal agencies are collaborating on aligning requirements for interoperability, like the use of standards and FHIR-based standards specifically. This collaboration and proceeding regulatory action will help align the technical and interoperability stars.  the all-hands-on-deck focus on patient health equity is a big area of concentration for not only innovators in the market but the White House, HHS, standards organizations like NCPDP and HL7, and community and public health organizations.  There is just so much happening to try and close gaps in equitable care and the data/digital transformation that needs to happen to help facilitate change.     Jocelyn followed Kim to share her perspective on the biggest highlights of 2022 first joking that Kim got to go first and steal some of the things she was going to say.She laughingly shared that she agrees with all of Kim's points and then said that she wanted to focus more on the tone and the tenor of the work happening in the industry. Jocelyn shared that from her perspective it feels as though the industry has moved from thinking about interoperability projects as something that will happen "someday" to action and reality.  She clarified that this may not be the case for everyone, but many organizations and projects are moving forward to not only do the IT work but the business transformation. The examples she gave included the real progress made on TEFCA, real-world deployments of FHIR guides, live usage of APIs, prior authorization (PA) on pharmacy getting an infusion with last year's Medicare Part DJocelyn added that she wanted to focus on and add to Kim's comment about coordination at the federal level. She explained that policymakers at the federal level have been working for well over a decade and using their levers to make change extraordinarily well.  Jocelyn went on to say that as she sees it there are three camps of folks; people and organizations who are working ahead of policy by paying attention to published roadmaps and reading between the lines of public statements, folks trying to get their organizations prepared to respond to the next wave of policy, and others playing the waiting game to see if it's real and if they'll have to follow or if another path will emerge. Finally, she added, that the last highlight from 2022 is all the waiting! The industry keeps waiting for certain regulations to drop. She explained that she doesn't think she remembers another year where there has been this much policy anticipation at year-end. Pooja thanked Jocelyn and Kim for sharing their perspectives. She shared two important topics that have been more under the radar but are growing in importance and focus. The first is consent, specifically eConsent. Stewards of change published the report “Modernizing Consent to Advance Health and Equity” to bring more attention to the need to solve this issue – not only in the context of healthcare but also social services as those are such an important tie-in to health outcomes.  Add to that, the ONC half-day discovery workshop on eConsent.  Pooja explained to those who may not have attended – that it was an amazing session that brought together so many different people across the continuum of care in addition to the people working in the social services arena.The other area is pharmacy and the growing role of pharmacists in the care team and the work that is being done to ensure that they have access to more data and information to support care teams and support patients.  Pooja explained that there has been a lot of movement by retail chains to add primary care services to their offering and community pharmacies are supporting more clinical services.  This has led to more focus and a flurry of discussion around interoperability in the pharmacy space. Pooja gave the example of the Health Information Technology Advisory Committee (HITAC) recently proposing adding a pharmacy-focused subcommittee which is a huge indicator. Pooja shifted the discussion to policy highlights, specifically, requirements that went into effect and whether the industry met the deadlines or is still working on it. She explained that she is thinking specifically of: No Surprises ActTransparency in Coverage RuleInformation BlockingKim jumped in by saying that with the No Surprises Act there is still some pushback and uncertainty about how providers are going to comply with having to pull together all the data to provide Advanced EOBs (AEOBs) and good faith estimates (GFEs) when there are multiple providers involved in delivering the expected care; however, the Da Vinci Project is working on advancing implementation guidance to support patient cost transparency. Kim encouraged folks and organizations listening to this episode to get involved in these efforts. Kim added that she expects to see more price transparency-related policies, especially given the latest request for information on AEOBs. Kim went on to say that compliance with the ONC 21st Century Cures Final Rule on information blocking has been a mixed bag. She added that she wished ONC had called this "information sharing" instead of information blocking. Kim went on to say that most of the non-compliance has been on the provider side because it is challenging when a provider falls under the rule as an actor but maybe the health system they work in does not, especially when the health system may hold the data being requested. She added that most of the EHRs have spoken with are up-to-speed on the full EHI sharing requirement. Jocelyn added her perspective on information sharing specifically around EHI. Technically all of this information needs to be put out there, while the industry waits for USCDI to fully encapsulate patient information, there is probably a lot of non-codified data in the system that isn't actionable or really useable. The EHR certification requirements will likely do more to move the industry forward.  Jocelyn confessed that she fell down the RFI response rabbit hole and spent an hour looking at the feedback to the RFIs.  She thinks there is a disconnect between the goal of the rule and how to operationally do the work. An example she provided was around PA and that it isn't automating the submission of the PA alone but how to automate the 10 steps that need to happen before a PA is submitted. Pooja shifted the conversation to ask Kim to talk a little about the state activity around price transparency and why it's so important for stakeholders to pay attention not only to federal policy but what's happening in the states.Kim agreed that so many organizations forget that state policy is a big part of the equation too.  She shared that on the data and cost transparency side, states doubling down to move the needle on data fluidity. The POCP Regulatory Resource center has its finger on this pulse.  From the required patient-specific cost, benefit, coverage, and eligibility data sharing to confirmation of compliance enforcement of the No Surprises Act and Hospital Transparency, just to name a few.Pooja concurred and added that many people forget the states can add enforcement teeth above and beyond federal enforcement. She then remarked that this has been a year of anticipation and asked Kim to share where the burden reduction and prior authorization rule that was shelved back in 2020 is currently. Kim responded by explaining that there has been so much anticipation and even angst for some when the original rule came out in 2020 but then was pulled back.So many in the industry have been endeavoring to fulfill the promise the Da Vinci CRD, DTR, PAS IGs provide on solving for medical PA. Probably the most promising sign from CMS is the rule sitting at OMB since mid-October, waiting for review and then ultimately release. Given OMB has a max of 90 days to take action on the review, health plans, vendors, providers, and their partners should be closely monitoring for OMBs response and action.   Jocelyn joined in to say that the rule that came out in 2020 was definitely more than just burden reduction and it would have codified the use of patient-access APIs. She added that the 2020 rule didn't just require FHIR but named a particular implementation guide or "recipe" for the industry to use. Jocelyn anticipates that the version of the rule that has reemerged and is sitting with OMB likely includes Medicare Advantage plans which weren't included in the 2020 version. She's really interested to see what the NPRM will include. Jocelyn added that there is legislation pending that includes prior authorization and many are hoping the proposed rule drops before the legislation passes. Pooja thanked Jocelyn for bringing up the pending legislation and then moved on to ask about the recent CMS requests for information out there. She asked about what kinds of questions is the government asking and what do these questions tell us about where their heads are at? Jocelyn started by saying that the industry is seeing an unprecedented amount of coordination and policy-making activity. It has been a challenge to marshall the resources to respond to these RFIs and participate in the conversations and discussions these RFIs generate. Clearly, the industry is leading and the RFIs are an indication that CMS and ONC want industry input into their policymaking. Jocelyn went on to say that after reviewing the comments to these RFIs, the common themes were that the industry needs time and an incremental approach is needed but no one is saying what is being explored can't be accomplished. Kim added that she was struck by how aligned the agencies releasing these RFIs seemed to be on solving for interoperability, digitization, using/reusing or referencing FHIR resources for use and across different areas of health care, from the public health infrastructure, TEFCA, Certification of HIT, PAs and more, even the RFI from CMS related to the National Directory wants to hear from health care on the applicability of the use of FHIR standards. In transition, Pooja remarked that POCP and everyone on the podcast work in the standards development space through the support of some of the Accelerators like FAST, CodeX, CARIN Alliance, and of course, Da Vinci. She asked for the discussion to now cover the biggest accomplishments so far and what's expected in 2023. Kim responded by saying that while not officially announced, the CodeX PA in Oncology Use case – focused on solving for automating PA for cancer patients using the Da Vinci IGs is progressing to the Execution Phase. Members represented in this use case are payers, EHRs, physician groups, and health systems and they have collaboratively moved the needle on this use case and will execute the proof of concept for prostate cancer in 2023. Kim added that she is proud that NCPDP for their October Pilot launch announcement of the National Facilitator Model to strengthen pandemic and epidemic preparedness using industry standards and technology to enable pharmacies, prescribers, and government agencies to access real-time information on prescription, testing, immunization, and related data – across state lines - to support patient health interventions during public health crises. The model can also be used to effectively support public health surveillance.Jocelyn chimed in to express her awe at the pace of work on IGs and new use cases. She added that another big milestone is that FHIR at Scale Taskforce (FAST) transitioned out of ONC into the HL7 Accelerator program. FAST progressed work on Security, Identity, and Exchange and they are pulling the TEFCA team in to align their work. She added that Da Vinci has made a lot of progress on Risk Adjustment, allowing payers and providers to share information to inform a change in a patient's risk status. Jocelyn went on to say that there are also some exciting real-world implementations happening with a specific shout out to the team comprised of MultiCare, Providence, Regence, leadership from Optum, and Da Vinci champions launching the first in the nation FHIR-based pre-authorization embedded into the clinical workflow. Pooja seconded the kudos for the NPCPD vaccine pilot and she also mentioned the CodeX REMS use case which is marching toward a pilot and is once again bringing NCPDP and HL7 together. Pooja went on to recognize Helios as an Accelerator that is starting to gain traction and the industry should pay attention to their work. Pooja commented that while price and cost transparency for the patient will always be a passion of mine, the growing role of pharmacists in the care team is another area she is really excited about. Additional services are being performed by pharmacists, the prescribing authority is being extended to pharmacists, and the need for standards and technology to enable clinical data to flow from pharmacists to care team members in other environments like doctors' offices and hospitals. Pooja continued by saying that the pandemic and really the Federal PREP act accelerated this movement.  Now pharmacists can administer pretty much any vaccine on CDC's list, and there are around 25 states that allow pharmacists to prescribe HIV medications. Pooja explained that this expanding role and some of the regulatory requirements make pharmacy interoperability and connection with the rest of the care team critical. For example, for pharmacists to prescribe Paxlovid, they must order or access labs for the patients.  Unless pharmacists are in a health system they will likely not have access to a patient's lab report.  If the industry wants pharmacists to continue to support providers and patients with more clinical services – there has to be a focus on interoperability. Kim agreed that it is an exciting time for the pharmacy community.  The need for clinical and administrative data access, use, storage, and exchange to improve and coordinate patient care knows no boundaries – the whole of the care team, including the pharmacist, must be able to operate in an environment where this takes place.  Kim added that the NCPDP Strategic Planning Committee Value-Based Care Subcommittee acknowledged that the industry is well positioned to support pharmacists as a part of a value-based arrangement and we have the standards to support all types of clinical care and exchange so pharmacists can provide services like dispensing, screening for Social Determinants of Health or taking and reporting labs or blood pressure, etc.   2023 will be filled with opportunities within the NCPDP standards development process, the industry, and policy, to further the role of the pharmacist, closing gaps in care and the innovations needed for the future of pharmacists as part of the care team.Pooja asked to do a round-robin weigh-in on TEFCA, HIPAA 2.0, and Health Equity. What's new, what's real, and what should our listeners be on the lookout for in 2023? Jocelyn responded by saying that each of these topics has so many sub-topics and what will be interesting is to see how these all intersect with one another. She added that there is a movement to the platform where companies are partnering to solve some of the challenges related to these areas and make data fluid but secure. Kim responded by saying that there is still confusion and conflict between HIPAA and the ONC Information blocking rules.  Technology has evolved and new interpretations and requirements are needed that provide patient data security without limiting data sharing.  The industry will see some movement from OCR in 2023.TEFCA is real and moving forward in establishing the infrastructure model and rules that will govern how different networks and their stakeholders (including providers, payers, and public health) securely share clinically relevant information with each other. Nine organizations have provided letters of intent to the Sequoia Project, the recognized coordinating entity on behalf of ONC, to apply to become QHINs including EHR vendors such as Epic and Nextgen, national networks such as the eHealth Exchange and the CommonWell Health Alliance, and tech vendors such as Health Gorilla. More organizations are expected to apply. It will be interesting to see how successful TEFCA will be in incorporating FHIR into the framework over the next few years There is a united effort that includes government entities, health systems, pharmaceutical companies, private payer groups, and community organizations working together to overcome disparities and improve equity. This requires improved access to shared clinical and social needs data. Just last week CMS released its “Path Forward to improving data to advance health equity solutions” which aims to increase the collection of standardized sociodemographic and social determinants of health (SDOH) data across the healthcare industry as an important first step towards improving population In closing, Pooja asked everyone to share what they are most hopeful to see in 2023. She kicked it off by saying that for her it's the continued focus on pharmacists. Kim responded by saying many great things are happening in health care and that she is excited as a patient. There is more focus on helping patients grow as consumers of their own health care, providing data and insights into what options are available to obtain quality, timely and cost-effective care. She also expressed excitement about working with industry and policymakers to advance medical ePA in 2023 via the HL7 Da Vinci standards and leading the CodeX work on a pilot to advance PA for cancer patients. She concluded by echoing what Pooja said about her excitement about leading and partnering with others at NCPDP to promote and advance the role of the pharmacist as a part of the care team. Jocelyn joined in to say that she is hopeful for the momentum that has built up and she is super excited to see stakeholders build their toolboxes and embark on real-world implementations. Pooja closed out the episode by thanking her POCP cohosts, Jocelyn and Kim, and wishing our audience the happiest of holidays and the best for 2023. She reminded listeners that they can find The Dish on Health IT on Apple Podcast, Spotify, or whatever platform they use to pick up their podcasts, including HealthcareNOW Radio and the Podcast Channel. And that videos of the podcast episodes can be found o on the POCP YouTube channel. Adding, Health IT is a dish best served Hot! 

Ken Kleinberg, POCP Innovation lead and host for this episode kicked off the episode by welcoming guest, Scott King, Chief Technology Officer at Vibe Health, by eVideon and co-host,Pooja Babbrah, POCP's Pharmacy & PBM Lead.Ken set up the episode topic explaining this episode will explore use cases and technology like hospital in-room technology integrated with the EHR and other systems that can keep the patient and their families informed as well as support provider staff. Ken explained that so often we talk about patient engagement and data access through the lens of patient-facing apps or ambulatory doctor visits but what about during hospital stays? The discussion will cover the use cases Vibe Health works to solve, the role of APIs, FHIR or not, and the interoperability landscape from policy to standards. Ken then asked Pooja to briefly introduce herself and for her to explain what she's looking forward to exploring and learning today. Pooja explained that because a lot of her work in interoperability deals with client-facing data, she is really excited to learn more about the technology that is being used in-hospital rooms because that isn't an environment normally discussed when thinking about patient-facing data.Scott King then introduced himself as the CTO of Vibe Health by eVideon. He went on to describe the Vibe Health platform as an interactive patient experience platform that is generally in and around the hospital room. He explained that over the last several years it's also become a staff experience platform. Scott described that platform as running on multiple devices in the room like the smart television, digital whiteboards, companion bedside tablets, and digital signage outside the room. The idea is to put the right information and controls in the right place at the right time.Scott delved into the staff experience component of the platform by giving an example of the whiteboard in most patient rooms. Many times, the nurses are expected to keep the information on the whiteboard up to date, but when it's digitized and the information can be taken directly from the patient record and displayed, the nurse's time is freed up to focus on more important duties. Ken thanked Scott for providing the introduction and background information. Ken went on to set the stage a little more for the rest of the discussion by saying that, we so often think of patient access to their data, patient engagement, and education as happening between doctor visits or during a doctor visit but a patient's experience during a hospital stay is also really critical. Ken went on to ask Scott to describe the unique challenges a patient might face in their hospital room and how smart-room technology including access to their data and customized education might help. Scott responded by saying that in the past the television and other tools in the hospital rooms were simply one-way mediums. The television was there to provide entertainment, and the whiteboard was there for the nurse to capture important information for the patient and other staff on duty but as technology has advanced, there are more opportunities to digitize these tools and make them interactive tools that can be more useful. Scott went on to compare hospital rooms equipped with interactive, smart TVs to hotel rooms where the patient can be greeted by name with personalized information on the screen. With smart TVs, the patient can use it to access relaxation content, set white noise to drown out beeps and buzzes common in the hospital setting. Additionally, it can be used as a tool to get the patient ready for discharge by using the smart TV for educational videos and content that will help inform the patient about their condition, dietary recommendations, or post-visit instructions without requiring the nurse to have to set it up. Once a patient views this assigned education, it can be noted in the medical record automatically which is another thing the nurse won't have to do. Ken agreed that most of us have either had a hospital stay or visited family at the hospital and that we can all imagine the challenges he described and how more real-time access to data would be helpful to patients, their families as well as the staff taking care of them. Ken then asked about what happens when the patient leaves the hospital and whether they will still have access to the data and education videos and content they could see in their room via the Vibe Health Platform. Scott responded by explaining that patients are in high-stress situations in the hospital and may very well get home and want to re-watch an education video when they get home and are less in pain or groggy. Through Vibe Health technology partners, many times hospital systems will make links to these videos and other content available to the patient post-discharge. Ken then asked Pooja to share her thoughts, because her work has her thinking consistently about patient-facing data exchange.Pooja shared a personal story about her daughter suffering a head injury earlier this year and there were still some COVID restrictions in place that impacted the number of visitors resulting in her husband and her having to take turns visiting. Additionally, overnight visitors were not permitted. Having an interactive way to have the most up-to-date information about her daughter without having to wait for a nurse or a doctor to come by would have been really helpful and made the situation less stressful. Pooja went on to say that she does work with the CARIN Alliance which is the patient-facing HL7 Accelerator. She described the patient stories she's heard that support the need for more data and more interactivity. Pooja posed a question about how this type of technology might positively impact medication adherence, which is another area Pooja is passionate about. Patient education and instruction about how to take medication are really critical and the patient getting the instructions while they're in the hospital and having the ability to access it afterward could have a significant impact on adherence. Ken thanked Pooja for her insights and went on to ask Scott to cover a topic covered during the prep conversation about the move by many hospitals to have cameras in all hospital rooms to enable virtual rounds, and monitoring and to give patients access to video calls with family members. Ken asked Scott to explain how Ken also asked Scott to talk about whether patients who might want to opt out of that for privacy reasons can do so. Before Scott answered Ken's question about cameras in the rooms, he went back to Pooja's comments about medication adherence. He explained that there is more that can be done to improve adherence. He pointed out that many times part of the problem is that patients never pick up their medications. The Vibe Health platform can help automate getting those prescriptions filled by the hospital's outpatient pharmacy, if they have one, so the patient has their medications in hand when they are discharged. Scott then came back to Ken's questions about in-room cameras. One of the main use cases for in-room cameras is offering ways for family and friends to visit the patient if they can't come in person. This was a big deal during the pandemic but continues to be important when the patient may have family across the country. Vibe Health offers the Hello platform to help support these visits and reduces the nurse or other staff having to serve as a help desk video calls. Scott described another emerging use case for cameras in hospital rooms for virtual monitoring. This has started to become standard in ICU rooms but now hospitals are seeing value in putting cameras in every room. This allows for specialists that may work out of a hospital across town to seamlessly visit the patient without having to drive through traffic to get to the patient in person. Some patients also require a sitter for patients that are a high fall risk, cameras in the room allow for this monitoring to occur virtually. Virtual rounding is another use case where cameras in-room can improve efficiencies. The Vibe Health platform can also integrate with telehealth platforms to automatically start virtual visits through the smart TV and then after the visit is over the TV can automatically go back to what the patient was doing or watching before. Patients are always made aware if there is a camera and if it's on. Over the last few years, the resistance to having a camera in-room by patients has come down a lot. Ken asked Scott to talk about the locationing capabilities of the platform and to describe some of the use cases around that. Scott explained that real-time location systems or RTLS can be used in a lot of different ways. One of the more common use cases is for locating equipment like IV poles, that have been labeled with a radio tag. It can also be used for patient tracking to make sure the patient is where they are supposed to be. Where Vibe Health has seen great value in using RTLS for staff tracking. For staff wearing a badge, the system can update the screen with the provider's name and picture on the screen to give that additional info but it also gets documented on the digital whiteboard so the patient and the family can see everyone who has been in the patient's room recently. Ken then switched gears a little and asked Scott to describe the health IT approach Vibe Health uses to make these integrations. Ken asked if Vibe Health is using FHIR and what the health systems Vibe is working with are usingScott explained that their first system went live about 15 years ago. At that time, they were told to support HL7. Admission, Discharge, and Transfer (ADT) data is the foundation data. So far, Vibe Health hasn't transitioned everything to FHIR because they need real-time information that is pushed from the EHR to the digital whiteboard or other tools vs having to query the system. There are some use cases where Vibe Health uses FHIR, but they are waiting for the FHIR subscription standard to get published. Ken found the explanation interesting and wondered if there is an opportunity for data exchange and access in the patient hospital room setting for some new use cases for the standards community to take on. So, somewhat tangential to the standards discussion what are your thoughts on where the industry is with interoperability in general and the role policy requirements play? Do you think ONC naming specific FHIR Implementation Guides in upcoming policies will help progress the industry by having a common playbook or is it too limiting? Scott responded by saying that the transition to more modern standards is a good thing. One of the things Scott has noticed is that there seems to be a shortage of developers that know HL7 standards including FHIR, so they are seeing the use of JSON and RESTful APIs. Ken asked Pooja if there is anything she'd want to add or ask here. Pooja added that as the chair of the board for NCPDP and currently working on the strategic plan, one of the comments recently was that they shouldn't be building standards for standard's sake. She went on to explain that standards have to be usable, workable, and make sense and that how patients access their data is still an area ripe with opportunities for standardization. Ken thanked Pooja for her input and then recapped the discussion briefly saying that Vibe Health platform serving up patient data and educational content has been covered. Ken then wanted to know about writing data into the EHR. Can a patient, for example, update their health family history? Scott confirmed there are some use cases where the Vibe Health Platform can write information back into the EHR like when a patient has finished watching an education video and then capture the post-educational comprehension survey and that completion can be written back into the EHR. Other information like pulse surveys on patient satisfaction with food or if another request was satisfied, while important data for the hospital, wouldn't be written back into the EHR. Pooja asked where there was a health equity piece to this capability as far as confirming understanding and comprehension and even maybe capturing consent after confirming the patient understands what they are consenting to. She went on to say that she sees this as an opportunity. Scott agreed to say that right now the system knows the age, ethnicity, preferred language, preferred pronouns, and all of that and it's possible to correlate that information with how the education or other content being provided is being served up and understood. Ken closed out the discussion by asking Scott if he had any final message or calls to action for the audience. Scott responded by saying that he'd want folks to realize that there are so many different technologies in the hospital setting and it's Vibe Health's goal to try to automate and allow all these different technologies to talk to each other and work contextually. He gave the example of having the TV automatically mute or turn off during a code blue. The second thing Scott wanted to highlight is that the sooner the FHIR subscription standard can be published, the better. Ken thanked guest, Scott King, and co-host Pooja Babbrah before reminding listeners that they can find and subscribe to The Dish on Health IT podcast on Apple Podcast, Spotify, or whatever platform listeners use to pick up podcasts and that videos of episodes can be found on the POCP YouTube Channel.

