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HIStalk Interviews George Dealy, VP of Healthcare Solutions, Dimensional Insight

November 28, 2022 Interviews No Comments

George Dealy, MS is VP of healthcare solutions for Dimensional Insight of Burlington, MA.

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Tell me about yourself and the company.

We’ve been building analytics technology for the last 30 years. My group uses the Dimensional Insight technology, the Diver analytical platform, to create healthcare-specific analytical applications that solve various problems within the healthcare system, primarily focused on the provider environment, but we also have payer and manufacturer customers.

I have been with Dimensional Insight for 15 years and in the healthcare IT space for 27 years. Before that, I was in the data management database area, working for companies such as Sybase in the early days of RDBMS technology. I was there for 10 years before I moved into healthcare-specific technology.

Do customers want a platform that allows them to develop their own analytics or do they prefer pre-built solutions that have been proven to work elsewhere?

We’ve seen a transition, over the course of the last five or six years, from folks wanting to build their own solutions to their own problems to being open to pre-packaged solutions like the ones that my group builds. Then, extending them for their own purposes.

But even beyond that, we’ve seen some of our larger health system customers essentially almost outsource their analytics process to us. They consume the data and they decide what problems we’re going to focus on solving, but they look to us to do the actual development work. A consequence of that is that they are able to put more focus on actually using the data versus building the systems.

Do they just give you a description of their problem or do they already suspect its underlying cause?

It depends. We have a family of eight healthcare solutions. We will typically start a conversation with a customer for a particular problem. I’ll use the example of a surgical service line where there’s lots of information. There are challenges around things like throughput and patient flow. They’re turning ORs around. We have a solution that provides common KPIs for that particular class of problem. They are able to extend that to more specific manifestations of those problems. We typically start with a pretty well-defined starting point for a particular problem. If their problem is something other than what we have a pre-packaged solution for, we still have a starting point in terms of the way that we go about developing applications.

We’ve created some technology that sits on top of our analytics platform and simplifies the process of defining and then calculating KPIs. One of the things that that tool has allowed us to do is to get the folks who understand the data and the problem they are trying to solve more directly involved in the process of defining and creating these analytical applications. That has also put our customers in a position to create their own applications in a similar style to the ones that we create. Among the organizations that have the wherewithal to do that, typically the larger health systems, we’ve seen a lot of innovation around things that we hadn’t thought about for one reason or another. They are solving the issues that are important to them.

Does the challenge remain that executives commission reports that frontline managers don’t use?

Two observations. One is that it starts at the top. You get good results if a CEO, COO, or C-suite executive who has operating responsibility is watching those numbers and holding the folks who report to them accountable. They have to then do the same thing right on down the line. I have a few customers where that’s the case and their execution is very good, largely as a result of having the information, but also selecting the right information to focus on.

The other thing is that my sense is that being data driven is something of a generational change or evolution. Folks who grew up with electronic media, understand information, and aren’t afraid of it are more open to incorporating it into their thought process. That’s not to say that folks in my generation aren’t open to it, but I think there’s more consistency around the younger side of the workforce because it’s what they’ve grown up with.

Do people have eye-opening moments when analytics shows them something they didn’t suspect?

All the time. There’s tremendous confirmation bias all over the place. You hear the story told frequently about surgeons and physicians who have this intuitive sense that their particular approach to a procedure or a diagnosis is the only way that you would do it and that it’s as effective as it can be. Then they start looking at the data from their peers in similar situations and realize that they didn’t know some things. Similar lessons apply on the operational side pretty much wherever there’s data. 

We have that in our personal lives, too. We think that something is a certain way, but when when we start quantifying it, we realize that it’s very different. You’re used to going a certain route and your GPS system tells you to go a different way that you never even thought about, and it turns out to be shorter and faster.

What are examples of customers using analytics to solve a vexing problem?

I would break this down into a couple of categories. Operational efficiency is a big area where it’s really not clear what is going on in complex processes. You look at patient flow through a hospital, where a patient comes in through the ED or maybe is going for elective surgery, and there are all these way stations along the way where there are potential bottlenecks that get in the way of freeing up beds for patients, getting patients discharged on time so that you can bring more patients into the hospital. Hospitals make much of their revenue on fixed-fee DRG hospitalization, so moving patients through the system as efficiently as possible is key.

Our customers use KPIs that break those work processes and flows down to where they can identify where the issues are. For example, moving certain bottlenecks out of the way to discharge patients from the hospital more quickly, or at least by a particular threshold that they’ve set. That would be one example of something that improves patient flow. Further back in the process, the emergency department, where a variety of bottlenecks can emerge, largely around the ancillary services, getting appropriate turnaround times on things like imaging and lab procedures.

Those are some operational areas where our clients have been able to improve using information to identify the problem, solve it, verify that there was an impact, and then monitor it to make sure that it doesn’t regress back to where they started, which can often happen if you don’t have ongoing visibility into the information.

On the clinical side, I’ll give you one example of a academic medical center customer that we began working with fairly recently who has come up with an algorithm for assessing mental health issues, specifically suicide risk. We work with them to integrate that algorithm into information that was compiled from EHRs. The patient clinical data is combined with the algorithm to come up with a risk assessment for suicide that can be used directly by providers when they are interacting with patients or prior to interacting with them in a formal healthcare setting. Or, to identify cohorts in a population that are at high risk for suicide.

Do customers often learn from analytics how to identify and replicate their own best practices?

That’s the whole premise and the opportunity for some of the advanced techniques around analytics. We have tremendous amounts of data, starting with the Meaningful Use era, where EHRs with clinical capabilities came into the healthcare environment in a way that they weren’t there before. You have 10 years of data that is getting better as time goes on. There’s still a data quality issue and data standardization issue, but as those issues get dealt with and interoperability becomes more standardized, you can compile a more complete picture of a profile of patients and populations. 

Then you are in a position to assemble this big base of information and use it to compare to outcomes over time and determine what care processes, what approaches have been most effective for improving outcomes or attaining a particular target level of outcome and eliminating some of the adverse events and consequences that can come when things fall through the cracks where processes aren’t followed. Or maybe there are suboptimal processes to begin with.

How have health system expectations for return on investment changed with the pandemic?

The big issue during and coming out of the pandemic is around staffing. The physician staffing shortage was there prior to COVID, but nursing is largely a consequence of COVID. Efficiency and productivity become that much more important because you’re dealing with limited staff resources. We have a lot of prospective clients looking at solutions to that type of problem. How do you objectively measure and improve efficiency and productivity given limited personnel resources?

I just realized that I haven’t heard the term “big data” used lately. Do health systems still need external data or they they have enough information of their own to make decisions?

That’s interesting, I don’t think I’ve heard the term “big data” in a while either. I think that may have come and gone. Maybe it’s just taken for granted at this point, with the likes of what we see with Google or Facebook. The amount of information that you can deal with is almost infinite from a practical standpoint. The capability is there, but the issue has shifted to, what big data? What are you going to use it for?

I was reading a research paper that came out of the MIT Healthcare Learning Lab, where they are they are experimenting with what they call multi-modal approaches to machine learning in healthcare. They are looking at not just the traditional, highly structured, tech-based information that comes out of EHR, but combining that with voice recordings, video, waveforms, and time series imaging, teasing value out of that to predict certain well-defined outcomes. This particular paper was looking at predicting length of stay in hospital, 48-hour mortality, and a few other things. They found that they could get a boost — it wasn’t a huge boost, but it was still a meaningful one – by employing some of these other modes on top of what we think of as the traditional information that gets collected and structured within an EHR. That’s huge data, maybe the next step up from big data.

What will be important to the company and the industry in the next few years?

Continuing to get the data house in order. There are tremendous opportunities and possibilities around these advanced analytic techniques, but it requires good data. We are focused on identifying what that data is and curating it to the extent that it’s meaningful within the organization. In other words, you don’t have five different ways of measuring exactly the same thing. There may be some meaningful variation, but reducing that duplication and quantitatively defining outcomes. Once you have that, you open up more opportunities for using these advanced techniques to become more efficient and productive and to improve outcomes.

Things like the standardization of vocabularies on the clinical side. SNOMED, RxNorm and LOINC have been around for a while, but they are gradually making their way into practice. As you get more standardized data, it’s higher quality in terms of what you can do with it. The HL7 FHIR standards are going to help in terms of being able to compile the standardized information around a patient or a population of patients so that you have more and more high-quality data to work with.

A lot of it is somewhat routine blocking and tackling, but until that happens, the potential for the more advanced techniques is going to be limited. But healthcare in general is very much looking forward to what advanced analytics can do. As you look around other industries, it’s pretty clear that it has the potential to make a huge difference, but you need to have the data in place and you need to understand what it is you’re trying to do with it.

HIStalk Interviews Eric Meier, CEO, Owl

November 16, 2022 Interviews No Comments

Eric Meier, MBA is president and CEO of Owl of Portland, OR.

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Tell me about yourself and the company.

I’ve been in the healthcare field for the majority of my career, both on the software side as well as the technology and medical device area. This area is probably lagging other specialties in technology, software, and analytics. This is the realm of behavioral health, which is the largest category spend in healthcare — I think it’s over a quarter trillion dollars spent on services. You can look at the impact from our productivity in our society. I don’t know the current prevalence of behavioral health conditions, but I think that an excess of 16% of the American population has suffered from behavioral health issues. 

