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How do you know if something needs prior authorization? Why does prior authorization take so long? What is electronic prior authorization? Discussing how to speed up prior authorization process using informatics in health care, HL7 and FHIR, computerized physician order entry, and more with Viet Nguyen, MD, chief standards implementation officer for HL7 International. American Medical Association CXO Todd Unger hosts.
In this interview, two health care interoperability leaders make a strong case for the value of the FHIR Business Alliance. We hear about FHIR as a path toward interoperability from Duncan Weatherston, Chief Executive Officer at Smile Digital Health and FHIR Business Alliance Chairperson, and Mario Hyland, Senior Vice President and Founder of AEGIS.net, Inc. and FHIR Business Alliance Board Member and Membership Committee.The Fast Healthcare Interoperable Resources (FHIR) standard, adopted several years ago by HL7, solves data sharing problems through well-defined, vendor-independent APIs, which are the modern approach to interoperability. Although FHIR is fully established and supported by nonprofit organizations, its implementation has been hampered up to now by lack of a strong business focus. The FHIR Business Alliance is bringing companies together to address that.Learn more about FHIR Business Alliance: https://www.fhirball.org/Health IT Community: https://www.healthcareittoday.com/
This episode's Community Champion Sponsor is Ossur. To learn more about their ‘Responsible for Tomorrow' Sustainability Campaign, and how you can get involved: CLICK HEREEpisode Overview: Healthcare's integration challenges have reached a critical juncture where clinicians demand seamless technology that enhances rather than hinders patient care. Our next guest, John Orosco, is revolutionizing this landscape as CEO of Red Rover Health. With over 25 years of healthcare IT experience, including his foundational role at Cerner developing their first API platform, John witnessed firsthand how rigid integration systems stifle innovation. This insight led him to co-found Red Rover Health, creating a normalized SaaS platform that serves as "the App Store for healthcare." By enabling true best-of-breed solutions through standardized APIs, John is breaking down the barriers that have long frustrated healthcare organizations. Join us to discover how Red Rover's pioneering approach is empowering providers to choose the tools they need while maintaining seamless EHR connectivity. Let's go!Episode Highlights:Healthcare's open integration platforms often get shut down when they threaten vendor sales of proprietary solutionsRed Rover Health serves as "the App Store for healthcare," enabling seamless third-party app integration with EHR systemsThe joke "if you've seen one HL7 interface, you've seen one" reflects how every integration requires custom codeHealthcare CIOs often function as "EMR administrators" rather than true technology innovatorsAI/ML represents the next frontier, with Red Rover positioning to enhance data access with AI-powered insightsAbout our Guest: John is a healthcare IT entrepreneur and expert in Electronic Health Record (EHR) integration with over 25 years of experience. He started as a software developer at Cerner Corporation, where he led the first Millennium RESTful integration team. John later founded JASE Health, providing custom EHR integrations for healthcare IT vendors, before co-founding Red Rover Health to develop a normalized SaaS platform for EHR integration. John is dedicated to solving complex EHR challenges and enabling healthcare providers to implement best-of-breed solutions regardless of their EHR system.Links Supporting This Episode: RedRover Health Website: CLICK HEREJohn Orosco LinkedIn page: CLICK HERERed Rover Health LinkedIn: CLICK HEREMike Biselli LinkedIn page: CLICK HEREMike Biselli Twitter page: CLICK HEREVisit our website: CLICK HERESubscribe to newsletter: CLICK HEREGuest nomination form: CLICK HERE
Is FHIR the key to seamless healthcare interoperability? Let's discuss its impact on AI, security, and patient care.In this episode, Dr. Ambreén Zaman-Riaz, a physician, healthcare innovator, and leadership expert, as well as the co-founder of Uppshot Lifesciences and host of the Leadership in Medicine Podcast, and our host, Christopher Kunney, a distinguished healthcare technology strategist, serving as Managing Partner and Digital Transformation Strategist at IOTECH Consulting and host of the Straight Out of Health IT podcast, the evolving role of interoperability in healthcare, particularly the shift from HL7 to FHIR (Fast Healthcare Interoperability Resources). Christopher highlights how FHIR's open standards, API-based structure, and cloud compatibility improve data sharing, patient access, and integration with emerging technologies like AI and machine learning.Dr. Zaman-Riaz asks about FHIR's impact, its role in AI evolution, and its future in patient-centric care. Christopher emphasizes that FHIR enables real-time data aggregation, predictive analytics, personalized medicine, and improved clinical decision support. He predicts AI-driven "digital doctors" and virtual care platforms will rely on FHIR for seamless, cost-effective healthcare delivery, especially in remote areas.They also discuss security concerns, with Christopher stressing the importance of encryption, blockchain, and secure APIs to protect patient data. Blockchain, in particular, is seen as a promising tool for data integrity, fraud prevention, and secure information exchange. Dr. Zaman-Riaz notes that her work involves integrating blockchain for oncology data management and patient-controlled records.Join Christopher Kunney and Dr. Ambreén Zaman-Riaz as they dive into the transformative impact of FHIR, the role of AI in healthcare, and the future of secure, patient-centric data sharing!
In this episode of SIIMCast, we chat with Dr. Marc Kohli, professor of radiology and medical director of imaging informatics at UCSF Health. From early days programming on an Atari to leading imaging IT at a major academic center, Marc shares his unique path into imaging informatics. He reflects on influential mentors, his work in Kenya, his passion for standards like HL7 and FHIR, and his deep involvement with SIIM. This conversation is packed with insight, stories, and a genuine love for innovation and mentorship in healthcare IT.
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.
For over 30 years, Health Level Seven International (HL7) has set the standard for electronic health information worldwide. Federal agencies also leverage HL7 standards to exchange and share electronic health information to ultimately improve patient outcomes and health system performance. HL7 provides a set of standards for exchanging clinical and administrative health data between applications. At HIMSS, Diego Kaminker, deputy chief standards implementation officer at HL7 International, discusses HL7's goals in the health care sector, the impact of the Centers for Medicare & Medicaid Services' Interoperability and Prior Authorization Final Rule on standards development, and the evolution of Fast Healthcare Interoperability Resources (FHIR) for data sharing.
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
For the past 20 years, under both Republican and Democratic administrations, the ONC has played a pivotal role shaping and regulating the health tech market. On the eve of the election, Micky Tripathi joined me to discuss the agency's recently expanded role. Now, two months later—though it feels like a decade—the future is uncertain. Will the ONC and ASTP continue as market regulators and opportunity catalysts, or is a new direction on the horizon?Here's what we covered:The government's role in shaping and regulating the health tech ecosystemAI in healthcare: balancing the risks of misuse vs. the risk of “missed uses” Health information sharing: why Micky is optimistic about the future Can technology take the pain out of prior auth?Micky thinks we are standing on the edge of a transformative era:“We are just at the beginning of the most exciting decade...health information technology can really start to show… the return on investment for patients. We've done a lot of hard work over the last 10 years… [With that foundation in place] we have the opportunity to say there's an ROI here for patients.”Relevant LinksBlog post on ONC reorganization: ONC's Next ChapterTEFCA overviewForbes interview: Where is interoperability headed?Healthcare Dive: HHS AI Task Force Takes Shape (March 2024)Blog post by Micky: Getting real about information blocking and APIs (October 2024)About Our GuestMicky Tripathi is the Assistant Secretary for Technology Policy, National Coordinator for Health Information Technology, and Acting Chief Artificial Intelligence Officer at the U.S. Department of Health and Human Services, where he leads the formulation of HHS technology and data strategy and coordinates technology policies, standards, programs, and investments.Dr. Tripathi has over 20 years of experience across the health IT landscape. Prior to joining the federal government he served as Chief Alliance Officer for Arcadia, a health care data and software company focused on population health management and value-based care, the project manager of the Argonaut Project, an industry collaboration to accelerate the adoption of FHIR, and a board member of HL7, the Sequoia Project, the CommonWell Health Alliance, and the CARIN Alliance.Dr. Tripathi served as the President and Chief Executive Officer of the Massachusetts eHealth Collaborative (MAeHC), a non-profit health IT advisory and clinical data analytics company. He was also the founding President and CEO of the Indiana Health Information Exchange, a statewide HIE partnered with the Regenstrief Institute, an Executive Advisor to investment firm LRVHealth, and a Fellow at the Berkman-Klein Center for Internet and Society at Harvard University.He holds a PhD in political science from the Massachusetts...
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!
Episode 90 is here and I'm joined by Scotland's own @DictatorBand . Dictator are a Scottish indie band who have amassed a huge following both in Scotland and England with tracks reaching over 50k streams on Spotify. We discuss their latest single HL7, which is out on all streaming platforms, a song about Celtic FC great Henrik Larsson. The boys also explain their summer, performing at Festivals like Truck and Isle of Wight while finishing the summer in Spain. Link to their single and social media is below; https://open.spotify.com/track/1LqyrdkieuGRUU7pen389P?si=eedfe5c2774f446e https://www.instagram.com/dictatorband?utm_source=ig_web_button_share_sheet&igsh=ZDNlZDc0MzIxNw== https://x.com/Dictator_Band Thankyou for tuning in to the Off Beat Podcast with Luke Bardsley! Please join us on our podcasting journey, subscribe, like and comment along the way, it really helps. As always both hosted and sponsored by Dark Peak Barbers based in Hadfield. Socials: Facebook - https://www.facebook.com/OffBeatPodcast1 Instagram - https://www.instagram.com/offbeatpodcast1/ Tik Tok - https://www.tiktok.com/@offbeatpodcast1? https://twitter.com/OffBeatPod1 Email - offbeatpodcast1@gmail.com Intro Music - https://www.youtube.com/watch?v=b2ryQCisQvg #dictator #dictatorband #dictatorscotland #dictatorbandscotland #offbeat #offbeat #podcast #pod #indie #indiemusic #indiepodcast
Pro Medicus Limited is an Australia-based healthcare informatics company. The Company provides a full range of medical imaging software and services to hospitals, imaging centers and health care groups in Australia, North America and Europe. Its products include Visage RIS, Visage RIS/PACS, Visage 7, Visage Ease Pro and Visage Ease. Its Visage RIS is a radiology information systems (RIS) medical software for practicing of management, training, installation and professional services. Visage RIS capabilities include patient registration, billing, scheduling, typing, HL7 integration, financial reporting, digital dictation and voice recognition integration. Its Visage 7.0 is a healthcare imaging software that provides clinicians with visualization capability for rapidly viewing 2-D, 3-D and 4-D medical images and picture archive and communication system (PACS)/digital imaging software that is sold directly and to original equipment manufacturers (OEM), training, installation and others.Shares for Beginners and Stockopedia proudly present "Weekend Watchlist". Each week we dissect a company using Stockopedia's Factor driven analysis process. Go to https://why.stockopedia.com/sfb/ for your free trial and special discount offer. Why not join Stockopedia today and take advantage of this special offer of 10% off the first year of membership and see for yourself why Stockopedia is the essential tool for every serious DIY share investor. 14-day free trial included, then a no-quibble 30-day money back guarantee: https://why.stockopedia.com/sfb/ Find out more about Stockopedia by going to my review:https://www.sharesforbeginners.com/stockopedia-aunz-reviewDisclosure: The links provided are affiliate links. I will be paid a commission if you use this link to make a purchase. You will receive a discount by using these links/coupon codes. I only recommend products and services that I use and trust myself or where I have interviewed and/or met the founders and have assured myself that they're offering something of value.Shares for Beginners is a production of Finpods Pty Ltd. The advice shared on Shares for Beginners is general in nature and does not consider your individual circumstances. Shares for Beginners exists purely for educational and entertainment purposes and should not be relied upon to make an investment or financial decision. If you do choose to buy a financial product, read the PDS, TMD and obtain appropriate financial advice tailored towards your needs. Philip Muscatello and Finpods Pty Ltd are authorised representatives of Money Sherpa PTY LTD ABN - 321649 27708, AFSL - 451289. Hosted on Acast. See acast.com/privacy for more information.
In this episode of SIIMcast, hosts Ali and Mohannad sit down with Isaac Vetter from Epic, a seasoned expert in the FHIR community and a leading force behind the CDS Hooks project and the FHIRCast specification. With over a decade of experience, Isaac shares insights into how these HL7 standards are revolutionizing healthcare interoperability. We delve into the core problems FHIRCast aims to solve, particularly in imaging, by enabling seamless context synchronization across multiple health IT applications. Isaac discusses the evolution of FHIRCast from its inception to its latest iterations, highlighting the significant impact of artificial intelligence in real-time imaging findings exchange. The conversation also explores CDS Hooks, a standard that facilitates real-time clinical decision support within EHR workflows. Isaac outlines various use cases, including regulatory requirements and innovative integrations that enhance clinical decision-making and streamline prior authorization processes. Join us for an enlightening discussion on how FHIRCast and CDS Hooks are paving the way for more integrated and efficient healthcare systems, and what the future holds for these groundbreaking standards.