This episode's guest is Dave Navarro, Senior Director of Data Science for Harmony Healthcare IT, a data management and lifecycle solutions firm. Dave joins the Dish on Health IT host, Ken Kleinberg, and co-host, Jocelyn Keegan,to talk 21st Century Cures Act and the change in the definition of “EHI”, critical components of plans to purge, archive, or transition data to new platforms, and how to marry data in various formats and versions of CCDA and FHIR. Ken kicked off the episode by asking co-host, Jocelyn Keegan, to briefly introduce herself and to share what she's looking forward to learning from today's guest.Jocelyn responded by explaining that she is the payer-practice lead at POCP, devoted to positive change and building/getting stuff done. She went on to say that her focus is on interoperability, prior authorizations, and the convergence of tech, standards, and product strategy. She also serves as the program manager for the HL7 Da Vinci Project. Da Vinci started as a conceptual idea of emulating the great work produced by the argonaut project but with a focus on payers and providers, value-based care, and clinical data interoperability and has become likely the most expansive of the FHIR Accelerators to date, focused on payer-provider collaboration.Ken then asked guest, Dave Navarro to briefly introduce himself and to include his professional background and journey to Harmony Health.Dave reiterated that he is the Senior Director of Data Science at Harmony and that he started his career about 22 years ago in the health IT world. He explained that he started by configuring EHRs and building clinical integrations for financial systems and clinical systems for Cerner Corporation.Dave explained that early on he had a lot of exposure to different data formats and files and that he's been spending the last 17-plus years in the health information exchange world. He landed at Harmony Health to work on the interoperability of legacy data and the legacy data solutions Harmony provides.Ken asked Dave to expound a little more on the work Harmony Health is doing.Dave explained that Harmony helps their clients' archive data from a legacy system or in some cases transition data from a legacy system to a new system.  If data are archived, they must still be in a format that can be managed, accessed, and consumed to inform clinical decisions.Harmony offers the Health Data Archivers solution, which includes extraction services. Clients can also earmark data that they'd like to have posted in their new system.Ken then shifted the conversation by asking how the industry as a whole or different stakeholders in particular view 21st Century Cures differently and whether Dave wishes there was a perspective the industry would share about how they approach compliance.Dave started by admitting that he hasn't read the entire 21st Century's Cures Act but has familiarized himself with the portions related to interoperability. He shared that he believes this legislation is a good thing. Dave pointed out that while it was signed back in 2016, the industry is just now seeing the results.He explained that he believes Cures has pushed the industry towards the adoption of content standards such as USCDI and transmission standards like HL7 CDA and now FHIR. Dave then went on to talk about the data blocking provision explaining that nobody wants to be a data blocker. This portion of the Act helps open the data stream and make data available where EHRs and ultimately patients can view it.Concerning what perspective he wishes the industry would share, Dave explained that it's about FHIR. He realizes that FHIR is a little bit scary to some, but that the industry should be starting with FHIR. Dave explains that one reason he believes this is the relative ease to understand and use FHIR compared to CDA, which has been a bit challenging to figure out. He went on to say that with FHIR, someone can study an implementation guide for an hour and pretty much figure it out. Dave also pointed out the FHIR US Core data set as being a good specification.Dave then went on to explain that while FHIR isn't an architecture guide it can be used to help make architecture decisions when an implementer is getting started. He added that FHIR builds on the work the industry has done on CDA and takes the lessons learned and fixes a lot of what the industry was frustrated by with CDA.Ken asked Jocelyn to share her view of Cures based on her day-to-day work as program manager of Da Vinci Project focused on payer-provider data exchange. Jocelyn expressed that everything Dave said is so incredibly important. From the Da Vinci perspective, she explained that there is an ongoing dialogue about the intersection of and confusion about the year-end USCDI V3 and FHIR R4 capabilities along with everything in the electronic health information (EHI) requirement.  Joce expressed that this is a great example where folks are looking for additional guidance before making new investments. She explained that most EHRs have a big lift to meet that requirement in a meaningful way. Joce continued by saying that FHIR alone isn't necessarily going to get the industry to the semantic interoperability that it's striving for but that if the industry would pick up the FHIR implementation guides in addition to the more advanced workflow guides, the industry would be making progress toward where it wants to be.The group spoke briefly about the expansion of the definition of EHI to expand outside of USCDI V1 and that many stakeholders are not ready to meet the October deadline. Dave pointed out that ultimately every journey starts with one step, and everyone just needs to pick a place to start which ideally would probably be USCDI V3, and start the work.Jocelyn pointed out that by nature stakeholders under regulation want to achieve certification She went on to say that investments were already made in CDA & CCDA and there's lots of CCDA data moving around. She went on to add that the big question is how the industry is going to manage the collision and misalignment of data formats. And how will the industry decide what needs to be codified, and cleansed and what's OK to remain unstructured? There are several stakeholders in the industry that have stood up to say that it's important that data created today needs to be usable and shareable going forward.Dave shared the experience he's had working in the historical archive world. He explained that for the most part, he encounters more organizations simply interested in checking the regulatory and requirements box, but that Cures pushes toward data being structured and codified simply by setting the expectation that patients will be able to access all their data which means that data, even unstructured data isn't going away. He went on to say that even if only minimum pieces of data or data from specific timeframes are migrated to a new system, archives must be able to be queried so a patient can access that data whether it's in the current EHR system or not.  The perpetuity of data required by the info-blocking rule must change the industry's mindset.Ken asked Dave to share some of the surprising or challenging questions from Harmony clients or notable projects. Dave explained that sometimes clients can share their entire database at the start of a project and this is ideal so the Harmony team can go through everything, and it makes extraction a little easier. What is being seen in many of these projects is that as the team goes through and looks for NDC codes, signature lines, problem descriptions, or allergy lists, the data isn't codified. This information will be there as text. For this data to be queried from any archive, it's got to be codified.Dave added that they use the specifications from USCDI and cross-reference them with FHIR US Core. Dave continued to explain in more complex detail some of the data types and mapping that occur to ensure the archived data can be queried effectively in the future. Dave pointed out that as painful as it sounds, he has been through every single element in the FHIR specification for US Core. He expressed how well put together US Core is and it's critical to how they do their work.Ken then asked about how consent is handled during these archiving projects. This led to a robust conversation with Dave sharing that consents get archived if they are found, however the most recent consent on record in the current EHR would likely be applied to how any data pulled from the archive would be shared.The group went on to discuss the complexity of consent and the importance of establishing and maintaining eConsent in a scalable way. Jocelyn pointed out that through the discussions she's had with stakeholders and through her personal experiences, the industry needs to solve this so that patients can manage their consents in a secure, central place so they can update and change their consents based on their changing lives.Jocelyn then shifted the conversation toward the nature of adoption. She explained that she's heard some express resistance to FHIR because they perceive a push to rip and replace everything with FHIR. Jocelyn shared that she and most other industry leaders aren't proponents of that rip-and-replace concept but rather an incremental adoption approach where you adopt and use FHIR in the use cases it can best support and that FHIR can co-exist and interact with other standards. Jocelyn asked Dave to share his thoughts on FHIR adoption.Dave responded by saying that as much as he's been talking about FHIR, he doesn't yet have anyone with FHIR capabilities coming to query and retrieve data. Dave explained that what he has seen are stakeholders on the eHealth Exchange are part of Commonwell and they're familiar with exchanging data via those networks primarily using CDA formats. We start with where our clients are now but it's important to have FHIR capability built in so multiple formats are supported. He went on to say that in some instances you may have an instance where a FHIR API is used to request data in a CDA document. The industry certainly isn't going to be purely FHIR anytime soon if ever.As is tradition, Ken asked Dave to close out the podcast by sharing what he would like to see from the industry.Dave joked that as cliché as it must sound, interoperability is a journey and not a destination. The industry isn't going to fix everything by some policy deadline, and we aren't going to solve everything with just FHIR alone.Dave went on to say that the industry can learn a lot about how to architect their data by examining these standards to help guide those decisions. While FHIR is not intended as a data model, it is a good specification that can inform a well-formed database.Ken thanked guest, Dave Navarro, and co-host Jocelyn Keegan before reminding listeners that they can find and subscribe to The Dish on Health IT podcast on Apple Podcast, Spotify, or whatever platform listeners use to pick up podcasts and that videos of episodes can be found on the POCP YouTube Channel.

This episode features special guests, Ceci Connolly, President and CEO of Alliance of Community Health Plans or ACHP and Virginia (Ginny) Whitman, Sr. Manager of Public Policy for ACHP. They join host, Pooja Babbrah, filling in for Ken Kleinberg and co-host, Jocelyn Keegan to discuss ACHP's perspective and work on building trust between payers and providers and why that's important, how price transparency policy is translating into real-world changes, and the cultural shift happening as more data becomes shareable. Pooja kicked off the episode by having Jocelyn briefly introduce herself and share what she's looking forward to learning from the discussion. Jocelyn shared that she recently had the good fortune of presenting at an ACHP conference in May where she met a lot of the community members.Jocelyn went on to share that she's been with POCP for six years as the Payer Practice Lead and has been focused on interoperability and the convergence of sharing clinical data between payers and providers to help automate interactions like prior authorization and support value-based care. Pooja then asked each guest to introduce themselves and share how they came to work with ACHP. Ceci Connolly shared that she is the president and CEO of ACHP now but had a 25 year-long career in journalism before catching the healthcare bug. She recounted that she was covering healthcare and specifically that passage of the Affordable Care Act which led her to pursue a second act of her career which entailed working the McKinsey and helping them set up the Center for Health Reform before moving on to lead the Health Research Institute at PwC before landing at ACHP. She expressed how fortunate she feels to havean amazing group of members and a passionate team that's aligned to take healthcare where she believes it needs to go. Ginny Whitman introduced herself sharing that she's been with ACHP for almost four years and that it was only a few months into her tenure that a dear friend and colleague pulled her into the world of health policy. She continued by saying that she's been focused on exploring what health plans need, what their pain points are and where can they excel and do wonderful and creative things to support their communities. Pooja then asked for Ceci to share more about ACHP, it's mission and the work it's been focused on most recently. Ceci responded by saying that the ACHP member criteria is essentially also the mission. ACHP represents not-for-profit provider aligned regional health plans adding that many of those are plans that are in big integrated systems across theShe explained that many ACHP members are smaller and local in their communities with tight relationships with their provider community which often include risk arrangements which ACHP believes is a model with a bright future for healthcare. Ceci went on to say that ACHP members are very much about access for all in their communities and focused on health as opposed to acute care. She relayed that the ACHP roadmap set by the board of directors includes setting a course to really serve the consumer, meet members where they are and improving transparency and data fluidity so consumers and providers both have the data they need to make the best decisions. Affordability is also a big focus for ACHP, they release a report each year and have taken a pledge on two chronic diseases, diabetes, and cardiovascular to start to move the needle in our members' communities on those.Ceci expressed that she is very positive about the recent law President Biden just signed on inflation reduction that included provisions about drug pricing which is a huge pain point for ACHP members and their communities. She explained that she is also pleased about the enhanced affordable care act provisions as well. Pooja then transitioned the conversation to focus on the theme of a recent ACHP event that highlighted the need to build and improve trust between payers and providers. Pooja asked Ceci to provide her assessment of the historic level of trust between payers and providers and why it's important to redefine and strengthen these relationships?Ceci responded by explaining that the recent event was Ginny's brainchild and would like her perspective on this topic. She went on to explain that ACHP has been hearing from all directions that trust is an issue. Ceci expressed that they were thrilled to have a keynote by Dr. Jan Berger who has written the book on the theme of trust in healthcare. There is a strong foundation to work from because ACHP members are grounded in their local communities. She explained that developments in the technology and the data arena can be positives when it comes to trust, but also pose potential risks. Ginny added that ACHP member plans have close relationships with their provider systems and provider groups but that sometimes the technical infrastructure doesn't support good communication. Part of the focus of the ACHP event was how to make technical level changes to improve that communication with providers ACHP members value so much. Pooja then asked if there were any specific initiatives or programs ACHP members have employed to improve trust with providers? Ginny explained that there are so many programs but one example she described was a vaccination campaign in Minnesota where the community health partners, using data, recognized they were missing communities of color in the vaccine effort. Stakeholders from across the community collaborated to create education and vaccination events to close those gaps. She went on to explain some other examples of partnerships and collaborations between ACHP members and their communities that help build on the foundation of trust. Pooja asked Jocelyn to comment on payer provider trust and data exchange based on her work as the program manager of Da Vinci.Jocelyn started her response by making the observation that there is a duality with how big nationals come into these regional markets and work hard to make themselves seem small and local. They will do things like sponsoring local teams, getting involved in local charities to make themselves seem like part of the community. The small plans, on the other hand, who are already connected to local provider system plans and the community, are spending all this effort to make themselves seem bigger and seem wider and deeper right out into the market. Jocelyn expressed that she finds this juxtaposition interesting. Jocelyn went on to say that the reusability of the work that's emerging in the industry around things like DaVinci and other FHIR initiatives and other standards helps create a more level playing field for smaller plans to make investments in interoperability and more easily tackle regulatory challenges. Pooja then asked what ACHP, and its members are doing around price and patient cost transparency.  Ginny responded by saying that many ACHP members had price estimator or cost estimator tools prior to any regulations coming out which put everyone in a very good place when regulations did drop. Most plans had either already met the requirements or only needed to make small adjustments to do so. She explained that the challenge now is how to incentivize the providers and patients to use these tools. Ginny expressed some concern around some future regulations particularly with some of the overlap of the No Surprises Act and the transparency and coverage rule. I'm not that worried about it, but I will say that I, I do have some hesitations and reserves when it comes to future regulations that we are expecting, um, particularly some of the overlap that was in the no surprises act part of the consolidated appropriations act and what's in the transparency and coverage rule.Ceci added that some ACHP plans are further along in this journey and are incorporating quality information for instance which starts to get at value. She expressed that healthcare is a funny world where transparency is currently defined with price. She explained that if you look at travel and are looking for a hotel, one might look at the cheapest hotel or the cheapest flight but maybe location or a comfortable bed is more important to you. It's the same in healthcare. Some consumers are going to be looking for that value package. Ceci added that some ACHP members have gotten very sophisticated and developed tools that are so easy to use but consumer uptake is still very small and slow.To make her point, Ceci highlighted a health plan in Michigan that developed a super slick tool that's extremely easy to use. The tool shows where plan members are in their deductible, what the co-pay is and where services are located. This plan put in financial incentives, and they have seen some uptick in the utilization, but it's going to take a long time and a big, big effort. In the meantime, there are all these machine-readable files out there creating an insurmountable mound of data that is challenging for payers to sift through. Jocelyn responded by expressing the important role of standardization in helping solve many of these issues. She explained that so many stakeholders are so focused on using standards to meet regulatory requirements they lose sight of the real-world problems that need solving like how to get patient important cost and value information so they can make better decisions about where they get their healthcare. Jocelyn continued to explain that here is a huge investment related to many of these transparency projects and when there is so little uptake, it can be discouraging but that the more we normalize the data using standards we can reduce the overhead cost.Jocelyn explained that it's important to get the right information to the patient at the right point in time. She went on to use an analogy of when someone is in Target shopping, they may look at their Amazon app to see if they can find the item cheaper but sometimes, if a person is on their way to a birthday party and hasn't shopped for a present yet, convenience may be more important in that moment than price. Jocelyn added that the question is how we can create information parody so the provider team and the patient have equal information about the patient's benefits so they can discuss a treatment, procedure or test and where or even when a patient may want to go to get maximum coverage. Ceci jumped in to provide an example of how a mid-Atlantic plan not only provides patients with where they can get a colonoscopy but will mail plan members a home test kit with all the pertinent information about risk factors. This helps make patients more health literate while also allowing them to take more control of their health in the convenience of their own home on their schedule. She added that it's about data, communication, and trust. If your health plan and provider sends information about a colonoscopy and home kit saying this would be good for you to do, you're probably going to do it. So, it's a win, win. Ceci explained that using data in this way to support the patient in a transparent way, it goes a long way in repairing trust in the healthcare system. Adding that if a patient is surprised by an astronomical bill, that's not going to repair their trust, but when data can be used to support conversations leading to a strategic care and financial plan, progress can be made. Pooja then zoomed out the conversation to focus on how interoperability projects are making more data flow and changing how businesses operate. Pooja asked Ceci and Ginny to describe how ACHP is counseling their members on how to approach making this cultural shift. Ceci shared that they emphasize that this is going to be hard work. She pointed back to the early days of electronic health record adoption which took about a decade. Change is hard, especially when it's something personal, like healthcare. Ceci and Ginny both expressed that they just continually beat on the drum to remind their member plans to not give up and make sure the interoperability and serving patients the best way possible through the best use of data must be a top priority, but it will take a long time. Jocelyn agreed that the cultural shift for both big and small plans is still in the early days but that there are some early adopters starting to make more substantial changes. She added that of course there are still organizations that are still checking the regulatory box versus making real, systemic changes but as CMS and ONC continue this unprecedented alignment and increased communication with the industry about their priorities, it may make it easier for stakeholders to make the changes needed. Ultimately leaders need to keep evangelizing and painting the picture of the future and what it looks like from a roadmap perspective. So really laying out where things are headed from a regulatory perspective, [00:34:00] it does still surprise me that folks are taking the checkup, check the box approach. But I wholeheartedly agree with CC and Jenny, I think that this is about evangelizing and painting that picture forward, helping people understand what the roadmap work is and that it includes APIs and a patient-centered approach. Some will lead and some will follow. In closing, Pooja asked the guests if there were any final messages or calls to action, they wanted to put out to the industry. Ceci responded by saying that she thinks this is an incredibly exciting and a bit unnerving time and that she wanted to share the mantra all ACHP members get on a laminated card which is “think big, start small, act fast” Pooja closed out the episode by thanking guests, Ceci and Ginny before reminding listeners that they can find and subscribe to The Dish on Health IT podcast on Apple podcast, Spotify, or whatever platform you use to pick up podcasts and that videos of episodes can be found on the POCP YouTube Channel. 