We came into the market realizing that unlike other specialties, there was really not a good way to determine and understand if care is working correctly. Behavioral health has been a people-based therapy and involves medication as well as psychotherapy. The ability to assess whether treatment is working has been lagging. Somewhere between 11 and 13% of clinicians are practicing measurement-based care, but it has been shown clinically to be extremely effective way to deliver effective and efficient care.

We were founded at University of Washington, looking to deliver an approach that would allow clinicians to understand or address the fundamental question — is care working, and to what extent? We’ve built upon that over the last five or six years.

What’s encouraging about it is that this methodology of measurement-based care clearly works. The platform was designed by clinicians for clinicians. When you take that type of approach, you can get an understanding of how treatment is being delivered and how effective it is at every step of the journey. 

We are seeing engagement rates well in excess of 90%, which means it is integrated into care effectively and is able to understand what’s the patient’s status at intake from a screening standpoint, but also being able to work alongside the treatment throughout the entire course of treatment. When it’s time to discharge, step down care, or have patients transition away from receiving services, understand the effectiveness from admit to discharge, and then if needed, to see if in fact there is a relapse, being able to detect that early on so care can be administered correctly if needed down the road.

What kind of measurements are used, and how many of them reflect the patient’s perception?

Patient-reported information is a true proxy of the patient’s status, not only for screening, but throughout the course of treatment. It minimizes clinician burden and it has been shown to remove quite a bit of subjectivity or bias. If you look at the early days of capturing assessments for clinical care, a lot of these were physician-reported scales. Over time, what has been increasingly accepted and recognized is that the patient can provide a far better status of their own condition. That also avoids the pitfall of many technologies in burdening clinicians with additional work.

We adopted the approach at the outset of capturing the patient’s status using patient-reported outcomes measurements or what is referred to as PROMs, in addition to looking at social determinants of health information, which in many ways can be key indicators of the patient’s status. Often in many cases, even a leading indicator — one needs to address issues like food insecurity, homelessness, et cetera. We provide this information to clinicians to help understand the condition at the time of screening or intake, then risk stratify populations, then being able to monitor or track treatment effectiveness over time.

Will those measurements became a standard for payers, similar to prior authorization?

I would look at the issue and say, why to date has it not been broadly accepted? I think it’s because of a number of previous solutions were fairly burdensome, relying upon either the clinicians to administer these tools or not fitting into the clinical workflow. We’ve taken a deliberate approach to make it fit into the existing behavioral health practice, whether it’s ambulatory, partial hospitalization or intensive outpatient, inpatient, or residential. You have to look at the clinical workflow and make sure that whatever you’re doing to capture critical information, like what we capture in Owl, fits in the existing environment.

On top of that, I’m pleased to say that there are existing CPT codes to support the capture of information that feeds into measurement- based care. We have customers being reimbursed for this. But you could also look at this information to be critical in the utilization management process, if you want to know that effective care has been delivered or if you need to extend treatment. We have customers using this information to help provide greater transparency around the type of services that have been delivered and how effective they are.

Behavioral health providers have been reluctant to use some technologies because of privacy concerns. Is that an issue?

We really haven’t seen that be an issue. The major questions around adoption are, how does this fit into my existing workflow, or how does this help me institute change management in a way that’s not overly burdensome and can actually make the capture of information easier? 

Around privacy concerns, we have developed a HIPAA-compliant system that is observant and supports conditions around privacy. There are additional requirements as it relates to substance use, but at least from our vantage point, we have not seen that be an issue around adoption of technology. It’s more about just making sure that it fits within the existing treatment model and doesn’t overly burden the clinicians, but actually give them greater information around the kind of care they’re delivering and making sure that using a platform to help improve the overall effectiveness and efficiency of care.

Who makes the decision to implement the concept as well as the technology?

If you look at our customer census — Ascension Health, Oregon Health and Science University, Texas Children’s, Inova Health System, and Carilion Clinic — it starts with leadership that is thinking strategically on how to deal with the basic questions of, how do I deliver the most effective and efficient care? How do I deal with access issues and try to address wait lists that may be occurring? How do I better understand, from a population health standpoint, the type of care that is being delivered within my ecosystem and also support alternate payment schemes, such as value-based care?

All of that hinges upon the understanding of the type of care that’s being delivered, which has been well accepted through the capture of clinical outcomes. With any new technology, getting leadership buy-in up front is crucial to embark upon measurement-based care, but also make sure it’s being utilized by the team on an ongoing basis.

We have been fortunate that our customers tend to think strategically on addressing the fundamental question of how effective is the care, how good a job am I doing? Then making sure that as we look at this from an implementation standpoint, it needs to fit the existing ecosystem, which typically consists of integration with their EHR, whether it’s Epic, Cerner, Athenahealth, or behavioral health EHR such as Netsmart, Streamline, and others. Then secondarily, make sure that information can be used on demand by the clinicians as part of an encounter, but also used by the leadership to assess the effectiveness and efficiency of care across their different clinical programs. 

When you think about the ability to benchmark, let’s take for example eating disorder service lines that may be spread across a health system in different locations. What you would like to understand is, how good a job am I doing? Am I seeing kind of best practices in one location that I can now, based upon the outcomes data that the Owl is generating, replicate and standardize on? 

The other point that needs to be understood is that people delivering behavioral health have probably one of the toughest jobs in healthcare. It is a really challenging job. Well accepted is its ability to not only provide effective care, but get more out of existing resources. For example, we’ve seen about a 56% reduction in time to remission from those folks that implemented the Owl versus those that have not.

Secondarily, given some of the resource constraints that have unfortunately become a consistent problem across the United States, we’re seeing about a 30% improvement in staff efficiency. You take an organization that may have 20 to 25% attrition, there’s a need to backfill those positions, but also make sure the consistency of care is happening across a health system, whether it’s in one geography or multiple. The beauty of the Owl is it provides a systematic way to deliver evidence-based care, and when you think of faster time to remission, I can treat more clients with existing resources.

How are measurement-based outcomes being used in telehealth?

We are an enabler to that. We were designed from inception to support telehealth, long before the pandemic occurred. Virtually 100% of our customers, going back to probably the second quarter of 2020, by necessity pivoted to a virtual healthcare model and, there was no interruption of the use. In fact, one of the things we’re proud of is that our platform has been used to assess the overall effectiveness and efficiency of care in both the on-premise as well as virtual setting. We’re seeing a consistent response. The upside for the patients is you have the ability to receive treatment services in probably a more relaxed setting. You avoid having the transportation and having to go to your appointment. Our platform has been used to give confidence to the providers that the quality of care is not compromised.

When you think about what is happening right now with the fact that there’s been a big focus on access to care and our platform is being used to support improved access to a faster time to remission or whatever your treatment target is, as well as the ability to be able to treat more in patients with existing resources, we’ve been well accepted in providing those values. I would say as you look forward, we think there’s going to be increasing focus on quality. As the access issue begins to abate, we are seeing health plans is saying, that’s great, let’s make sure that the quality of care is not compromised. The payers or the health plans are demanding more data, in the form of clinical outcomes, to document and validate that the treatment services have been administered correctly.

That’s the work we do. Think of us as not only supporting the providers and being able to deliver evidence-based care through the Owl of the measurement-based care platform in a seamless way, but secondarily provide the health plans to better understand the performance of their networks. There’s no better way to do that than to have well-documented, patient-reported clinical outcomes and social determinants of health information to make sure that the best care has been provided at the right level to the patients.

What changes do you expect to see over the next few years with your customers and the company?

In the early days of the company, it was around providing or enabling providers to capture clinical outcomes in a straightforward way. We’ve been able to provide information capture to our customers.

If you look at the evolution of measurement-based care, the next piece of the puzzle is providing detailed reporting and analytics to support internal needs around as a health system. How good a job am I doing relative to where I want to be from a performance standpoint? I think of this as a population health support.

The next area has been in supporting clinical decision support. Not only can I use measurement-based care to determine those clients or patients that may be likely to self-harm or harm others, so looking at suicidal ideation, our platform is designed to provide a safety plan to not only notify the clinicians and staff that immediate attention is warranted, but also say, what do you do? We’re building upon that now to look at different conditions such as depression, anxiety, substance use, et cetera, to provide supportive clinical decision-making so you are administering the right care algorithm.

The fourth area I would speak to is providing greater alignment between providers and plans. Providing visibility, which to date has been opaque, around the overall care that has been delivered by both the behavioral health specialty and primary care. Having an understanding of how a health plan’s network is performing, and once you baseline that information, then it provides the opportunity to be aligned around moving towards alternative payment schemes, such as value-based care.

As we look forward, we see not only continued and growing acceptance of measurement-based care by providers, but health plans using this information to understand the quality of care that has been delivered and making sure there’s alignment around payment schemes and addressing total cost of care.

From a business strategy standpoint, where we are focused is having a balanced portfolio of customers. Not only serving health systems, large community mental health clinics, and health systems supporting both behavioral health specialty and those that move into collaborative care or integrative care model, but also making sure the health plans are able to understand the type of care that’s been delivered. Not only behavioral health, but also recognizing that these behavioral health conditions can adversely impact medical care. This whole concept of whole person care is going to be critical and recognizing you need to address the behavioral health component of it.