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.
Host Jim Tate talks to Lisa Nelson, the SVP of Enterprise Integrations at ADVault. Her background includes leading roles in HL7 work groups as well as co-founding the Gravity Project. Currently she is heading up the My Directives Solutions initiative at ADVault. She bring a strong focus to promoting the assurance that data elements related to SDOH and advanced directives find their proper place in interoperability. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen
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.
Director for Terminology Management / Johns Hopkins University/ Biomedical Informatics & Data Science HL7 Terminology Services Management Group (TSMG)/ HL7 Vulcan Accelerator Operations Committee Vulcan FHIR-to-OMOP co-Lead / OHDSI OMOP + FHIR Working Group Lead / OHDSI CDM Vocabulary Working Group Liaison to HL7
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/
Frustrated by the intricacies of protocols like HL7 and API when integrating new technology with your EMR? Need a roadmap for seamless data transfer to optimize workflows? Join us as Shreeja Madduru, Infinx Product Manager, explores with us the hurdles of onboarding new technology and equips you with actionable insights for a smoother, more successful implementation with your existing systems. Brought to you by www.infinx.com
Introducing thoughtbot's ongoing maintenance service. Need reliable support and maintenance for your software? Look no further. Our expert team handles upgrades, bug fixes, UI adjustments, and new feature development. And the best part? Our maintenance packages start at just 5k per month for companies of all sizes. From Ruby on Rails to Node, React, and, yes, even PHP, we've got you covered. Trust thoughtbot for top-notch support and optimized performance. To receive a custom quote, contact sales@thoughtbot.com. Marc Mar-Yohana is the CEO and Founder of OtisHealth, a personal health application and platform for patient-caregiver engagement, population health, and clinical research. The conversation revolves around the origin and working principles of OtisHealth, a healthcare app designed to consolidate health information. Marc was motivated to start the app following the tragic death of his eight-year-old daughter, Constance, from an undiagnosed brain tumor. Despite being under the care of multiple health providers, the fragmentation of her medical data meant they missed the signs of her condition. Marc has dedicated his life to developing better tools for families and caregivers to manage their loved one's health. He aimed to create a unified system where all health data could be gathered, enabling caregivers, patients, and medical providers to see the whole picture. OtisHealth allows patients to integrate data from different sources, including wearable devices, and capture information outside clinical settings. The initial outreach strategy of OtisHealth through consumer channels was slow to get traction. The company switched to recruiting through organizations with health interests, such as health insurers or "payers," leading to a significant increase in users. Although not everyone uses the app daily, it is a crucial health management tool for those with chronic illnesses or emergencies. The trustworthiness of OtisHealth is demonstrated through accreditation from the Electronic Healthcare Network Accreditation Commission, indicating that their practices meet or exceed federal regulatory requirements and industry guidelines. This, along with community outreach and educational content, helped build trust with users. Marc's diverse corporate background gave him the skill set to lead OtisHealth, emphasizing the importance of team development and collaboration with other organizations, even competitors, to move the mission forward. __ OtisHealth (https://otishealth.net/) Follow OtisHealth on Facebook (https://www.facebook.com/OtisHealth), LinkedIn (https://www.linkedin.com/company/otishealth/), Instagram (https://www.instagram.com/bloxisawesome/), or YouTube (https://www.youtube.com/channel/UC5yGWpOTCOJnbxjD1LnkMXg) Follow Marc Mar-Yohana on LinkedIn (https://www.linkedin.com/in/marc-mar-yohana/). Follow thoughtbot on Twitter (https://twitter.com/thoughtbot) or LinkedIn (https://www.linkedin.com/company/150727/). Become a Sponsor (https://thoughtbot.com/sponsorship) of Giant Robots! Transcript: VICTORIA: This is the Giant Robots Smashing Into Other Giant Robots Podcast, where we explore the design, development, and business of great products. I'm your host, Victoria Guido. And with me today is Marc Mar-Yohana, CEO and Founder of OtisHealth, a personal health application and a platform for patient-caregiver engagement, population health, and clinical research. Marc, thank you for joining me. MARC: Victoria, I'm honored to be here. Thank you so much for inviting me to join you on this podcast. VICTORIA: You're welcome. I'm excited to have you. So, why don't you just tell me a little bit about what's going on in your world right now? MARC: Well, OtisHealth is keeping me pretty busy. So, I live in Northern California. My team is mostly in California, a little bit in Illinois. And we're busy every day, both supporting our members and working with clients. And so, it's exciting times, especially on our advocacy front. We work with organizations across the country to advocate for patient access to their health records and also for individuals themselves to improve their access to quality healthcare wherever they reside in the United States. The advocacy, the work with our clients, and the work with our members keeps us super busy. Although I do still try to make time to hike in the beautiful scenery out here. I'm new to California. I'm originally from Illinois, so it's great to just be able to get out every once in a while for a hike in the area. VICTORIA: That's wonderful. Have you made it to any redwood forest out there? MARC: Yeah, Muir Woods, which is just north of us, north of the San Francisco Bay Area. Most of the time, we like to walk the coastline. So just north of Santa Cruz is a great state park known as Wilder State Ranch. And they have amazing views of the coastline, wonderful views of birds, as well as occasionally spotting whales, and dolphins, and sea otters along the coast. VICTORIA: That's so cool. I had a friend, actually, who just went up there and went kayaking with the otters, and I'm very jealous. [laughter] It sounds beautiful. MARC: Yeah, that can be fun. Otters are really cute creatures. And they can be aggressive too. There's a concern right now. There's one female otter that likes to grab people's surfboards. And I saw a video of a sea lion jumping on top of a sea kayak to steal a fish from a fisherman. VICTORIA: I think if a sea otter or a sea lion wanted my vessel, a kayak or surfboard, I mean, you can have it. [laughter] You worked this hard. [laughs] MARC: Yeah, they're pretty aggressive. They're more comfortable in the water than we are, so they [laughs] pretty much are in charge in the environment. VICTORIA: That's right. We're in their house, right? So, I'm, like, okay, [laughs] you can have it. That's great. Oh, wonderful. I'm glad you still have time to get outside and enjoy hiking with your family, even though you're a very busy founder [chuckles] and very active advocate for your community. So, why don't you tell me how everything with OtisHealth got started? MARC: So, it started with a tragedy, a horrible tragedy in my life. My daughter, Constance, who was eight years old at the time and had been previously diagnosed with autism, apraxia of speech, and epilepsy, died from an undiagnosed brain tumor. She had great healthcare. She had a neurologist, a pediatrician. She had therapists that saw her five days a week and, of course, her parents watching over her. Yet, we all missed the symptoms, the major illness that claimed her life. And so, because all of her healthcare providers were on different systems, and as parents, we didn't have a system, there wasn't a place to put our observations together. And everyone attributed their observations of her changing condition to other medical concerns. And so, after she passed, I started to spend a couple of years trying to understand what happened. And I realized a big part of it was the information was in front of us. It was just in different people's hands. And when we put it together, we could have seen the whole picture that would have shown that she had a more serious illness. And so I chose a new mission in my life: to abandon my corporate career and move into this role of developing a better set of tools for families and caregivers to manage their loved one's health. And so, our mission today is to work with families, caregivers, and people with chronic illness to give them better tools to manage their everyday health and the health of their loved ones, and thereby also improving lives in the community. VICTORIA: Well, I love that out of the tragedy, you were able to find direction and purpose to solve this major problem, which I can relate to having moved across the country. Your medical records don't come with you. You have to basically kind of start all over, or they have to go get them from your past patients. It's not unified as a system, as you might think that is. [laughs] MARC: That's absolutely right. Our data is spread out across different clinical sources. Just in the time I moved out here to California from Chicago, I saw five different providers just because I wanted to get some tests done. So, I had to go to a few different locations to do a normal battery of tests. And so, I had at least five different health records created just when I moved out here. And they're all in different systems, and they're not even on the same type of application. So, to bring them together, I had to basically download them and put them in files on my desktop computer. With OtisHealth, I'm able to retrieve that data and put it onto one continuous record and watch it. But that's still just our clinical data, meaning data collected in clinical settings. We have more data to share of things that you and I observe as regular people or our families observe. And so, the part that's missing in the record is all the observations in the time that we're not in the physician, in a physician's office, or in the presence of a clinician. We can; with our tools today, such as wearable watches, or blood pressure cuffs that are Bluetooth-connected, we can get a lot more data and share that back into our records so that we have a true baseline, not the once-a-year that I go to see a physician, and they say my blood pressure is high. And the next time I go, it's low. It's because we only have two data points over two years. Where today, with our technology and our capabilities, we can have a baseline of true data continuously throughout the year that will give the physician or care team more insights into how we're doing in terms of our health. VICTORIA: That's so interesting. And it makes a lot of sense to me why someone would want to use this or why doctors would want to use this. And I'm curious, once you had this idea, how did you get that initial traction to get started with OtisHealth? MARC: Initially, it was a little difficult. And this is kind of part of our lessons learned when we started the company. We started advertising on Facebook. This is after we launched the product. So, we launched in 2021. We had the idea that we were going to make this available to a lot of people. We knew a lot of folks that needed it. It was okay to get the first 100 or so people because there were folks that we knew needed the application or folks that were curious about it and wanted to try it. And we started advertising through consumer channels such as Facebook, and LinkedIn, and other magazines to people that we knew had the need for the app. Yet, it was a very slow uptake. And the part of what we learned and we started applying to our marketing or our membership development or recruitment thesis is that the health records are kind of like an umbrella. We don't think about the umbrella or going out to get an umbrella until it's raining, and for most people, it doesn't rain very often. And so, it's not something that people would use every day. In most cases, they use it only when they have an emergency or when they're managing their chronic illness or the chronic illness of a loved one. And so, we eventually changed the way we were recruiting and started recruiting through other organizations, such as clients where we're able to get thousands of users through the client that has members. And then, slowly, over time, teach them the importance of managing their everyday health, and taking their own vitals, and recording that, and they record for themselves and their family. VICTORIA: Right. So, you were able to offer the app for free for daily users because you found another group that was interested in having access to the data and having this app, right? MARC: Yeah. So, anybody today can go to the Apple Store or the Google Play Store and they could download the app for free. And they can use the web version also. And they could share it with friends and family, which I always encourage people to do. So, if you have an emergency contact, invite them to your medical records; at least they have your basic medications, and allergies, and other key information in case of an emergency. What we did in terms of our change of strategy early on is we started going to organizations that also had an interest in improving the health of their population and, in particular, health insurers or what we call in the industry payers. And so, payer organizations could be Medicaid, Medicare, or it could be employee health plan, one of the big health insurance companies like Blue Cross or UnitedHealthcare. They have an interest in people managing their everyday health. And so, one of our clients right now, everyone that enrolls in one of their plans automatically gets enrolled in a version of OtisHealth specifically for their members. And those members could still invite people to join them on the platform, and those people can get on with OtisHealth. But the nice thing is now this payer has a way to both encourage healthier activity or healthier practices for their population and monitor if there's a problem. So, if somebody is missing medications, or not taking their medications on time, or has vitals that are tracking poorly, this gives the payer an opportunity to reach out and ask them if they need help managing their health. VICTORIA: So, how does that dynamic affect how you measure successful engagement on the platform, like, a successful rate of engagement? MARC: So, for us, most people don't use the app every day. Most of us don't even think about our health [laughs] on a daily basis from a standpoint of our medical health or clinical health. Sometimes those of us that exercise regularly think about it in those terms or eating healthy. But we don't think about keeping a record or using an app to maintain our health. And so, for us, an active user is anybody that's logging in at least once a month to update their information. Our really great users are the ones who are using the reminder features to take supplements or take their medications. And so, I would say of the few thousand users that we have—we're approaching 10,000 right now active users—only a small percentage of those, maybe 10%, are actually using it on a daily basis for themselves or their family. And so, for us, a good engagement and good practice is folks setting reminders on at least a weekly basis to take vitals, weigh themselves—something that would help them track their health over time—and if they're taking