Host Pooja Babbrah, Senior Consultant and Payer and PBM lead kicked off the episode focused on prior authorization, reducing burden and why working ahead of final federal rules isn't as risky as you might think. Pooja filled in for Ken Kleinberg, who is out of the office on an extended grand adventure. Pooja was joined by co-host Jocelyn Keegan. They welcomed guest, Danny Brennan, Executive Director and CEO of the Massachusetts Health Data Consortium (MHDC). Jocelyn introduced herself and shared that she's literally done hundreds of hours of educating and evangelizing out in the industry about the work that is happening within HL7 from the FHIR community. She went on to explain that while doing this industry education, John Kelly, now retired from Edifecs, recommended she meet Denny Brennan explaining that Denny literally knows everyone in Massachusetts. Jocelyn continued to say that she has gotten to know Denny and the MHDC team over the last four years and has learned they are super smart, focused industry veterans filled with a lot of pragmatism about how the industry can get things done. Denny Brennan then introduced himself, sharing that he's been the executive director of MHDC for the last 10 years. Denny explained that he spent the prior 20 years evenly divided between consulting and technology services. Denny added that MHDC has been around since 1978, so going on 45 years. Denny responded to Jocelyn's point about knowing everyone, by saying0 that getting to know everybody in Massachusetts would have been an extraordinarily difficult thing if he didn't work for MHDC. Pooja then asked Denny to tell us more about MHDC before the transition over to the discussion topics. Denny shared that MHDC is comprised of everyone in the health data community in Massachusetts, some regional and some national players but that the center of gravity is the Commonwealth of Massachusetts. MHDC came about because the state, health plans and providers wanted an unbiased organization focused on health data with less focus on technology. Denny explained that nowadays technology and data are so intertwined that industry stakeholders end up moving between them more effortlessly than historically. The mission of MHDC is to create a patient centered health data system that enables the kinds of cost reductions, burden reductions, improvements in quality of care, enhancements in the patient experience, improvements in equity and access that are not possible when enterprises try to do this on their own. The MHDC motto is to start small, to start at the individual, and work from there. MHDC approaches this in a few different ways. One is to assist payer and provider members in understanding data governance in this new world. What does it mean to comply with regulations? What does it mean? What is FHIR? What does it mean to move to a world where patients are banishing their health data from the device and are connected to any and all of the services that help them achieve health? Denny continued to say that governance is just a start, to help people understand what's coming. Why? What happens if their organization doesn't do it? What happens if they do? MHDC offers exchange services that operate to provide payers and providers the ability to share data with each other. MHDC also uses the exchange service as a launchpad, or a test kitchen, to explore how to automate real time processes, like making real time prior authorization a reality. MHDC also offers a web-hosted analytics service called Spotlight to organizations. Finally, Denny explained that MHDC is also called in to support consulting efforts to help organizations figure out how to implement some of these more modern approaches to data exchange. Pooja responded that she loves the idea of the test kitchen role. She then asked him to expand more on the test kitchen idea, describe why the Massachusetts location is so important, and why prior authorization seems to be such a central focus on MHDC. Denny responded by saying that the test kitchen concept is a reflection of a personal bias of his, but also that healthcare is an industry that is governed in many respects by followership. He added that nobody wants to be the first to fall off the pier and land on their heads. They want to see other organizations do that, do it successfully, and then others will follow creating a tidal shift in adoption. Denny emphasized that it's important that organizations recognize that they won't know everything when starting out and won't know where a project may end up. He went on to explain that rather than ready, aim, and fire, the MHDC approach is more aim, fire, get ready again, aim, fire, get ready again. Interoperability is an iterative process. Denny changed analogies and said that the industry doesn't have to try to eat the entire elephant and to just take one bite at a time.Denny further explained that the test kitchen is a way for organizations to start with what is known but to reduce the risk so an organization can experiment without basing major business operations on it.Denny transitioned to talk about why prior authorization is a major focus of the work that happens in the test kitchen. He explained that it's because everybody hates prior auth. PA involves patients, physicians, and health insurance plans. Denny observed that it seems everyone would like to do it better but has a different idea about how to do it better based on their perspective. The MHDC approach is that this is a business process that, if automated, will enable organizations to automate other things that are far less complex. The work undertaken to automate PA could take a big chunk out of what goes into avoiding another industry focus, surprise billing. Denny stressed that MHDC is a consortium and brings members, who are both competitors and partners, into the same room to tackle what is essentially infrastructure challenges they all face. This type of collaboration allows MHDC to learn what their issues are, what their fears are, what their concerns are and we can start addressing those right up front. Pooja then shifted the conversation and asked Denny to explain the Automation Advisory Group including its maturity, how many members are participating and whether listeners can expect any reports or other outputs.Denny explained that the Automation Advisory Group is being done in partnership with the Network for Excellence in Health Innovation (NEHI) and the effort is one side of a two-sided coin that MHDC is using for prior auth. The other side is prototyping, a real prior authorization implementation in an automated compliant, industry standardized way so it can be replicated and scaled across multiple payers and providers. MHDC is starting with one payer and one provider, one technology company to take a bite out of the first piece of prior authorization sticking to the rules, sticking to the standards and learning from the experience. The Automation Advisory Group is made up of about 40 approaching 50 individuals, representing payers, providers, hospitals, medical groups, individual physician practices, vendors and policy makers, that will be assembled over the course of the next year or two. Denny went on to say that MHDC's strong suit is bringing together a coalition, a consortium of representatives from across the industry in Massachusetts and nationally to tackle problems together. Government participation includes Center for Medicare and Medicaid Services CMS, the Office of the National Coordinator (ONC), Massachusetts Executive Office of Health and Human Services as well as the Health Policy Commission. The effort is being funded by a mix of vendors, technology services companies and the Health Policy Commission. The goal is to take the Commonwealth of Massachusetts and automate prior authorization statewide in two years which will require legislation. Regulators were brought to the table so they can get everything they need to create a meaningful law. The idea is that this law should not just be a stick, but also offer carrots in the form of implementation and technical assistance. Jocelyn responded to Denny by saying that this Automation Advisory Group is providing a great test bed that allows organizations to see how certain products and technologies can be leveraged but to also think about the business processes that will need to change. Joce explained that there are hard decisions about what happens when new technology is applied in the real-world. Jocelyn continued by saying that the industry is at a sea change where standards have a critical role. Jocelyn then expressed how thankful she is for organizations like MHDC who are willing to be forward first and that she wishes there were more organizations out there doing this kind of work and recognizing that there is a competitive advantage to starting down the path early. Jocelyn went on to say that this work is a set of building blocks putting together the right technology with the right processes to solve problems rather than checking a regulatory box. Pooja asked Denny whether he felt like it was risky for organizations to move toward automating prior authorization before the PA and burden reduction rule is re-issued. Denny responded that there is always a risk at being out in front, but the risks are bounded by the fact that you stub your toe in a relatively circumscribed implementation and you move on. The downside risk of not moving forward is you don't know what you don't know and can be caught flat-footed when a project has a longer lead time than expected or requires expertise or resources an organization doesn't have. Denny further explained that the emergence of acute need for telemedicine during the pandemic has made the use case for innovation more clear in some cases which helps make the decision to act a little easier. Denny added that the risk of a failure to implement is much higher than being out in front. Denny continued by saying there is a convergence of consumer demand for information and transactions to be more real-time and at their fingertips in the same way they get it from their bank or shopping on Amazon, policy to drive interoperability and standards and technology to enable the shift. Denny concluded by saying that consumers will find the payers, providers and tools that meet their needs so if an organization doesn't act, there is a huge risk of losing customers, members, patients to competitors that have done the work to be interoperable. Jocelyn responded by commenting on the unique Massachusetts landscape due to the competitive payer market. There isn't one predominant payer that owns most of the market. Jocelyn went on to say that another thing that is different now is that CMS and ONC are looking to the industry to lead, they are watching and listening to what is happening and making policy to spur the rest of the industry into the direction of what seems to be working which is APIs. Jocelyn expressed her complete agreement that there is more risk in doing nothing rather than taking on incremental projects and incurring some risk but moving the needle. Jocelyn continued to say that we know these projects will take longer than people think and that means that those choosing to do nothing and wait policy to force change will be at a huge disadvantage. Pooja followed up by asking about the seemingly increased coordination between CMS and ONC in their policy making and wanted to know whether Denny felt this coordination made their overall rulemaking stronger and more robust. Denny responded by explaining that MHDC knows Micky Tripathi, the National Coordinator well because he is a Massachusetts native and used to manage the Massachusetts eHealth Collaborative. Denny continued by saying that Micky knows the provider side of the business extremely well, he understands APIs and knows technologies. Micky also knows moving providers to interoperability is an entirely different exercise than moving payers to interoperability. He also knows there are deep cultural shifts that must happen. Denny went on to say that because the industry initially built enterprise level electronic medical records, health data was sort of feudalized and in many ways, providers were incentivized to hold on tight to their data. This enterprise level approach did not develop the kind of agility required for interoperable data exchange that will better support patient care but the industry didn't know then what it knows now. Denny continued to say that with respect to ONC and CMS that when the first rule was published from CMS about prior auth. The rule was groundbreaking because it brought the agencies together and put the patient squarely in the middle. This was a different approach from focusing on the bickering that had been happening where providers arguing they weren't paid enough and payers arguing providers spent too much. CMS and ONC, rather than saying payers and providers start getting along, they said, you've forgotten about somebody, the patient, the consumer, the member, the person, the individual. There are 330 plus million of them and they are a critical part of solving healthcare problems. Denny concluded by saying that neither payers or providers want to seem like they don't care about the patient and ultimately consumers need access to information to help make the best healthcare decisions. Pooja expressed her agreement that the patient should be the focus and asked Denny to describe his future vision of healthcare. Denny responded by saying that he believes that having patient advocates at the table will help get us where healthcare needs to be. He clarified by saying that by patient advocates he means people who can give voice to the type of data that is most needed by patients and their caregivers to make the best decisions. He explained that health plans and health systems in the healthcare delivery business may lose sight of those granular patient needs because they are dealing with administration, regulations, and compliance. Denny continued to say that another movement that is huge is health equity. With equity the industry doesn't yet know what to measure to make an impact. Denny recommended that everyone start small instead of trying to set up a great big equity initiative. Denny added that instead of trying to envision the perfect equity solution, which is impossible to envision because everyone is different, start with something that supports the disadvantaged members of your own community. Try out something on a smaller scale, see what works and build on it, just take a bite out of the problem.In closing, Pooja asked if there is a final message or call to action that Denny wanted to pass along to listeners. He responded by saying to get outside of your organization, meet with business partners and competitors and recognize that many of the challenges they all face is about infrastructure not sources of competitive differentiation. He went on to say the industry needs to lay the railroad tracks or the highway system or the power grid. He expressed that the industry is building something that will make it possible for us all to live better and do business better and care for patients better than before, but it can't be done in silos. He encourages the industry to come together. He continued by saying that as organizations start working on things and start winning, however small, people will start coming to those organization because they've done something that hasn't been done elsewhere. Denny concluded by saying that organizations just need to take a step, however small, and to not forget about the patient. Pooja concluded the episode by thanking Denny for joining the podcast as a guest and thanking Jocelyn for being a fun and informative co-host along with a reminder to any new listeners that they can find The Dish on Health IT on Apple Podcasts, Spotify, Healthcare Now Radio and the Podcast Channel and that videos are posted on the POCP YouTube Channel.  

Ken Kleinberg, Practice Lead of Innovative Technologies at Point-of-Care Partners (POCP), and host of The Dish on Health IT kicked off the episode by welcoming co-host Jocelyn Keegan and our special guest, Gabriela Pelin, Chief Innovation Officer with Avaneer Health. This episode will feature a discussion on how Avaneer Health is establishing a trusted network to streamline health care processes, the technology they're using that significantly includes blockchain and the vision they have for the industry. Ken explains that he first met the folks at Avaneer, a couple of HIMSS conferences ago and he's been excited about the work they're pioneering ever since.Jocelyn Keegan, Payer Practice Lead at POCP introduced herself explaining that she is a devoted change agent focused on getting stuff built and done for real. She went on to say that her focus, at POCP is on interoperability, prior authorizations, and the convergence of where tech standards and product strategy happens. Jocelyn also conveyed that she is the program manager for Da Vinci Project, which is probably one of the most expansive FHIR accelerators to date. Jocelyn explained that she is excited to hear from Gabriela and the work that Avaneer is doing, especially with the introduction of technologies like blockchain into the space. Guest, Gabriela Pelin thanked Ken and Jocelyn for having her on and expressed excitement to be part of the podcast. She began introducing herself explaining that her career seemed to constantly land her in the middle of transformation or innovation. Gabriela went on to say that luckily, over the past three and a half years, she stumbled over blockchain technology. She discovered that blockchain is a fascinating technology that enables people to work together. Her drive for innovation was immediately stoked and she was propelled to understand it. She went on to explain that Avaneer has many people at the table from very influential payers and providers who are all very interested in how to make progress in applying blockchain in healthcare. Ken then asked Gabriela to give a high-level overview of Avaneer health, their founders, participants, targeted use cases, and the network being established. He explained that he thinks most listeners will likely be wondering if Avaneer is like a clearing house or other entity already out there.Gabriela explained that the founders of Avaneer talked for a long time with founding network members about the purpose of the work, why the network needed blockchain and what about the industry needed to change. Each discussion brought them back to wanting to improve the patient experience and outcomes because each person either has been, will be or have a loved one that is a patient and that it was imperative to improve the overall experience and outcomes because all people deserve better. Gabriela went on to explain that the health care market is notorious for discrepancy in interests between the different players in the market, and they don't necessarily naturally work together to solve broader, industry problems. Avaneer wanted to create a network that would allow these stakeholders to come together to fix these issues for all patients and their families. Avaneer wants to reimagine the industry, and all of the steps in the back-office administration and care delivery so that we can accelerate healthcare, Gabriela explained that this is how they came up with the idea of connect once and consume many solutions, many use cases and connect direct. Moving forward, Avaneer wants payers, providers, pharmacies, clearing houses, really anyone needing to exchange clinical and administrative data to be part of this all-inclusive network so that everybody can connect directly, and we can make a difference for people.Ken then asked for Gabriela to list founders and members, and to describe some of the use cases Avaneer is tackling first.Gabriela explained that Avaneer has payers like, Anthem, Aetna, CVS, and HCSC. Those organizations are considered visionaries in terms of the different projects they take on to move the market and make a difference for their members. Cleveland clinic, known for its innovation in the industry, is also a member. She explained that Avaneer members so far are early adopters and that there are also members from the financial and broader technology industries participating like PNC Bank and IBM. The participation of these non-healthcare companies brings a different point of view and an important balance throughout the journey. Gabriela closed her commentary about members by affirming that it's good to have a diversified group since Avaneer wants to be all inclusive,Gabriela then went on to explain the initial use cases Avaneer is tackling. Coverage and eligibility data is one of the first things Avaneer will be tackling to make sure that all parties have access to a patient's coverage information, information related to services performed by whom and when and that everyone has access to the same copy of the same information. Gabriela explained that if everybody's on the same page and the communication is direct, then you can cut steps between what is your eligibility, what are your benefits, and here is the payment from the insurance company. Avaneer believes this can be accomplished, even if it's a difficult process, by using blockchain. Ken turned the floor over to Jocelyn to comment on her thoughts about what Avaneer is trying to accomplish. Jocelyn expressed excitement about the network and the use of blockchain. She explained that through her work with Da Vinci and in her projects at POCP, she's recognized that the claims database is the only place considered a source of truth and there isn't currently a lot of transparency with the patient and the provider about what a patient's specific benefits are at a specific point in time. Jocelyn then asked Gabriela to talk about what this kind of transparency would look like in the real world for payers, providers, and patients and to explain what these initial Avaneer projects really look like. Gabriela stated that the work is still new but that the technology stack has been deployed. Avaneer founding members are focused on completing the technology stack and getting a few applications running this year. Once that goal is met, Avaneer wants to open the network to the market. Ken asked for more details about the technology Avaneer is using whether blockchain, FHIR or cloud. Gabriela explained that the industry has been moving towards the cloud at a steady pace even if it's only really picked up steam over the last couple years. The core Avaneer architecture is cloud-based as a basic layer and network management layered over to ensure its scalable and increased traffic can be routed over time. Additionally, the information that can be allowed or should be disallowed based on HIPAA rules must be programmed in based on roles network members will assign to their employees. Blockchain as a service is the other part that allows members to build on basic blockchain but ensures that everyone has agreed to the same process. She observed that Avaneer is learning from the work of Da Vinci regarding how to get multiple stakeholders to agree to a joint process. The discussion moved to talk about FHIR, the HL7 Accelerator program and other standards development happening and how more stakeholders seem to be coming together to collaborate and contribute to standards development to solve these bigger more complex issues which is ultimately going to move the industry forward. Ken then shifted the conversation back to TEFCA and other organizations like Carequality, the eHealth Exchange, CommonWell and asked Gabriela to describe how Avaneer compares or fits in with these initiatives. Gabriela explicated that they are appreciative that the industry has made progress with the initiatives Ken named and that Avaneer sees them as supporting the traditional point to point connection. This approach enables one transaction between willing parties, whereas Avaneer is trying to solve for this problem of payers and providers constantly having to review every single solution that they want to implement on their system. So Avaneer is building this network to allow one connection to consume many services. This would allow members to essentially review security and other connection considerations once and then perform transactions or use solutions as needed. Gabriela reminded Ken and Jocelyn that they are still in the stage or proving their approach works.Ken followed up by asking whether Avaneer is considering becoming a QHIN under TEFCA. Gabriela said that Avaneer met with ONC. And that during those discussions it became clear that HIEs are using technology from 20+ years ago and Avaneer wants the opportunity to build new solutions from scratch instead of patchworking into already old and deteriorating technology systems. Jocelyn then asked Gabriela how she would want listeners to the podcast to get involved or figure out how to align with Avaneer or adopt something like blockchain. Basically what actions could listeners take to take bigger leaps in leveraging new technologies? Gabriela responded by explaining that Avaneer is happy to talk to organizations and offer practical advice but for the time being they are very much heads down trying to prove the network is viable. Once they are past the proof point, Avaneer will be in a better position to work more closely with stakeholders on how they can join and move forward. In closing, Ken asked what Gabriela would like the industry to know or if she had any final message that they want to send out. Gabriela responded by asking the industry keep an open mind on blockchain. She explained that she recognizes not everybody is there yet. She and the people at Avaneer really believe that blockchain is a technology that is going to help healthcare. She explained that it must be said that blockchain doesn't belong in every single use case. But she asked that the industry keep an open mind and be willing to help explore the possibilities on this journey. Ken then thanked Okay Gabriela and Jocelyn for being on the podcast and reminded listeners they can find past episodes on all podcast platforms and the POCP website and that videos of the conversations are posted on the POCP YouTube channel.  

Pooja Babbrah, filling in as host for Ken Kleinberg, kicked off this first episode of 2022 by welcoming guest, Kim Boyd, industry consultant, regulatory and standards and Health IT expert. This episode will cover the regulatory landscape in health IT and what may be coming in 2022 from new rules to compliance and enforcement. Jocelyn Keegan, senior consultant with Point-of-Care Partners, chimed in to explain she and Kim Boyd have had a chance to work with each other on the National Council for Prescription Drug Programs, (NCPDP) electronic prior authorization (ePA) task group and that she has such admiration for her and her work. Kim Boyd then introduced herself and described how she got into regulation. She explained that while she does have a law background, having served as a paralegal in the United States Airforce, that's not where her love for policy started. In reality, the policy bug bit her in a chance encounter with a couple of entrepreneurs who mentored her and taught her their business from the ground up. In 2001, California proposed a regulation that would have been detrimental to their business, and she was asked to go up to Sacramento and talk to the regulatory bodies and legislature about why the policy wasn't good for patients or business. She was hooked from there. Pooja reaffirmed how important policy and regulation are in Health IT and pivoted the conversation by asking Kim her take on what could be expected in 2022 after several very active rules and policy years. Kim explained that many are of the mindset that Centers for Medicare & Medicaid Services (CMS) and The Office of the National Coordinator for Health Information Technology (ONC) will continue to build on the endeavors we saw over the last several years. The focus will continue to be on interoperability, data fluidity, transparency, and other areas that have already been a major focus of the industry. She went on to explain that the pandemic really helped underline the importance of solving some of these industry challenges. Kim went on to say that there is so much work left to be done to move toward full interoperability in healthcare and a merging of the clinical, administrative, and financial data. She added that she is really excited by the ONC Health Interoperability Health Outcomes 2030 initiative, stating that we need to strive toward truly collaborative and coordinated care and maybe we'll finally succeed in getting rid of faxes once and for all.Pooja followed up by asking about whether there were any pieces of legislation that have enough bipartisan support to get passed. Kim explained that there is so much we need to accomplish and, thankfully, there are a couple of areas that seem to have bipartisan support. One of those areas is health equity. Legislation looking at reimbursement models leveraging social determinants of health data and funding around standards development around social determinants of health (SDOH) are up for consideration. Kim added that she saw at least 99 pieces of legislation related to health equity for congress to take action on. Pooja then asked Jocelyn if there are any rules she hopes get published or if she has a policy wish list. Jocelyn responded by agreeing with Kim that there is so much activity going on in the policy space. One of the things near and dear to her heart is prior authorization. She recounted that at the end of 2021, ONC was making progress in certifying people around prior authorization. CMS signaled via the unified agenda that they plan to pick back up the rules that were tabled during the administration transition. Jocelyn went on to say that she hopes to see rules that align the   industry on a shared path forward around prior authorization. A certain level of certainty is needed by the industry — from a policy perspective—to help spur them to pick up the implementation guides and work coming out of Da Vinci and other FHIR accelerators. Pooja asked Kim to weigh in on the future of prior authorization, specifically automating PA based on her work with CoverMyMeds and on the NCPDP ePA task group. Kim said that Jocelyn is on point. There has been an evolution in the healthcare ecosystem, especially on the medications front. CoverMyMeds has done a lot of work to move away from faxes, that there are still smaller payers that just aren't yet on board with ePA, but the needle is moving. This will be really important to ease the administrative burden for providers. If regulatory bodies require certification for ePA, that will help move the needle even further. She went on to say that as the standards bodies are evolving in their approach to automating PA, the regulatory bodies are paying attention and will hopefully issue policy that will support that work. Pooja then asked Jocelyn to weigh in on how creators of these tools can drive adoption and use outside of policies or rules to require use whether through user-based designs, establishing strong value models, or other methods. Jocelyn responded by saying that Kim touched on one of the topics earlier, which is to look at all the workflows holistically and make sure the tool being created is solving immediate problems faced by providers and giving them more information and transparency around eligibility and benefits for their patients. Before providers adopt a new tool, they are asking themselves “is this going to be better than what I'm using now?” The creators of these tools should also be evaluating their tools over time to determine what's working and what isn't and iteratively improving them. Jocelyn added that, ultimately, adoption is really a one butt in the seat at a time. It's important that any policy doesn't add additional burden to providers but, outside of policy, the creators of these tools need to ensure they are being mindful of the providers' workflows, and that the tool is usable and solving real problems. Ultimately, the reason we are in 2022 and still using faxes is that they solve the provider's immediate problem.Pooja then asked Jocelyn and Kim on how they would advise payers who work to adhere to new policies but are just checking the box and then asking “now what?”Jocelyn stated that the shift to standards-based design is a game changer. With the iterative approach of standards development at NCPDP and HL7, the standards development process is much more collaborative and iterative than in the past. Additionally, more testing is being done so the standards have already been road-tested before being named in policy. That makes it easier to meet some of these new rules. Ultimately, many of these new policies intend to unlock data, and stakeholders who are going to be successful will go beyond checking the box and will think more broadly about how this additional data can be leveraged across their organization. It's really about stakeholders mastering their data and how to best leverage the shift to APIs. Those that can take the time to do that planning, rather than just trying to meet deadlines of a new rule or piece of legislation, will be most successful. Kim agreed with Jocelyn's points, adding that while we're trying to make more data available for decision support, further upstream we're also talking about transparency. Data has to be usable and real time. The requirements from the CMS transparency & coverage final rule, the Medicare hospital outpatient perspective rule, and the No Surprises Act are all catalysts to improve the patient experience: the intent being to make us all more informed consumers. Operators in this space have a real opportunity to not only make this data more readily available to consumers but to help them understand it. We have a real health literacy issue in this country. Plans and providers need to factor this into their strategic initiative and position themselves as trusted resources for patients to better understand their data as a means to build brand loyalty. Jocelyn chimed in to say that back in July, payers all scrambled to meet the patient access API deadline. Some leapt across the line, some dragged themselves across the line. Everyone was at a different point when they started the work to meet this policy but they all met it. This step was one building block in building how we do business for the next several decades. The industry needs to take a collective breath and consider how we can set ourselves up for success and how can we move forward to make sure that each additional block we put in place is incrementally better. Jocelyn added that she and Kim both testified to a sub-group underNational Committee on Vital and Health Statistics(NCVHS) on the intersection of clinical and administrative information and talked about the needs to bring these two worlds back together. Everything ties back to the fact that to provide care, you've got to understand what the patient's coverage is. There is a relationship between care, quality, and the cost of the care. This isn't going to get fixed overnight. The idea of transparency is good but it has real-world implications on how we all do business. Pooja then shifted the discussion to cover compliance and enforcement. She mentioned that there has been a lot of shifts in deadline and delays in enforcement. Pooja asked Kim to weigh in on these shifts and changes and what stakeholders need to know. Kim relayed that although there have been delays in several rules, the policy teams and strategy teams should still be dedicated to evaluating and planning to comply. They should also be thinking about how to not only comply,but also factoring in how they can comply and how to leverage those rules to support more cost-effective use of healthcare services by both patients and providers. They should also be thinking about value-add services through these initiatives that will help build brand loyalty. Ultimately, stakeholders should be working to stay ahead of deadlines and moving forward in good faith. Jocelyn chimed in to say that many times policy guidance following legislation is really important to get the industry out of limbo. Many times, there might be abhorrent behavior as stakeholders try to meet a piece of legislation when they've misunderstood the intent or ways to really address it in a real-world setting. We should be recognizing that new policy and legislation are coming and to not panic until the final rule comes out. Because ONC and CMS are much more involved and providing some funding for some standards development, there are fewer shocks and surprises in recent policies.In an effort to close out the episode, Pooja asked both Kim and Jocelyn for last thoughts to leave with the audience. Kim conveyed that she advises everyone to just keep on pressing. If you have a policy team, work with them to align your strategic goals with policy requirements. Bring your SMEs to the table, highlight your organization successes out in the industry, work to educate and assist regulators to better understand the challenges and solutions that have shown promise. Also, work with the standards organizations and influence the standards development process which ultimately influences policy. Jocelyn's last thoughts were to point out that as the industry evolves, we are moving away from a place where only a small group of people within an organization are considered experts or in the know about interoperability but moving toward a reality where interoperability is just how we get things done. The organizations who are looking at interoperability holistically and doing the training across their organization are tightening partnerships, and really getting everyone in their organization ready to solve problems and respond to regulations. It's a much easier task when everyone in the organization has the understanding and can contribute to the solution. Pooja then closed out the first episode of 2022 by thanking Kim Boyd for joining us and to the audience for listening. She reminded the audience they can find past and future episodes on Spotify, Google Podcasts as well as HealthcareNOW Radio and other podcast carriers.       