We benefited from taking a clean slate five to seven years ago and the ability to develop a measurement-based care platform by clinicians, for clinicians. The area we focused on was number one, making sure we integrate in the clinical workflow in a seamless capacity. This is across different clinical approaches to delivering behavioral health services, everything from ambulatory to partial hospitalization, intensive outpatient, inpatient, as well as residential. We’ve extended that to support when behavioral health is being delivered in a primary care setting as well. Secondarily, once you fit the clinical workflows, to make sure you’ve got a broad enough amount of content that support all the different subspecialties, whether it’s eating disorder, substance use, depression, anxiety, adolescent, or late-life care. 

The upside of this is we’ve got a high engagement level, upwards of 90%. You need those kinds of numbers to fully utilize measurement-based care and capture the benefits of accelerating time to remission and improving effectiveness of care as well as efficiency. Once you accomplish that, you start to address one of the primary issues today, which is access to care. In other words, how do you make sure clients are receiving care in a timely capacity? As I mentioned earlier, we’re seeing compelling and supportive statistics with faster time to remission of 56%, as well as being able to get more out of existing resources.

With that in mind, with this information, then it becomes meaningful not only for providers, but also obviously those that are doing accreditation work, such as the Joint Commission or CARF, as part of their audit process. Lastly is making sure that the health plan has a better sense of the type of care that’s being delivered by their network.

We have been fortunate to have supportive strategic investors in the form of the Ascension Health Network, First Trust, Cardinal Partners, Blue Venture Fund, and the Entrepreneurs Fund.

HIStalk Interviews Ben Albert, CEO, Upfront Healthcare

November 14, 2022 Interviews 1 Comment

Ben Albert, MBA is co-founder and CEO of Upfront Healthcare of Chicago, IL.

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Tell me about yourself and the company.

I have been in healthcare for my whole career. Prior to starting Upfront, I founded a company called Care Team Connect, which was a care management platform for population health that was acquired by The Advisory Board. We did a lot of care management work through a digital platform that enabled care managers to support the high-risk patients that they were serving and supporting in a shared risk agreement.

That experience it led me to found Upfront, because every patient, not only those who are high-risk in some population health agreement, deserves to be navigated to the care that they need, and technology is required in order to scale that type of navigation for every single patient across a health system. That is the foundation of Upfront Healthcare, to help every patient get the care they need.

How do you differentiate the patient engagement and digital front door technology market?

It’s a confusing market, for sure. The digital front door is mostly tied to patient acquisition. Where Upfront focuses is on how to retain every single patient that you serve. If the digital front door is going to bring in a bunch of new patients, how do you use personalized engagement and access to optimize the experience for that patient so they stay with the system for the long term after the digital front door is activated and you engage that patient initially?

Health systems are starting to understand how to get patients into the system. Do they also study why patients leave the system?

They definitely study why patients leave the system. They look at referral patterns and if patients are leaking out. If they are being used as a retail service and the front door generates only retail visits, how can they convert that patient into an empaneled patient on the primary care side or the system of choice for that patient for the long term?

They definitely look at that conversion and understand how to keep that patient and retain them. Especially in light of all of the specialized services that are coming to market, Amazon and Oak Street Health for example, that are focused on particular types of patients, to help attract those patients to their services. Our clients, the health systems, need to focus on how to differentiate and keep their existing patients.

How do health systems engage with patients whose encounter was one-off, such as in an urgent care center or telehealth visit, and determine how much of a relationship those patients want?

They need to engage those patients through a more personalized experience to help understand the needs of those patients and then guide them to that service proactively. Patients are often left to figure that out on their own. They might get a simple text message thanking them for their visit or preparing them for a visit, but they aren’t really aware of options within the system and how to best use the system to meet their own needs.

We often talk about patients as the most underutilized resource in healthcare. How does the health system look at that initial encounter or initial event as a way to help educate the patient about all the services that are available to them in a personalized way, so that only those services that are going to be the most impactful for that patient are put in front of them?

How is that different from retailers, who are happy to sell you whatever you want to buy and hope you keep buying, when what patients want isn’t always what clinicians think they need?

The patient will make the right choice if they are given the education and the appropriate information to enable them to make that choice. Often the clinician might be communicating what the patient needs, but the patient doesn’t understand it at the time that communication is provided. It’s not as personalized in some ways as it could be.

You can give patient the alternatives in how to get that care. Let’s say it’s a flu shot for example, something very simple. You give them the alternatives of, you don’t have to go to your primary care physician because we have these different options for care for you, including our urgent care, where you can get this flu shot. We are going to help guide you and let you pick what service is most convenient for you to get that care that you need. It flips it around a little bit to give that patient choice to meet the needs that they have by availing them of the information to optimize their own care.

Is there any comparison to dental practices that message their patients effectively, albeit with list of services that is much shorter and predictable than that of a health system?

It will be as simple as that. It’s not the complexity of the system, it’s the communication of what pieces of the system meet the needs of the patient. 

There is a way — we call it care traffic control — to understand all the services that a health system can provide to a patient, and then to personalize that service and the access to those services so that the patient will know exactly where they’re supposed to go and when they’re supposed to go there. They will get that care that they need from the system and it won’t feel so complicated. It won’t feel like there are so many choices because it has been tailored for them and guides them directly to where they need to go.

So yes, it can feel like the dentist. Does it today? No, because it’s a lot of fragmented communication coming through different channels that confuses a patient as opposed to one omnichannel communication that will ultimately all be on the same page to enable that patient to get where they need to go.

How will you apply the consumer science capabilities of PatientBond, which Upfront acquired in August 2022?

We are excited about the acquisition of PatientBond. Psychographics, in combination with the behavioral analytics that we already do at Upfront, will help us understand how to best engage a person. Psychographics are a consumer capability that helps create these personas of individuals, so that we know exactly what communication pathway to take to engage that person so that we can ultimately understand how to best communicate with them.

You use the right imagery, you use the right language, you use the right time of day and super tailor and personalize the experience for that individual. You tie that in with the behavioral knowledge that the Upfront platform has and that really understands that when they go for care, where they need to go. You optimally tie those things together to have a communication pathway, then access that pathway for a patient that is unique to them and scalable. They are getting to that care 40% more than they were before because of that communication pathway.

If value-based care ever becomes significant and maintenance of health becomes more financially important to providers, will the same messaging platform support it?

Yes. From our point of view, whether it’s value-based care or not, every patient should be getting these necessary preventative services. How it gets paid for on the back end, we certainly understand the value of that. But ultimately if you take the patient-first approach, everybody should be getting that annual wellness visit who needs it and everybody should have those care gaps closed who need them, not only if they’re in some value-based care arrangement.

How do you help every single patient, regardless of what the economics are behind their care, get to the most optimal care for them? It’s informed by what type of care they need to receive and what type of model of care they’re in to make it super efficient for the health system while still enabling every patient to get the same level of care across the system. In a value-based care context it’s incredibly important, but it’s equally important in a fee-for-service context where these patients still need that same care.

How do health systems change their philosophy about consumerism and then choose systems to support it?

They all want to be more consumer centric and they’re on this journey to be so. They have built all of these services, retail-type services like urgent care, virtual care, on-demand care services, asynchronous care, and in-person services like traditional office visits. They have built all of these services to be more consumer centric, tried to increase access points, tried to make themselves more convenient.

Ultimately, though, they have not optimized that for the patient. What they are doing now in that next wave is saying, we have all these services and we can compete for access, convenience, and efficiency for the patient. How do we tie it all together and enable the patient to understand which one of those services they should be utilizing within our system to ultimately get the best experience for them and get in for care when they need it?

We see a big effort in tying that all together to make it feel seamless for the patient, even though we know that under the hood, it’s not as seamless as it probably should be in the long term from a health system point of view. You can enable the patient in a way that feels seamless and guides them across those services. That’s how they are digitally transforming right now. The first step is how to enable that consumer even if you can’t fix everything across the system on the back end right now.

Does consolidation into larger health systems change the scale and speed in moving to a more patient-focused direction and the use of technology to support it?

In theory it’s helpful, but ultimately you are now on multiple EMRs. You have to reconcile all of that data and all of those services across the system. Unless you have something that can sit beside the EMR, sit outside of that ecosystem and look across multiple EMRs to understand what services are available and guide patients, it doesn’t actually advance the cause. It can slow it down because of the focus is so heavily on the EMR itself and not on how to activate your patients and help all those patients navigate through the integration of a couple of systems coming together, which is incredibly complex for patients to navigate, but also for the system to execute on as well.

How do you see the consumerism aspect of playing out over the next few years and how will the company change in response to it?

To us, healthcare needs better personalization for every single patient. The more we can delve into truly understanding exactly what service the patient needs and enabling them proactively to get that service, the more efficient we will be at a macro level. For us, it’s continuing to enable patients through personalization, through psychographics, through behavioral data, through the right type of communication and omnichannel communication that is integrated across the system so that access and appointment booking is frictionless and easy to get to. 

I would love to say that it’s a one-year journey to be able to tie all of that together, but those of us who have been in this industry for a long time recognize the complexity of it. We will just stay with it and keep doing more of it over the next few years, and you’ll look back at the body of work and say, wow, we’ve made a big impact. More patients are getting the care they need. They are getting a personalized experience that feels much more consumer centric, and they are actually healthier as a result.