medications, to set daily reminders for the medications that they take. And so, we currently have far more people enrolled in OtisHealth and that, you know, 5,000, 6000 I mentioned that are active. But they basically bought the umbrella, and they just put it in their closet. They're waiting for that rainy day that they have to pull it out and start using it. VICTORIA: That makes sense. And I'm already in my head going through the people in my family who would benefit from this where, you know, I have family members who have a learning and a physical disability, and tracking everything that they're supposed to be doing to maintain their health is quite difficult. So, I can definitely see the value in that and why people would want to use it. And I think for, you know, healthcare apps, you have to build this high level of trust. You know, people are giving you all this data about their health information. So, how do you go about building a product that people can trust from the beginning? MARC: One of the things we sort early in the life of OtisHealth is an accreditation. An accreditation is not required by law. It's not required by any institution necessarily. It's a third party that reviews our practices and our systems to see if we're actually following good privacy and security standards and practices. And so we went live in November of 2021, and by the end of December of 2021, we already had our full accreditation in what's called a comprehensive level from a national established organization known as The Electronic Healthcare Network Accreditation Commission. And so, that was the first step of making sure that folks understood that we took their privacy and security seriously. That accreditation means that our practices and our technology meets or exceeds federal regulatory requirements and industry guidelines. And that's just the first step. Then after that, it's really a matter of people gain their trust because an accreditation itself doesn't necessarily mean that we trust that brand. That's just a basic starting point for us. After that, we publish articles about maintaining health. We have launched some videos about different aspects of our advocacy, such as with autism for caregivers. And we participate in community activities at the national level to improve patient access and to talk about how important it is to manage our own health and the health of our loved ones. And so, it's a combination of both basic accreditations that show that we made the investment, and we provided a third party to critique us and to review us. And we actively maintain that accreditation is not a one-time stamp. And then, the second part is continuous outreach, and letting the community know what we're working on, what's important to us, so that, over time, they start to look at what we do and start to trust it and invite other people to trust it as well. VICTORIA: That makes a lot of sense. And I'm curious if there were experiences from your corporate career that informed how you acted as a founder and what you prioritized. MARC: I've had an odd corporate career. [laughs] So, I started my career as an engineer in manufacturing operations and in product development and then went down to as a consultant strategy in ops and market management, and then, later, investment management and private equity, and then, later, for a safety science company where I was managing global capital investments in technology and new operations. And so, I've been fortunate that I've had a breadth of experience, from marketing to sales, to product and technology development, and infrastructure management. So, I had some basic skills that helped me understand what...well, the endeavor before I jumped into it because I spent a couple of years thinking about whether or not I even wanted to do something like this. And then, I would say probably the most important part of my previous experience that I apply every day at OtisHealth is developing teams and developing collaboration with different organizations. You know, aside from the team that I have, our own staff, we also work very closely with other organizations, even competitors, to make sure that we're all successful. And so, that collaboration across organizations that don't even have a necessarily contractual relationship is something that I brought over from my previous work and seeing how working across the industry, we can help each other and serve the mission. So, I think that was probably the most important part of my previous work experience that I apply today is this: building a team and building a coalition of organizations that want to move forward together. VICTORIA: That's great. And I'm wondering if there was anything that surprised you in that early phase of building collaboration with other companies and understanding your users that changed the strategic direction you were going with in the app. MARC: So, one of the things that I was really just in awe of was how willing people in the healthcare industry were to jump in and help out when we started talking. And so, many of the organizations that we work with, the founders or the senior staff within the nonprofits we work with, all have a story of why they're doing what they're doing. Many are brilliant people who could have taken their careers in many different directions, not in healthcare. And they chose to move forward in healthcare because of some personal experience in their life. And so, as I learned about the people I was working with, I was surprised how quickly they just took me under their wing and said, "Hey, let's get you started marketing. Let's move OtisHealth forward." And so, we have organizations like Onyx and Invitae [SP] that are giving us support in data access. There's another organization that I can't mention yet; that's another private entity that has offered their support, and we hope to launch with them in the next couple of weeks. And so, we're forming these data access bridges to help get patients more access to their data, their loved ones' data. And then, there's the nonprofits in the advocacy and standards organizations we work with, such as HL7, which is an international health technology standards organization, and DirectTrust, which is an organization that establishes trust networks in ecosystems, as well as the technology infrastructure behind how those systems communicate. And we work also with EHNAC, the accreditation commission. So, we not only are using the accreditation from EHNAC, we're on committees to advise them on future criteria for accreditation. VICTORIA: That's really cool. I love that there's that collaboration and just openness and willingness to try to make things better and to invest in solutions together. Mid-Roll Ad: VICTORIA: Introducing thoughtbot's ongoing maintenance service. Need reliable support and maintenance for your software? Look no further. Our expert team handles upgrades, bug fixes, UI adjustments, and new feature development. And the best part? Our maintenance packages start at just 5K per month for companies of all sizes. From Ruby on Rails to Node, React, and, yes, even PHP, we've got you covered. Trust thoughtbot for top-notch support and optimized performance. To receive a custom quote, contact sales@thoughtbot.com. VICTORIA: And with me here, I have Richard Newman, who is the Development Director on our Boost Team, to talk to me a little bit more about what maintenance actually looks like once you've built your software application, right? RICHARD: Hi, Victoria. VICTORIA: Hi, Richard. You have experience building applications. I wonder if you could describe to a founder who's considering to build an application, like, what should they consider for their long-term maintenance? RICHARD: Well, like you said earlier, part of what you're going for with that long-term maintenance is making sure the health of your project, of your application, is always there. And you don't want to be surprised as you're continuing to work with your users and so forth. And so, a number of things that we pay attention to in maintenance are, we're paying attention to keeping the application secure, providing security updates. We want to make sure that the ecosystem, basically, all of the tools and third-party services that are tied to your application that, we're responding to those sorts of changes as we go along. And then part of it is, occasionally, you're going to find some smaller issues or bugs or so forth as your user group continues to grow or as needs continue to change. You want to be able to respond to those quickly as well. And so, a lot of what goes into maintenance is making sure that you're paying attention and you're ahead of those things before they surprise you. VICTORIA: Because what can happen? Like, what are the consequences if you don't do that ongoing maintenance? RICHARD: Well, the security updates those happen across gems and in the platform sort of tools that are there. And so, if you're not keeping those up to date, your exposure, your vulnerability to being hacked, or having a bad actor come into your application start growing on you if you're not doing the maintenance. The other ones that can come up is there's new interfaces that these third-party services...they may be updating their APIs. They may be updating how you're supposed to work with their tool. And so, those can occasionally break if you're not paying attention to what's going on or you're suddenly surprised by an upgrade that you have to make. And then, finally, there's this long-term sort of code change that just builds up over time if you're not keeping it refactored for the changes that are upcoming in a language or the gems that you work with. And then, suddenly, after a while, it suddenly gets to the point where you have a lot of work that you might have to do to rehabilitate the application to take on some of the newer features that are being released. And so, that makes it that much more difficult, that much more friction about being able to deliver updates for your users or to be able to respond to changes that are happening out there in your application. VICTORIA: Right. So, if you don't have that ongoing maintenance, you could run into a situation where, suddenly, you need to make a very large investment and fixing whatever is broken. RICHARD: Absolutely. It's going to be very tough to plan for if you weren't keeping up all the way along and, yes, absolutely ends up being much slower if you have to remediate it. VICTORIA: That makes sense. I wonder if you have any examples of a project you've walked into and said, "Wow, I wish we had been doing a little bit more maintenance." [laughs] And maybe you can share some details. RICHARD: Yeah. We had a fairly large application that involved a number of clinic services. So, we had an application that users were going in every day and counting on our fast response. And, over time, we've got surprised by a database upgrade that had to happen. Basically, the database was going to be changed by our third-party hosting service, and that hadn't been tested. There hadn't been procedures in place when we discovered this need. And there was a very hard date that that change had to be done or else the entire application was going to go down. And it came at a very inconvenient time, at the end of the year around Christmas, that we had to respond to all of that. And had we been in front of it and just updated it every quarter and staying current with it, it wouldn't have been nearly the lift that it turned out to be. We were facing a pretty hard deadline [laughs] there to keep things going. It was very, very stressful and disruptive for the team and potentially for the clinics. VICTORIA: Right. And it always happens around a big holiday or something like that, right? When it all comes to a head. So... [laughter] RICHARD: Absolutely. You want to be in control of the timeframe and not have the timeframe be in control of you. VICTORIA: Right. And if you have a team like thoughtbot supporting you, you can go on your vacation with a little bit more knowledge that if something breaks, there's someone there who can respond and fix things, and you don't have to interrupt your very valuable time off. So... RICHARD: [chuckles] Absolutely. VICTORIA: Yeah. Well, thank you so much, Richard, for joining me today. I appreciate you coming here to talk with us. And we'll talk to you again soon. RICHARD: Yeah, it was a pleasure. Thank you. VICTORIA: You mentioned advocacy. And I'm curious if you could say more about what advocacy are you doing or how does that blend into your business model and what you're doing with OtisHealth? MARC: I'll give you an example. One of the organizations we belong to and I participate in personally is the Health Information Management System Society. And so, this is a professional society of healthcare IT professionals. And in Northern California, there's an advocacy committee that works directly with the state legislature to promote legislation that will improve the quality of healthcare for people in California. We actively talk to members of the legislature to tell them what bills we think are important. The ones we focus on and the ones I personally focus on are the ones that improve access to our data and also improve our privacy. So, there's a legislation in California, as an example, that will prohibit access to people's healthcare data without proper legal warrant. So, it's basically extending HIPAA protections across any health app launched in California. And we, of course, are already HIPAA-compliant, so that's very easy for us. There's also advocacy specific to certain health conditions. So, my daughter had autism. I work with the Autism Society here in California and also Achieve Tahoe, which is an organization that teaches skiing and other skills to people with disabilities in particular. This past season was my first season. I work primarily with children and young adults with autism and other developmental disorders. And then we also partner with organizations when we think that they're aligned with some of our mission. And so we work with the Caregiver Action Network. We also will work with AARP and other organizations regarding caregiver rights and also teaching caregivers how to access the healthcare data of their loved ones and how to take care of themselves personally. VICTORIA: That's wonderful. And I guess it's not really a question, but I saw that autism service dogs are a thing, and I just thought that was really cool. [laughs] MARC: Yeah, OtisHealth is named after Constance's autism service dog, Otis. And so, service dogs are extraordinary animals. They're highly trained. Otis had been trained for two years before we received him. He was trained specifically for Constance's needs, and he kept her safe. And that was the primary interest in Otis is observing things that she...because of her cognitive limitations, wasn't always aware of her surroundings and wasn't always safe. And so, the dog maintained her safety and her boundaries and kept her focused, as well as just basically blocked her if she was going to do something that was unsafe. So, there are many different kinds of service dogs, and I'm talking specifically about ADA, the Americans with Disability Act type service dogs. These aren't, like, companion dogs or therapy dogs. These are truly highly trained animals that are focused on specific tasks to help an individual be safer, more free, or have more abilities than their disabilities may allow. VICTORIA: Well, I love that. And I like that the app is named after her dog as well. That's just very sweet. And I love that that's how that worked. And I'm curious, what's on the horizon? What are you most excited about for OtisHealth in the next year? MARC: Like