This episode features guest, Daniel Stein, President of Stewards of Change Institute (SOCI). The discussion explores why connecting the healthcare ecosystem with human services is critical and goes on to highlight the role of consent specifically highlighting the new “Modernizing Consent to Advance Health and Equity” report published by SOCI with industry input.Co-host, Ed Daniels, Senior Consultant with POCP, then introduced himself explaining that he's worked in Health IT for over 30 years and has been working in the world of electronic informed consent over the last several months. Guest, Daniel Stein, President of SOCI then introduced himself and gave an overview of the work of Stewards of Change. He first focused on SOCI, which is a non-profit that cuts across and connects all the public welfare and safety net programs from healthcare to social services. SOCI has worked to bring together all the different players in these realms. Daniel explained that he got started in this work 20 years ago after a career at Kraft Foods working in project management. He started working with a non-profit in California and became intrigued by how certain business practices could be applied in the non-profit world and that's how he started on this path. Daniel explained that he gained insight from work he did related to child welfare in California and New York, he observed there were huge disconnects between the services families really needed and the ability of families to access these services. It was clear these families were already stressed and then were asked to jump through hoops and hurdles to understand eligibility, fill out documentation and such to get the services they needed. On top of that there was a lot of duplication between service providers. He made the point that If you wanted to design a worse program, you really couldn't. Daniel explained that he started to ask how this bumpy process of accessing services could be smoothed out. Ken then pivoted to ask Ed about his background in emergency services and other work he's done to give his perspective of the problem outlined by Daniel. Ed agreed that he recognizes that disconnection Daniel outlined and its impact on people and their families. Ed then pointed out the role of consent in contributing to that problem of disconnection. Ed then asked Daniel how he feels the industry is doing at tackling these issues. Daniel responded by saying that he's encouraged that there has been movement over the last couple of years specifically the acknowledgement of the importance of social determinants of health and the need to explore how to capture that information. While healthcare is taking steps in the right direction, there still seems to be some hesitancy. Healthcare is so large and so complex, it's still somewhat insular with just a few systems and solutions starting to look at connecting outside of healthcare. Ken followed up by asking for Daniel to dig into the work to connect healthcare and human services, and specifically about Project Unify. Daniel responded that in the beginning of the Obama administration, SOCI had the opportunity to work on the Affordable Care Act (ACA) through a contract with the Administration for Children and Families (ACF). In the ACA, there was a provision that explicitly looked to integrate health exchanges, the infrastructure of the ACA and all the services under HHS. This provision is still in the rules and regulations. Recent guidance coming out of CMS has reiterated this provision. SOCI helped translate this provision and communicate it out to the states at the time. Unfortunately, things didn't go as smoothly as one would hope primarily due to the complexities of the ACA. It also became clear that there was a lack of connection between the Centers for Medicaid and Medicare Innovation, CMS, Office of the National Coordinator (ONC) and ACF. SOCI was instrumental in helping bring these federal agencies together to better understand the whole person approach to care. Daniel explained that Project Unify grew out of a 4-year initiative funded by the Kresge Foundation. SOCI's proposal to Kresge outlined the need to bring together subject matter experts (SMEs) from across healthcare and social care to avoid recreating the wheel. SOCI used the funding they received to establish the National Interoperability Collaborative (NIC). The NIC's purpose is to bring all these various stakeholders together to share information about the challenges and initiatives to solve problems being done across the various fields and cross-pollinate. The NIC has been holding conferences and has hosted over 75 webinars over the last several years. While sharing information on these webinars and conferences was helpful, those involved in the NIC wanted to do more than talk and to take on a project that was really doing something. Something. That is how Project Unify was born. The vision for Project Unify was to demonstrate how data interoperability and data exchange could happen across all the siloes of healthcare, human services, and other areas. The work on Project Unify led to the work on consent that SOCI has started to focus on. Ed added that he has participated in several SOCI webinars and recounted a particular session where a local county agency's project to connect the various services in their locale. The attendees of that session expressed that their agencies don't even have standard systems within their own agency. Many expressed that they are just working to create standard forms they can use across agencies and that they'll work on harmonizing the technology later. Ken pivoted to focus of the conversation to health equity and social determinants of health. Daniel explained that SOCI's focus on social factors and health equity grew during COVID. SOCI was preparing for a conference in early 2020 and pivoted to make it virtual rather than cancel because they didn't want to lose momentum and then focused on what the NIC could do during the pandemic to make a difference. The NIC brought together stakeholders almost every week and this effort was nicknamed the “interoperability support group”Daniel went on to say that one of the things that stood out during COVID was that so many of the communities hit hardest by COVID were the poor, black, brown, and undocumented people. The lack of services, access and transportation in these communities exacerbated the issues. It became clear that if these challenges were going to be overcome, that these communities needed to be at the table to offer their perspective. Health equity has become a major focus of the administration and of the industry. For SOCI and NIC, as they began bringing members of these communities into the conversation, the issue of consent, data stewardship and trust bubbled to the surface. Ken picked up the thread of consent and brought up the comprehensive report SOCI recently published entitled “Modernizing Consent to Advance Health and Equity”. Ken explained that as he sees it, consent is a complex and layered issue because most people don't have medical or legal degrees and understanding the information, they have been given access to and the consequences of consenting to give access to others. Ken asked Daniel to explain his perspective and how this paper on consent came to be. Daniel responded by saying that exploring consent has been one of the more fascinating roads he's been down. Over the course of holding all these meetings with this diverse group of stakeholders, they started to ask what one or two things could be done to really make an impact. Through an iterative process, the group came up with about six recommendations and consent was one of them. Consent has such a broad impact and not just in healthcare. For example, if one wants to share school attendance or grades, foster care status, consent is needed. Consent is the blocker of data sharing and interoperability. It became clear that this was a challenge across every area and if small improvements could be made, it could have a tremendous impact.The group recognized that this issue was certainly bigger than healthcare. There needs to be a whole person view through coordinated care. Daniel added that fixing one thing doesn't get us to the goal line but at the root of coordinated care is giving people the ability to access data from different areas. The only way that will ever happen is people can give consent to remove a lot of the friction of sharing data. The technology piece can be figured out later.Ed, who was involved in helping develop this report, added that through talking with various organizations about their challenges and attempts to solve the issue of consent, they gained a lot more insight into the complexities of the issue. In healthcare, privacy has always been a big issue but at the same time we all want the right information to be shared with the right people if it's going to impact our care such as advanced directives or clinical trial matching. Add to that social factors that impact health or indicators of issues in non-healthcare settings would also be helpful to have in the healthcare setting. But the same is true in non-healthcare settings. In social programs having a more complete picture of someone's life can help the program provide more appropriate resources. As people move from state to state, having those consents following them is another factor. Daniel explained that there was consensus across the board that consent is a challenge but there was a lack of awareness of the work being done across jurisdictions, programs, and care settings and it was impossible to build upon the work that's already been done so one of the first things SOCI did was identify and document the consent work already being done so that work can be built from. Daniel added that there is another side of the equation. It may be necessary to temper our enthusiasm for getting and sharing this kind of data. As SOCI has talked to people in these communities, they were told it's very important for this information to be taken back to the family so a decision can be made as a family. Ed agreed and added that while solving the technical ability to document consent, we can't forget that the data being exchanged belongs to a person. We're all patients so this shouldn't be a hard perspective to keep in mind for any of us. Ken brought up 21st Century Cures regarding who regulates the data once the patient has given consent to share it with a 3d party app or another actor not covered by HIPAA. One must wonder if the data is really being protected. Daniel said that they found that most people assume their information is being shared and don't want to be filling out a consent form for the 14th time. Many times, it's the lawyers who are advising multiple documentation of consent to mitigate risk. Ultimately, we have the capability to make this information accessible, but we need more uniformity and not have the data all over the place. Maybe we need a trusted entity that can be the traffic cop and authorize the flow of information and authorize access based on roles to say this person is granted access to this information for this purpose, for this period of time. There is some work in this area that is working to demonstrate how this could work. Ed pointed out that the report goes into all of this in detail, and it may seem daunting. He recommended that readers review the executive summary first and then dive into specific sections of the full report if there is interest to dig a little deeper.Ken, in closing out the podcast, asked Daniel to share any other issues he'd like to highlight or calls to action for the industry. Daniel responded by saying he is heartened by the interest of federal agencies and other organizations in doing work to solve the challenges around consent. Daniel expressed his hope this report will help support the work in this area. SOCI will be holding more webinars over the coming months to discuss consent and other issues and Daniel invited all listeners to get involved by attending some of these sessions which will be posted on either the NIC events or SOCI events pages.Ed added that these events aren't just work, but also have an aspect of fun, networking, and an opportunity to make connections outside of one's normal circles. Ken closed the episode by thanking Daniel for joining the Dish on Health IT podcast. Be sure to follow Stewards of Change Institute on Twitter and LinkedIn to stay up to date on this work. 

Jonathon Feit, co-founder and CEO of Beyond Lucid Technologies & Consulting joins The Dish on Health IT hosts, Ken Kleinberg, Pooja Babbrah and special guest host Ed Daniels to talk about the role of emergency services (EMS) in the healthcare ecosystem now and in the future and how EMS fits into healthcare's interoperability journey. The hosts, Ken Kleinberg and Pooja Babbrah briefly introduced themselves. Guest host, Ed Daniels introduced himself by saying that the majority of his career has been spent on interoperability, data exchange and HIEs. Ed was a volunteer firefighter for 14 years and is currently working on the development of a multi-stakeholder collaborative on eConsent which is why this discussion was of particular interest to him. Jonathon then introduced himself explaining that he is not a field practitioner or first responder. He shared that he joined the military after September 11, 2001 but discovered that his Tourette's syndrome disqualified him from service, which led him to find another way to serve. He decided to leverage his skills as a technologist to solve problems related to data exchange to support EMS and first responders. Beyond Lucid, the company Jonathon co-founded is focused on solving these issues. Right now, Beyond Lucid spends half of their day in the world of Fast Healthcare Interoperability Resources (FHIR), EMS, critical care both ground and air, the other half of the day is in the world of electronic health records (EHRs) focusing on things like patient matching. Beyond Lucid is currently running the Oregon Portable Orders for Life Sustaining Treatment (POLST) registry from a technology standpoint and are branching into pediatrics and medical complexities. What Jonathon finds interesting about this work is identifying what field providers do and what they need. Using end of life medical orders as an example, Jonathon pointed out that there is really a 0% margin of error. If someone has indicated in their records that they don't want to be resuscitated but first responders are unaware of these records, the patient's wishes may not be followed. Another aspect of data exchange from the field to health systems so that data captured in the field can be incorporated into the patient's record fast enough for it to be useful in how the patient is cared for in the emergency room (ER). The future of Beyond Lucid is focused on car crashes, winning a patent on a system to gather crash intelligence about the passengers such as number of passengers, whether children are in the car, or special medical needs of passengers such as hemophilia. There are mission critical pieces of data that need to be exchanged in real-time. What prompted Jonathon to reach out to Point-of-Care Partners initially was the episode of the Dish on Health IT about social determinants of health (SDOH) because it highlighted patient data that helped look at patients as people. SDOH is important to providing holistic care. Host, Ken Kleinberg asked for a little more context of how EMS fits in the overall healthcare ecosystem, asking specifically about how EMS has historically been billed separately from other healthcare services as transport. Mr Feit explained that yes, it's true that EMS is billed as transport is many places but it's a yes with an asterisk because things are changing due to COVID. He explained that you really have to look more broadly to federal laws and how EMS is regarded. For example, up until the last 18 months, CMS regarded EMS as a supplier to healthcare, not a provider. This impacts not only how services are billed but related to interoperability rules as well.  Meaningful use doesn't apply to EMS which is a big problem because EMS uses a different data set that falls under the department of transportation and not Health and Human Services (HHS). He added that EMS is the most expensive taxi ride you'll ever take. With the exception of one value-based care experiment happening now, EMS services are generally billed on a per mile basis and the rate is cost adjusted based on the experience level of the driver and the severity of the patient. EMS is emerging as a central part of safety net care in rural spaces where there aren't enough doctors to serve the population and the fact that it's a service available 24/7. Viewing EMS as a provider is a critical distinction that's starting to change. Ed agreed with how Jonathon characterized the current view of EMS in healthcare generally and in regulation. Ed explained that historically, ambulances were intended to just get the patient into the hospital as soon as possible but it's changed drastically over the years with life-saving services being performed on site and in transit. Ambulances are no longer just transport but definitely a provider situation. It's time for a change in how this type of care is provided and being billed and reimbursed.Ken observed that it would be a real problem if the patient was charged in hospital for how far they were pushed in a wheelchair from their room to get a test. Ken then asked Pooja if there was a parallel between how pharmacists have transitioned to be part of the care team as opposed to an adjunct service. Pooja responded that she does see some parallels and mentioned reading a CMS blog post by Chiquita Brooks-LaSure and other CMS leaders that discussed the Center for Medicare and Medicaid Innovation (Innovation Center) which explored 50 alternative payment models to fee for service. While only a handful were considered successful, the ones that had some success had mandates to back them up. Pooja added that she thinks that just as the payment model in pharmacy is being revisited, the payment and reimbursement model for EMS should be re-examined as well. Ed added that another scenario where the pay for transport model for EMS just doesn't make sense is when a patient maybe just needs to get emergency care at home but doesn't need to be transported to the hospital. The current reimbursement structure doesn't allow for this. Jonathon pointed out that there is currently an “allergy” in the mobile medical arena to good data. He went on to clarify that when you mention CMS, where they have extremely wonky geeks who are truly good at their job, people forget they need fuel for their work, they need data. Jonathon went onto explain that when creating mandates versus voluntary guidance, you really need not just data but good data to back that up and see what is working and what's not. Right now, entering in information about a patient encounter by EMS staff isn't a priority because there isn't an understanding of how good data could transform things for the better. EMS has so much catching-up to do. Jonathon added that this lack of good data problem isn't unique to EMS by any means but it's an issue that needs to be tackled for us to see real change. Jonathon explained that part of the reason he reached out to Point-of-Care Partners was because he felt we provide a breadth of perspective to these issues in healthcare that reflects the bigger picture. He added that when docs talk to other docs or nurses and EMS techs to talk to Fire fighters, they aren't hearing from outside their environment to gain that broader perspective and close the gaps in understanding about their role in the ecosystem. He continued to say that we need to make the case why it's so important to get good data into the system and for that data to be fluid across environments. Ken interjected and said that now that the now we're getting into the interoperability part of the conversation, he wanted to ask about the system that's generally used by EMS called The National Emergency Medical Services Information System (NEMSIS) and asked if it was connected to EHRs.Jonathon responded that NEMSIS is separate and therefore and unequal data set maintained through the National Highway Safety Administration. It has a rich history of tracking data for car crashes and heart attacks while driving which Jonathon admitted was a gross over-simplification. There is a way for NEMSIS to connect to EHRs but there hasn't been education and discussion from the federal level down to the state, county and regional level on why the data and connecting to EHRs matters. Beyond Lucid was awarded a project in California back in 2015 to build the bridge between NEMSIS using HL7 standards like CCD. Beyond Lucid completed a gap analysis to understand what it would take to go from one to the other. What they found was an 85% overlap between what was required in the EMS system and the HL7 CCD. The 15% gap fell largely in 3 buckets including family history, past encounters and mental health which is very similar to SDOH. There are efforts to plug this hole with real-time data. Jonathon added that there are other efforts giving an example the largest fire service in Southern Denver, Colorado which was the first to send real-time data to Sentara health system in 2018 which shows it can be done, however, Jonathon added that health systems and EMS aren't doing a good job of talking with each other about their respective needs. Ken asked Jonathon to talk about Beyond Lucid being one, if not the first EMS IT vendor to join the Commonwell Health Alliance and whether they are now getting some SDOH data from HIEs. Jonathon explained that about 2 years ago at the National Association of State EMS officials, there was an outcry for SDOH and contextual data. Up until then this demand was mostly at the local level. Beyond Lucid volunteered to be the vendor to make this possible and develop a superset of data and has announced this capability to populate SDOH data for 911 calls. This project made a lightbulb go off for those involved on why this data should be a separate data set when it really should be integrated in the overall record. Jonathon explained that strong ID is really important because especially when you're looking at end of life orders, you want to make sure you're looking at the right patient. Unfortunately, a lot of initiatives required affirmative permission from he patient to look them up but the problem is that this doesn't work in the back of an ambulance. Ultimately the trust framework is critical but right now there is so much dirty data. Jonathon went on to say that now that FHIR V4 has been balloted and approved and Carequality/Sequoia was awarded the trust framework project, it seems progress is being made and EMS is finally at the table. Ken asked Pooja to provide her perspective on how EMS might use SDOH and eConsent and advanced care directives. Pooja shared that when you think about the knowledge first responders gain about a patient's living situation and environmental challenges, it makes sense that they could contribute valuable SDOH data that could be used downstream. It's about time the industry start looking at how the data going into EMS systems can be shared along the care continuum. Jonathon interjected that it's also important for police to have access to some of this information and that Beyond Lucid has helped create a database of medically complex children so police know if they are interacting with someone that perhaps is non-verbal so can't explain their situation or who can't follow verbal commands. Without this information Police encounters can end tragically. Encounter data really needs to flow throughout healthcare and also community services. Ken re-focused the conversation on eConsent. Ed shared that he is working on an initiative now on how to get electronic informed consent and advanced directives. It's a very complicated question and there isn't one answer. Ken began to close out the podcast by asking Jonathon if there was any last topic he'd like to cover suggesting perhaps something about COVID and vaccines since Jonathon had mentioned this in conversations prior to the podcast. Jonathon responded that he knows vaccines can be controversial and really he isn't talking about vaccinations per se but it's important to talk about interoperability and data quality and that for many years vaccination registries didn't talk to each other or couldn't be accessed by providers. This is important in the context of when you're planning to hold someone to account on getting vaccinated and proving they've been vaccinated. Jonathon posed the question that shouldn't there be a single source of truth rather than asking people to hold onto a little card? If we get the smart people in the room to solve these problems, we can make so much progress. Pooja added that in her role on the NCPDP board, they've had many conversations about how to use existing standards to create a central source of truth. Pooja explained that she's glad we were able to have this important discussion. 