HIStalk Interviews Douglas Fridsma, MD, CMIO, Datavant

November 9, 2022 Interviews 4 Comments

Douglas Fridsma, MD, PhD is chief medical informatics officer of Datavant of San Francisco, CA.

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Tell me about yourself and the company.

I’m the chief medical informatics officer at Datavant. Before that, I was president and CEO of the American Medical Informatics Association. Before that, I was the chief science officer at the Office of the National Coordinator for Health IT during the Meaningful Use era, as we were trying to get electronic health record adoption.

A lot of the work I did at ONC was to set up the basic infrastructure for collecting data. The goal, for many of us who were working on these projects, was to make sure that once we collected the data, we would get rid of the lazy data. That is data that would  get collected and then just sit there and not be used for population health, a learning healthcare system, or those sorts of things. That’s my history and where I come from — let’s figure out ways to make data useful for patient care and for healthcare delivery.

Describe how tokenization is performed and how the information that it enables is being used in healthcare.

A lot of data out there is fragmented. If you were to try to get your medical record, you’ve got bits of your information that might be in a claims record, some of it might be in a specialty pharmacy, and some of it might be with your primary care doctor or within a hospital in which you were seen in the emergency room. The problem is that when data is distributed like that, it’s hard to bring it all together into a longitudinal view of that particular patient’s experience in the healthcare system.

If you want to link a record from one hospital to another hospital, you have to have some kind of identifiable information. But if you are using the data for research purposes, HIPAA doesn’t allow us to release that kind of information without lots and lots of safeguards, IRB approvals, and things like that.

It is possible to strip out all of the identifiable information from the medical record — eliminating names, genders, changing birth dates from a month and date to just a year, removing addresses, maybe abstracting ZIP codes to a higher level. Datavant strips out that information and replaces it with an irreversible hash that we call a token. It’s like baking a cake — you cannot go back and get back to the original ingredients. This hash is derived from a lot of that personally identifiable information, but that hash has nothing that would point that back to the original person.

Datavant allows people to de-identify their data within each of their organizations. Then we have the ability to link that data back together without ever revealing a person’s name, Social Security number, or phone number. Using these tokens allows data to  move in ways that protect patient privacy and that reduce the risk of re-identification.

How reliably can the process generate a token that correctly matches the same patient across multiple data sets?

We did a lot of work when I was at ONC on trying to make sure that we could optimize patient match. Patient match is determined by three things — the algorithm that you use; the kind of data that you use, whether you’re doing it based on a phone number or a name or something like that; and the quality of the data. Probably the biggest impact is making sure that you have high-quality data that can then go through this process to generate the tokens. We work with organizations to make sure that their addresses, for example, conform to the US Postal Service standards.

With high-quality data and the algorithms that we use to generate these tokens, our metrics can be very high. It can be almost comparable to what you would get if you had a Social Security number, the name, or all of the identifiable information. It’s quite comparable as long as you’ve gone through the process of making sure that you’ve cleaned up the data and made sure that it’s accurate and an accurate reflection of the patient’s record.

Does that raise the same challenges as in interoperability, where matching data from multiple systems then brings up the new issue of semantic interoperability, where systems represent the same data concepts differently?

You raise a really important point. Datavant can link two records together and do it in a reliable way while protecting a patient’s privacy. But suppose you have one record that has all of the diagnoses in an ICD-10 code and another one that has all the diagnoses in a SNOMED code. You’ve linked the records together and you know that it’s the same patient, but now you have semantic incompatibility between a record that was collected in ICD-10 code and another one that was collected in a SNOMED code.

That’s not part of the problem that Datavant solves. We do find, though, that in the work that the NIH has done with the N3C — the National COVID Cohort Collaborative – before they run data from everybody who is contributing data through the tokenization engine, they normalize the data to an information model that consistently represents diagnoses and consistently represents things like vaccination status or other things like that. Often you can normalize the data and make it semantically consistent at each one of those sites, and then when you combine them, that data flows together much more easily.

There are ways to do it after the fact, after you’ve done the linkages, because now you might have two records that are inconsistent. The National Library of Medicine and others have ways that you can transform, say, one code into a different code to make that happen. The issue that you raise around semantic interoperability is a critical one, but it isn’t one that is solved by the process of tokenization.

Life sciences, public health and particularly COVID research, and real-world evidence would seem to be good use cases. What opportunities and users do you see for tokenization?

Let me break that down into a couple of use cases that you mentioned and give you some examples of that.

One example that you mentioned was around COVID. We as a country were trying to understand COVID and who got vaccinated, and if they were vaccinated, what their outcome was compared to people who were not vaccinated. The challenge that we had is that people had their vaccinations done at the public health agencies, their primary care provider, or CVS and Walgreens. Their hospitalization or their care might be in an outpatient clinic, the emergency room, or in a hospital setting. The problem was this fragmentation issue. The only way to understand who got vaccinated, who got infected, and who got long COVID was to link together all these different data sources. It’s a tremendously complicated thing to do, particularly because you have to have identifiable information to be able to link, say, your pharmacy record with your emergency room record.

We worked with the NIH to create tokens across this ecosystem from pharmacy, public health, and most of the major medical research institutions in the country that were part of a research program at NIH. That allowed us to pull together all the data and then create data sets that basically said, here are the folks who got vaccinated. Here are the folks who got hospitalized. Here are the people who had long-term complications related to that. That has provided a lot of rich research for the folks at the NIH who are doing that.

We see other use cases in life sciences. When pharmaceutical companies want to do a clinical trial, they get consent to collect information as part of participation in a clinical study. They have identifiable information that they use for that study. But it’s important for drug safety to be able to monitor patients after they have left a clinical study to see if they have long-term follow-up or other things that may happen as part of their participation. That can be tremendously expensive. Those are called Phase 4 clinical studies.

We have found that a lot of life sciences companies are getting permission to tokenize the information of those patients and their record. Then they can find that patient at a population level — not at an individual level, but at a population level — to identify cohorts of patients that might, say, have an increase in their cancer risk. O they may find that their five-year follow-up was fine, but their 10-year follow-up might be more challenging. That has been tremendously valuable within real-world evidence and using that for clinical studies in the life sciences. By creating those tokens as part of that process, they are able to do a lot more of the Phase 4 studies, which are expensive and they take a long time, but to do those efficiently by using this real-world data and being able to collect it directly.

As this becomes increasingly relevant, we are finding that a lot of hospitals and providers are starting to see de-identified data as not just a nice-to-have, but part of a strategic approach to how they use data. For example, within a large-scale academic medical center, there are hospitals that will de-identify and tokenize these very large data sets, and they’ll have them within their institution. They provide the ability to link that data together and reduce the risk of breaches, reduce the risk of other problems, because the data has already been de-identified and can then be used for research purposes.

Other hospitals are taking a look and using de-identification to enhance the data that they already have. They might create tokens within their hospital, but use that as a way of drawing in other data, matching it into their population, and being able to do a richer analysis at a population health level because they have augmented the data with mortality data or with social determinants of health data that allows them to get a better picture of their population. Again, not to the individual patient level, but at that population level.

Many of the providers are using this data to participate in some of these clinical studies, to be able to take their data, de-identify it, and then make it accessible to life science companies and to people who are doing research in a way that is respectful of the patient’s privacy and that prevents that lazy data. They are able to have the data that has been collected as part of their provision of care and make it be useful for other purposes that advance our understanding of how to deliver better health and healthcare.

Could tokenization be used by an EHR or other system to de-link a patient’s identity from their detailed information so that if a hacker exfiltrated their entire database, they still couldn’t connect a patient’s identity to their data?

This whole notion of being able to take two data sets potentially that have been tokenized and not be able to link them together is a fundamental part of the Datavant technology. We have probably 100 billion records and 300 million covered lives that have been tokenized using the Datavant technology. Should someone inadvertently get a copy of, say, one hospital’s tokenized data and the records from another hospital’s tokenized data, our system creates different tokens for each of those sites so that it’s impossible, even if someone were to get that information, to be able to link it together and potentially re-identify a particular patient.

If you had a list of everybody’s name, and you tokenize that and then use that to link to other data sources, as soon as you got a link, you’d say, “I know the name of this person.” We don’t allow those kinds of linkages to occur except under strict review. We also do other reviews to make sure that, even after you’ve linked the data, it is no longer re-identifiable. That’s a fundamental piece of the puzzle.

To your second point, how does an organization reduce their liability or risk if somebody were to breach their system and get access to this data? Obviously, if you have lots and lots of research data sets that are lying around that have identifiable information, the more identifiable information you have, the greater the risk. If, however, you have those data sets that have been de-identified, but it’s still possible to link them together even within your own institution, there are organizations that use that as a way of helping mitigate the risk around research data and still make it useful to people, because it’s not as if you’ve de-identified it and now it can only be used for one purpose. You can de-identify it, but by making sure you’ve got those tokens, you can still then reassemble different kinds of data sets for different purposes as long as you’re being very careful that the risk of re-identification remains low.

If FDA receives tokenized data that requires urgent follow-up with individual patients, would it be possible for them to go back to the contributing source?