all startups, we have [laughs] a lot of plans. And we've been invited to speak at some conferences. I spoke at two already this year. And I have another one coming up in Washington, D.C., where we're going to advocate, again, for patient access. And this is primarily talking to the health systems themselves in adopting technology that makes it easier for patients to securely access their health records. And so, we're excited about that movement in the industry to recognize and start to act on that need for patients to be able to access their health records. And we work with our partners to promote that and also with the federal government. We work with the health and human services to promote this access. And we were published in a report earlier this year because of our technology demonstration with health and human services. And it sounds like it's finally getting some real traction in hospital systems. And members of the Federal Congress are also saying that this is something we need to move forward with in a more aggressive manner. On a more direct path, we're excited our membership's growing. We've had tens of thousands of people register to use the app, with thousands actively using it today. We're working on some new programs right now for payers and for providers that will improve health outcomes and within their populations, as well as bring on hundreds of thousands of other people on the app. We're really excited to know that we're getting both recognized for the work that we're doing and that people are starting to understand the importance of managing everyday health, whether it's with OtisHealth or another application. VICTORIA: Well, I love being excited for these opportunities to advocate for your product and for the mission behind the product. I'm not going to recommend being excited about going to D.C. during the summer. [laughs] Last time I was there when I landed at 9:00 p.m., it was 90 degrees outside [chuckles] and humid, like, 90% humidity. But it's great to have access to people who care and are trying to make things better and have that voice. I'm excited to see you grow. And then, it's been two years since you started the app. I wonder, if you could go back in time to when you first were getting started, what advice would you give yourself? MARC: So, this is a really hard thing for anybody to look back and say that they'd like to change a few things. There are things I would change. I have a lot of experience managing large, sophisticated programs. Because in the past I had large budgets, it was really easy to maintain strict discipline around the implementation. And I think I was too loose in the implementation process at the onset of OtisHealth. I would have been more disciplined around my program management and the accountability that I had to developers I was using. As a startup, I didn't have a large development team in-house. I needed to use external parties. And I should have been a little more closely on top of that process. The other things that we experienced were primarily a result of pivots. We were constantly pivoting as we were learning. I think having a team to review our process and pivot more quickly is really critical. You don't want to pivot 20 times a week. You need to stay focused for a while, but also having friends or advisors or members of your team that can help you assess when a pivot is necessary, or a new opportunity presents itself, I think, is critical. And so, we all know, as founders, the team is key. And I think the earlier you engage a team and not be bashful by asking for advice, the better. VICTORIA: I love that. And I'm curious if you have any advice from your program or from your startup career now on choosing the right development teams. And how do you find those right partners to actually build the app and have that accountability? MARC: So, I would say the number one thing that I've learned, that I knew previously, but I really appreciate it more now as a founder of a small company, is you need mission alignment, not just company to company, but person to person. And I took my time picking advisors to join us, and I took my time getting people on board to OtisHealth. We pick folks that we believe understand what we're doing, and we take our time and make sure that they appreciate it and that we're comfortable with them. Our startup is too small to make a bad hire or to have the wrong perspective because somebody has other motives, such as just making money. If I was providing advice in terms of picking teams or picking vendors to work with, I would say take it slow. Don't rush, even though you may be in a rush, or we may be in a rush to get moving, either for financial reasons or personal reasons. It's important just to feel comfortable. Get to know folks. Meet them in person if you can and spend a few hours with them at a time [laughs], just to make sure that they believe in you, and you believe in them, and that you have a common vision. Because when things get rough or tough, financially or otherwise, you need people that are going to be able to stick through it and work with you. VICTORIA: That makes a lot of sense. There's a lot of pivots happening. You want everyone to be on the same page. And you don't want to have to be corralling everyone all the time if they have competing priorities, so that makes a lot of sense. MARC: Absolutely. Just to be clearer on that, we all run into challenges. So, in some cases, we had to make some financial sacrifices, and everyone did it together. You really need people that are that committed that say, "Okay, I understand where we are, and so, I'm willing to take a pay cut for a while or not get paid for a while until we can get this spec started again." Even vendors I work with today that are strategic vendors understand that and have helped us financially when we need some time to get more revenue in. VICTORIA: Great. And so, when you were building a healthcare app, was there people you needed to have on your team who had that exact specialty in either patient care, or medical records, or something like that? MARC: Yes, yeah, you need experts. So, I'm a quick read. I mean, I spent a couple of years learning the industry and understanding the technology. But the person that's our IT director he has over 25 years of experience in healthcare IT systems, so he is the expert in-house. We also have advisors on our team that are experts in payer services and payer systems, launching healthcare apps, managing standards, and managing SaaS services. We have a data and an AI expert, and a clinical research specialist. We also have physicians we refer to. [laughs] So, we have a pretty big entourage of individuals that we go to for very specific advice and work. VICTORIA: That makes a lot of sense. Let's see, what question should I be asking that I haven't asked yet? MARC: You know, I think most of the people listening to this podcast are technical founders. And it was surprising to me, and I had some founders contact me, asked for some free advice, which I'm happy to do, but they didn't seem sincere in their interest in being in healthcare. And one thing I told them, and I would say to anybody that's interested in being a healthcare technology developer, is you have to have a reason to do it besides the money. It will be a really hard battle to move forward with a technology if the only motivation is a financial opportunity. That isn't going to sustain the pivots or the development. You'll run into a lot of walls, primarily because everyone will see it. Everyone in the industry sees those players come in that just have a financial interest, and the consumers see it, and they don't like it. So, my advice to anybody that wants to develop technology in healthcare is you have to be a little sincere about it and have a real reason to do it beyond just making money, and I think you'll find it more rewarding. There's so much need for healthcare technology and better technology out there. So, I welcome folks to join the fight, the battle, or the opportunities. But I would say that just come in with the idea that you're helping people, not just making money. VICTORIA: I think that rings true for any business you're in, right? But especially in healthcare because it is this big target. Even in consulting, if you're doing business development and you're thinking of working on health IT projects, there's just a huge market that you have to narrow down and figure out where you're going to be. So, if you don't have that intrinsic motivation, it can be overwhelming and scattered, and then people won't connect with you, right? Because everybody is going after the same thing. MARC: That's exactly right. One of the conferences I went to earlier this year, a speaker got up and said, "People invest in people, or people make deals with other people." We talk about companies signing a deal with another company, but it's really one person trusting another person. Whether it's in healthcare or another industry, obviously, that trust needs to happen. At some point, if I don't trust the individual I'm talking to, I'm less likely to have a deal with that company. VICTORIA: Right. It's like; I don't know how, you know, it doesn't really matter how impressive your credentials are. If there's not a basic level of trust, you might not move forward with it, so that makes a lot of sense to me. MARC: Yeah, that's absolutely right, Victoria. VICTORIA: Absolutely. Is there anything else that you'd like to promote at the end of this podcast? MARC: I'd love for folks to try OtisHealth. If you have family that have chronic medical needs or need help managing their medical information, please download OtisHealth, help them join. There are videos on YouTube that explain how to use it if you need some guidance, but we believe most of it is self-explanatory. We are continuously adding data access points. We're going to be launching this week new versions of OtisHealth that have access privileges for people in New York and Nevada and parts of California and Colorado. And so that means that with the app, once you're ID-proofed on the app, you can use it to get your medical records from different sources without having to log into all these different patient portals. So please try it. Use it for yourself but especially use it for your family or anybody who you care for. We'd love to get your feedback as you use the app too. VICTORIA: That's great. And I'm actually already thinking about...next week; I'm going to be going to The San Diego Annual Veterans Stand Down, where anyone who is experiencing homelessness can come in and get access to all the services that they might need, whether it's legal, or healthcare, or dentistry, showers, food, all of these things. And I'm curious if that organization might benefit from having a tool like that for their users. So, I'll be talking about it. [laughs] MARC: Oh, thank you so much. That'd be wonderful. Thank you. VICTORIA: That's great. Well, thank you so much, Marc, for joining us. MARC: My pleasure. Thank you, Victoria, for having me on the show. VICTORIA: Excellent. You can subscribe to the show and find notes along with a complete transcript for this episode at giantrobots.fm. If you have questions or comments, email us at hosts@giantrobots.fm. And you can find me on Twitter @victori_ousg. This podcast is brought to you by thoughtbot and produced and edited by Mandy Moore. Thank you for listening. See you next time. ANNOUNCER: This podcast is brought to you by thoughtbot, your expert strategy, design, development, and product management partner. We bring digital products from idea to success and teach you how because we care. Learn more at thoughtbot.com. Special Guest: Marc Mar-Yohana.
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.
As an expert in building a next-generation data platform at Briotix Health, Russell Hertzberg shares his valuable advice on how data integration can revolutionize occupational health practices and enhance the overall well-being of employees. In this episode, Russ uncovers the dynamic world of custom and on-the-shelf EHR/EMR solutions and shares the emerging trends such as speech processing, wearable sensors, and genetics shaping the future of healthcare. This conversation opens a deeper understanding of the obstacles in the US healthcare technology market and brings you many insights into the challenges faced by healthcare organizations, software developers, and industry stakeholders. Uncover practical strategies and innovative solutions that can help overcome these obstacles and drive positive change in healthtech. Enjoy the listening! Links: Russell's Linkedin: https://www.linkedin.com/in/russhertzberg/ Briotix Health: https://www.briotix.com/ Jcloud: https://jcloudco.com/
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!
Integration methods like HL7, API, X12, and FHIR are essential for transferring large volumes of healthcare data and managing administrative workloads between practice management systems and third party solutions. Learn how to evaluate and select the right type of integration for your organization, with Navaneeth Nair, Infinx Chief Product Officer.
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.
Dawn Carter, Director of Product Strategy of Centauri Health Solutions joined Sean to discuss Risk Adjustment Audits and the ins and outs of these often times annoying administrative requirements if you participate with an MA Plan... This was such an interesting discussion and we believe you will think so too! Links to articles from the show: Article 1: Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,' Part 1: The Risk-Score Game - https://www.healthaffairs.org/do/10.1377/forefront.20210927.6239/full/ Article 2: Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,' Part 2: Building On The ACO Model - https://www.healthaffairs.org/do/10.1377/forefront.20210928.795755/full/ Article 3: Halvorsen/Crane rebuttals: https://www.healthaffairs.org/do/10.1377/forefront.20220106.907235and https://www.healthaffairs.org/do/10.1377/forefront.20220203.915914/ Article 4: Gilfillan and Berwick rebuttal to Halvorsen and Crane: The Emperor Still Has No Clothes: A Response To Halvorson And Crane - https://www.healthaffairs.org/do/10.1377/forefront.20220602.413644 Article 5: Kang/Duncan/Hunh response: Making The Right Diagnosis: A Response To Berwick And Gilfillan - https://www.healthaffairs.org/do/10.1377/forefront.20220706.909897/ About Dawn Carter: Her career in healthcare spans 28 years, which most recently includes extensive experience in developing revenue integrity and quality software solutions, with a focus on encounter management, risk adjustment, and social determinants of health solutions for Medicare Advantage, Medicaid and Commercial health plans, as well as providing risk adjustment strategic advisory services for these markets. Prior to that, her experience spans all domains of health care including health plan and provider systems administration, finance, compliance and healthcare applications development inclusive of EDI and X12 and HL7 development. Her experience also includes multiple teaching engagements in medical administration, billing and coding. Dawn holds a Bachelor's degree in Business Administration, and she holds the American Association of Professional Coders CPC (Certified Professional Coder), CRC (Certified Risk Adjustment Coder), and CPMA (Certified Professional Medical Auditor) credentials. She is also a Certified Scrum Product Owner (CSPO). Dawn is a passionate and prolific industry speaker, author, blogger and subject matter expert in claims, EDI management, and risk adjustment.
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.
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.