On this episode of the Dish on Health IT podcast, guest Troy Trygstad, Executive Director of Community Pharmacy Enhanced Services Networks (CPESN) speaks with Ken Kleinberg and Pooja Babbrah about how pharmacy is evolving as a key part of the health value chain. Troy started with a brief overview of his background, which includes a degree in health economics and pharmacy policy with over 15 years in primary care. While in primary care, his focus was on accountable care, value-based care, clinical integration, grants, innovation, the state and commercial payers. All his learnings on the medical side were a great trajectory to transferring this knowledge to the pharmacy field where he set up the same version from a regulatory structure, operations, and data integration that you would see on the clinical side. Ken posed the question of: How do you see the role of pharmacy evolving to meet the needs of value-based care? Troy commented that, “This is nothing new, leaders in pharmacy have been saying this for 30 years. What it really took was market dynamics, payment reform, alternative payment models coming from a purchaser marketplace saying that they have had enough. This finally stimulated action. You just can't be fee-for-service anymore, and it was prompted by market change and that is happening in pharmacy now.”Pooja responded to Troy's answers and agreed in full. She also mentioned the point that manufacturers of medication are working on providing the best value for medications, but there is no way to track this effort. In pharmacy, this is where we can really see a difference. For example, a pharmacist sees their patients and can directly prove outcomes. She used smoking cessation tactics as one example. Troy's response was, “What is past for medical is becoming prologue for pharmacy.”Ken moved the discussion to focus on what CPESN does, for example, eCare plans specifically, helping the industry improve communications, closing the gaps, improving communications, and focusing on quality and asked Troy to talk more about that. Troy responded by giving a brief overview of a project he worked on with the Center for Medicare & Medicaid Innovation (CMMI), which was to answer the question of how to integrate care processes in order to pay pharmacies differently and explore what a value-based contract even looks like. A year into the project, participants started to say that requiring providers to log into another system wasn't working with workflow. The project did a 180-degree turn and moved to working within systems that providers already work in. This led to a call with CMS and Office of the National Coordinator (ONC) about a high-impact pilot project to find a standard to share clinical information in and out of a native community pharmacy system of record. This led to 18 vendors that serve at least 20,000 pharmacies. Troy said, “So here we sit now with millions of care plans that now transact under the Health Level Seven (HL7) pharmacist electronic care plan standard. Which is not great for claims adjudication.” The main goal is to get all the information in one transaction. Pooja responded by saying that there is a lack of awareness and that we need to start talking about this more. From a payer and reimbursement side specifically. ONC is looking at adopting this as well, and we need to get this out in the industry and get more support because the systems are in place. Troy added that back when he was doing practice transformation and going through ePrescribing adoption and then HITECH/ARRA era and we always said it's much easier to go from paper to EMR than going from EMR to EMR. Sometimes there is an advantage to getting into the game a little later. Of the 18 health IT vendors that offer care plans, 17 of them use FHIR and not CCD-A so, it is already baked in. He went on to say, for example, that if you already have your labs, vitals, and drug therapy problems, then the next step is that you must have a user interface so that you can enter labs, etc. We need the pharmacies to meet the standards so that they can enter these contracts. Ken's next question was, “The N in CPESN in for network-- how do you see the role of a national look-up for example and ability to do patient matching here- and how does this integrate with the workflow of pharmacists and other stakeholders?”Troy responded that we need to flip the priorities and the sequencing, but you have to start with the easy things first. The first reason data started to be collected was the regulatory obligation to collect clinical information based on improving quality and reducing variation. Once we got the information, we had to decide who we shared it with-- a university, care managers, care coordinators, etc. Then, when you get to the hard stuff it takes a community. It takes, NCPDP, ONC and a much larger community-- when you start talking about switchboards, you're just in a whole other level. You must determine who it is you're working with, how do I load the directory, what am I able to send to help support care coordination. Starting with the easy and then working towards the hard is something that's really good to see the industry doing. Pooja then responded that we are making strides on the medical side, wrapping the value-based contract between the providers and pharmacies. It is particularly important to get a better handle on FHIR endpoint directories which hasn't even been solved on the clinical side of the house.Troy went on to say that there is going to have to be some sort of incentive and marketplace innovation financially absent from a federal mandate for this to happen. Federal mandates in pharmacy aren't expected since pharmacy has been left out of regulations to date.Ken countered that pharmacies are considered an actor in 21st century cures and information blocking, so how do you see the focus in Washington as it relates to pharmacy and your goals? Troy quipped, “How many podcasts do you have?” Right now, pharmacy is a 100 million dollar industry, that is peanuts in healthcare! The denominator in healthcare is in the trillions. We need to focus on the industry to go from 100 million dollars to the billions to get government funding. We are not even in the right arena right now.The market currently sees pharmacy as a vendor. The value-based contract comes after the billing. We currently provide a service and should get paid for it. For example, smoking cessation programs offered by pharmacies should be reimbursed now before we can answer the question, how many quit? We have to get to the point where we can bill for a service first. The pharmacy has to be recognized as a service provider instead of a vendor in order for a baseline to be established so pharmacies can truly enter into value-based agreements and get paid based on outcomes. Pooja picked up on the pharmacy as provider status thread. “Just with the changes we've seen and the impact of COVID, in some states pharmacists are recognized as providers, but until we get this recognition at the federal level, and allow pharmacists to charge for their services that it's a huge barrier and an especially important thread. Right now, there is just talk about 'pharmacists are trying to get provider status,' but if you unpack the reasons why and if you take anything from this podcast, that is a crucial point to watch out for and that is a path down the road to success.” Troy responded that pharmacies have been providing services this whole time but getting paid at the prescription fill level doesn't make any sense, especially when that fill fee has gotten smaller and smaller over time. “So, don't pay pharmacies for each prescription fill, but pay them in a different way, if you want to call it 'provider status‘ then call it what you will.” Ken posed the question, with the caveat that the discussion may have covered it to some extent already, but how is the market evolving in the financial space for pharmacy?Troy compared the market to the game Blokus. The basis of the parable is: So, what most people think is the best strategy is to protect your spaces on the board (block), but the trick is that there are not enough spaces in your corner of the world to play all your blocks. This is what is happening in pharmacy right now, there is not enough money in dispensing. 50% of the drug cost is 2% of the fills. Three to five years from now, it could be 80% of the drug costs is 3% of the fills. The key to winning Blokus is to penetrate other's defenses and that's what pharmacy has to do. It is all about whose territory you are going to invade.  Pooja added that in the pharmacy industry we must be thinking outside of the box. We are set up in a position to change things in the pharmacy. “I see CMS and ONC starting to focus more on pharmacy. The real question is, how do you make sure that you can stay as a viable business in pharmacy and get paid? How do you make sure you're able to collect the data you need? We should be working more directly with the payers and thinking in a broader spectrum.”Troy followed up by saying, “Do the math. Most pharmacies are only operating at 1.5%  average profit margins. So, if you are a 10 million a year pharmacy (which is successful)-- what is 1.5 % of 10 million? $150,000, that is nothing. In comparison, services industries average 40% margin. So, pharmacy must understand this shift. It's about what you bring in that you can keep. COVID has provided a 'craft beer' moment for pharmacy. Meaning what matters is consumers and purchasers and COVID has changed people's mindset that pharmacy is a provider of care. Pharmacy Quality Solutions (PQS) Trend Report has great data. One data point is a question to payers about whether they would pay to get A1C results, blood pressure, and other biometrics from pharmacies if it was available in a structured way. Three quarters of the payers responded that they would. Payers have come a long way in adopting new technologies when they used to be the laggards. So, now it is pharmacy IT that is really behind.” Ken closed out the discussion by asking whether there is anything you would like to ask the industry and our listeners to do today. Troy responded with two key points. The first being that he is on a mission to communicate to the world that we need some sort of consensus-based or the Pharmacy Quality Alliance (PQA) to step up services billing and value based contracting process. “What is our compass, how are we getting together as an industry? What does that look like? Second, pharmacies should be paid differently. Our associations need to make that happen. We need advocates going to the consumers and saying, you are in harm's way if you do not pay us.”Pooja closed the podcast by saying that consensus building is key. “We talk all the time about needing a Da Vinci-type Accelerator program for pharmacy to help do this work and build the consensus and I am all for that. I am excited to hear Troy's take and consider what the future in pharmacy holds.” 

On this episode of the Dish on Health IT podcast, guest Charles (Chuck) Jaffe, CEO of Health Level Seven (HL7) speaks with Ken Kleinberg and Jocelyn Keegan about the history of FHIR, FHIR adoption today and tomorrow, and why non-technical people should get more involved in the standards development process. Chuck provided a brief overview of his background including his education as a medical doctor and then additional education in computer science. Chuck transitioned to working with the National Institutes of Health (NIH) focused on immunology and oncology. He then worked for AstraZeneca as its first global head of medical informatics before moving on to SAIC as the VP of a large biomedical community. Chuck's journey ultimately led him to HL7. Chuck shared that over a decade ago was when he was first introduced to what would eventually become Fast Healthcare Interoperable Resources (FHIR). Grahame Grieve introduced the concept of FHIR after realizing the positive impact Application Programming Interfaces (APIs) could have in healthcare. FHIR has since been on a trajectory that has accelerated beyond Chuck's expectations. Ken pointed out that some of the traction gained by FHIR is in response to the policy. He then went on to ask Chuck the impact FHIR will have on point-to-point interfaces. Chuck responded that FHIR was first envisioned as a way to share data between an individual patient record and an individual provider record to circumvent some of the more cumbersome processes already in place. Original HL7 standards didn't envision the possibilities of the future environment that went beyond push only data exchange. So, what began as a point-to-point solution has grown enormously as FHIR has embraced other technologies. Jocelyn quipped that as FHIR began to emerge, it was pleasantly surprising how easy it was for developers to pick it up and use it. Another key to FHIR's success has been the focus on identifying the problems that need to be solved and clearly defining the use cases. It's also important to realize that we're using the existing the infrastructure and transitioning to a purist FHIR ideology. FHIR will be used in concert with other standards to solve industry problems. Chuck agreed and gave an example of feedback he heard at a conference early on where a stakeholder with a complex infrastructure shared that they saw FHIR as a way to augment their existing infrastructure. Their first FHIR implementation took two months and they thought that was fast, but the second implementation only took two weeks!Jocelyn shared her experience of getting her first smart phone. Her imagination of how she could potentially use the various apps available was limited “maybe I'll be able to check my email when I'm away from my desk.” Cutting to now, she drives her life from her phone. She compared FHIR adoption to her smart phone experience by saying that early FHIR adopters are still uncovering secondary, tertiary and fourth and fifth use of data that previously had been siloed and begin to do things they never would have been able to do previously. Ken moved the conversation along by asking about the push for FHIR Implementation, after all, concepts aren't valuable unless they are implemented. Chuck responded by saying that the standards world was slow to accept and adopt FHIR at first. Those communities have come to accept that the concept of APIs makes interoperability incrementally more seamless. It wasn't so much an act of persuasion but simply the growing body of evidence demonstrating what FHIR APIs could do. Chuck shared that back in the day that at conferences, he used to ask the audience “Are you familiar with HL7? Have you heard of FHIR?” and now he asks, “Who is currently implementing FHIR?”. Chuck shared that he is extremely excited about what the future will bring. Ken inquired about the challenges and keys to manage the collaboration required across so many stakeholders. Chuck responded that the elephant in the room is change management. There are so many sunk costs in legacy systems and that must be recognized. The industry doesn't really continue to recognize some of these legacy systems but there is an opportunity to look ahead and view the legacy systems as a foundation to build upon. There will be greater opportunities in the future.Jocelyn agreed with Chuck's assessment and added that FHIR is an enabler. There was unmet demand to solve seemingly simple problems of data exchange with partners. Rather than share data every 4 hours or daily or every week, partners can now create access points that allow real-time exchanges. This is a good example of how the industry is leading and exploring the possibilities and policy is following rather than policy forcing change.Chuck added that security and safety will eventually be embedded in the technology. He provided an analogy about how there is a transition from using metal house keys to using apps or keypads to gain entries into our home. For now, sometimes it may be more convenient to use the physical key instead of an alternative method but as technology continues to advance, one day people will wonder how we ever used physical keys. Jocelyn pointed out that it's common to hold recent technologies to a higher standard around security and privacy and put those concerns up as barriers to adoption when there are huge gaps in security and privacy in our current system as we're using PDF files and faxes that can't be traced. Chuck shared an example of this. He had a patient that needed a lab test outside of the university system so he asked the national lab company if he could enter it through the portal, but he wasn't registered, and he was advised that he had to write the lab request on a prescription pad. The lab company then asked where to fax the results. They said they must fax the results due to security concerns. Chuck informed them that he didn't have a fax machine and asked if they could email it. They proceeded to try to fax the results to his phone number for a week before finally emailing the results. It's extremely hard to get people to change when they have processes in place and sunk costs. That's the challenge FHIR faces. Ken asked Chuck to speak to some of the collaboration happening internationally and how we can learn from it. Chuck assured him that there are a lot of examples that we can learn from whether from their regulatory bodies or the solutions that have emerged. Canada, Australia, and Argentina have done amazing things through their national health systems. A change that's very heartening is that while FHIR has always been free of charge to use there is now documentation in various languages and based on those countries customs to make it easier to adopt internationally. Jocelyn pointed out that while POCP tends to do US-based work with some work with our neighbor to the north (Canada) that there is a community aspect to FHIR that allows us and all stakeholders to convenes and learn from each other whether through Connectathons or creating their own community to focus on specific areas. In closing, Ken asked Chuck what he wants listeners to do with the information from this episode. Chuck responded that he's been driving a car for many years without knowing specifically how the car works. He doesn't need to know in order to have confidence that car will crank with the turn or a key or press of a button or to have opinions about what could be done to make the car better for him. He encourages people who are not technical to come and participate in the standards development process. Not as a code writer or developer but being able to come and articulate their needs and the problems they need to solve so the solutions will be based on real-world needs. Jocelyn echoed Chuck's point adding that it's really connecting the technology experts with the people using the data and doing the work day to day that have intimate knowledge with workflows and the hiccups to them. 

On this episode of the Dish on Health IT podcast, guests April Todd VP at the Council for Affordable Quality Healthcare (CAQH)and Erin Weber Committee on Operating Rules for Information Exchange (CORE) Director at CAQH to discuss driving adoption of transactions and standards in pharmacy and medical benefit, FHIR use cases such as prior authorization, burden reduction and return on investment as well as value-based care.April opens the discussion by giving a brief overview of her professional career and time at CAQH. She notes her fortune in being able to work in almost every sector of the healthcare and healthcare policy space. April has had experience in government, the health plan side working in the consultant and IT space, and now with CAQH within the nonprofit sector. She mentions her learned appreciation of the diversity of perspectives and the need for agreement and alignment to make progress within the industry.Erin says her experience is in strategic revenue cycle consulting. She has done work with the Veterans Health Administration as well as with an advisory board company where she worked with hospitals and health systems around the country to identify and implement best practices. The mission of CORE speaks to April. She is passionate about bringing together disparate stakeholders to have difficult conversations around driving interoperability.Ken asks April and Erin to give an introduction into CAQH and its activities. They explain CAQH is a nonprofit organization focused on helping to streamline and simplify the business of healthcare, mainly the administrative space. The company can be divided into three parts. The research arm, called Explorations, works with the industry to gauge the progress towards automation and to identify areas of improvement. There is also a policy arm called CORE trying to work towards consensus on how to operate between plans and providers on transactions and standards. CAQH also brings solutions (utilities) to the industry, a central place to do things where a competitive approach doesn't make sense. Overall, the organization is really trying to bring people together to drive consensus. Ken asks how the industry is managing recent transformation. April states that as technology advances, the industry is going to need to learn to adapt more quickly. She believes we are always going to have a push and pull between existing standards and technology and new standards and technology. CORE is trying to facilitate organized industry advancement where there are common expectations. April notes there are always going to be organizations way ahead and others that trail behind. We're seeing the biggest challenge to be getting stakeholders aligned and moving in the same direction using similar processes.Erin adds that “attachments” mean clinical documentation (for CAQH and their participating organizations), and how you connect the clinical and administrative data to support where the industry is at now. She goes on to explain there is a lot of partially electronic and manual work being done to exchange this documentation for both prior authorization and claims, which is a significant source of administrative burden. A CAQH subgroup just completed the development of draft operating rules for prior authorization use case related to the exchange of attachments. The hope is those rules will be finalized later this year. A key aspect of the draft rules was how to consider how both X12 and FHIR transactions can work well together. We know this is what will have to happen for a successful transformation, so the group looked at the various exchange formats, and both are included in the draft rules.Jocelyn notes that as we see transformation happening, we must be cognizant of our massive investment in X12 and the fact it runs a large part of the world we operate in. However, we need to bring administrative and clinical data together to make the shift to value-based care. Looking at stakeholder roadmaps and pipelines, what is being prioritized is what's pushed from a regulatory standpoint. We need to make sure we're meeting everyone where they are today. We've seen if we don't acknowledge current state, then we don't get the adoption we expect. Jocelyn says the work CAQH and others are doing are going to be incredibly important for regulators to look at to make sure they have an inclusive answer, taking advantage of the existing technology, but also understanding people may want to leverage existing rails already in production.Ken asks April about CAQH's methods for determining cost reductions, time savings, burden reduction, etc. for standardized transactions. What are the findings? April says one of their methods is through their explorations program, particularly the CAQH Index that surveys payers plans, providers and vendors in the industry. The goal is to understand the volume of different types of transactions. How are they conducted? Are they done manually? If your phone and fax and mail? Are they done electronically using the standards that have been established? What is the cost of staff time to do all the transactions? More recently, the survey included questions about value-based care, the use of FHIR and the impact of COVID on transactions.Jocelyn reinforces the importance of the survey as we must measure things in order to understand where we're making progress and where there are barriers. The goal is to get people to move to automation.Ken asks the group why the use case of prior authorization has the lowest level of adoption and what could improve the current situation. Erin says there is a lack of understanding around the breadth of information available in the transaction. She was surprised by the number of providers they spoke to who were unaware of the HIPAA transaction, despite the work done to educate the industry. Erin did see a bit of an uptick in the automation of prior authorization in the CAQH Index from 2019 to 2020. CAQH CORE has developed a set of prior authorization operating rules addressing things like additional data content needs to convey documentation needs. The industry needs to continually adopt and align expectations across various transactions and standards available. Ken asks what role CAQH plays in the adoption of value-based care. Erin notes that, just as when CAQH CORE was founded and HIPAA transactions were first being implemented, the board is feeling some of the same pain points. Even though you may have standard processes and ways of doing things, everyone will still do things just a little bit differently, which makes it hard to automate and can create real burdens. The board proposed conducting research to really understand where there might be opportunity to create some more uniformity in the industry and reduce that administrative burden, improving information change and enhancing transparency across the clinical and administrative verticals. Erin says you can't look at value-based care and fee for service as two separate worlds, it's a continuum. They approached research by looking at the revenue cycle, across fee for service and value-based payments, and tried to understand where there needed to be differences where there were different data needs.April discusses next steps. She says they have a priority list from the advisory group and attribution was identified as most important. They are also monitoring FHIR, and progress being made there. April says they are currently working on things we can do in the exchange of information to support quality measures and gaps in care. They are conducting an environmental scan to gauge what is happening and what could be done to simplify. Overall, she thinks CAQH's role is aligning and bringing stakeholders together to create common expectations. Erin's gives her final thoughts. She asks that if you see a request for their Index, please respond. She also brings up the fact that they have been working to help put a utility out to support the CMS and ONC interoperability rules and to help people connect to have a trusted place of information around FHIR.

On this episode of The Dish on Health IT, Alix Goss vice president and senior consultant at Imprado joins our hosts Ken Kleinberg, Pooja Babbrah and Jocelyn Keegan to talk historical policy and standards milestones, how they brought us to where we are today and why it's important for the industry to go above and beyond the mentality of just checking the box for policy adherence in order to gain a competitive advantage and achieve better patient outcomes. Kens asks Alix to give us a breakdown of how we got to where we are today in health IT. Alix kicks off the podcast by explaining that for several decades, we've been trying to address improved affordability and outcomes in our healthcare system. It's about the right data at the right time for the right patient and in the right format. In 1996, under the Health Insurance Portability and Accountability Act, we set off on a journey that forced us to be on a trajectory, as a nation, in our information exchange for administrative simplification. Think of that as governing, or establishing, pharmacy and medical standards along the way, in the 1999 to 2003 timeframe.Then, we rolled up our sleeves and tried to make all of that work only to realize we really needed to bring clinical aspects into it too. We started working on the American Health Information Community (AHIC) under the Bush administration, which helped us figure out what clinical data exchange needed to look like. A lot of the work was memorialized under the Health Information Technology and Economic and Clinical Health Act (HITECH) of 2009. Shortly after, we got the Affordable Care Act. Then came the Medicare Access and CHIP Reauthorization Act of 2015, which established a robust Quality Payment Program, changing the way Medicare rewards for clinical value over volume. Most recently, our journey continued with the 21st Century Cures Act in 2016, which promotes and funds the acceleration of research and drug and medical device development. In the end, HIPAA gave us administration simplification and now 21st Century Cures is bookending decades of progress and forcing us into this intersection of clinical administrative data all around the patient.Ken asks Alix if she believes Fast Healthcare Interoperability Resources (FHIR) application programming interfaces (APIs) and rated standards are innovative. She responds with a question. What is your definition of innovation? If you're in other industries you're probably thinking, yeah, not so much. But for healthcare, we're so complex with the variability of all the data elements. Our current transaction evolution to adopt FHIR will provide us with greater flexibility throughout the entire process. Alix thinks FHIR is the way we're going to bridge a great deal of problems, but she does not necessarily see electronic data interchange (EDI) going away. It's gotten into the DNA of our architectures and our business decisions. It's the way we do things. We like to adopt new standards, but where we always fall short is doing the cultural transformation of workflows as opposed to sometimes just having a “check the box” mentality.Jocelyn, who has extensive FHIR Accelerator experience, notes it is no longer just about the rules or the laws that have gone into effect, it really has to do with if we're not figuring out how to make value-based care work, what is our alternative? What will push people to make the shift? The pandemic further exposed current weaknesses in our ability to exchange clinical data, to let us roll out vaccines at scale across our public health infrastructure. There could not be a more compelling business case for why it's so imperative for everyone to start picking up existing tools and implementing. As data starts to free and more players implement, those that don't react or those that have the “check the box” mentality are going to put themselves in a significant competitive disadvantage in the coming years.Pooja has examined these issues from a patient, CARIN Alliance perspective. She is concerned with how we make it easier for patients to access and share their data. FHIR APIs finally get us to that point where it's easier for patients to download their data. We're getting to the point, thanks to some of the recent technology and standards, where it is easier for patients and consumers to download their information and to do searches on price transparency. Ken moves the conversation to payers. He asks Alix if this stakeholder group is embracing change or just “checking the box”. Alix says it is a very mixed landscape out there as far as opinions and corresponding strategies. There are some who are only going to come along when the axe (aka penalties) comes down. Then there are others who are pushing the envelope and pulling folks along. Alix thinks there is a landscape in the payer community that feels overburdened and has its own compliance fatigue. She believes there is also skepticism around what might change. That skepticism coupled with longer term trust dynamics in the payer-provider community plus the sustainability themes for payers (rapidly changing business models) has caused them to start considering things with different lenses that they've never had to before. Past approaches have trained the industry to wait for regulations and incentives to create movement, meaning there is far more “check the box” mentality than anything. Alix is optimistic though, especially under the FHIR Accelerator community, that there is a group of thought leaders who are leaning in and trying to drive a stronger course forward for us all.Ken asks Jocelyn what her comments are about payers being burdened. She notes it is a fair point and that there a couple of factors at play here. To Alix's point, there's a lot of entrenched operational support and infrastructure in place that's been running to support EDI for a number of years, and there has been minimal effort in doing clinical data exchange with payers. Because of the historical combative relationship between payers and providers, we haven't seen much progression yet. However, with the Da Vinci Project, we get to see daily how those relationships are changing. Payers who leverage modern APIs will transform their organizations, how they work and how they view their relationships with provider partners. They will be the ones who come through the curve faster.Pooja notes we are essentially flipping the entire model payers are operating under today. They're not used to opening up their data to others. It's the same in the PBM space. On the pharmacy side, we're not quite there yet but how do we make it easier for data to be shared? How do we make it easier for patients to access their data?Pooja also brings up that payers are having to meet interoperability, patient access and price transparency rules, which is a lot. She has a feeling payers might default to just “checking the box” because they will all be in a rush to meet what's in place today. The point is though, we need people to be thinking outside of “checking the box”. Where can they focus? What are the specific use cases that they could look to in order to achieve a market advantage? Pooja thinks that's where payers need to be paying attention.Alix comments that we're not just transforming standards, we're transforming culture. How does a patient become informed? We have an educational foundation here of using technology to interpret information in collaboration with someone's payers, providers, benefit plans and their family's budget. That's how we stitch this all together. However, to Pooja's point, the history of payers and the cultural transformation is one of our shortcomings in implementation efforts that we've undertaken in the last 30 years.Ken asks Alix how she sees the new federal administration playing out over the next few years. Alix says public infrastructure has been duct taped together and underfunded for decades. The work people have done at a local and state level in partnership with the Centers for Disease Control and Prevention (CDC) has been amazing. It is also amazing how the commercial sector relies on registry and public health information. So many use the data, yet very few people help support the public health infrastructure. So, Alix thinks we are going to see a lot of transformation in the public health space (for the good). Having a new national coordinator like Micky Tripathi is going to really help leverage implementation efforts and take us to the next round of progress. Additionally, Alix does see FHIR as a key factor in bridging a number of issues out there, but she's not expecting a hard left turn in this next administration.Ken asks Alix for her final thoughts. Alix stresses for people to get educated and involved in standards development, both policy and technology standards. If you can't play at the national level directly, you can always offer your public comment on proposed rulemaking. We all have experiences to share and we all should exercise our voice to strengthen our nation's trajectory and agility to respond to all the amazing technology and medical advances that are yet to come. So if you can't get involved directly, tap into the expertise of the folks at Point-of-Care Partners or Imprado because they can inject that knowledge and add your story to their library of perspectives from which we influence.