If it’s your data, if you’re a provider and you have data within your electronic health record, you can maintain a look-up table that will have the patient’s identity, your medical record number perhaps, and the token assigned to that as well. But that would be something that an individual hospital would maintain and it would never become public knowledge. So the short answer to your question is, absolutely, if the FDA said, “There’s a safety concern, and we’ve identified within this population that there are specific patients that we need to reach out to,” you can go back to the contributing hospitals and you can ask them that question – “We have some folks, here are their tokens, can you help us identify who they are?” If that organization has maintained that look-up table, then yes, we can get back to those things for those safety needs that the FDA or others might have. That look-up is not something that Datavant does. That would be something that would be within the purview of the owners of the data.

Is there a consistent de-identification method that is being used by all these companies, EHR vendors, and even providers themselves who are selling de-identified patient data?

We take maintaining the de-identification of the data pretty seriously. We provide the ability to remove the PHI and to add in the tokens. But you can imagine, you might have one dataset that is perfectly de-identified and another dataset that is perfectly de-identified, but when you combine them, you increase the risk of re-identification.

Suppose the first dataset has specific diagnostic information and the second dataset has specific geographic information. You combine those two and you might say, we have a geographic area in which there’s only a single diagnosis of this particular disease. That becomes highly re-identifiable if somebody connects some of the dots. De-identification, in and of itself, doesn’t necessarily mean that it can’t be re-identified when combined.

For folks who have complex data or complex linkages, we always recommend expert determination, which is a statistical approach to analyzing the risk of re-identification. You can run a series of algorithms across the dataset that can tell you that you have too much geographic specificity or diagnostic specificity. Given the kind of study that you’re trying to do, maybe we need to aggregate this at a less granular geographic area so that you can still ask the questions that you want about the details of a particular diagnosis. That expert determination is a way of assuring, even if the data has been de-identified or linked to other data sources, that you remain compliant and that the risk of re-identification remains low with those datasets.

What kind of expert performs the expert determination?

There aren’t a lot of rules out there around this. A provision within HIPAA says that expert determination is the statistical approach that has a low-to-no risk of re-identification. Typically, you have academicians who are doing expert determination. It’s really about controlling the release of information in a way that has statistical controls around it. There are companies that do this.

Within Datavant, we have a firewalled relationship with a company, Mirador Analytics, that does this expert determination. They work essentially independently when it comes to the expert determination effect. But it’s offered as a service so that people who are doing this tokenization and then linking have the ability to then, in an efficient manner, determine whether there is a risk of re-identification. There’s a whole host of folks that are out there, from academicians that have a shingle and they do a good job of this, to an organization like Datavant that provides that as a service to folks who use our tokens.

You’ve seen healthcare grow data-rich going back to your days working on Meaningful Use. What issues remain on the table for using the wealth of data that is suddenly available?

The Institute of Medicine had a series of articles going back 10 or 15 years — I think it predates some of Meaningful Use work I did at ONC and has has continued since then – describing this notion of the learning healthcare system. To me, that is a societal goal that I would love to see, where every interaction that a patient has with our healthcare system becomes an opportunity to learn how to take care of the next patient, and the next patient after that, in a better way.

There’s a whole host of problems that we have to overcome to get there. One of them that Datavant is addressing is that when your data gets fragmented and you want to get that longitudinal record, is there a way you can do that that preserves a patient’s privacy?

We have got lots and lots of regulatory frameworks in which your data is used. If you are a student and download your student healthcare record, combine it with your electronic health record information, download it to your Apple Watch, and then use that information on your Apple Watch to support a clinical trial, you will have traversed five different regulatory frameworks. People tend to think that if it’s health data, it must be covered by HIPAA, and that’s not the case. For the data that is in an app or that is part of a commercial venture, it’s that 80 pages of stuff that you just scroll through and you click OK because you want to be able to use the app that defines what they can do with your data. One of the things that we’re going to have to address is getting a consistent way in which we address privacy.

The last thing I’ll say about that is that because there is this notion and there are some concerns that data that is outside of the healthcare environment may need some additional protections that the FTC or that Common Rule or whatever doesn’t necessarily cover, we are seeing a lot of states that are starting to come up with their own privacy rules about how health data gets managed. We run the risk of having inconsistent definitions of what de-identification and expert determination is, and that’s going to create a tremendous burden on the industry and it’s going to create potential holes in which patients’ privacy could be otherwise compromised.

As we begin to solve these technical problems, there becomes other kinds of problems that come up. Keeping consistency across all of the different states, as well as integrating the different frameworks that we have, even at the federal level, becomes important, because if we’re going to use data in this learning healthcare system, we need to have consistent, reliable, and effective means of making sure that patients’ privacy is protected and done in a consistent way.

HIStalk Interviews Clement Goehrs, MD, CEO, Synapse Medicine

November 7, 2022 Interviews No Comments

Clement Goehrs, MD, MSc, MPH is co-founder and CEO of Synapse Medicine of Bordeaux, Nouvelle-Aquitaine, France.

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Tell me about yourself and the company.

I’m a public health physician. I have been involved in a lot of research. I was a researcher in biomedical informatics, first in France and then at Stanford University. I returned to Europe, where I co-founded Synapse Medicine with another physician. Synapse is improving medication safety and helping clinicians achieve medication success. We help physicians, pharmacists, nurses, and patients with prescribing, deciding what drugs to take, and how to take them. We provide reliable information on drugs.

How does your offering improve on existing technologies such as as point-of-care drug information, clinical decision support, and order checking?

As a physician and in talking with my colleagues, we were aware of clinical decision support inside the EHR and various resources online. But we came to the conclusion that for a good number of people, it was frustrating to use these tools. They aren’t always up to date, sometimes you have to use several different tools to get your answer, and it can be too time-consuming. As a result, it was not really used. If you ask a pharmacist or physician if they love the clinical decision support tools that they have, such as those found in their EHR, most of them will answer that they don’t use them and aren’t even opening them because there are too many alerts and too many things in the EHR.

We want to improve on that in two ways. The first improvement concerns the content itself, by providing information that is always up to date. We do this using algorithms. It’s using a lot of natural language processing that goes through all the guidelines from the FDA continually, every day and every night. The algorithm processes all the documentation regarding how you should use the drugs and builds a huge knowledge base regarding drugs that is always up to date. The content part ensures that you always have the best-in-class information and that it is always up to date.

The second way that we are trying to improve these tools is by displaying this information in a good way, not just a long list. We have developed software and components are used as standalone products or plugged directly inside the EHR to display drug-drug interactions, side effects, and contraindications in a way that is super easy for the physician or the pharmacist to understand.

How does the EHR integration work?

We are Europe based and we have completed a number of integrations with basically every major EHR. We see a similar context for EHR integration in the US and Europe, where a number of leaders say they want to interoperate with startups, but in reality, we see a lot of resistance. You have to find ways to do deals and motivate them to do their part and do the interoperability work.

We are just entering the US market. We are working with Vanderbilt University Medical Center and Brigham and Women’s Hospital in Boston. We are in the process of integrating with Epic, but for the moment, just inside these two hospitals.

The study description says that pharmacists on rounding teams will use the system. What does that look like and what results do the organizations hope to achieve?

The use case is for very complex patients. Let’s take a patient who is on 15 drugs for several comorbidities. You want to do a complex medication reconciliation. It’s complex because this patient has a regimen of 15 drugs and you want to determine what the best possible medication history is. You need to check for side effects, drug-drug interactions, and contraindications. 

As a pharmacist using our tools, you would log into our app on synapse-medicine.com. You are getting all the information on the patient and the medication history from Epic, because there is interoperability. You are going to do first a complex medication reconciliation, where you will have a visual representation of the different sources of information regarding the patient’s current drug regimen.

Let’s say you have one set of information from Surescripts and another set of information from the main caregiver or the nurse. Using the software, you can compare the different sources of truth for this patient’s medication history. As the pharmacist, you’re going to choose which source of truth you want to follow for each drug, and you are going to complete the best possible medication history. Then you are going to go through a complete pharmaceutical analysis. Our tool is going to give you insights regarding drug interactions, managing side effects, and managing contraindications, so that you can write the best possible prescription for this patient at discharge. Lastly, you are going to be able to automatically generate the necessary documentation for the patient and their care team as a record of their treatment, along with any changes that were made and why.

Your website mentions the platform’s use in telehealth. How would those providers use it?

That’s a cool story. Three years ago in Europe, just before COVID-19, there was a growing number of telehealth companies. Basically every single one of them was building their own EHR for their providers. A number of them came to us saying, we want to improve our EHR. We want to have a best-in-class clinical decision support system for prescriptions. We want to improve patient safety inside the EHR.

These were young companies that didn’t have the resources to integrate drug databases and for build the complete system that they needed. We came to the conclusion that we would be able to help them by creating components. It’s not just an API, but rather like an API with a UI on top of that. You write one line of code and you can import them inside your tool.  We created an entire library of components. We have, for example, a drug-drug interaction component, a side effect component, and a number of other front-end prescribing tools.

The value proposition here is for a young telehealth company or a more mature one that wants to improve the EHR for their provider. You can easily integrate this library of components, and in less than one or two days, you can improve the entire clinical decision process for prescribing by adding the components that your prescribers need. That’s how we partner with telehealth companies. In Europe, we are the leader in prescription assistance for telemedicine and telehealth.