For people with common health problems like diabetes or high blood pressure or high cholesterol, progress in pharmaceuticals has worked wonders and extended lifespans enormously. But there's another category of people who tend to get overlooked by the drug industry: patients with rare genetic disorders that affect only one in a thousand or one in two thousand people. If you add up all the different rare genetic disorders known to medicine, it's a very large number; Harry's guest this week, Charlene Son Rigby, says there may be as many as 10,000 separate genetic disorders affecting as many as 30 million people in the United States and 350 million people worldwide. That's a lot of people who are being underserved by the medical establishment.Rigby is the head of a new non-profit organization called Rare-X that's trying to tackle a systematic problem that affects everyone with a rare disease: Data. In the rare disease world, Rigby says, data collection is so inconsistent that each effort to understand and treat a specific disease feels like reinventing the wheel. For longtime listeners of the show, that's a familiar story. Time and again, Harry has talked with people who point out the harms of storing patient data in separate formats in separate silos, and who have new ideas for ways to break down the walls between these silos. Rare-X is trying to do exactly that for the rare disease world, by building what Rigby calls a federated, cloud-based, cross-disorder data sharing platform. The basic idea is to take the burden of data management off of rare disease patients and their families and create a single central repository that can help accelerate drug development.Harry talked with Rigby about the challenges involved in that work, how it gets funded, how soon it might start to benefit patients, and what it might mean in a near-future world where every child's genome is screened at birth for potential mutations that could lead to the discovery of rare medical disorders.Please rate and review The Harry Glorikian Show on Apple Podcasts! Here's how to do that from an iPhone, iPad, or iPod touch:1. Open the Podcasts app on your iPhone, iPad, or Mac. 2. Navigate to The Harry Glorikian Show podcast. You can find it by searching for it or selecting it from your library. Just note that you'll have to go to the series page which shows all the episodes, not just the page for a single episode.3. Scroll down to find the subhead titled "Ratings & Reviews."4. Under one of the highlighted reviews, select "Write a Review."5. Next, select a star rating at the top — you have the option of choosing between one and five stars. 6. Using the text box at the top, write a title for your review. Then, in the lower text box, write your review. Your review can be up to 300 words long.7. Once you've finished, select "Send" or "Save" in the top-right corner. 8. If you've never left a podcast review before, enter a nickname. Your nickname will be displayed next to any reviews you leave from here on out. 9. After selecting a nickname, tap OK. Your review may not be immediately visible.That's it! Thanks so much.TranscriptHarry Glorikian: Hello. I'm Harry Glorikian, and this is The Harry Glorikian Show, where we explore how technology is changing everything we know about healthcare.For people with common health problems like diabetes or high blood pressure or high cholesterol, pharmaceuticals has worked wonders and extended lifespans enormously.But there's another category of people who tend to get overlooked by the drug industry.And that's patients with rare genetic disorders.By definition, rare diseases are rare, meaning they might only affect one in a thousand or one in two thousand people. But here's the thing. If you add up all the different rare genetic disorders known to medicine, it's a very large number.My guest today, Charlene Son Rigby, says there may be as many as 10,000 separate disorders affecting small populations.And if you count everyone who has these conditions, it may add up to as many as 30 million people in the United States and 350 million people worldwide.That's a lot of people who are being underserved by the medical establishment.And Rigby is the head of a new non-profit organization called Rare-X that's trying to fix that.Now, there are a lot of rare disease organizations that are looking for a cure for a specific condition.Rigby actually came to Rare-X from one of those, the STXBP1 Foundation, which is searching for a treatment for a rare neurological condition that affects Rigby's own daughter Juno.But Rare-X is a little different. It's trying to tackle a systematic problem that affects everyone with a rare disease. The problem is data.Rigby says that in the rare disease world, data collection is so inconsistent that each effort to understand and treat a specific disease feels like reinventing the wheel. For longtime listeners, that'll be a very familiar story.Time and again I've talked with people who point out the harms of storing patient data in separate formats in separate silos, and who have new ideas for ways to break down the walls between these silos. Rare-X is trying to do exactly that for the rare disease world, by building what Rigby calls a federated, cloud-based, cross-disorder data sharing platform.The basic idea is to take the burden of data management off of rare disease patients and their families and create a single central repository that can help accelerate drug development.I talked with Rigby about the challenges involved in that work, how it gets funded, how soon it might start to benefit patients, and what it might mean in a near-future world where every child's genome is screened at birth for potential mutations that could lead to the discovery of rare medical disorders.Here's our full conversation.Harry Glorikian: Charlene, welcome to the show.Charlene Son Rigby: Thanks. Nice to be here, Harry.Harry Glorikian: So I've been reading about what you guys are doing. I mean, all of it sounds super exciting. I'm, you know, been looking into this space for a long time from a rare disease, but many different angles of it. But can you just start off, tell us a little bit about yourself and how you got active in this world of rare disease research?Charlene Son Rigby: Yeah, thanks for that question. So I've spent most of my career building scalable software solutions for analyzing big data, and that's been both in health care as well as enterprise software. And so I'm now the CEO at Rare-X where we're building a platform to analyze rare disease data cross-disorder. And prior to being at Rare-X, I was the chief business officer at a company called Fabric Genomics, where we developed artificial intelligence approaches to speed diagnosis of patients through genomics. We had a considerable focus on rare disease and contributed to projects like the 100,000 Genomes Project and also the work that Stephen Kingsmore is doing at Rady Children's with diagnosing critically ill newborns in the NICU. And so when I started at Fabric, my daughter Juno was ten weeks old. She's my second child. And it was kind of a fortuitous timing, in some ways kismet, because at when I started at Fabric, I didn't know that she was going to start experiencing issues with her development. But at around four months she started missing milestones. And that started us on a three and a half year journey to find an answer to what was going on with her. And so during that time, we went through many, many tests, including genetic tests, MRIs, all kinds of all kinds of things, and everything kept coming back as negative or inconclusive. And so I was working at a genomics company, and so I kept pushing for whole exome testing, which at that time was still not, not readily available clinically and by insurance was still considered experimental. So we were denied three times, until we finally were able to get authorization in 2015. And so in early 2016, we got my daughter's diagnosis and she has a mutation in a gene that's involved in communication between neurons and the genes called STXBP1.Charlene Son Rigby: And so it's very rare. Thirteen kids born a day somewhere in the world. So thinking about Juno and thinking about this from a science standpoint, that it was pretty interesting that when she was diagnosed because she didn't have a classic phenotype for STXBP1. So most kids, 90% of the kids have seizures. And she has more of the symptoms around developmental delay, low muscle tone, cognitive issues and delayed walking and motor issues. And, you know, this this kind of challenge around these atypical phenotypes, I think, is actually becoming much more common in disease generally, so in rare disease and also more broadly in more common conditions as we're really starting to understand kind of the true breadth of patients. So in terms of your original question about my journey through rare disease, so I went on to co-found the STXBP1 Foundation to accelerate the development of therapies for kids like my daughter. And then coming to Rare-X was really a kind of joining of my software background with my passion for rare disease and really wanting to do something more broadly for the rare disease community.Harry Glorikian: I have to tell you, like what you said, three and a half years, I'm like, oh, my God. Like, I would be I have so many stories. And like when I was at Applied Biosystems and, you know, we're doing all this work. It just boggles the mind that some of these things are not really readily available to help get over that diagnostic odyssey for especially parents, because you're going to do anything to help your child. I'm glad it's actually moving theoretically faster these days. I'm not sure if insurance has actually kept up, but we're, on the technology side, I know we're everybody's pushing the envelope now. But when we talk about rare disease and you did some of the numbers but we hear about these rare diseases, I think a lot of people think of like there's an n of 1, right? They assume that this disease only affects a tiny number of people. Right. Maybe just one or a handful worldwide. But I mean, the fact is, if you add up all these different rare genetic diseases that exist in the human population, the number of people is actually pretty big. I mean, can you sort of. Put that into some sort of scale for us in what you've seen.Charlene Son Rigby: Yeah, you're absolutely right. You know, rare disease is by definition rare. And so it's easy in some ways to be dismissive of a rare disease because, oh, it's only affecting a few people. And it's true that a single rare disease can affect a very small number of people, even down to the n of 1 case that you talked about. From a definition standpoint, so, in the US, rare disease is defined as a disease affecting fewer than 200,000 Americans. And in Europe, in the EU, it's defined as affecting no more than one in 2,000 people. So we even though for ultra rare or n of 1 diseases, we can be talking about a small number of people, or like in my daughter's disorder, we can be talking about low thousands, there are still thousands of rare diseases and the traditional number that we hear a lot is 7,000. So 7,000 rare diseases. Rare-X is about to come out with some research that indicates that there are over 10,000 individual rare diseases, and this is really due to our growing understanding of genetics. So previously we might have grouped together a set of disorders based on what the symptoms were like. But now we understand that those actually are due to a different genetic etiology or different cause at a genetic level. And so if you aggregate all of those people up, across those 10,000 rare diseases, you know, what we're looking at is one in ten, potentially one in ten people in the world. And so in the US that's about 30 million people and in total 350 million people worldwide. So it's really a huge number of people. And from an impact standpoint, it's staggering when you look at the impact from a health care standpoint and from an economic standpoint.Harry Glorikian: Yeah, I mean, if you can diagnose, I mean, if there is a way to treat someone, then you get to it faster. And the economic impact is huge and unfortunately, if there isn't, maybe it spurs a pharmaceutical company to, you know, start working on it or figure out a way to treat that patient better. But at least you, I always tell people, the better the diagnosis, the better the next step. I see people sometimes, it seems like they're throwing a dart, you know, and they're it's an educated guess, but it's not, you know, the accurate diagnosis that you'd like to have. So. But how and where, when was sort of Rare-X born and what are you trying to do with the organization? What do you want to fix?Charlene Son Rigby: Yeah. So Rare-X was a pandemic baby. The organization was started in early 2020 and I just joined the organization last year. But, you know, it's really been quite a journey being able to have the, launch the platform during COVID. And I know we can talk about that in a little bit, but the unsolved problem that we are working to address is really around collecting data for rare disease. And one might ask, well, why is this an issue? I'll give an example. From the early days of the STXBP1 Foundation. W e assembled our scientific advisory board and we got together for our first scientific meeting. And we were going to develop our roadmap so that that would guide our priorities in terms of scientific development. And we were all very focused on therapies. So my expectation going into the meeting was we were going to talk about all the mice models we were going to build. What did we need to do in the lab? How are we going to get to that first therapeutic candidate? And the number one priority that came out of that meeting was to build a prospective regulatory-compliant natural history study. And so it was a huge learning for me because if you look at the kind of canonical steps in terms of drug development, it's always preclinical and then you move into clinical. And what I think that kind of simple model misses is this foundational layer around the data that you need and the real kind of understanding of the symptoms and the disease progression that is critical to building effective therapies, developing effective therapies.Charlene Son Rigby: And so that's really what Rare-X was started to do, was to enable the gathering of this data, the structuring of this data and enable it to be shared and to do this at scale. So, cross-disorder. And there are several problems today that that make this challenging. And so maybe I can talk a little bit about that. There are three or four of these significant challenges. So today some of this data does exist, but it's often kind of trapped in data silos. So it was generated in an individual project that might have happened in academia or industry. And then the data is often really only accessible to the group that collected it. And in rare disease where we don't have that many patients, it really makes it challenging to create a kind of more comprehensive understanding and picture of the patients if that data is trapped in these individual silos. Charlene Son Rigby: Another challenge that that we've seen is the lack of usable data. So individual studies may not include the key data that's needed to drive drug development forward. So some of these data repositories, they might either be a symptom specific. So they're looking at a specific organ system that might have been of interest to that researcher. So they're an incomplete picture. Or some of these repositories or these registries were started by passionate parents. You talked about that, the urgency that one feels as a parent, that I feel as a parent. And the registry may have been structured or the questions may have been structured in a way that isn't necessarily immediately usable by researchers because of the fact that it was started by a parent who, like you, you might not have had a statistical analysis background, you might not have had a survey methodology background. And we so those can be challenges in terms of having the data be robust and usable later. Charlene Son Rigby: And then the other thing that can be challenging and probably is often the most challenging is, is especially in these very, very new diseases, there's no data, and it takes quite a bit of funding to start data collection. Often, often passionate parents are going around trying to get researchers interested in their disorder. But it's often that you have to have a little bit of data to get a researcher interested. And so this is a huge challenge in terms of implementing data collection. And the other thing that kind of underlies this is that patients often are not empowered in this process. And so that was a fundamental piece of the way that we've structured Rare-X and the way that we collect data and the way that we enable patients to participate in the process to power data collection.Harry Glorikian: Yeah. I mean, it's, you know, they make movies out of this, right? People trying to push this boulder up a hill. So, what are the new ideas that say Rare-X is bringing to the table? I mean, your organization has called for like, you know, the largest data collection and federated data system and analysis platform in rare disease. So, I think unpacking that statement because it's a big statement, right, of, you know, what are you doing to improve data collection? What do you mean by federated, for those people that are listening? And why is it important? A nd how will the platform enable better analysis of this rare disease data?Charlene Son Rigby: Yeah. Great question. From a design perspective, the one of the things that we wanted to do was make sure that the platform was cross-disorder. So a lot of registries are started for an individual disorder. And what we really wanted to be able to do was given that number of 10,000 diseases, how do we scale to support so many disorders to accelerate therapies? And so a fundamental design principle was to do that cross- disorder. The other piece of this is that we are focused on patient-reported data. So typically a participant will join the research program, create an account on the platform and they are either a patient or a caregiver of a patient and providing information on their symptoms. There is a lot of other data out there in the ecosystem that could come from other related registries, or it could come from clinical data, it could come from many different types of studies. And so we really want to enable the aggregation of or federation of that data. So you