This episode of The Dish on Health IT features distinguished guest Evelyn Gallego, CEO at EMI Advisors and Program Manager at the SIREN HL7 Gravity project. Our new host Ken Kleinberg along with co-hosts Jocelyn Keegan and Pooja Babbrah talk with Evelyn about value propositions for collecting social risk data, establishing agreed upon language and vocabulary for social determinants of health (SDoH) data and the issue of consumer and patient privacy.For those who don't know, what is social determinants of health (SDoH)? Evelyn quotes the World Health Organization's definition of SDoH, which defines it as the conditions in which we are born that effect our overall health. To put this in perspective, it is estimated that over 50 percent of our overall health is driven by socioeconomic factors and our physical environments.Evelyn notes that as the industry shifts towards value-based care, organizations are increasingly pressured to address some of these unmet social needs that negatively impact patient health outcomes. Disparities among racial and ethnic groups have been further exasperated during the COVID-19 pandemic. In fact, nearly 47.8 percent of COVID-19 deaths (from May 2020 – August 2020) were people of color. She states that there are obvious value propositions for collecting and using social risk data. The collection of this data not only would improve clinical care and delivery of care, but it also would improve social risk interventions, population health management, community health improvement and research. However, Evelyn explains that even though the business case is made clear, clinical systems have not been able to consistently and effectively address social needs due to the existing challenge of how to document this data.Ken asks Evelyn to further discuss the specifics of the Gravity project. She shares that the Gravity Project began in May 2019 with goal of developing consensus-based standards for the interoperable data exchange of SDoH across health services systems. The project was initiated by Social Interventions Research & Evaluation Network (SIREN) with funding from the Robert Wood Johnson Foundation. There were three specific social risk domains that the project focused on, and those were: food insecurity, housing instability and quality, and transportation access. Evelyn says those three risk domains have been tackled since, and they have moved on now to financial insecurities, education status, employment status, veteran status, social isolation, stress, and interpersonal violence.Since its inception, Evelyn says the project has had over 1500 participants in the health and human services ecosystem. Her team found success in reaching out to a large number of players with their value proposition and welcomed them a seat at the table. Many of these community-based organizations (CBOs) are weary of health systems, and fear medicalizing SDoH, yet want to help establish agreed upon language to ensure clear understanding of all parties involved.Evelyn and her team had overwhelming interest in this area to which they realized their current model of operating would no longer be sustainable. They needed to raise money and looked to the Da Vinci project's structure for guidance. In August 2019, Gravity became an official FHIR accelerator. Evelyn said they wanted to make an initiative that would incentivize different stakeholder groups to participate and sponsor, and not make it a pay to play model because they still needed stakeholders who would never sponsor the project still be at the table.Jocelyn jumps into the conversation and says the FHIR community has the ability to bring the right people, the right model, and the right funds together to get work done faster.Jocelyn explains that we will not get the patient impact we want to see if not all stakeholders are engaged with this process. We can build all the implementation guides we want, but if no one picks them up and uses them, there is no point. Jocelyn applauds Gravity for being hands on and for bringing incredibly dispersed and perpetually underfunded stakeholders to the table.Ken asks Evelyn about the use and value of FHIR interoperability, pilots and testing and potential challenges. She says that Gravity's process has two workstreams: terminology and technology. The project started out to address coding gaps in the market. FHIR standards move data from one point to the other, but data definitions must be in place in order to understand that data. It goes hand in hand.The Gravity project has three use cases and one FHIR implementation guide focused moving clinical care data to CBOs. Evelyn and team are currently funding by ONC, under the HL7 cooperative agreement, to investigate what standards are used by CBOs as well as what data infrastructure exists and how can they be made FHIR compatible. She notes that we do not know for certain if FHIR is the best way to exchange information in CBOs. We're working on that. She goes on to say Gravity engages a lot with government agencies, Administration of Community Living (ACL) being one. ACL provides grants to state agencies on aging to support elderly services in the community. ACL issued a challenge grant for innovations in the market, and they made it a requirement of the grant to adopt the Gravity standards. This is huge.Finally, Evelyn stresses that we can't ignore the power of mobile technology. How do we use mobile technology to support referrals, ultimately allowing individuals to finish the loop? For example, using QR codes for individuals referred to a food bank. They go to the food bank, use the QR code, and then receive or don't receive food (depending on the available resources). We would be able to receive feedback to see if 1) the individual went to the food back and 2) they were able to receive food.Jocelyn notes the importance of identifying where endpoints are in the community. Ones that we can leverage and better enable technology but that's not going to be an expensive IT system. Pooja wonders if there are international examples we could be looking to for mobile technologies. Where else could we look in foreign countries where they are making connections and using existing rails that are already there, especially for some of the CBOs?Ken moves the discussion to the burdens of SDoH. Evelyn notes the obvious, ongoing provider burden in documenting SDoH information. She also brings up the burden CBOs face with SDoH around capacity, they are not equipped to start receiving referrals.Jocelyn explains that as soon as organizations receive direction from regulation, that dictates how goals and efforts are prioritized. We hear people say they don't want additional regulations, but we see organizations often don't prioritize certain things unless they are under regulation. The FHIR community is a great example of how providers, payers, vendors and the government can come together to put those “levers” (regulation) in place.Ken brings up the final topic. He asks Evelyn to speak to consumer and patient privacy. She states we must remain vigilant. We must work to maintain privacy, security and equity as we collect and share whole person data. The Gravity project works with very large communities of people to advance towards collecting and sharing SDoH data; creating standards; scaling standards. But it must be done judiciously.Evelyn notes that as more data is collected, it has the potential to further disadvantage those who were already marginalized or socially excluded. If social risk data is collected, she has had feedback that there is a fear of judgement for those individuals. The Gravity Project just published data principles, which outlines how to use SDoH data in an ethical way. We do not want to further exasperate what we see in the market. Patients must trust us to use their information in the right way. Consent will be key to all of this. Pooja adds that the stigma around mental health will add complexity to patient consent. What will patients want to share? Will it only be a portion of their information? This is a huge topic we must work through, but the data principles Evelyn mentioned is a step in the right direction. Ken asks Evelyn for her final remarks. She wants to plug Gravity pilots for her concluding remarks. She us currently raising funds for the pilots. She wants to have a diversity of actors testing the pilots, which makes the funding all that more important. We cannot achieve interoperability without having all the systems responsible for capturing and sharing data come to the table. Standards cannot be matured without first testing in the field.  

Our first podcast episode of 2021 features distinguished guest Steve Posnack, Deputy National Coordinator for Health Information Technology for The Office of the National Coordinator (ONC). Our new host Ken Kleinberg along with co-hosts Jocelyn Keegan and Pooja Babbrah talk with Steve about the administration transition, FHIR, moving to APIs in healthcare and the mission to achieve interoperability.  Ken first asks Steve what he expects to see from the Biden administration, more specifically, how that transition will impact ONC and Centers for Medicare & Medicaid Services (CMS) moving forward. Steve says we were set forward on a course related to the 21st Century Cures Act and there is still more to be done in implementing the statutes. Health IT has largely received bipartisan support. The technology work and how technology can be used to support healthcare to make it better is something he believes everyone is passionate about. Steve's points echoed an expected continuity of cross-party support toward areas like health IT, health data and improving the overall functioning, effectiveness, and outcomes of our nation's healthcare system through the use of technology. He did, however, expect to see a greater focus on pandemic response with the Biden administration.  Ken transitions to the next topic and asks Steve and our co-hosts to give their thoughts on how we will see APIs and the work of FHIR accelerators used to support the COVID response and management of the pandemic moving forward. Steve notes the event Accelerating APIs in Healthcare: A Year in Review and Momentum for 2021 that took place on December 1, 2020, which highlights the accomplishments of four years of initiatives, investments and industry participation. He sees opportunity to continue to reduce burden and automate processes as well as work to enrich the point of care through the use of technologies and tools.  Jocelyn points out that the impact of COVID, and the pandemic in general, falls into two classes when it comes to advancing APIs. We've seen some folks pull away from their progress toward value-based care due to delays in compliance dates. However, then we see some people who are no longer waiting on vendors and are understanding the role of APIs. There's nothing else that could have happened to further splay open the current state we tolerate as members of the United States' health system in terms of lack of interoperability. She says it's not about ripping out or replacing old standards, but rather, identifying where we can leverage APIs and tools we get out of FHIR to be able to sew together all these disparate parts.Pooja notes an important topic gaining attention during the pandemic: advanced care planning. People are ending up in the ER or getting intubated. It's not easy for providers to get that information for people who are ending up in the hospital. These patients may have a do not resuscitate or do not intubate order in place. It's not just the HL7 FHIR accelerators that are taking what everyone is doing around these FHIR APIs, but we're taking that and applying it in other areas.  Ken asks Steve what other stakeholders who have not traditionally been involved in ONC's rulemaking will be included in future efforts. Steve says ONC's footprint is widely expansive as his office is the cross section of healthcare as a whole. The Cures Act touched on pediatrics a little bit more heavily and we've been putting out some resources in that regard. Long term post-acute care was another place that was ineligible for incentives under the original HITECH Act money. Then we have everything in between such as behavioral health, mental health, other types of specialty care that are trying to connect to your home base (primary care physician, hospital or ADT notifications). We want to make sure the care community serving patients is aware of what's going on. All of this relies on data and interoperability. Steve also mentions that pharmacy efforts around electronic prior authorization and support for opioid care and management of medication are exciting areas of work as well.An interesting topic, Ken asks Steve how industry participation helps drive ONC's rulemaking. Steve explains that most all his office's efforts are focused on longer-term visions to make lasting change, which means building relationships and establishing trust with stakeholders is essential. He says we can't regulate our way out of everything, but rather, we must get everyone on board for the same mission. Steve notes the importance of seeking knowledge from industry colleagues. Pilot testing and standards performance testing are a vital part of the process, yet he finds that it is sometimes difficult to find stakeholders to back investments.Jocelyn brings up the issue of incentivizing  people so they want to become early adopters. How do we lift the ceiling for those who really want to innovate? She poses a question to Steve asking how they go about making sure that standard ceiling is lifted while at the same time making sure people are meeting the requirements of the floor. He responds by saying this is an issue they have been chipping away at for some time. It's difficult form an interoperability perspective because if two people are at very different levels, sometimes is okay, but other times there is a hard break resulting in friction. As long as it doesn't create a discrepancy in interoperability, we will allow communities to move forward with standards on a voluntary basis once their other requirements are met.  To finish the podcase, Steve leaves us with an honorable mention to Project USA, something to look out for in the coming year, as well as a nod to the continuation of TEFCA and the 21st Century Cures Act in 2021.Pooja's final comments commend Steve for bringing up pharmacy. She notes there actually is a lot of work coming out of ONC that supports the pharmacy-side of healthcare. She advises her fellow colleagues in pharmacy to pay attention to the happenings of ONC and utilize them as a stakeholder in the coming year.Jocelyn ends the podcast by saying she would like to see what momentum will look like on the existing proposed rules once the dusts settle, especially with the delay around the information blocking rules themselves and what will the industry need to do to keep things moving forward.  

On this year-end episode of The Dish on Health IT podcast, host Gary Austin and co-hosts Ken Kleinberg, Pooja Babbrah and Jocelyn Keegan discuss prognostications on the year ahead in the areas of COVID-19, technology innovation, health data, and price transparency. Gary begins the episode by addressing the elephant in the room: the ongoing impact of COVID-19. He asks Pooja to open the discussion by giving her thoughts on the impact of the healthcare vertical COVID-19 is going to have in 2021. Pooja says COVID-19 is going to impact a lot of things, starting off with the vaccine. For the vaccines that are beginning to roll out, two different doses are needed for it to be effective. Tracking immunizations will be tricky for HIEs. Who has received the first dose? The second? Adherence will be critical. We need to make sure those who received the first dose of the vaccine also receive the second dose. Even the payers and pharmacies are going to be impacted by COVID-19 not just with the vaccine, but with how people are seeing their doctors. Pooja references past The Dish on Health IT podcasts that covered telehealth, the expanding role of pharmacists such as giving vaccinations, and the opportunity to better include community pharmacists in efforts, which all will remain relevant moving into the new year.Jocelyn agrees with Pooja in saying we need to drive volume in this market to the most suitable place that can best serve a patient and have the right tools and connectivity to make sure that data is comprehensively gathered. Jocelyn does see two things we will have to grapple with when moving into the new year. The first is the impact of profits and loss from a provider organization standpoint. There is massive loss happening for those in the direct line of care. She thinks when we look at 2021, it will be about leveraging the tools in front of us and taking advantage of the new technology that is being laid down. The second issue at hand will be impacts of market readiness. We wanted these rules to be put in place and then the rules were put in place. Will delays on these rules slow us down when we were at a point in time when we could have had a perfect storm to push through a lot of technology change? How fast do we allow ourselves to move? How much do we acknowledge what our provider teams are dealing with?Ken believes the vaccine will be key. He recently read an article that correlated the degree of someone's education with their willingness to take the vaccine. If you had an advanced degree, you would be most likely to want to take the vaccine. The less education a person had, the less likely they were willing to take it. There are big trust and education factors here that payers, providers, IT vendors – all of us really – need to take responsibility in helping with that. Gary moves the discussion to the next topic: health technology, specifically telehealth, FHIR APIs and health information exchanges (HIEs). What are your thoughts as to where these technologies are going in 2021? Ken notes that all three of these technologies have something in common and that is that they are connecting stakeholders together. We've experimented and piloted. We've had our successes and less so over the last two decades, but now we are seeing these technologies come together and become mainstream. This could be due to leadership, regulations, relaxation of regulations (in the case of telehealth), or simply the need to fight the pandemic. Once data starts to flow, we will be able to run advanced analytics with more varied data sources. This can inform decision support, risk stratification, analysis of social determinants of health, precision health and so forth. Ken is particularly excited about the promise of natural language processing and AI machine learning. Pooja agrees with Ken in saying these technologies are essentially connecting people together and sharing more information, which brings up trust. We are starting to open up more data. We have HIPAA which spans across our business entities. What will happen when we open up data to the patient? Patients having trust in applications will be critical for them in getting their information. Then comes the issue of who the patients are willing to share the information with. eConsent plays a huge role in this. Who are patients going to share the data with? Do they understand that when they share their record, it will essentially share their entire patient record? Is that something they want to do? Moving into 2021, trust and eConsent will be a huge focus. Jocelyn points out that if a problem is big enough, we can make the existing artificial barriers disappear. She goes on to explain that people have been leveraging tools that are available to them. When you're in the middle of a pandemic, it is about what tools are there that are being underutilized such as the HIE. She goes on to address new technologies and the unleashing of data by using APIs predominantly through FHIR. The pandemic has clearly shown how important these projects are and will allow stakeholders to progress towards more real work in the upcoming quarters. Payer and provider rules continue to get dropped. Jocelyn feels the work around FHIR and APIs is truly a nonpartisan topic. We are seeing universal agreement and will continue to push forward. Gary moves to the next topic, which is health data. What do you see happening with health care data in 2021? Jocelyn sees a couple of things happening here. First, payers and EHRs, around the information blocking rule, are mastering their information in a way that they haven't had to before; being able to comprehend where their clinical and claims data are. What's most interesting is the scope of data that's under regulation and having people meet those initial regulations. Secondly, we are realizing this is real. There are the people who are getting their house in order and then there are people who are trying to just check the box to get through this set of regulations. Ken notes that terminology and code set management have been important to providers and now to payers as well. Payers will need to get a handle on the clinical data they have and share it. Ken says some may only do the bare minimum while others will use this as a business advantage.  Jocelyn hopes that the next round of USCDI addresses some of the deficits in the payer-based data. Pooja adds that while we often talk about clinical and claims data, we need to also be thinking about pharmacy data. With USCDI 2.0, we need to start thinking about those stakeholders who haven't been involved like pharmacies. To have clinical, claims and pharmacy data together would be a very powerful thing.Gary asks Pooja to address price transparency. Pooja says that real time benefit check feels old hat now since it has been in the market for five years. With consumer-facing, there are implementation guides in place, and we are starting to see some PBMs pick those up and start to look at it. The biggest thing though is the final rules that dropped a couple weeks back for the payers and providers. Pooja thinks that's where we're going to see a lot of traction in 2021. Payers and providers need to be looking at this as a way to give themselves a market advantage. There is a long way to go, but it all comes down to freeing data and putting more opportunity in the consumers' hands. To find the care they need at a price they can afford it.  Ken says that consumers can play a very important role with price transparency. He wonders how we educate the consumers to operate in the proper vector. The more information you provide them, in an easily-digestible way, can make a difference. Ken believes these final rules can be used as a market differentiator that could lead to stronger consumer loyalty. Gary asks Jocelyn to discuss accelerators in terms of price transparency. Jocelyn says the name of the game with price transparency is that it needs to be patient-focused. It's about information equity, having the same information as my provider, which requires all the players to be involved. Jocelyn thinks that if we look across the board, that's the sentiment of what's happening. That's the foreseeing function we see coming out of these rules is make the data available so that we can have the innovation we need to get to a well-educated consumer. The final topic relates to the new administration. Gary first asks Jocelyn where she sees CMS and ONC going? She predicts that we can expect public health to get some money to actually do real work. Since this is a non-partisan topic, she also expects regulations to continue to come through. Jocelyn is confident that with the work coming out of the ONC and CMS teams around regulations and the work we are seeing come out of cross collaborations, we are making real meaningful progress in helping our consumers. Pooja adds that with CMS, we are still waiting on a final rule for the consumer-facing real time benefit check transaction. These topics seem to have bi-partisan support, so she does not see many changes in these focus areas. Ken gives his final thoughts. He thinks 2021 is going to be one of the most intense years in decades for health plans, providers, and IT vendors as they start to tackle all the game changing open API regulations that are going to require them to share data. Jocelyn thinks we have never been better positioned to impact change. We are in a unique situation with the move toward FHIR and APIs. It is rare to be able to fundamentally change how an industry works. That's what we're doing. Pooja closes by saying she thinks this pandemic has opened our eyes to everything that is wrong. The CMS and ONC rules were coming out just as we were going on lockdown. It makes you wonder, if we had these rules in place just on our own without being forced to do it, how much of this heartache and struggle we are going through now could have been avoided? Pooja was frustrated to see the rules get delayed. We are in the middle of a pandemic. We should not be slowing things down; we should be speeding them up. 

This episode focuses on the recent CMS price transparency rule. Hosts Gary Austin, Ken Kleinberg and Pooja Babbrah discuss the new rule, break down its components and outline what it will mean for the industry across stakeholders including opportunities that shouldn't be missed..Gary begins by asking Ken to summarize the concept of price transparency. Ken notes that in the past, consumers were not concerned with healthcare costs because it was handled by insurance companies. It was a fee-for-service model. The challenge was costs kept going up. Our costs here in the U.S. are nearly doubled of any other country in the world. For a long time, our model has been deemed unsustainable and it makes it difficult to compete on a world stage. Over the years, the government started to move towards a pay-for-performance model, value-based care and all the way up to a more advanced model, accountable care. As part of all this, patients, with their co-pays and deductibles, are becoming much more engaged. Now we are looking at requiring providers to disclose how much they charge and payers to disclose how much they pay. Consumers should get a better view of what they have to pay. In theory, this should increase competition, give us more of a market and reduce costs. Gary asks Pooja to give an overview of the pending CMS rules around price transparency directed at providers. Pooja explains that if you count everything over the past few years, there are five rules around price transparency. We've seen a couple of those get finalized in the past few weeks. The goal around all this is to make sure providers and payers are letting consumers know how much things are going to cost them. The provider rule was finalized almost a year ago and as of 1/1/2021, providers are required to give a machine-readable file of standard charges. That can include gross charges or payer-specific negotiated charges. Pooja says it really just allows a consumer to better understand what their charges are going to be if they are going in for some type of service or procedure. The other piece of this is providers are required to provide consumers with the price of 300 shoppable services, in an accessible manner. How do providers look at this rule? Pooja notes that from the initial lawsuit, it was not received well. But depending on the way providers look at this, the rule could be to their advantage. We're trying to push for value-based care and this could accelerate that. The forward-thinking provider groups and hospitals should be thinking of it that way. Gary asks Pooja to speak to the new payer price transparency rules. Pooja explains that from a payer perspective, a lot of it is the same thing. As a payer, you must provide to the patient what it's going to cost for a cost-sharing portion. This allows patients to price shop for coverage and understand what they are getting for their coverage. Usually, when we see rules from CMS, it only applies to Medicare/Medicare Advantage plans. However, the payer rule applies to commercial plans as well, which is a change we haven't seen in the past.Pooja notes that in the past, there have been two rules around real time benefit check, which required payers to provide consumers and providers the ability to understand the price of medications. From a PBM standpoint and a pharma manufacturer standpoint, there's information required to be shown to the provider when they are going to prescribe the medication.    Gary asks Ken why we need governmental intervention in healthcare. Ken notes that in healthcare, we are only in the early stages of how we are going to deal with price transparency. Healthcare, due to its complexity, is the most difficult industry to go after. Will bundled options become a problem here? Ken notes that for anything that is very repeatable, it should be possible to get a clear price. Then, it comes down to can you deliver at that price with greater and greater efficiency. That is the direction we want this to go. Gary asks Pooja if these rules will help alleviate the surprise billing situation. Pooja says that is one of the downsides of all these price transparency rules, it doesn't account for every cost. The mandatory list of 300 shoppable services will not cover everything.  Gary asks Pooja what this will do for providers. As much as we all think consumers are looking for this information, there are studies out there that say even if a patient is given all this information, they're not actually going to look at it. This is going to help the industry move to capitation, which means you are paid a specific amount, you are not negotiating all these different rates. Providers need to be thinking of these rules a positive thing. If you can get this information into a patient's hands, they are able to shop around and look at outcome. They know if they go in for a procedure, they will come out better. That's the way providers need to be thinking about this as opposed to a required mandate. Pooja doesn't think a lot of providers are there yet.  Gary asks Ken if quality is something needing to be published in order to compete. Ken points out that CMS has been requiring quality measure reporting for years which can be accessed through Hospital Compare but also points out that most consumers may not even be aware that this site exists but thinks people will find it illuminating as he did when he looked up his local hospital only to find that it had only one-star.  Ken wonders why we can't extend healthcare to other parts of the clock to take advantage of less demand at those times and to provide lower pricing at those times. Consumers should have that choice. And for many people, they would take advantage of demand care pricing.  Gary asks what the opportunity is here for payers. How can they differentiate themselves in the marketplace? Pooja zooms out to talk about interoperability rules, which require payers to provide their members with their data they have on you, clinical, claims, all of that. So, if you look at that and add on the fact that you're now letting the patient know how much it's going to cost them for these services, this could be a huge advantage for you. Make it easy for members to understand everything about your plan, their coverage and how much it's going to cost them and give them access to everything. I think as a payer, you should really be looking at this as engaging the member and patient, which is really what all these rules are about. We want patients and members to take greater control of their care. I think this does provide a huge advantage and if you wrap it up with everything else you are doing as a payer, you can go out to the market with great advantage. It's just a matter of thinking about it a little differently. Ken says if you are the organization that's educating your consumer, then you are effectively making a better customer and they are going to want to stay with you. Pooja's closes by saying to payers and providers, don't look at this as a mandate. Shift your thinking around this to better understand how you can use this to your advantage. If you are one of those groups that do that, you will have a greater advantage in the marketplace until people catch up with you.  