Can it support pharmacovigilance and reviewing a patient’s profile for opportunities to de-prescribe?

Our objective is to save as much time as possible for the provider in the case of a 12- or 15-drug regimen. This means also to consider de-prescribing. Our business model is constructed so that we are not incentivized based on the number of prescriptions, because we want to advocate for fewer prescriptions and de-prescribing.

When it comes to pharmacovigilance, we are trying to close the loop . You and I have been talking about prescribing, dispensing drugs, and reconciling medications, so let’s talk about patient information and that last item of pharmacovigilance. In that way, you’re closing the loop for the entire pathway of a drug after commercialization. In terms of pharmacovigilance, we’ve been working with the French FDA on a tool that saves time for the people in charge of assessing side effect reports for their level of severity and classifying the side effects.

This solution is driven by the same technology. It uses natural language processing. It can interpret the side effect reports very efficiently. For example, let’s say a patient says, “I took acetaminophen this morning and then I felt lightheaded.” The tool will understand everything that is reported and will recognize the side effects to make a first assessment of the severity of the case. Subsequently, a pharmacist and a physician can just say, “We think the technology made a good assessment” or they can correct what the system has been doing.

This is already up and running in France nationwide for all declarations of side effects. Every single side effect reported in France goes through our system first, and the initial assessment is made by Synapse.

How are you working with First Databank?

We are just starting our collaboration. We will see how it evolves. There is a lot of movement in this space, and First Databank has been trying to do more and more. We have a long history of partnering with commercial drug databases, which may be surprising, but we help them find new ways to ensure that their content is always up to date. On the Synapse Medicine side, we use this commercial database as a gold standard for our algorithm to think, “This is the truth.”

What opportunities and challenges do you see in increasing your presence in the US market?

The key for the US market will be EHR integration. The strategic path that we have chosen for Synapse is to offer a tool that has already been proven clinically. In Europe, our tools are used to prescribe, to do medication reconciliation, and to manage complex regimens like oral chemotherapy. We are directly inside the workflow, which is super important because in healthcare, nobody wants to add another tool. If you are outside the workflow, you will have low adoption and will probably end up with no adoption and die. Or, you do the hard work needed to be inside the workflow.

To do this, it is necessary to focus on EHR integration, and integration with the systems that are already in place. This is definitely difficult. It takes time, but then once integrated, you are there for the long term. This is exactly what we are working on right now with a number of EHRs that are being used for prescribing.

HIStalk Interviews Bill Grana, CEO, HCTec

November 2, 2022 Interviews No Comments

Bill Grana, JD, MBA is CEO of HCTec of Franklin, TN.

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Tell me about yourself and the company.

I started my career as a lawyer with the largest for-profit health system in the country. Since then, I have been a tech entrepreneur since for close to 30 years, mostly in software. HCTec is my first stint in a pure services business, but I have run enterprise software companies that had exposure to healthcare.

HCTec is a 12-year-old, Nashville-based IT services firm that is focused exclusively on the healthcare provider sector of the market, so hospital systems and other providers. Our people have specialized skills in different areas of healthcare software and technology. They provide services according to the needs and circumstances of our clients.

What is the labor dynamic in healthcare today?

It is fascinating on one level and maybe terrifying as well, depending upon your perspective. A lot of what you see in the media centers around clinical labor and staffing challenges, which continue to be significant. But I would say that those challenges also extend into non-clinical areas of healthcare, including IT. The great resignation has changed the workforce of our clients. Certainly in compensation, where there has been significant wage inflation over the last two years. We’ve seen that within our own business and with our clients as well.

The dynamic of remote work certainly has had a big impact. In certain type of roles, remote work is here to stay. For those that require of face-to-face interaction and collaboration, hybrid is the model. For many of us, I don’t necessarily see a full-time return to the office the way that it was before the pandemic. As the leader of a business, I’ve had to adjust my thinking. I’m very much a face-to-face type of person who feels that teams are most effective when they can be face-to-face on a regular basis. But I also recognize that the world has changed, and so leadership thinking has to change as well relative to the work environments of our team members.

How will your business change as your clients increase their use of remote work?

I would have expected more of a transition, or at least an increase in the level of open-mindedness, over the past couple of years to outsourcing certain functions within our clients’ IT organizations.  We are seeing that in certain areas, particularly the help desk and service desk arena. But many others that are necessary but not strategic are ripe for partnering with a firm like ours. Because of our scale and focus, we can typically do those functions at a lower cost and a higher level of quality. 

Application support around the enterprise EHR would be one area. The daily care and feeding and maintenance that is required of an enterprise EHR is a perfect opportunity for outsourcing. PC and desktop support is another arena. Provisioning applications, and system provisioning, is another area. We aren’t seeing that trend develop the way that we would have predicted and continue to predict, so that’s an interesting dynamic.

How much business impact are you seeing from Epic’s move to Hyperdrive?

Hyperdrive is the move to a pure browser-based interface. We have seen some opportunity from that, but not a tremendous amount.

What types of consumer-facing technologies are providers considering?

Obviously telehealth, which the pandemic really catalyzed. Usage is down, but still much higher than what it was pre-pandemic. I think it’s fair to say that telehealth is here to stay, certainly for certain use cases. 

Patient portals are playing an even bigger role in how health systems give the patients what they want in terms of access to their information and scheduling and that sort of thing. We’ve seen a huge demand on the help desk side for patient-facing support, much of it related to supporting patient portal applications. We’re doing some remote patient monitoring support as well. As we look forward five years, we think we will be doing a lot more of that. We all know that technology doesn’t always work as designed, and sometimes users don’t understand how to use it and need channels to reach out to get the support that they need.

How has system training changed?

Training continues to play an important role in the ability of users, whether clinicians or patients, to take advantage of the technology that’s in front of them. Most of the patient-facing technology is fairly simple, but depending upon your demographic and whether you grew up with smartphones and computers, training is critical.

How will support needs change as systems are more widely rolled out to patients and caregivers in homes?

That is happening as we speak. Within our help desk capability, we have a specific offering and specialty geared to patient-facing support, recognizing that there are some nuances and differences to how you support a patient end user versus a doctor or non-clinical provider user. The support experience is always important, but for a patient who is calling in or chatting in, that experience is even more important. These are the customers of the health system and their experience with the clinician and the care they receive is obviously critically important, but the experience that they have with supportive technology is equally important. 

Some health systems understand that very well and deeply. Others are getting there with their thinking. We are huge believers that patient experience is critical for these providers, and that isn’t just about clinical care, that absolutely is about their experience with the technology that is being put in front of them.

Several big health system IT and revenue cycle outsourcing deals were signed in the past couple of years. How will that trend progress?

Financial stress is a driver. We are seeing that play out in real time right now, with half or more of health systems operating in the red, partly because the cost structure and partly because the of the revenue side. I’m not sure that things are ever going to return to normal, at least with respect to the cost structure of both labor and non-labor related items. That will force systems to think differently about how they do labor resourcing in certain areas.

Back to my comment earlier, health systems don’t necessarily have to build large organizations of IT professionals to be effective as an IT organization. There are plenty of opportunities to outsource aspects of IT, those things that are necessary but non-strategic or where it’s hard for individual health systems to build real competency. Part of this is a bias, because it’s a big part of what we do, but I believe that there is going to be a trend to more outsourcing within hospital IT functions. It’s going to be more surgical in nature than if you look back 15 or 20 years ago, where there was wholesale outsourcing of IT functions. It will be limited to certain aspects of a hospital’s IT organization.

What are health systems doing strategically after putting plans on hold for the pandemic?

We have a lot of dialogue occurring around help desks and service desks, and much of that around patient-facing support. The pandemic also spurred the notion of patient-centered thinking and the related technology investments that support that. The shift out of inpatient settings and their heavy fixed assets and into light asset settings — with the home being the lightest that you can imagine — is a big trend. That is creating opportunities for us, both on the staffing side as well as the outsourcing side.

What will the company’s strategy focus on in the near term?

In the environment that we are in, it’s important to have a long-term vision. It’s hard to do strategic planning much more than a year or two out given the amount of uncertainty that exists. We are heavily focused on our own team and making sure that we are positioning ourselves as an employer of choice. We have seen some turnover in parts of our business that is higher than we have ever experienced, and we are not alone in that. But we think and talk a lot about how to source new team members for our business more effectively, how to train them to be successful in their jobs, and how we continue to make HCTec in an attractive place for them to stay.

Interestingly, pay is typically not the most important thing. We are finding that the most important thing for keeping people is around is to define clear pathways from a career and professional development perspective. 

We made an acquisition in July 2021 of a company in Winston-Salem, North Carolina called Talon Healthy IT Services. That was a fantastic acquisition for us. It bolstered our capabilities in the help desk arena, but also gave us new capabilities in the ambulatory and smaller provider space, where we have the capability to be the outsourced IT function for those providers. We are continuing to look for other complimentary businesses to expand our service portfolio and to increase our market presence and footprint. That’s a big part of our strategic focus, and where I’ve spent a lot of my time.

We are now back to where we are actually seeing our clients in person after a two-year hiatus where not a lot of that occurred. We are staying close to our clients; looking at their demands, needs, and opportunities within their organizations; and making sure that we are delivering high quality services and staying ahead of those needs.