asked me to define that term. It really means bringing together multiple different data sets in a way that enables those data sets to be analyzed together. And I think, again, going back to this theme that for any individual rare disorder, there aren't that many patients. And so analyzing that data, kind of individually, we are really missing the opportunity to maximally use the data that's been contributed by rare disease patients. And I would even argue that it's a moral imperative for us to do that as a rare disease community, because we urgently need to move these understanding of these disorders forward in development of therapies as well.Harry Glorikian: I almost wish I could take all the companies I know doing this and put them there so the n goes up for everybody. But I know that there's all sorts of reasons that that doesn't happen. But, you know, when you were saying we're pulling in patient-reported data, you know, the first thing, and we talk a lot about this from different groups on the show is, you know, would a wearable or one of these other devices that are now available give you more granular, real- time information that might be valuable to this sort of study. And have you guys considered things like that?Charlene Son Rigby: T he short answer is yes, because the our desire is to really continue to expand the types of data that are collected. And the I think that the nice thing about mobile, mobile devices, wearables, is that it makes it very easy to collect that data. And so we have a partnership with Huma. They do work in the mobile space. And we're definitely continuing to evaluate where we can develop partnerships there. I mean, our goal overall is to de- burden patients and so that the, if we can do that in a way that additive to an overall body of research, then we're huge proponents of it. And I think that it's also important that we're really trying to create an open system. So our partnership model is a very, very open partnership model in terms of who we can work with.Harry Glorikian: Yeah, I had a really extensive conversation with the head of data sciences at WHOOP yesterday and you know, they're pulling in somewhere between 50 and 100 megabytes of data per patient per day. I shouldn't say patient -- per individual per day. Right. I was like, that's a lot of data. And she was, you know, the kid in a candy store because they're she's like, we can really see what's happening with people. And you can ask questions at a scale that you couldn't ask before. Like she was saying, you know, the last one of the things that we're working on publishing is 300,000 people. You couldn't imagine that in the world of, say, a clinical trial of 300,000 people are just going to, you know, and you have all the data, almost 24/7 on this person that's delivered by this device, which is sort of interesting, you know, place to be. So, you know, I know that you don't have 300,000 people in one in one area, but it'd be interesting to have that sort of 24/7 data available from these kids if you could, you know, get a device that would lend itself to that. But what stage is the company at in building the platform and you know, I guess the killer question is, when will drug developers or other researchers be able to start using it? If they already are, do you have any early success stories you can share?Charlene Son Rigby: Yeah, yeah. It's really a very exciting time at Rare-X. So the platform launched last summer and we have over 25 communities on the platform. And those encompass several hundred participants already. So we're really starting to see some exciting numbers in terms of in terms of participants. So we are launching our researcher portal at the end of Q2. So very soon. And at that point, any researcher, so academic researchers, pharma researchers, will be able to access the data and be able to utilize analytical tools to really interrogate the data. I'm excited that we also have launched our first sponsored program, and that's with Travere. They're supporting the homocystinuria community to start data collection, to start a registry. And we just launched that at the end of February.Harry Glorikian: So I want to. Jump back, like just talking through some of the biggest technical challenges along the way. I mean I know one of your goals is like interconnecting all these disparate data sources. But one of the issues that always comes up is how do you clean up that that existing data so that you can store it all the same way. And then obviously that enables somebody to then do the analytics right after that. But the biggest issue that I hear from a lot of people is, man, it takes a lot of effort to make sure that that data is cleaned up and put in the right place.Charlene Son Rigby: Yes, the data munging. Yeah. I mean, I think that that is really the, a significant challenge, because creating research-ready data and then harmonizing data sets is a huge amount of upfront work that has to happen before you can actually do any of the analysis and the data mining. So what we have done with the core data that's being generated within Rare-X is that we have mapped it to data standards. So we utilize standards like the human phenotype ontology, OMIM, HL7, so that the data that we're producing already is mapped to all of these generally utilized standards. And then we would if we were working on a federation project, the same thing would need to happen with these other data sets to really enable that type of integrated that type of integrated analysis. And you're right, it's it can be a very brute force effort in terms of doing it accurately. And that's why I think that it's really important from a from an industry perspective to really start adopting these standards and putting them into the base model, you know, for assuming just making the assumption up front that the data is going to be federated and utilized downstream. I think that kind of traditional studies, a lot of the scope was more really looked at in terms of what are we doing with the data today? And we need to be really thinking about from a lifetime perspective, how is this data going to be used?[musical interlude]Harry Glorikian: Let's pause the conversation for a minute to talk about one small but important thing you can do, to help keep the podcast going. And that's leave a rating and a review for the show on Apple Podcasts.All you have to do is open the Apple Podcasts app on your smartphone, search for The Harry Glorikian Show, and scroll down to the Ratings & Reviews section. Tap the stars to rate the show, and then tap the link that says Write a Review to leave your comments. It'll only take a minute, but you'll be doing a lot to help other listeners discover the show.And one more thing. If you like the interviews we do here on the show I know you'll like my new book, The Future You: How Artificial Intelligence Can Help You Get Healthier, Stress Less, and Live Longer.It's a friendly and accessible tour of all the ways today's information technologies are helping us diagnose diseases faster, treat them more precisely, and create personalized diet and exercise programs to prevent them in the first place.The book is now available in print and ebook formats. Just go to Amazon or Barnes & Noble and search for The Future You by Harry Glorikian.And now, back to the show.[musical interlude]Harry Glorikian: Now if we go one step before like getting that data, I mean. I have to imagine there's a huge political, bureaucratic or organizational challenge when it comes to who controls that data. And I think I have to assume, part of your job is convincing them to share it, right, despite its potential as intellectual property. Right. So how do you get on the phone and say, “Why don't you press send and shoot that over to me and so that we can take the next steps with it?”Charlene Son Rigby: Yeah, well, this is a really significant challenge, and I think that we're in a time of change in terms of attitudes around this. And part of it is what's been happening in terms of national programs to collect data. And people are starting to see the benefit of being able to share and really utilize these larger data sets. But the reality today is that in terms of the status quo, researchers control the data, and that's because the data was generated in a specific project that might have happened in academia or in industry. And there's a challenge with alignment of incentives. So on the academic side, I think that if one were to ask a researcher, do they want to hoard data, they don't want to hoard data. But the reality is, is that we still have this challenge with academic tenure and needing to publish or perish in that environment. And so researchers are still rightly concerned because of that paradigm that they have to write their paper and get their paper in before they can feel comfortable with allowing others to access the data. And so something really needs to happen there to that incentive system. Charlene Son Rigby: And in pharma, interestingly, I think that that's also an area where there has been a feeling that data is almost akin to intellectual property. But I think that especially in rare disease, there has been a growing understanding that accessing natural history data is not going to, at the end of the day, enable pharma to win because they're going to win on the quality of their therapeutic pipeline and how quickly they can get those therapies through to a successful market approval. And so what we've been really working to do is position natural history data as pre-competitive and for rare disease, frankly, it's too expensive to build these data sets, you know, alone. They're, as we scale to all of these disorders it's going to become untenable to for each company to build their own data set. The thing that we need to do and what Rare-X has been working to do with our collaborators is to transform the way that research has been done and initiated and break down these barriers and just show that the model of building these pre-competitive collaborations can work, both from a how does the business model work and then how is the data shared? And so I think that Rare-X being a nonprofit and a kind of neutral third party is really additive in terms of building those relationships so that this, this kind of public-private partnership model can really serve as a way to drive this type of change.Harry Glorikian: Now. Okay. So we've talked about industry sharing data, but I always I mean, especially in the last maybe 5 to 10 years, I keep thinking about, you know, how much of this comes directly or will come directly from patients, right? If they have control or access to their data, they have the ability, theoretically, the ability to then share that data. Right. And it could be just for the research in general as opposed to, not specifically to find a cure for a specific disease. So how do you get that data or convince patients to share it?Charlene Son Rigby: Yeah, well, I think that in in rare disease patients are typically highly motivated. You know, there are many rare diseases that can be pretty devastating in terms of the symptoms and the disease progression. And so overall, there is a a good portion of the rare disease population that is motivated to provide their data. And so what we do there and I think that that your points about the paradigms and thinking about it, that the patients are sharing their data, is really important. Because I think that that gets lost a lot. You know, a patient, and we've all signed up for some research study in our lives. You go and you fill out a survey or you contribute a blood sample or something, but oftentimes the patient contributions get forgotten because it becomes part of the researcher's data set. And so the what we're really trying to do is turn around that kind of paradigm with a core principle that patients are the ones who own their data and they're contributing their data. And so we enable them to, through an innovative consent process, we enable them to basically say that, yes, they're willing to share their data for these types of projects, and they can change that at any time. And we really feel that that changes the paradigm and allows them to have a real seat at the table. And then I wanted to also talk about, because obviously not everyone is — there is this proportion of folks who are motivated and trust and that's part of the reason that they will be willing to share their data — but there is also a portion of the population that might not be as motivated. And so it's important for us to be able to reach those populations and to build trust in the approach that we're taking and the value of it in terms of really being able to drive research. And so patient education is an important component of our model patient education, patient engagement. So we work directly with patient advocacy organizations and patient advocates to educate their communities on the value of data collection, how it really spurs and supports research. I think that that's a critical component to this as well.Harry Glorikian: Well, hopefully people will listen to this podcast worldwide and me that may spur someone to search you guys up on the web. But I noticed that another principle of the company is you don't sell patient data, right? Does that mean you're giving it away? And if that is true, what's the criteria of doing that? And do your data partners that you're giving it to have to meet certain standards?Charlene Son Rigby: Yeah, this is a great question because monetization models around data are very, very common today. Some companies have built significant valuations around data monetization. And for from a Rare-X standpoint, and this is part of the reason why we were started, is that the question was asked like, is that the right thing to do, especially for diseases where we're in the very early stages of understanding a disorder, and so I talked about this a little bit earlier, that if you have no data, getting any researcher interested is already then a huge challenge. And so we're here really to break down barriers to advancing rare disease research and encourage that research. And so I say sometimes that it's really important that we free the data. So we don't sell data at Rare-X. And we have an open access model for researchers to access the data. Charlene Son Rigby: And so there it is not, “we open the doors and anybody can come, come and access the data.” It's done in a responsible way. So one of the key things is that the data is de-identified. And so it is it is critical to do that, because we want the data to be utilized for research. It doesn't need to have identifiable information in it to drive that research forward. You know, the second thing is, is that researchers need to submit information on their project, and then that's reviewed by a data access committee. And the idea behind this data access committee is not to slow down things. It's a streamlined and efficient process. But the idea is that there is a review process. The researchers need to specify whether there's an IRB with whether that protocol has gone through an institutional review board review, and patients can opt to only have their data. As an example, patients can opt to only have their data shared with projects that have gone through IRB review. So there's really kind of a, since this is in many ways a two sided platform, there's really a way that patients can actively engage in terms of who's accessing their data. And then the researchers also in terms of the types of projects that they're that they're going to put forward.Harry Glorikian: Okay. So now you're giving away the data. Remember, I'm a venture capitalist, so you're giving away the data, right? First question somebody like me asks is, how do you pay for the operations? I mean, you're building this fairly sophisticated system that is, you know, you've got to clean the data, you've got to make it available. You're trying to talk to all these people. I mean, are you funded by let's say, I mean the typical stuff, grants? Is it member donations? Is it major gifts from individuals? You know, those are all the questions that that would cross my mind.Charlene Son Rigby: Yeah, absolutely. So frankly, it took me some time to get my arms around this, because my whole career has been in tech and venture backed companies. And so so I took some time to really think about this and think about this scalable model from a scalability standpoint before joining. So we get our funding largely through pharma and industry, as well as some grants. And the way that that funding happens is, it's basically platform investment. And I think that this is a really key thing from my perspective of, of thinking about the, the platform as something that is, if you will, a social good. Because they're investing in expanding the platform. They might invest, like Travere did, additionally to help to onboard specific groups or expand our capabilities in terms of being able to gather data in a particular disease area. But the funding that they're providing is to make the platform and the research program more robust. The data at the back end will be open in the way that we've we have talked about it. We have a unique ability to do that and create that kind of model as a nonprofit. And you're right that what we're doing, we're kind of blending this health tech company with this this nonprofit tmodel. But I think that there are some good examples out there of public private partnerships that have been very successful in the long term in doing this. And that's the model that we're really pursuing.Harry Glorikian: This area is small. I feel like I've been in and around it for a long time because of, you know, being in and around genomics. But there's a small but sort of growing infrastructure of support for rare disease, you know, patients in the world, sort of nonprofits, NGOs, patient advocacy group. Tthere's Global Genes, right? There's the Rare and Undiagnosed Network, RUN. There's the Undiagnosed Disease Network Foundation, and then there's the n-Lorem Foundation. And so many others that I don't want to leave out, right, the long list. But how does your, or, does your group overlap with these? I mean, I was reading a press release that this summer you guys will launch a collaboration with RUN and the Undiagnosed Disease Network Foundation to launch something called the Undiagnosed Data Collection Program. I mean, if you could sort of talk about what that project is about. Is your real ambition to be the data infrastructure sharing platform for the entire