This episode features guest Aneesh Chopra, the first Chief Technology Officer of the United States and more currently, the co-founder and president of CareJourney. Hosts Gary Austin and Ken Kleinberg sit down with Aneesh to discuss smarter choices the industry can make to move more quickly towards value based care, specifically direct contracting and third party apps.Aneesh first gives some background on his company CareJourney. He explains that CareJourney is, in many ways, the private sector implementation of his passion of serving in government around open data, open APIs and payment reform. His primary mission is to make sure we use all these open resources to help patients, through the organizations they trust, make smarter decisions throughout the healthcare delivery system.Gary asks Aneesh to overview direct contracting as well as what's to win here for providers. Aneesh says direct contracting is ripping the band-aid off the move to value-based care. Direct contracting is Medicare Advantage-like, but without the insurance company and without the consumer changing their actual insurance benefits. They retain all their Medicare benefits, but they have their capitated dollar. They can bring their resources to a primary care group and integrated delivery network to help them better manage their care without taking away any of their rights to see any doctor they wish. This model is a leapfrog from training wheels to full downside capitated risk. Aneesh explains that remote patient monitoring could be a category. CMS explicitly invites applicants who have proposals who can reduce the cost burden and improve quality for high needs patients, especially those who have historically fragmented care. The model allows for these entrants to drive the process and bring along a physician network that may help administer some of the services. Aneesh thinks it is traditional doctors and networks applying from Medicare Shared Savings to direct contracting.Gary asks Ken how interoperability plays into these arrangements. Ken says risk is about what you know and what you can control. The more you know, the better you can control that risk. Interoperability can bring in all kinds of data about that patient, traditional clinical data, social determinants of health and claims data. We can pull information from many different sources and understand our population in ways we've never been able to before. That gives you the power to control risk and do a better jobGary asks Aneesh what he thinks of the “patient gets everything from everyone, on demand, delivered anywhere model.” Is it good for the marketplace? Aneesh says it's great for the marketplace. It builds the healthcare data sharing infrastructure on a foundation of “must share.” One of the challenges we've had for the last 20 years is that we've built all these data sharing networks and policies that try to square a complicated circle. We are saying we want all of the information flowing where it's needed, but we have to honor the HIPPA minimum data necessary provisions. So, the broader the network, the broader the use cases, the weaker the signal because by definition, someone is on the network to do something that is only entitled to a minimum amount of data. If I have to join a network where I've got to meet the lowest common denominator, I'm not going to get the information I need nor am I going to help make better decisions for people because limited information, limited affect. What we need is a mechanism to right size the information sharing to the legal frameworks under which those information sharing provisions exist. The consumer's right to access health information by being bedrock as a foundational right in HIPPA. Now technically materializing through these two rules is a smarter method of sharing data because no matter what I am entitled to my full medical record and if I choose to share it with my primary care doctor, that's my choice and that's my right. Gary asks Aneesh how to get payers moving along. Aneesh suggests that instead of just working to meet the letter of the rule, payers should ask themselves what they are doing to meet the spirit of the rule and how that benefits the strategic plans of their organizations. His overarching message is shift from defense to offense. How can the investments you're making advance the goals you have? What apps are you putting in the hands of your consumers? Are you working to get those apps connected to every single EHR in your network? Ken agrees with Aneesh on the compliance. He says these organizations often ask themselves what is their bigger fear? Is it financial penalty? Losing some business? Will we do the best by just giving the minimum possible? In the end, what you're really trying to do is meet the business objectives, which is increase your brand and gain loyalty. You do that by providing information in a format that's more usable. That's where a lot of these technologies can play a role. That's where we get into these apps. You have the potential to give people information in a format that's usable to them. Gary moves the conversation to third-party health apps. Aneesh views CommonHealth and Apple Health as infrastructure. He notes there is a hypothetical fear that Google, Amazon, or Apple are going to swoop in and take over healthcare, but he does not believe that is the case. Aneesh says if anything, Google, Microsoft, and Amazon are going to be infrastructure partners to existing players in healthcare or these new direct contracting entities who are managing risk, building clinically integrated networks and engaging patients.Gary asks Ken what he thinks of third-party apps. Ken agrees with Aneesh in that trust starts with primary care physicians. Primary care physicians are likely going to go with apps that work with the EHRs and the portals that they are already familiar with. With regulations coming up, some consumer-type apps may surface that tend to do a better job than what might have been offered to the physician and their EHR vendor. As community pressure builds, the physician may go back to their EHR vendor and ask why they can't support this. That can drive some advance here. Gary asks Aneesh if this is an opportunity for payers to engage their members more deeply. Aneesh explains that high need patients suffer from terrible care fragmentation. It's so obvious that the plan can do a better job here. The decision support to go from fragmentation to coordination is best done by an entity that is trusted by the consumer to do that coordination. You want to trust an app that can be connected to a portal, get the updated feeds and have other context about my healthcare needs. Gary asks Ken for his closing remarks. Ken says this really has been a long journey, measured in decades. He is optimistic that things are getting better. Interoperability in the past decade or two has been like the wild west. Now, he thinks we are aiming with FHIR, projects like Da Vinci and USCDI to be much more practical. That's going to benefit everyone.Aneesh shares in Ken's optimism. We don't have the luxury of waiting decades for this chapter to have success. So, while it does take decades, we must move faster and make smarter decisions to comply with the rules, embrace value-based care and better engage consumers. These things will help accelerate that timeline. Let's do it smarter, together.  

Steve Bratt, lead of CodeX joins hosts Jocelyn Keegan and Gary Austin to discuss the integration of minimal common oncology data elements (mCODE)and leveraging FHIR API technology to accelerate significant improvements in cancer care and research.Gary first asks Steve to give listeners some background on CodeX. Steve credits the early conception of CodeX to the initial research his company MITRE conducted on standard health records. After recognizing the potential of their study, Steve's group decided to focus on a more specific problem within healthcare, cancer. The goal was to develop a common language for cancer data sharing. His team worked with the American Society of Clinical Oncology to convene a group of experts across pathology, radiology, surgery, chemotherapy and other areas to identify 90 of the most important data elements needed to treat all cancer cases. Gary asks Jocelyn how CodeX and Da Vinci interrelate. Jocelyn explains that with FHIR, they are building communities who can pick up and use preexisting toolkits. However, it is specificity that is needed to make these powerful tools work. That's where there is overlap. Da Vinci and CodeX use cases started to talk about where CodeX could build upon Da Vinci payer and provider frameworks. CodeX is extending the purpose by utilizing subject matter experts who know these workflows well. Jocelyn adds that she believes CodeX is amazing in many ways. It is focused on an area of healthcare that touches most all our personal lives, not just our professional lives. There is so much to be gained by unlocking and freeing this data. That is different from other accelerators. Gary asks Steve what types of people are engaged with CodeX. Steve says they start with the thought leaders. People like Aneesh Chopra, Dr. Monica Bertagnolli, and John Halamka. These individuals not only have far-reaching networks who listen to them, but they also help develop the vision and unite communities. So how does CodeX get patients involved? Steve notes that one of the first use cases was patient clinical trial matching, which as is, is a very inequitable process. CodeX works with the American Cancer Society to automate the collection of data from EHRs. The data is sent to matching services using mCODE who then send back structured clinical trials matching certain patient characteristics. Patients will then be able to search and prioritize results.Another use case addresses how do we conduct clinical trials out of data in the EHR. If you're in a clinical trial, you receive high quality, structured data. Only 3-6 percent of cancer patients get in clinical trials, so if we get all the cancer patients' data out of EHRs and into mCODE, now there are 100 percent of the cancer patients from which we can learn. We will have a massive amount of information from all cancer patients. When you bring the EHRs up to a higher level, not just the quality of data, but also in a standard language, this would allow the EHRs to be a source of patient data for many use cases. Jocelyn notes that since FHIR makes data functionable and portable, there could be even more use cases developed. If we can make data move and be accessible, projects that previously could not get funded now become possible. These accelerators bring interested people together to do the right thing. Gary asks how accelerators can come together to quicken the prior authorization process. Jocelyn says layering is key. The value that Steve's team will bring to the table is to augment tools around prior authorization that have already been built. His group will look at their specific workflow, understand how it is different from a typical prior authorization and build upon that. Steve notes that many people affiliated with CodeX also work with Da Vinci, so they know the value it could provide if vendors adopt it. If we could share patient clinical pathways needed for prior authorization, it could speed up the process for patients who really need care. It would reduce back and forth on complex issues. There are so many promising things that can be done working with Da Vinci, provided we get the payers to table. Jocelyn points out that all the work we're doing by freeing this data via APIs is meant to automate when possible. We want healthcare equity. No matter where you are physically located, you have the same access to the same type of treatment. The second piece here is transparency. There's so much unknown when somebody is going through their initial cancer diagnosis. The ability to say, at a patient-specific level, here are what your options are and here is what your insurer will cover is game changing in helping that patient. We can make better care decisions if we can bring the two worlds of administrative and clinical together. Gary asks what engagement we are seeing from vendors. Steve has seen a lot of interest from many different vendors. Jocelyn notes that these projects, at their core, are human-powered efforts. It's the volunteers that get the work done. Steven has had great interest but in order to make the accelerators fully functional, it's really about the participation of organizations. Gary asks Steve what he would say to key decision-makers who could be involved in this work. Steve says everyone we talk to just gets it. We need to go beyond saying it's great, let us know when it's delivered. They need to see the value proposition in CodeX now and understand they can impact the direction it goes. You can get early insights into what is happening and work directly with vendors to let them know what your needs are. It's all about getting the word out. We need people coming to the table.  

On this episode of The Dish on Health IT, hosts Pooja Babbrah, Jocelyn Keegan, Ken Kleinberg and Gary Austin discuss key takeaways from the annual ONC Tech Forum. The discussion highlights key areas covered at the conference such as Fast Healthcare Interoperability Resources (FHIR), Health Information Exchanges (HIEs), Public Health, United States Core Data for Interoperability (USCDI), Lab orders and results, and Social Determinants of Health (SDOH)Gary kicks off the discussion with a baseball theme and asks everyone to give their game (conference) highlights. Jocelyn first commends the ONC team for providing a positive, interactive online experience for participants. It was the next best thing to meeting in person. As for the content, the message of the day was FHIR and the urgency to make it work. Jocelyn brings up that those who are perceived as information blocking will also start to be targeted. Ultimately, she likes the synergy happening between CMS and ONC, there is uniformity among the sessions around moving forward.Ken's favorite session discussed healthcare systems in other parts of the world. He says there are certain aspects of healthcare that we do exceptionally well, and there are other areas where other countries do things better. Ken also listened in on a session highlighting the challenges facing labs, especially concerning inefficiencies with the exchange of results.Pooja observes that the overall theme of the conference seemed to reflect a pent-up consumer demand for a better healthcare system. She attended sessions she considered to be “off the beaten path,” such as long-term care. Pooja notes it's the specialty groups that feel like what is being done today does not meet their needs. When we look at the goal of supporting value-based care, we need to be thinking about everyone on the healthcare spectrum. How do we bring those other marginalized groups into the fold as well?Gary asks Jocelyn how fast is FHIR's fastball. Jocelyn says it's still too early to tell as FHIR is still maturing as a standard. However, she notes that it has been fantastic to watch real-world examples and leadership unfold in the meantime. More now than ever, it is evident as to why unleashing this data is so important. We are no longer tolerating inefficiencies like we have in the past. Jocelyn praises those on the frontlines using FHIR who come back and evangelize how they are leveraging it. Gary asks Ken what role HIEs will play in all of this. Ken mentions that HIEs vary considerably in their success, size, and scope. Some HIEs have started to work together, which is a very good thing. There are around 100 significant HIEs in the country now, much less than just a couple years ago. They've had to have some sort of sustainability in who they are working with. The providers have been key in clinical data. It's not quite clear what payer involvement looks like with HIEs. Ken says some payers claim that HIEs aren't fully focused on their needs. He thinks that is something that will probably change. HIEs will serve both payers and providers more equally than in the past.Pooja says HIEs can bring the longitudinal patient view. HIEs can take data from different sources and bring them together in a patient record as opposed to just bits and pieces sitting everywhere. We have the potential to reach more groups using HIEs during COVID that you couldn't normally reach with an EHR. Pooja agrees that we are down to a smaller group of HIEs, but the ones who are out there are doing innovative things and figuring out their new role in the environment. Gary asks how we can get payers more engaged with the HIEs. Jocelyn thinks the people who have focused on use cases and real business problems are the ones who will be viewed as a trusted partner when situations like a hurricane or pandemic arises. Payers will be more likely to wire in with HIEs when they are solving real business problems.Jocelyn hopes there are real, meaningful dollars put in place, so public health has an equal footing when it comes to implementation guides. Population health is complicated because there are so many endpoints. She hopes what we take out of this is that we need to seriously invest in our infrastructure for public health, then we all will win. Ken adds that on some issues, states are going to do things their own way, but when it comes to a pandemic, we need a more national approach. We are on our third attempt at a nationwide exchange, which is still, realistically, several years away. There may be some successes with the current HIE structure, yet in some areas like public health, it has proven to be inadequate. ONC is starting to fund some of these areas.Gary asks if there is any movement on a national patient identifier. Pooja mentions that ONC recently held listening sessions on universal patient identifier and a national patient identifier. She notes we are waiting to see if congress passes legislation to allow research on it. Pooja thinks we should look to other industries, outside of healthcare, who are doing this today, such as the financial industry. Other questions also arise concerning privacy and security. How do we share necessary information in a secure manner? Gary asks Jocelyn what she heard at the conference about USCDI. Jocelyn says the team at ONC recognizes there needs to be more frequent updates and ways for the public to impact what's in USCDI. There is a path forward to include ways for people to submit new ideas and to rely less on big annual/bi-annual updates. This becomes important as the expanse of people participating in the FHIR community gets larger and other stakeholders get engaged. The introduction of this new process to be able to expand and advance USCDI independent of the big turn of the wheel, is important for those who are implementing in the market. Gary asks Ken what he heard about labs. Ken notes key challenges like terminology and distributing results. For example, physicians may be ordering what they think is a certain lab test when they are actually getting another because the names are so similar, a capitalized letter could mean the difference between two tests. Then, you also have the challenge of distributing results. Public health often does not get results for a week or more after the results are known. The test results pass through many different places, which can sometimes also result in lost information.Pooja's final remarks talk about players on the bench, those who are waiting to get into the game. This is everyone outside of the main groups, including long-term care facilities, pharmacies, specialty providers, labs, or social determinants of health. She says that if we don't invest in these groups, we will not be able to accomplish what we are trying to achieve.Jocelyn is starting to see the work from the past several years produce itself in meaningful ways. She appreciated hearing from those on the frontlines who are using the tools at hand. Our healthcare system has unique challenges due to both our economic and political landscape, but there are plenty of opportunities for us to continue to lead around things like APIs and FHIR.

Guest Dale Sanders, CTO of Health Catalyst, joins hosts Gary Austin and Ken Kleinberg to discuss the future of interoperability and health analytics and how healthcare can be positively impacted.  Gary begins the discussion with patient identification. He asks Dale why patients do not yet have a single healthcare identifier for their healthcare records. What is going to change this situation? Dale explains that the answer is a combination of a voluntary system for those in the commercial healthcare space combined with a mandatory system for those that are benefitting from Medicaid and Medicare. We need to commercialize the management of those patient identifiers, just like we've done with internet domains. Ken states that TEFCAis looking at an infrastructure for a nation-wide health information exchange with a lot of these interoperability initiatives. He thinks we could do the same with patient identifiers if we could agree upon a dozen or so fields to try to do a better job capturing core data that could aid with patient identification.Gary asks Dale why we can't have data normalized across the board. Why is this such a difficult process? Dale explains that it boils down to economics. He suspects we've normalized enough to enable reimbursements but that's it. If you think about it, does it matter to a single healthcare system to normalize to a national or international standard? Dale explains that it is probably not that valuable for individual institutions. They are normalizing to their own vocabulary, which works for them. If we're interested in analyzing data beyond the boundaries of healthcare systems – as we need nationally for public and population health – we need to incentivize or mandate broader normalization of vocabulary and go way beyond LOINC codes.  Gary asks Dale if he sees the CDC mandating some of this for public health purposes post-COVID. Dale strongly believes it is time to mandate normalization. Ken notes that lab mapping is strikingly ineffective. There are physicians ordering tests by names that they know, but they don't really know what tests they are actually asking for because what's behind the scenes isn't visible to them. There is no convention for how those things are named, which can be a problematic situation.Gary asks Dale why there is not a standardized vocabulary. Why can't the power of the computer be used to translate all of this in a normalized fashion? Is the power just not there? Dale points out that human language alone is a very difficult thing to make sense of, especially the English language. If you layer on the complexities of clinical vocabulary, then it gets even more complex to turn that into computable, discrete elements. We can progress toward passive dictation, but there will always be a need for humans to make edits.  The discussion moved on to cover combinatorial data. Gary asks “How do you look at pulling this data together and rationalizing it across the two massive domains (administrative and clinical data) that are really driving healthcare in this country?” Dale explains the Health Catalyst data model. He says what you would see are domain and vocabulary-oriented data models that sit in between late binding and enterprise data modeling. There is this middle ground of curated data that is a manageable thing to keep up with and execute.Gary asks Ken who he thinks is going to win by pulling all this payer and clinical data together. Is it the analytics companies, the EMR companies, big tech or who? Ken says there is this concept of a converged platform between payers and providers. Registries are an example of how pulling information together that a lot of people can use. The EHR vendors have taken a run at this, the analytics companies have taken a run at this. We've got the population health management vendors, some of which have been more on the business side of value based care, but there are also some that are on the tech side. It's frankly a huge opportunity. The payers don't have the same reliance on vendors that the provider side has. We have a very defined market of electronic health records vendors for providers, but how do you identify who the vendors are for payers? They are, in a way, a fortress to penetrate. I think Health Catalyst has a huge opportunity to sit in the middle and bring these two worlds together. Dale suggests that in the future, payers will need to become providers and providers need to become payers. The payers are moving toward the provider space at warp speed, the providers are moving into the payer space at a snail's pace. Providers need to be capable of working in the claims space, risk management and risk prediction space better than they are right now. The payers have to do the same working in the other direction in the clinical space. Are the recent CMS ONC regulations around FHIR APIs going to make a real difference for healthcare moving forward? Dale believes the regulations are going to be transformative. However, for FHIR to be successful, he thinks we're going to have to see more transformative changes in the EMR vendors. He'd like to see some aggressive re-architecting with the major software vendors to see if we can't move that along faster. Gary asks Ken to give a profile on consumer applications. Where are these things going? Ken thinks there are a couple of intersecting categories to consider. We have those apps that come under more FDA certification or approvals that are more medically oriented, and then others that will be more generally available that didn't have to go through all those approvals. There is another category of apps associated very specifically with, for example, EHR vendors, health systems or payers. Then, there are other apps that are more independent. The interesting competitive angle here is that those independent apps that can potentially tap into provider systems and payer systems can put a picture together that any one provider or payer organization can't equal. So it becomes more of a cross industry view and we're talking about a longitudinal view and it's usually longitudinal to the provider and the payer, but what it used to be was longitudinal to the patient. Whether those independent apps will succeed or not because they have a battle with the large players in their space. What CMS and ONC have delivered here is in fact that competitive environment far beyond the competition we saw in the past. Gary asks Dale if he sees Health Catalyst getting into the consumer applications space. Dale says the data operating system they build has three missions of data, including analytics, workflow application development and interoperability. They can build applications on top of that data operating system. We have a care management platform that we call a data first application so it looks like an analytics engine but it is really about the workflow of care management. We'll eventually put some patient-facing app on that as soon as the market calms down. That touchstone repository that I mentioned earlier is the national repository that I would eventually like to expose to the public so you, I and ken can query that national repository to other patients like me to see other patients like me where they are being treated, how they are being treated and eventually allow them to socially interact with other patients who are like them. We have to create social interactions between patients like all of us that's what will keep people coming back. Dale gives a primer about healthcare from a battlefield perspective. In the nuclear decision space, a lot of time is spent on subjective and objective data fusion as well as its reliability. The military has formalized decision making and the data required to support decision making. There's a concept known as intelligent preparation for the battlefield, which can be overlapped conceptually onto healthcare. We can build the digital battlefield of healthcare that would support population health, public health, ambulatory care, the framework applies.What is the biggest change we are going to see in healthcare next year? Dale says we will see a relaxation in some of the rules for FDA clinical trials. Additionally, he would like to see an increased emphasis on what we need to do to make quality measures more effective, less burdensome for clinicians. 