HIStalk Interviews Guillaume de Zwirek, CEO, Artera

October 31, 2022 Interviews No Comments

Guillaume de Zwirek is founder and CEO of Artera of Santa Barbara, CA.

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Tell me about yourself and the company.

I founded Artera seven years ago. We recently rebranded from Well Health. I had never been in healthcare before I founded the company. I was going through a personal experience with cardiac issues and had a really frustrating time interacting with all of my care providers outside of the four walls of the hospital. The question kept coming back to me — why is healthcare not amazing at customer service?

I founded this company with a simple mission, which is to make healthcare the very best industry when it comes to customer service. I came into it with a lot of naiveté and ignorance. We spent seven years thinking about how to build an effective patient communication system for hospitals that is open; that allows every vendor to deliver its interactions through that platform; and that allows health systems to control the flow, rhythm, and prioritization of their communication so they can have an effective and convenient relationship with their patients.

Is it harder in healthcare where health systems have a large volume of customers but see them infrequently and often involuntarily?

Healthcare is complicated for good reason. It’s protected information, and we want to be sensitive to the privacy of patients and their medical records. There are a lot of stakeholders, even within the hospital. You have your primary care doctor, specialists, labs, pharmacies, clinical trials organizations, payers, and employers. Those parties are are all competing at some point in time for the patient’s attention.

There isn’t a library of five care journeys. This isn’t like an airline, where people are only booking one-way flights, return flights, or getting connecting legs. An infinite number of scenarios could happen for a patient, which makes this so challenging,. Then you layer in all of the ecosystem of vendors who are all trying to help make that experience smooth. When you think about streamlining that communication, that’s a lot of people to consider.

Health systems will have different ways of thinking about the priorities. That’s what we’re trying to solve. How do you consider all of those voices; bring that and surface that to the hospital in a way that is easy to manage, control, and manipulate; add and remove players; and then have that experience feel completely seamless to the patient? We are largely SMS, but the dream is that you are on your phone, your doctor is saved as a contact, you have an issue, you send a text, you get a response back. Whether that response is automated, a human being, a PA that reports into a physician, I’m indifferent to that as long as we get the right answer to the patient every time in the medium that is most effective to them.

If I can just share a quick story, this came to life for me last week in a wonderful way. I got a call from one of our customers with a story. This customer, their population, is rather elderly. They skew probably 70-plus. They had a patient who had a fall and they were wearing an Apple watch that had their emergency contact saved as that hospital. When the new Apple Watch detects a fall, it will text your emergency contact. That text hit our system, a staff member saw it right away, and they got in contact with the family and arranged emergency services for that patient. There are so many scenarios like this one that we haven’t considered yet. That’s what makes this complicated, the infinite number of scenarios and players.

Amazon has set up its own personal monitoring program that is linked to Echo devices. Could a user’s preferred health system replace a third-party call center as a local first step for medical issues?

I had never thought of that, and I think that’s a very logical assumption. My wife works at Google and she just got a pamphlet in the mail for a 24/7 urgent care service where you can jump on the phone, and within two minutes, somebody’s on the other end triaging you. That’s actually driven by the payer, circumventing the health system that she would normally go to. The same thing could apply in this Apple example or Amazon with Echo.

It will be interesting to see where they start. If you can be that first point of contact, you have tremendous influence over where the care gets delivered. If that care is acute, if it’s a specialist type of visit, that’s where the money is made. It could be a big threat to hospitals.

My personal opinion is that competition is great and we should all challenge ourselves to do better. At my core, I believe in the physician-patient relationship. I believe that to be thoughtful and proactive about your care, you have to have a relationship with your PCP. You need to feel like you’re disappointing somebody and somebody has your back if you don’t adhere to directions.

I’ve been using the gym more regularly for three months. I went to see my PCP and he said, great news, your cholesterol has dropped 50 points, what changed? I said that I had started going to the gym. Now I’ve kept it going and I think of him every time. Maybe that’s just me, but I believe that when people have a great relationship with their PCP, they never leave, kind of like the dentist. That’s who our energy is going to be focused on serving,

How does a health system define their customer when people move around, change insurers that take them into or out of network, and perhaps don’t want to hear from providers until they have an acute need?

There’s a whole market around that with population health. Many companies are tackling who to reach out to and onboard, how to bring panels into the system. That’s why the relationship outside of that visit is so, so important. I texted my PCP to see if I could get the third booster, for example. There are so many opportunities for the physician to engage with you, or for you to engage with them, outside of the point of care.

When you think about the younger generation, if you can create that relationship with the parents, many children will follow in their parents’ footsteps. I hope that there doesn’t have to be an art of engaging this lost population who never got care. COVID may make that necessary for us to catch up. I hope that we can build those types of relationships from birth and it can be a habit that is sustained throughout a patient’s life. I hope that’s the norm that we can get to as a civilization.

We don’t expect to have a telephone conversation with an actual human employee when we need to interact with a big company like Amazon, where most communication is via an online form, email, or other electronic message. How has that expectation affected healthcare?

Access is good. The mode of the day may be messaging, but it will undeniably change. You see this with connected devices. The example you just highlighted presents an interesting opportunity for health systems and providers. These big tech companies are actually going to a further extreme, which is attacking the labor problem. They want to optimize, they want margins to go up, and they have started making everything automated.

I had an issue recently with a ride hailing service. I called the company and couldn’t talk to a human being. It only gave me automated menu options. I went through it five times just to keep saying I was dissatisfied. I wanted them to know five times that I was dissatisfied. There’s an opportunity for health systems to give real human care and not over-rotate the way some of these big tech companies are doing because of pressure from the public markets. It’s an interesting thing to explore. I’m going to bring it back to the team.

Who within a health system defines the messaging to customer personas that include both active patients as well as potential ones?

In the seven years since we started this company, this has changed. Seven years ago, it didn’t exist. There wasn’t anybody making those decisions. People were thinking about how to make sure patients show up to their appointments. It was a very specific point in time with the acute problem of making sure that we don’t have wasted slots. There’s more and more competition for the patient’s time right now, and there are more and more people who want to engage with a patient. 

The role that we have seen come up increasingly is chief digital officer or chief patient experience officer. They may be VPs or SVPs. Maybe the most famous example of this is Aaron Martin when he was at Providence. Right now, he’s at Amazon, going back to one of your earlier points, which should probably make us a little more scared of Amazon. I have seen the role of chief digital officer that focuses on end-to-end patient experience. Cedars-Sinai has a similar role. We’re seeing this more and more, and we are also seeing a lot of folks outside of healthcare being brought into these roles, pulling from places like Disney and AARP and other brands that have done a decent job of building those relationships with their customers. I like the trend and I hope it continues.

Was it a big change for EHR vendors to open their system to third-party applications? Do you expect further EHR integration developments?

There were couple of announcements recently. You wrote about this, with Larry Ellison at Oracle Cerner making a big push around partnering and saying that partners were really important to them. I love to hear things like that. It warms my heart. Epic has done a lot of work with their App Orchard, and they’ve announced a lot of enhancements to that program. That significantly expanded the APIs that are available. We have a close relationship with Oracle Cerner and Meditech as well, and we have seen them be open in terms of data sharing. It certainly is moving in the right direction.

With the interoperability that just went into play, there was some disappointment by a lot of folks in the space that it was pared back a little bit. There’s a lot of hoops that we have to jump through in healthcare. Even when we think about these feeds, APIs may cover 20% or 30% of the use cases for a vendor if you’re lucky. For the remaining 70%, you’re doing custom HL7 or going to FHIR or Interconnect web services.

That stuff is custom, and it rarely translates from customer to customer. That makes it significantly more complicated. It’s not like an app in the App Store, where you deploy it to Apple and anybody can download it. It requires an implementation. There’s a whole industry in healthcare around professional services and consulting firms that do this for a living. So we are definitely going in the right direction, but we are nowhere near where some other industries, like high tech, are.

A lot of technology adoption happened during the pandemic. As we try to find the new normal, how will that experience be applied?

I have this belief that in the universe, everything has to balance out at equilibrium. This is true for politics, relationships, you name it. Everything needs to find its balance. Things went off balance during COVID. What I’m seeing now is that we are going to shift to the other extreme, and eventually, we are going to find the middle ground. There was really quick adoption of lots of different forms of technology, purchasing cycles, and shortened deployment cycles. We solved problems very quickly.

I’m hearing more and more about consolidation. What does my EHR do? How much of this can I bring back to the EHR? I think we will see a significant paring back of the ecosystem of vendors that provider organizations maintain, along with a shift towards bringing things to the EHR that can be brought to the EHR. We will probably go to that extreme a little too much, and it will likely be a year or two before we find that balance again, where the EHR continues for those core investments and the truly additive things get prioritized and integrated and built on top of it.

How does the market for innovation look if EHRs replace some of those third-party applications and health system consolidation creates bigger but fewer prospective customers?

There’s a famous saying in Silicon Valley that down markets are where the best companies are formed. That creates pressure and forces entrepreneurs to the right places. If a health system can get “good enough” from their EHR, they’re going to go with that. Innovation will need to be unique, differentiated, and tough to replicate. It will do a good job of weeding out the possible solutions in the market, which could be good for healthcare IT overall. In the markets, it will look like investment dollars are slowing into healthcare IT. It will look like fewer purchasing decisions and like more consolidation. But the very best companies will form out of that pressure.