community of rare disease patients and families?Charlene Son Rigby: Yeah, well, I love that you call it infrastructure because I think this is critical from a concept standpoint. Rare disease should not be a model where each rare disease is doing it on its own. That was one thing that really struck me, thinking again about my daughter's disorder, where we were looking at ways to ladder up to that prospective natural history study. And we were trying to do something. I talked to a few other genetic neurodevelopmental conditions that were kind of our cohort, if you will, and we were all doing it in different ways. And it's such an opportunity cost to be figuring out the model new each time. And so these groups like Global Genes, amazing organization, actually, the Rare-X founder, Nicole Boyce, was also the founder of Global Genes. And we were, the STXBP1 Foundation used every single resource possible that came out of Global Genes. You know, that there's this broad this really broad education and enablement that needs to happen for people who want to become rare disease advocates. And that Global Genes has really done that in a tremendous way for so many organizations and so many individuals. And so we partner with them in terms of, and are very complementary, in terms of providing that infrastructure where Rare-X is focused on this area of how do you accelerate research through data collection, and then we use that.Charlene Son Rigby: It's great that you saw the announcement on the work that we're doing with RUN and the UDNF. I'm particularly excited about this because Rare-X, we talked earlier about ultra rare diseases, about n of 1 diseases. The reason why Rare-X is able to collect data across all of these disorders is that we have a fundamental assumption in the way that we collect data, which is that we don't assume that anybody does or does not have any symptoms. So we start out with a very high level, head to toe type of set of questions that if you say yes to any of them, it leads into a more detailed set of questions to collect data on particular symptoms. And so this is really ideally suited to situations where there isn't a lot of characterization around or understanding of the symptoms in a disorder and where you don't have a diagnosis. Because then what we're really enabling an individual to do is to gather robust data about their individual symptoms and disease progression that then can be utilized for research. And so we're very excited about being able to work with and support RUN and UDNF in in that effort. Charlene Son Rigby: And so do we have, you asked about ambition? You know, do we have a goal of being the only data sharing platform? I would say that our goal is to be an incredibly robust comprehensive cross- disorder platform. We believe that the way that we are approaching things really is enabling us to support all rare diseases. And we're really focused on de- burdening patients. So we're enabling patient communities to get started very quickly. And they don't have to become experts in protocol development, they don't have to become experts in creating clinical outcome assessments, etc. At the same time, the world is large and that they're going to be groups who decide that they need specific solutions. They may want to take on the role of being a principal investigator, as an example. And so I think that that's also the reason why federation is an important component of what we're really bringing forward as a as a way to bring all of that data together.Harry Glorikian: So again, you know, being on the venture side, right. You can lead a horse to water, but you can't make them drink, right? So you can do a lot. You can improve clinical trial readiness. You can make sure the data is better about rare disease patients, and that it's available. But you can't force the drug discovery companies or the drug makers to sort of develop a cure for a specific disease. Right. How do you think about that as part of a rare disease problem? Is that is that part of the work that Rare-X is,are you making it less risky so that they are willing to take that next leap?Charlene Son Rigby: You're right that pharma is going to be making, I would say, rational business decisions based on commercial drivers. And the challenge with a lot of rare diseases is that no one knows about that individual rare disease, and there isn't much data on it. And so anything that can be done to de-risk that process for a pharma company is huge in terms of increasing their interest or generating interest for them and then increasing their interest. And those things can include knowing that there's an activated community, you know, because if you have a clinical trial and nobody wants to participate in the clinical trial, that's going to be a huge problem in terms of being able to get that drug through an approval process. And so Rare-X, by building a very robust data set, is able to de-risk that process in terms of that investment, of trying to understand what the disorder is and also trying rto understand disease progression. And going back to that point about activation of the community, we're also able to help to demonstrate the activation of the community because of the number of people participating in the in the data collection.Harry Glorikian: I know it's not science fiction. I think it's right around the corner, hopefully, but I think, isn't an ideal future where we do either whole-exome or preferably whole genome on every newborn and scan for these genetic changes that are associated with rare diseases. I mean, I'm assuming that would really push this area much farther along. And if that is true, if that statement is true, how long do you think it'll take for us to get there?Charlene Son Rigby: Wow. You're reminding me of the Gattaca movie, but hopefully that's not the real future for us, you know. Winding things back. So my daughter was born, my daughter Juno was born in 2013. So that's nine years ago. And it took three years for us to get a diagnosis. And, you know, that's like an entire other podcast. But I think that the really, if we fast forward to 2022, we have groups like Stephen Kingsmore's group at Rady Children's where they're diagnosing newborns who are in the NICU, in less than 24 hours. And even standard exome testing, which it took us three months to get our results, the standard exome testing results are now returned in less than two weeks. You can also get it faster if you have an urgent testing and we have the tech. Illumina has long been dominant and continues to be dominant in the clinical area. But you have these new entrants with Oxford Nanopore, Element, Singular, and there are others that are entering now. And so these costs are coming down and this is really going to be a transformative in terms of becoming, I do think that this is going to become standard of care and it's closer than we think. I think that it's probably going to be in the next ten years, less than ten years.Charlene Son Rigby: We already have some analogs to this in terms of or precursors, I should say, in terms of newborn screening. And so what I think is going to happen is that genomic sequencing is is going to become a core newborn screening tool. And the interesting thing is that there are applications, not just in rare disease, but also in common conditions and the value of genomic sequencing. So today, 5% of rare diseases have a therapy, but there are right now hundreds of gene therapies that are currently in preclinical and clinical pipeline. So this picture is going to change enormously in the next five years. And so because the value of is going to grow, because there are therapies, the other important thing is therapeutic windows. So therapeutic windows are when we can intervene to have the most impact on a disorder. And so that's often when someone's young before the symptoms present or start or very early in that process. And so I think that this is going to become a reality in the next decade. And frankly, I think it's a very exciting time. I have always been a big believer that knowledge is power. And this is this is one of those great situations where we have the ability to do something because we know.Harry Glorikian: Yeah, I talk about some of this in my book and there's some, you know, interesting stories and it's a fascinating time. And when I think back, you know, to when we first started sequencing and people would say, why would you want to sequence anything? And now it's the complete opposite. And the price is coming down. It's becoming easier and faster. And I mean, at some point, I think the price is going to be low enough between the actual sequencing and then the analysis, that as my friend says, it's going to be a nothingburger. I mean, it's just going to be like, yeah, we should just do that because it gives us the information we need for the next step, which is sort of going to be interesting.Charlene Son Rigby: Yeah, absolutely. I think that the that is the challenges that I talked about, cost of sequencing. But you're right that, you know, the analysis is still quite expensive today. And that's something that we're also going to need to need to improve. I mean, AI and the growing knowledge bases is really going to help to address that. Yeah. And but that's a huge component of it as well today. Absolutely.Harry Glorikian: Yeah. I'm looking at a company that in this particular area of oncology, they've gotten the whole genome analytics down to about $60. So it's, you know, it's coming to a point where you're like, why wouldn't you do that? Like, what's stopping you from doing that? So it's been great having you. Great conversation. I wish you guys incredible success. A nd I'd love to keep up on how things are going with the organization.Charlene Son Rigby: That'd be great, Harry. Really enjoyed it today. Thanks.Harry Glorikian: Thank you.Harry Glorikian: That's it for this week's episode. You can find a full transcript of this episode as well as the full archive of episodes of The Harry Glorikian Show and MoneyBall Medicine at our website. Just go to glorikian.com and click on the tab Podcasts.I'd like to thank our listeners for boosting The Harry Glorikian Show into the top three percent of global podcasts.If you want to be sure to get every new episode of the show automatically, be sure to open Apple Podcasts or your favorite podcast player and hit follow or subscribe.Don't forget to leave us a rating and review on Apple Podcasts. And we always love to hear from listeners on Twitter, where you can find me at hglorikian.Thanks for listening, stay healthy, and be sure to tune in two weeks from now for our next interview.
In one of our most important podcasts released to date, we're proud to talk with Dr. Laurie Whitsel, Vice President of Policy Research and Translation of the American Heart Association & Senior Advisor to the Physical Activity Alliance, a non-profit that, "Brings together stakeholders in the physical activity communities for us to speak with one voice on significant policy and systems changes," states Whitsel. Joining her is Integrity Square's own Chief Political Architect and policy veteran, Tom Richards, JD who also heads up Activist in Motion. It is critical everyone in the HALO sector know about the work going on behind the scenes in something called the HL7 process (Health Level Seven International) and the steps currently being taken to, "Build standardized measures for assessing, prescribing, and referring physical activity for patients." Concurrent with that is the Time To Move initiative, a multi-year, multi pronged approach which (among other things) involves bringing in and standardizing billing codes for physical activity, connecting wearables so the data can flow and follow the patient through healthcare delivery, but also working with with CMS (Centers for Medicare and Medicaid services) to get coverage determinations for the exercise prescription for health and fitness professionals to offer it and more. These things are happening now and Dr. Whitsel is the tip of this particular spear. Pete Moore, host of HALO Talks, mentions early on that this is indeed like "moving boulders" but they are moving. . . perhaps further and faster than we all thought. Policy conversations may not be everyone's particular cup of tea when you have a business to run and 100 other things demanding your attention. However, what Dr. Whitsel discusses here and what is literally happening right now will have incredibly far ranging positive effects for the entire industry-and probably sooner rather than later. This is one of our longer episodes and we hope you enjoy it as much as we did. All the resources mentioned are available at the links below. Get involved now! PAA Letter to the White House PAA HL7 Slides PAA Action Plan Click here to download transcript.
How can medical document errors become easy to fix, everywhere the error lives, & fit in the workflow? Virginia Lorenzi and HL7's Patient Empowerment Workgroup. Blog subscribers: Listen to the podcast here. Scroll down through show notes to read the post. Subscribe to Health Hats, the Podcast, on your favorite podcast player Please support my blog and podcast. CONTRIBUTE HERE Episode Notes Prefer to read, experience impaired hearing or deafness? Find FULL TRANSCRIPT at the end of the other show notes or download the printable transcript here Contents with Time-Stamped Headings to listen where you want to listen or read where you want to read (heading. time on podcast xx:xx. page # on the transcript) Proem.. 1 Introducing Virginia Lorenzi 03:31. 2 HL7's Patient Empowerment Workgroup 04:56. 2 An intelligent customer understands some of the technical 05:45. 2 Requests for corrections – a sign of engagement 07:12. 3 Fixing errors - from the fifties 08:01. 3 Patient satisfaction and errors 09:30. 4 Release more information, find more errors, feel worse 10:07. 4 Burden on clinicians, burden on patients 11:42. 4 What if you could push a button and start and track the correction process 12:12. 4 Connectathons – a meeting of the minds in a sandbox 13:17. 5 Making decisions about data standards 15:32. 5 Eureka, we have standards. Now, who's going to use them? How easy can we make it? 18:41. 6 An error is not an error, is not an error 21:11. 7 Ink on paper 24:07. 7 HIPAA-federal rules about requirements to correct errors 26:38. 8 Misdiagnosis – Out damn spot! 28:54. 9 Impact of errors 32:07. 10 Motivation to fix errors 33:50. 10 Reflection 38:44 12 Please comment and ask questions at the comment section at the bottom of the show notes on LinkedIn via email DM on Instagram or Twitter to @healthhats Credits Music by permission from Joey van Leeuwen, Drummer, Composer, Arranger Cohelo as originally played by Mandrill, here played by Lechuga Fresca Latin Band, Danny van Leeuwen soloing on Baritone Sax Web and Social Media Coach Kayla Nelson @lifeoflesion The views and opinions presented in this podcast and publication are solely the responsibility of the author, Danny van Leeuwen, and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute® (PCORI®), its Board of Governors or Methodology Committee. Sponsored by Abridge Inspired by and grateful to Liz Salmi, Tom Delbanco, Peter Elias, Grace Cordovana, Dave DeBronkart, Debi Willis, Laura Marcial, Bryn Rhodes Links How accurate is the medical record? A comparison of the physician's note with a concealed audio recording in unannounced standardized patient encounters in the Journal of Informatics in Health and Biomedicine the Patient Empowerment Workgroup HIPAA, you have a right to get your record fixed HIPAA rule says that if a record is amended or if a record amendment the 21st Century Cures Act. the Patient Requests for Corrections FHIR Implementation Guide United States Core Data Set for Interoperability. How to Correct Errors in Your Medical Records Correcting Errors In the Electronic Medical Record Impact of Electronic Health Record Systems on Information Integrity: Quality and Safety Implications IHE Connectathon: A Unique Testing Opportunity Late addition: Beat cancer? Your Medicare Advantage plan might still be billing for it. Related podcasts https://health-hats.com/pod158/ https://health-hats.com/opennotes-a-gold-mine-of-community-organizing/ https://health-hats.com/misdiagnosis-how-can-patients-help-doctors/ About the Show Welcome to Health Hats, learning on the journey toward best health. I am Danny van Leeuwen, a two-legged, old, cisgender, white man with privilege, living in a food oasis, who can afford many hats and knows a little about a lot of healthcare and a lot about very...
In this episode, hosts Mohannad and Prasanth interview Brad Genereaux about his chapter on Standards and Interoperability in the new edition of PII. Going beyond the #alphabetsoup of the important standards that govern the imaging informatics world, the discussion covers a brief history of the development of standards, such as DICOM, HL7, IHE, and looks at how they shape the landscape of the Imaging Enterprise. Indeed, awareness of these standards is even essential in deciding whether to adopt them, particularly when looking through the lens of deployment, maintenance and support, and eventual upgrade paths for the enterprise. In addition to developing richly integrated enterprises, standards play a crucial role in ensuring data portability. Brad highlights the working groups and their interactions with the community to maintain and improve these standards. Brad Genereaux is Medical Imaging and Smart Hospitals Alliance Manager at NVIDIA, and has a keen focus on accelerating artificial intelligence, visualization, and virtualization in healthcare. As a passionate and engaged healthcare and medical imaging leader, Brad evangelizes the ubiquitous adoption and integration of seamless healthcare and medical imaging workflows at scale. Brad is deeply involved with the community in building and implementing standards like DICOM, HL7, and IHE to make this happen. Resources: https://www.dicomstandard.org/activity/wgs https://wiki.ihe.net/index.php/Committees https://www.hl7.org/events/workgroupmeetings.cfm https://siim.org/page/siim_taskforces Connect with us! You can find our podcast on Apple Podcast, Google Podcasts, Stitcher, or anywhere else you subscribe to podcasts. Please help us out by leaving a review on Apple Podcasts. You can find us on Twitter: @SIIM_Tweets, and individually at @mohannadhussain, @jaynagels, @AliTejaniMD, @AAnandMD Visit us at https://siim.org/page/siimcast Special Thanks to @RandalSilvey of http://podedit.com for editing and post processing support.