Carm Huntress, CEO of RxRevu, joins hosts, Gary Austin and Pooja Babbrah to discuss price transparency. Gary asks Pooja to start the discussion with a primer for price transparency. Pooja states that the topic itself is quite complex and, unfortunately, not very transparent. When receiving a prescription from your doctor, you never really think to ask if you should go to a different pharmacy or if there are coupons available for the medication. You simply pick up the prescription and pay the price that is due. Additionally, since the price of medications are going up, many patients do not pick up prescriptions because they are too expensive. Patients cannot afford to pay for them. Pooja explains that when we think about price transparency, it is all about being transparent with the consumer, letting them know what prescriptions and procedures are actually going to cost them out-of-pocket.Gary then asks Carm to briefly go over RxRevu and to give some opening comments about price transparency. Carm shares that RxRevu is a Denver based company focused on price transparency around drugs. The company helps providers at the point of care make cost-effective decisions by providing a large amount of information. Carm says on a monthly basis, RxRevu is helping millions of patients around affordability issues with their prescription drugs.There is a recent CMS ruling requiring hospitals and payers to post their charges online. Gary asks Carm what all of this means for consumers. Carm says the big idea of this ruling is directionally right. Healthcare is really the only industry where consumers don't know the price of products and services before they buy them. Carm explains that the problem with price transparency is that there's so much complexity in actually pricing medications and procedures, especially since negotiations are affecting these prices. Pooja says this ruling was an important step forward. There's a list of 300 items hospitals and payers are required to give pricing on. She notes that it may not be easy for them to offer this information and the timing for when they actually provide a complete list may be far into the future. Gary points out that price transparency sounds like a good thing for consumers, but what about the physicians? Gary asks Carm if the availability of this information will really change physicians' prescribing and referral habits. Carm explains that price transparency thoughtfully puts the right type of information into workflow, including what the patient will pay at their preferred pharmacy, types of lower cost therapeutic alternatives and insurance coverage. Carm states early findings show that one in every five doctors who are presented with this information make a cost-dynamic change.Prescription price transparency is moving along faster than medical procedure transparency, is that a fair observation and if so, why? Carm agrees with Gary and believes this is the case because the need for price transparency in pharmacy has been driven harder given the longevity of the idea. He says the claims system and the engines that we talk to in terms of getting the data out are a little less complex than on the medical side. The PBMs and the systems behind the PBMs were more ready to do real time benefit and that's why it came to market and matured faster. Gary asks Pooja what's going to be the tipping point for price transparency across the industry. Is there some event or some thing that will be a tipping point as we look out a year? Pooja thinks that from the PBM to the physician standpoint, we're almost there, but in order to progress further, we need to incorporate the consumer side. Doctors can't be price shopping for consumers all the time, so that's where we bring in the second piece of consumer-facing price transparency.RxRevu is growing exponentially. What is your company doing better, faster, or cheaper than the next guy with price transparency? Carm explains price transparency is the company's singular focus, which allows them to execute at a high level. RxRevu works alongside clinicians to finetune those transactions to make sure they go through clean and with the best experience possible. Secondly, Carm notes the company is a startup. There is no legacy business or bureaucracy in their organization. There's a real mission in delivering more value through better prescribing decisions. Lastly, Carm states that RxRevu is a startup. They have taken venture money, but also have several health systems as major investors. This has allowed the company to have a much more intimate relationships with providers at the point of care. Carm believes it has allowed them to uncover things others have not. Why haven't digital companies like Amazon or Yelp entered this space? Or have they and just failed? Carm says more than $10 billion dollars have been invested in digital healthcare over the past 10 years and we're really not seeing any outcomes. He believes this is happening due to the wide-spread assumption that the consumer is always the answer. Carm suggests focusing dollars and efforts on improving physician decision making instead. To conclude the discussion, Gary asks Carm to explain what he would say to a payer CEO about price transparency. Carm stresses this is the number one thing you can do. Bringing transparency is one of the first and most effective things you can do to help physicians understand there are lower-cost options. It's informed autonomy for the doctors. They still have the decision power, but you want those decisions to be informed by a high level of information and a narrow set of options. 

Guest, Patrick Murta, Solution Architecture Fellow with Humana and Chief Architect for the ONC FHIR at Scale Taskforce (FAST), joins hosts Gary Austin, Jocelyn Keegan and Ken Kleinberg to discuss how Fast Healthcare Interoperability Resources (FHIR) is transforming health data exchange and what HL7 FHIR Accelerators are doing to expedite progress and FHIR adoption. Gary Austin kicks off the discussion by asking Murta a couple of level setting questions. Why are FHIR APIs so different from legacy EDI transactions? Is this just an IT thing or is it a generational technology and business change? Murta explains that FHIR allows integration from not only an administrative perspective but also a clinical perspective. Information can now be served directly into the workflow at the exact time it's needed. FHIR enables business and clinical processes that were not yet possible with previous generations of technology.  Gary shifts focus to FHIR API Accelerators. He mentions POCP is a program manager for the Da Vinci FHIR Accelerator, has representation on CARIN (consumer-facing accelerator) as well as Gravity (social determinants of health accelerator). How do these accelerators “accelerate” the adoption of FHIR APIs? There are two important factors contributing to this acceleration: the technology (FHIR) and the cross-industry agreement and willingness to collaborate. Put these two things together and you can achieve much more, much faster than if operating ad hoc across the industry. On top of the FHIR API accelerators, there is FAST (FHIR at Scale Taskforce). Gary asks both Murta and Jocelyn to weigh in on the subject, including an overview, its origins and why it's needed. Murta notes the reason FAST exists is due to the development of “functional consortiums” like Da Vinci, CARIN and Gravity. Those groups focus on functionality whereas FAST focuses on the infrastructure capabilities needed to run those functional use cases at scale. FAST was created to identify any barriers to scalability of FHIR and create the appropriate tiger teams to start coming up with solution frameworks to address those problems.  Jocelyn points out that implementations happening today are targeted toward point-to-point traditional connections, but everyone that is building is asking themselves how I can reuse and leverage this API over and over again with all of my business partners. Although those questions are not being answered right now, implementors are evaluating how and where they can take advantage out of the recommendations and tools coming out of the FHIR community and specifically FAST . Gary asks Murta how he balances the details of specification and implementation guides with the galactic vision of accelerating the entire industry? Murta says it is rather easy to separate the different parts of the technology stack. With Da Vinci, the focus is on solving something for a stakeholder in healthcare (use cases). How would the provider, clinician or member interact with this data? Where do they need it in the workflow? What information do they need? On the other hand, with FAST, there is an emphasis on core capabilities and infrastructure. What do these transactions look like when flowing through the technical layers? What identities are going to be used? Jocelyn goes on to explain the temporal dimensions of the matter. What happens in 2020 with respect to these accelerators? Where do you see 2021 going? Jocelyn states that the current pandemic reveals why these workflows are critically important and how we need to move forward as an industry. In spite of the world we are living in now, Jocelyn is excited that we will exit 2020 with some good production implementations of Da Vinci implementation guides and start to see real recommendations coming out of the FAST community. She believes 2021 will be about continuing to finetune and support the wave of people needing to implement.  The discussion pivots to Ken as Gary addresses a significant problem plaguing the industry: identification at the human level. How do we take the intricacies of TEFCA (Trusted Exchange Framework and Common Agreement) and deliver that at scale? Ken explains that TEFCA is the federal government's latest attempt to connect the network of networks. It is voluntary and still in the development phase. TEFCA is being designed to address three modes of communication, including message push, targeted query and broadcast query for the information retrieval. FHIR is a newer approach to information exchange and its heavily used in the new ONC final rules. Ken believes it is likely FHIR will be included in future versions of TEFCA. What are challenges for accelerators? Murta worries that as we get additional accelerators, there may be saturation. The industry must keep in mind there are a finite number of resources available to accelerators. It would be detrimental to spread the scope too wide, only to halt forward momentum.  Gary asks Murta one final question. What would you tell an executive business leader in a payer or an IDN who may not be behind this interoperability transition? Murta would tell them to look where the industry is going. You owe it to yourself, your customers, your patients and providers to look at this. If you're not recognizing the value of this technology, you're not fully optimizing your processes.  Jocelyn concludes the discussion by promoting everything being built in the FHIR community. She says it is available for anyone to pick up and use. 

Pooja Babbrah from Point of Care Partners joins hosts, Gary Austin and Ken Kleinberg to talk about changes in the way payers are dealing with pharmaceutical management. Ken Kleinberg opens the discussion by emphasizing the impact of medications on the health of our nation and healthcare costs. Ken notes that payers are now more focused on medications than ever, particularly due to the rise of specialty medications and cost increases. To combat the challenge of prescription costs and healthcare coverage, Ken calls for an industry-wide team effort. For example, physicians need to be more aware of prescription costs, understand how much coverage patients have as well as what they can afford. Patients need to have access to better information in order to participate in their treatment decisions and adherence. Additionally, payers need to focus more on value.Gary moves the conversation to talk about key transformational topics in pharmacy, including consumer access to pharmaceutical data. Pooja mentions the recent approval to publish a joint HL7 and NCPDP implementation guide, which allows consumers to research the lowest price for their medications with a mobile application. The goal of the guide is to allow patients to identify the cheapest drugs and to compare insurance coverage against discount programs. When developing the guide, Pooja notes that there was an existing transaction within the marketplace that Health IT vendors, PBMs and payers had already employed. The new guide was made as a joint effort between the two standard development organizations to make sure it would be easier to implement from a PBM and payer standpoint as well as a Health IT vendor standpoint.Gary then asks Ken how payers might benefit from these changes. Ken explains that payers recognize if patients do not take their prescribed drugs, their health may deteriorate and lead to greater downstream costs. If the reason patients are not filling prescriptions or adhering to treatments are cost-based, payers need to know this. Payers also have the motivation to ensure patients are only prescribed what they need.Gary goes on to ask Pooja about price transparency around pharmaceuticals and what it means to the average consumer. She states it is all about consumers having a place to go to figure out what is the cheapest way to get a medication, where to get it and how to get it. Other content you may be interested in: CARIN Alliance Workgroup to Help Advance Real-Time Pharmacy Benefit Check for PatientsUrgent Need for Real-Time Pharmacy Benefit Check Confirmed in Senate Committee Hearings 

Kurt Schiller and Mark Hughey from Arcweb join hosts, Gary Austin and Ken Kleinberg to talk about innovation in health IT. Our guests share what kind of innovative projects their Philadelphia-based software development firm is tackling, how they guide their clients through innovation projects and the importance of starting with a business use case before tackling a new project. Ken Kleinberg kicked off the conversation by setting the stage around software innovation and the use of APIs. Ken explains that while many leading EHR softwares, despite their large R&D budgets, are still using decades old technologies. Many EHR companies have developed their own app stores, however, many of these have relied on proprietary technology. With the entrance of and expanded of adoption of open APIs, there is a bigger opportunity fill in the gaps and impact patient experience in a big way. Arcweb is in the world of innovation and acceleration rather than enterprise systems. Mark Hughey shared his analogy comparing Health IT innovation with a successful race car driving team. Hughey shared that a main focus of the innovation Arcweb is seeing is around patient experience, more specifically, technology being applied to better meet patient's changing expectations. Kurt Schiller shared some examples of recent work completed which are examples of three different areas where there seems to be a lot of activity. One example is patient scheduling. Rather than expecting patients to call the physician office to make an appointment there is a desire to allow patients to make appointments via an app. Up to now, the barrier was a business issue related to software architecture. Allowing patients to book an appt in two clicks versus The next is around rare disease management to allow physicians to share data between themselves and augment their ability to treat patients with disease states they may not see frequently. Finally, apps to support behavior change to better support disease state management. Gary asked how Arcweb approaches new projects and how they go about planning the execution, timeframe and budget. Hughey empasized that they always begin by introducing customers to the idea of the iron triangle with three core pillars of scope, budget, and time. Two of these at any point can be optimized but never all three at once. This drives a conversation towards priorities so these are clearly articulated at project start. This helps Arcweb tailor the approach. Gary then asked how they measure success. Hughey explains that key metrics of success are established from the beginning. This helps ensure the client team is on the same page with expectation. Half of Arcweb's business is healthcare. Compared to other industries, healthcare key metrics of success are more confounding to set whether the client wants to improve patient experience, reduce administrative burden, improve clinical outcomes or some other metric. Ken weighs in on key metrics of success by saying the conversation that reminds him of the old balance scorecard and that innovation/excitement measure could almost be added as an additional metric on the scorecard. Gary then moves the conversation to talk about how COVID-19 has served as an accelerator for innovation planning. Schiller explains that many stakeholders realize there are gaps in data exchange inhibiting their response to the pandemic.  Some decisions for short-term ease may cause some longer term issues but definitely have stakeholders looking more long-term with how they can build solutions that will better support telehealth and other areas in the longer term as well as revisiting frameworks and infrastructures.The big challenge structurally is that even though you have innovation labs, core IT ops  and research but in the case of research they don't have access to core IT and the purpose of core IT is to keep data safe and not innovation. Key takeaway from Arcweb? As those responsible for bringing technology solutions to life to enhance the health and well being of those we serve, we should be unwilling to be less than we can be.  

The discussion continues with guest, Dr. Tim Pletcher, Executive Director of the Michigan Health Information Network Shared Services (MiHIN) joins The Dish on Health IT panel of senior consultants, Gary Austin, Jocelyn Keegan and Ken Kleinberg to discuss the role of Health Information Exchanges in healthcare, their role in the response to COVID-19 and what role they can serve in the future once TEFCA is finalized.  Part 2 of the discussion jumps in with how MiHIN responded to COVID-19 by creating a separate group to serve public health needs during the crisis. MiHIN also created a telehealth service to better serve patients and support stay at home orders. Dr. Pletcher explained they acceleration the connections with labs and expressed his desire for results to be sent back via API instead of batch files to expedite results availability. Data links and analytics have taken on a whole new role during this time. MiHIN has taken on a support role which may have pumped the brakes on some innovation projects but there has been opportunity to increase the priority of other projects that could directly positively impact the pandemic response. Jocelyn explained why its so important to meet people where they are in order to make progress. This time is also a time for these simulated barriers to drop. She asked Dr. Pletcher how MiHIN is dealing with perceived security issues when working with innovation projects or partnering with new stakeholders. Dr. Pletcher responded by saying that their biggest challenge right now are Quest and Labcorp because they don't like to share data but this will be resolved through government intervention. The issues generally are not technical issues but business issues with one partner either not wanting to share data or restricting how the data can be used. The group went on to discuss how dropping the rules to facilitate the use of telehealth more readily will be a huge driver for change and innovation and hopefully the rules will remain suspended because patients should have more access via telehealth even over state lines. The conversation moved to data blocking with Gary pointing out EHRs are usually the ones getting the finger pointed at them for data blocking. Dr. Pletcher expressed that Epic or Cerner have never blocked or withheld data in Michigan so he doesn't know who it really is doing the data blocking. Will the US do more around pandemic surveillance like Taiwan and South Korea? Will HIEs support something like? Ken pointed out that some people don't want to be tracked in this way and will opt out or avoid it, however, if it's the only way a person is allowed to get into a ball game or something, they likely will. Dr. Pletcher explained that opt-in and opt-out is an archaic concept. There is a much better framework which would allow patients to express a more granular desire of how they want their data to be used. Doctors have choices too and when patients consent to receive treatment, physician choices come into play. The group highlighted where there are similarities between the financial and healthcare industries related to security and data access until the complexities of healthcare ends the similarities with identity being a major hurdle. With the explosion of patient apps, there is also a trust factor the that comes into play as far as understanding what data that can be obtained from patients apps can be trusted and whether they will look at HIEs as the consolidator of data vs going to Payers.        

Guest, Dr. Tim Pletcher, Executive Director of the Michigan Health Information Network Shared Services (MiHIN) joins The Dish on Health IT panel of senior consultants, Gary Austin, Jocelyn Keegan and Ken Kleinberg to discuss the role of Health Information Exchanges in healthcare, their role in the response to COVID-19 and what role they can serve in the future once TEFCA is finalized.  Gary Austin kicked off the episode by having Ken and Jocelyn give their perspective on HIEs. Ken went on to provide a primer on the history of HIEs and their varying role depending on the model before going on to mention that the Trusted Exchange Framework and Common Agreement (TEFCA) may change the ecosystem once finalized. Dr. Pletcher explained that the MiHIN Group is comprised of 3 companies: MiHIN,  Velatura & Interoperability Institute. Each company serves a specific purpose. Velatura was created to stay aware of what is happening at the national level and to operate nationally. The Interoperability Institute is a research and development group staffed by interns who are the next generation of Health IT professionals. HIEs were compared to public commons, like parks and good roads and bridges that people want to have but don't necessarily want to pay for. Dr. Pletcher pointed out that many HIEs were created prematurely before EHR standards and adoption was where it needed to be for valuable data exchange. Ultimately the value model for MiHIN is based on use cases that are then driven to mass adoption.    The value lies primarily with the government and health insurance companies so payers primarily pay for MiHIN service so providers are incentivized to improve data quality while being subsidized to change their workflow to do so. What's the difference between the successful HIE vs struggling models? Dr. Pletcher pointed out that it's centered around the value the HIE is bringing to each stakeholder and building upon it over time while following the money. Jocelyn added that solving real problems and talking about the elephants in the room to deal with barriers head-on is crucial. She offered that having MiHIN join the HL7 Da Vinci Project is hastening progress. There is an opportunity for HIEs to reinvent themselves as more flexible API standards are developed and take advantage of fielded codifiable exchange tools to get things into real production environments and take out custom codes and massive production efforts. The team continued to discuss the financial model of HIEs and how they may evolve post-COVID-19. Will there be more government funding after COVID-19 calms down? Maybe, but there are a lot of people in need and the general funds at the state level are tapped. There may be some federal programs that look toward automation to cut down on some of he manual processes that are still eating up resources. There may be other non-government revenue streams that open up either with employers or by offering telehealth services at the HIE level. Jocelyn pointed out that while streamlining and making data liquid in general (whether through HIEs or just better adoption of APIs in general) is a money saver for health systems and payers,  patients also win through getting better, more informed care and ultimately leading to better outcomes. Part 2 of this conversation is coming soon!  

The panel and guest, David Szabo, Co-Chair of the Health Care practice, a Partner in the Corporate and Transactional Department, and a member of the Privacy & Cybersecurity Practice Group with Locke Lord, LLP continued the discussion from Part 1 by shifting the focus to the complexities of price transparency. Not only with what data is needed to provide meaningful information about the price patient's can expect to pay but to how widely this information should be expected to be shared without crossing a line to reveal contract details that companies may feel are proprietary. There has been a push by this administration to increase transparency of contract prices as well. This has been responded to in a patchwork of approaches. Ultimately, the panelists and guest agreed that the importance and impact of price transparency on patients is different in situations whether the patient is experiencing a chronic illness or an acute episode.  When a patient is in the middle of an emergency shopping around for price goes out the window. Price transparency for chronic or scheduled elective procedures may be where work around meaningful price transparency will progress more quickly. The panelists and guest then moved to discuss data privacy and patient consent.  As patients begin to adopt 3rd party health apps and consent for their physicians to share their data with these 3rd party applications, data privacy no longer falls under HIPAA. Physicians may play a role in encouraging patients to carefully read privacy policies for these apps, however, physicians ultimately don't have any control over what the patient chooses to do with their data. The discussion talked about the philosophy driving these rules is the fervent belief that the more data patients have, the better decisions they will make which remains to be seen. Data in these apps could be used by pharmaceutical companies to better track efficacy data in the real world. Will FTC have a bigger role in enforcement/protection of health data shared with 3rd party apps? Szabo felt that congress would need to grant more powers to FTC for them to get into the role of mandating a minimum amount of protections versus their current role which is to investigate after a breach or misuse of data has already occurred.What should payers, health IT vendors, and providers be doing? Szabo recommends that everyone get ready. Have an interoperability policy that addresses your obligations and lays out a framework for the rules and exceptions. Ken added that stakeholders should take this time to consider how their policies and long term health IT strategies will make healthcare better rather than meet the minimum regulations requirements. 

Gary Austin kicked off the podcast by introducing Ken and Jocelyn who provided their opening comments on the ONC and CMS rules, information blocking and telehealth. Gary then introduced David Szabo before kicking off the discussion around the CMS & ONC Rules where they discussed how much enforcement teeth these rules carry and the opportunities for innovation for forward thinking organizations. The discussion then moved to information blocking where the group discussed why it may matter if an organization inadvertently blocks information because they don't understand the regulations versus organizations which may blatantly block information. There are implications not only for health IT companies but for payer and provider organizations. The group then moved to discuss the implications for patients when they consent to their clinical information to be shared with a 3rd party app outside of the protection of HIPAA. This is especially important because most consumers don't read the 10 page agreements they need to "consent to" before using an app. The group then tackled the explosion of use of telehealth which may have been an operational challenge for some providers. In the midst of COVID-19 there are waivers, relaxation of the site of practice and mandated reimbursements levels which may change once the pandemic wanes. With claims going up by as much as 1000% in some areas, there is also a huge risk for fraud. Look forward to Part 2 which covers price transparency and pick up the conversation around data privacy issues that may arise due to information blocking regulations and the priorities organizations should put on complying with new rules and regulations and developing interoperability roadmaps and agreements.     

Gary Austin kicks off the discussion by asking the panel about the massive increased use of telehealth. Guest Brian Bamberger defines what he means by telehealth and the distinction between telehealth and telemedicine. The panel moved on to address rule changes that make the use of telehealth more accessible to everyone. Bamberger acknowledged that telehealth for a long time was adopted to service patients in more rural areas but that moving forward, telehealth can improve accessibility for at risk, mobility challenged individuals in urban areas as well as capacity is built. There is no reason physicians or patients shouldn't continue conducting more routine visits as virtual visits. Jocelyn shared that her municipality, where she is a government official, has leveraged their first responders to do virtual visits for triage and help disseminate information. In the future, remote monitoring, delivering test results and other routine visits can be done virtually. This practice may increase usage overall and potentially increase the number of preventative visits which can help improve outcomes and for certain, generate more data that would be available for analysis. The panel then discussed how to "productize" telehealth in a fiscally viable way. What's pricing? What technology is needed? Will it help reduce medical loss ratios for payers? How does telehealth fit into value-based care? Bamberger makes that point that telehealth will also be critical for the next epidemic or for the second wave of this one.  The panel then discussed the risk of fraud and ways to monitor and avoid it. Each panel then shared their closing thoughts on impact, action items and strategies payers and providers should take around telehealth.   

Gary kicks off the podcast with introductions. Jocelyn and Ken tell the audience a little about their background and expertise across the healthcare industry and health IT. Jocelyn explains that Point-of-Care Partners is an objective consultancy with a "Switzerland" status. Gary leads the discussion by introducing the key topics covered by the news non-stop like availability and production of COVID tests, delays in lab results, shortage or personal protective equipment like masks, mass immunizations while looking at all these issues from a health IT perspective. Then the panel focused on the opportunity for positive change coming out of the pandemic starting with telehealth. As patients and physicians have embraced telehealth as a lifeline during COVID-19, will this stick or will patients and physicians go back to doing things the old way or will there be profound transformational effects? What about Interoperability and standards? Jocelyn provides her perspective on whether this crisis will be the impetus for an acceleration of new use cases or will the industry be forced to use old tools they never bothered to pick up before? The panel then moves on to discuss the crucial role of Health Information Exchanges (HIEs) and Public health and liquid data flow that needs to occur during a pandemic and beyond. The panel then tackles whether work on streamlining and automating prior authorization will slow down during the pandemic or is it more important than ever? Audience reminded they can submit topic and guest ideas by emailing podcast@pocp.com