In this episode, hosts @mohannadhussain @jaynagels Prasanth and @AliTejaniMD interview @ChrisRothMD, @IntegratorBrad, and @_kodon, co-authors of the IHE AI Interoperability in Imaging White Paper. Chris Roth serves as Vice Chairman of Radiology, Information Technology and Clinical Informatics at Duke University, Director of Imaging IT Strategy at Duke Health where he is also associate professor of Neuroradiology. Brad Genereaux is Medical Imaging and Smart Hospitals Alliance Manager at NVIDIA, and has a keen focus on accelerating artificial intelligence, visualization, and virtualization in healthcare. As a passionate and engaged healthcare and medical imaging leader, Brad evangelizes the ubiquitous adoption and integration of seamless healthcare and medical imaging workflows at scale. Brad is deeply involved with the community in building and implementing standards like DICOM, HL7, and IHE to make this happen. Kevin O'Donnell is a Senior R&D Manager at Canon Medical Research USA. As an enthusiastic believer in the value of standards to healthcare in general and medical imaging in particular, he is a past Chair and contributor to DICOM and IHE (Integrating the Healthcare Enterprise), and is currently a member of the SIIM Board of Directors and Chair of the Process Committee of QIBA (Quantitative Imaging Biomarkers Alliance). IHE Wiki Page on the paper, including the video on navigating the paper by Brad. The White Paper can be found here. Connect with us! You can find our podcast on Apple Podcast, Google Podcasts, Stitcher, or anywhere else you subscribe to podcasts. Please help us out by leaving a review on Apple Podcasts. You can find us on Twitter: @SIIM_Tweets, and individually at @mohannadhussain, @jaynagels, @AliTejaniMD, @AAnandMD Visit us! Special Thanks to @RandalSilvey of PodEdit for editing and post-processing support.
HL7 has been working to advance FHIR - Fast Healthcare Interoperability Resources Platform standard since 2012. In 2014 healthcare industry players started to band together in the Argonaut project which was the first implementation community comprising leading technology vendors and provider organizations stakeholders. Since that time, several consortiums of health industry leaders have rallied around various health IT initiatives such as health payer initiatives, puplic health and health equity, infrastructure, and research initiatives. There are now eight FHIR accelerators who have published implementation guides that provide important documentation on how technology builders should use the FHIR resources within their systems to advance data sharing. These implementation guides have become the foundation for use of the standard as prescribed in Interoperability rules set forth by the Center for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT. Now that so many implementation guides are near complete, the HL7 organization has added three new executive positions to support standards implementation in the new HL7 Implementation Division. So today we will talk to the spearheads of the Implementation Division to better understand how this expanded focus will impact the business of healthcare. Dr. Charles Jaffe is the CEO of HL7. He completed his medical training at Johns Hopkins and Duke Universities and post-doctoral training at NIH and the Lombardi Cancer Center. He served in various academic positions in the Departments of Medicine and in the School of Engineering and has worked in healthcare technology for more than 30 years.. Dr. Jaffe has led the charge at HL7 since 2007. Viet Nguyen, MD, will head the standards implementation division as chief standards implementation officer alongside Diego Kaminker who will fill the role of deputy chief standards implementation officer. Viet is an internist, pediatrician, and clinical informaticist who has held leadership roles such as chief medical officer and chief medical information officer at Leidos Corporation, Lockheed-Martin, and Systems Made Simple. HL7 selected Kaminker as the deputy chief standards implementation officer. He is the founder and owner of Kern IT with specialties in integration, software development, and project management. Kaminker has been a member of the HL7 community for twenty years and has served multiple terms as the chair of HL7 Argentina as well as an affiliate director of the HL7 International board of directors. Throughout his career, Kaminker has defined, implemented, and maintained hundreds of HL7 interoperability projects. On this episode of the podcast this powerhouse leadership team talks about their strategies for engaging more healthcare stakeholders in the implementation process to better inform those building the specification.
This week, host Chris Gorog interviews Gora Datta, the founding member of HL7 mobile health. This conversation is packed full of interesting perspectives from IEEE healthcare and the world of emerging technologies. The exciting matter of emerging technologies is not to take lightly – from A.I. or simpler machine learning algorithm designs to blockchain and quantum computing. However, there is an ever-present danger to blindsight us on what is possible and miss out on the most crucial focus path: the problems we need to solve. This episode has some fascinating insight into the emergence of future healthcare technologies; you won't want to miss this episode of New Cyber Frontier. Visit our sponsors: BlockFrame Inc. SecureSet Academy Murray Security Services
March 3: Today on Townhall, https://www.linkedin.com/in/brett-oliver-md-1b1b6017/ (Brett Oliver), Family physician and Chief Medical Information Officer at https://www.baptisthealth.com/ (Baptist Health) interviews https://www.linkedin.com/in/andrewtruscott/ (Andy Truscott), Global Health Technology Lead for https://www.accenture.com/us-en (Accenture). Health Level Seven or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. What is top of mind for HL7 and how does it relate to the frontline clinicians and organizations taking care of patients? How does it relate to interoperability, cybersecurity and 21st Century Cures? What 2022 trends are we seeing in the healthcare IT space?
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.
February 15: Today on TownHall. https://www.linkedin.com/in/ldm007/ (Lee Milligan), CIO for https://www.asante.org/ (Asante) interviews their Director of ITS Enterprise Services, https://www.linkedin.com/in/mark-stockwell-8ba7928/ (Mark Stockwell). What exactly does a Director of ITS Enterprise Services do? It takes Project Management, technical and leadership skills. Mark gets into the nitty gritty of HL7 interface, transaction engines and serving the medical device integration team and the HIM department including functions, scanning deficiency analysis for release of information plus data governance and the after effects of 21st Century Cures. Plus what is it like coming from a non-healthcare background? How does a leader with extensive IT experience in other industries deal with the shock of the complexity of healthcare?
Our guest this week is Micky Tripathi, the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services, where he leads the formulation of the federal health IT strategy and coordinates federal health IT policies, standards, programs, and investments. As the Office of the National Coordinator (ONC) chief, Micky Tripathi is advancing healthcare interoperability to support value-based payment and improved health equity. Before taking the helm of the ONC a year ago, Micky served as chief alliance officer for Arcadia, a population health management and healthcare intelligence platform company. Our conversation with Micky covers the ONCs efforts in COVID-19 response in support of public health, aligning with federal partners, improving health equity through purposeful and intelligent HIT design, improving EHR and interoperability, TEFCA standards adoption, information blocking, FHIR APIs, and the development of a robust apps ecosystem to improve population health. This episode is sponsored by Arcadia, the only healthcare data and software company dedicated to healthcare organizations achieving financial success in value-based care, and recognized as Best in KLAS in Value-Based Care Managed Services three years in a row. Episode Bookmarks: 01:50 Introduction to Micky Tripathi - the National Coordinator for health information technology with the ONC 02:20 This week's sponsor: Arcadia - Recognized as Best in KLAS in Value-Based Care Managed Services 4 years in a row 04:15 Visit arcadia.io/theschema to explore how we can use data to improve the current and future state of healthcare 05:00 There are 40 times more bytes in the digital universe than there are stars in the observable universe! 07:20 Micky provides perspective on how to begin getting more visibility into data and analytics in order to transition from volume to value 08:10 How the data explosion and exponential growth of computing power requires data liquidity and fluidity 09:00 The increasing competition for data science expertise – how does healthcare compete with tech companies and financial industries? 10:20 The self-imposed industry barrier of cleaning and wrangling data and the need for authorized aggregation of health data 11:20 Rethinking what access to data means in light of the information blocking rules within the 21st Century Cures Act 12:15 Micky references his tenure with Arcadia and how the information sharing landscape is changing population health management 12:40 Making both structured and unstructured data available and how/why unstructured data is valuable 14:30 The implications of SDOH on health equity and the concept of “health equity by design” where SDOH can be a core feature of Health IT 16:50 Micky explains how the ONC is influencing “health equity by design” through the trajectory of Health IT 18:00 Accessing data to identify outcomes disparities in communities and the heterogeneity of data collection (e.g. OMB and CDC classifications) 20:00 Deploying data-driven, upstream interventions for social determinants of health (e.g. UT Dell Med Community-Driven Initiatives) 21:40 Streamlining consistency and focus in the collection of race, ethnicity, and language data to lower friction in healthcare 23:00 How lack of “health equity by design” contributed to the development of modern-day EHR systems 25:00 How an event notification algorithm design flaw caused failure in providing appropriate population health interventions 27:20 “Value based care is critically important and it is a key driver of interoperability. We need to move from basic information exchange to apps that will use the whole portfolio of interoperability capabilities.” 28:00 FHIR-based CDS Hooks – an HL7 specification for clinical decision support 29:20 “The business case for Value-based Care is a key driver of interoperability in the marketplace.”
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.
From July's Summer Forum, a session focusing on the work the HL7 FHIR Da Vinci Project is conducting on Payer to Payer Data Exchange. We welcomed Jocelyn Keegan, Program Manager of HL7's Da Vinci Project and Payer Practice Lead for Point-of-Care Partners and Michael Gould, Business Lead-Interoperability with BlueCross BlueShield Association
Enter the code PODCAST at wedi.org to receive 20% off the registration for WEDI 2021 (May 14, 17-20), our annual Spring conference that showcases best practices and emerging trends in health IT. This week Matthew has a conversation with Sagran Moodley, Chair of the HL7 Da Vinci Project Steering Committee and Senior Vice President of Clinical Data Services & Technology for UnitedHealthcare's Clinical Services organization. Sagran offers his thoughts on why Da Vinci is needed, the accelerator concept that HL7 uses and looking forward to the time that we don't have to talk about interoperability in healthcare.
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.
The CyberPHIx Roundup is your quick source for keeping up with the latest cybersecurity news, trends and industry leading practices, specifically for the healthcare industry. In this episode, our host Brian Selfridge highlights the following topics trending in healthcare cybersecurity this week: Telehealth adoption trends and highlights from a new KLAS report released this week Lessons learned from a recently reported breach event for a telehealth app Federal HIPAA and state exemption extensions and modifications related to telehealth platforms and recommendations for steps that healthcare providers can take to secure telehealth platforms 21st Century Cures Act enforcement, fines, and technical integration and security mandates Smart phone app integration standards for EHRs as part of the Cures Act including HL7's FHIR standard, EHR and app development progress, and related security requirements and recommendations for healthcare entities
Aneesh Chopra is one of the foremost names in healthcare IT today. He was appointed by President Barack Obama to serve as the United States' first Chief Technology Officer. After his three years as CTO, President Obama hailed his service, saying Chopra's “legacy of leadership and innovation will benefit Americans for years to come.” In the years since he served as the nation's CTO, Chopra has worked tirelessly to promote a better and more efficient healthcare system. Aneesh was one of the four industry leaders that convened the CARIN Alliance in 2016, a bipartisan, multi-sector collaborative working to advance the consumer-directed exchange of health information. He was also part of the founding group that started the Argonaut Project, an effort designed to accelerate the development and adoption of HL7's Fast Healthcare Interoperability Resources (FHIR®) standard. Chopra authored a book, “Innovative State: How New Technologies can Transform Government.” Currently, Aneesh is president of CareJourney, a healthcare analytics company based in Arlington, Virginia. Aneesh Chopra and Niko Skievaski covered many important issues in this engaging conversation. Some of the topic highlights can be found at: 02:25 – Aneesh's service as U.S. CTO 15:12 – The role of government policy in encouraging innovation in healthcare 25:12 – Evolving infrastructure and incentives to promote interoperability 33:54 – Explaining the new rules from CMS 45:11 – Creating the apps that will facilitate consumer and industry adoption of new programs 54:05 – Resources for driving interoperability Interoperability and open APIs are clearly things that Aneesh Chopra believes will improve patient care and reduce the cost of healthcare. This new interop paradigm will be accomplished sooner if private and public forces work collaboratively in the interest of a better system for all Americans.Our thanks to Aneesh Chopra for joining us on The Redox Podcast.
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