It will be net positive, but it will feel rough for a while. It may hurt health systems that adopted a lot of those technologies during COVID. Some of those technologies may disappear because the company goes out of business or is gobbled up by somebody else. It’s more important than ever to provide differentiated value and to understand the problems du jour of our customers, because they are very different than they were during COVID. It’s a totally different set of challenges. Now it’s labor shortages, labor costs, and margins. We see this in the news every day. We see a tremendous number of layoffs despite a really strong jobs market. It’s a confusing time.

What will be the direction of the industry and company over the next three or four years?

We absolutely have to be added to the EHR. We need to work with the big EHR players, understand what they’re going to tackle and what they’re not going to tackle, and fill in those holes. We need to pair that with what our customers are telling us they need, that are must-dos for them to get through this. It will  be a dark period for the next couple of years. 

We believe in creating an open platform. It will be important to create and invest in our infrastructure so that anybody in the healthcare IT space, any vendor, can route communications through us. I’d like them to be able to do it with no friction. Plug in to Artera once and you can send communication to any of our healthcare partners who enable you.  That’s where we need to get to. We need to create that network. That will create a lot of value for healthcare IT and health systems.

HIStalk Interviews Mike Alkire, CEO, Premier

October 26, 2022 Interviews No Comments

Mike Alkire, MBA is president and CEO of Premier of Charlotte, NC.

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Tell me about yourself and the company.

I’ve been in my role as CEO for the better part of a year and a half. Premier is an evolving business and has been an evolving business in the 18 years I’ve been here. We started as an organization that was focused on supply chain cost reduction and healthcare system quality improvement. We’ve morphed into doing those two elements plus many other capabilities, including standardizing the way that clinicians practice and pharma and med device looking at utilizing our capabilities to help them in real-world evidence studies and in identifying patients for trials.

We created a couple of subsidiary companies in the last few years. They are focused on helping our healthcare systems as they think through new revenue models and are working more closely with the employers in their market. That’s our Contigo Health initiative. We also have an initiative called Remitra, which is all about e-invoicing and e-payables.

Everything we do and contemplate doing is about helping healthcare systems become more efficient, using technology to reduce labor usage and to help them generate more revenue and more profitability.

How can technology make the health system supply chain more efficient?

During COVID, we stood up a coalition of all of the suppliers and distributors of PPE, personal protective equipment. Then we melded that with HHS , FEMA, CDC, and FDA. Because what became painfully apparent in March 2020 was that the federal government didn’t have a real good idea of the location of products to protect caregivers. We quickly stood up that coalition and started getting some traction on getting access to product and getting that supply chain up and running. We understood the utilization patterns of PPE in New York. We used some AI and machine learning capability to forecast from our data as well as the Hopkins data on the progression of COVID. Then we layered our utilization patterns on top our models so that we could help health systems determine the amount of product they needed.

That was important, because everybody was in the market at the exact same time looking for product. That was driving up the cost. Everybody was trying to stockpile against those that actually needed the product. We needed to bring some sanity to that madness. We developed that technology. Some federal agencies are looking at it today as something that they might want to continue to use going forward.

Another element is labor extenders. It’s amazing that 75% of healthcare invoices are still paper. Or focus is to use technology to automate that or digitize those invoices. We have some pretty cool advanced optical character recognition capability and some machine learning capability to make that more effective. But the point is that this invoicing and payment function is still fairly antiquated, and our goal is to bring that up into the 2020s as opposed to being something that has existed for 25 or 30 years.

We are also looking at products and drugs and the outcomes associated with those. We’re so much better at that with our acquisition of Stanson Health. Writing standards of care in Epic, Cerner and Athenahealth that are based on data, how the patient presents themselves, and lab values and other screens is critical. That will evolutionize healthcare. We want to continue to proliferate technology like that all throughout the healthcare system.

You launched Contigo Health three years ago and it recently made a big acquisition of contracts and technology. How is that business doing?

It’s going incredibly well. Thank you for asking. It is meeting its growth profile. Health systems are obviously under a great deal of stress and pain, struggling with high labor costs and supply cost inflation. We are creating new models for them to get access to revenue that maybe they hadn’t had access to in the past. 

Contigo is just one of those ways to do that, to help build plans and capabilities so that health systems can go directly to employers, both in their market and at a national level. That program is doing really, really well. We continue to build the high-value network of health systems that provide care to a significant number of large national and international companies. We bought a third-party administrator a few years back for the centers of excellence programs that most advanced employers or innovative employers use, so that when folks need a knee or a hip done, they can be sent to a national center of excellence. The TPA supports that function.

As you said, we recently ran an acquisition of an organization that has access to a 900,000-provider contract. Our healthcare systems that have health plans can leverage a wrapper that is very economical and has a number of providers who can fill the needs of those health plans outside of the region of where that care is being delivered by that provider. We are excited about the direction that Contigo is going.

Will health system consolidation continue to the point that we have just a dozen or two regional and national health systems?

It’s tough to tell. They are battling against the sheer scale of health plans. Optum and UnitedHealth Group have $500 billion in market cap. You have Anthem, Aetna, and Cigna with market caps of tens or hundreds of billions of dollars. Then you look at the health system, HCA being the largest at $60 billion. It’s a huge issue in access to capital. Do you want our health system being innovated by the providers, or do you want it being innovated by the payers? These health systems are trying to create enough scale to bring a bit more balance against the payers on this.

I don’t necessarily have a prediction in terms of what large health systems will look like. I think you’ll have a lot of regional health systems and then still have local health systems, because those communities have specific needs to the point that they will probably need to remain independent, especially as healthcare continues to move outside the four walls of the hospital.

The way that we will look at health systems in 20 years will be much different than today. We have these big acute settings, non-acute settings, clinics, physician practices, rehab, labs, and all those kinds of things. But health systems are trying to move as much into the community as possible. That means trying to figure out ways to lower overall variable cost and fixed cost. The way that care will be provided in the future is going to be dramatically different, and advanced technology will be needed to help drive that transformation.

Optum is hiring a lot of physicians and buying practices, and at the same time, big retailers could be planning to cherry-pick the most profitable parts of the health system business. How are health systems responding?

When you have well-capitalized companies getting into any space, you’re always going to keep an eye towards that. Our interest, and that of many of our health systems, is to figure out ways to partner with those entities and help them meet the needs of what they’re trying to accomplish. That’s one of the reasons that Contigo got started. It was driven by Walmart trying to figure out ways to get more value for their healthcare dollar. I don’t think this is going to go away. With the rising cost of health insurance, you will see employers continue to look at unique models. We want to be there with capabilities, services, and technology to help them as they transform their healthcare costs.

How is the data connectivity between health systems and life sciences companies changing?

The most important aspect is data security and data protection, making sure of de-identification capabilities and using things like avatars to represent people. Those will be essential in research going forward. That scale will be important. That pharma or med device doesn’t have the ability to reach out to 5,000 hospitals, so scaling all that data and technology is going to be important.

How you consume the data and serve it up will be important in the future as well. Everybody will have different needs in terms of what they’re trying to consume from a data standpoint. You’ve got people in the middle of trials, you’ve got real-world evidence studies, you’ve got off-label utilization of products, you’ve got identification of patients just because of the need for more heterogeneity in these studies and those kinds of things. It depends on the prevailing needs. But the most exciting thing is that technology is coming to a place where we can meet all those challenges just because of a lot of the work that has been done over the last 10 years.

How do you see the business environment playing out over the next two or three years, especially for smaller companies?

It is incredibly important to have strong ROIC, return on invested capital. We want to have nice return for our shareholders and to drive our EBITDA and our cash flow and those kinds of things. Those are the most important parts of a business. When you launch new businesses and you’re making investments in those kinds of things, you have to make sure that you have the right plan in place and that you are getting the right level of returns. Organizations that have great ideas, a strong history of delivering ROIC, and a strong history of delivering performance will generally do well going forward.

The other side of that, as you were talking about it from an investor standpoint, is that it is even more important that we are creating offerings that can show short-term, mid-term, and long-term returns for our customers. It is no longer the day that you’re implementing something that will provide a a return in a year. Health systems are under such duress. You have to be able to walk in with options, services and technology that will help you drive results very quickly. Then, as much as possible, get a lot of that information and insights embedded into the electronic medical record so that you have long-term sustainable improvement as well.

What will be important for the company over the next three or four years?

A couple of things will be critical for us. Even with market’s labor factors being the way they are, this is all about getting great talent into the organization. Recruiting great talent is so interesting. I had a conversation with a student in an MBA program that is top five in the world. I was impressed with her and asked, “Where are you thinking about doing your internship, Google, Apple, or Amazon?” She said, “Yes, I’m considering those because I’m really interested in what they’re doing in healthcare.” I said, “One of the things that we think is unique about Premier is that we truly understand healthcare and have been building incredible technology capability over the years, as opposed to a great technology company that is trying to understand healthcare.” Getting access to great talent is going to be really important.

I constantly challenge my team. Are we continually pragmatically innovating? How are we taking the platforms that we’ve created and creating those next layers of innovation? We’re doing some amazing things using a artificial intelligence, machine learning, and natural language processing.

The sky is the limit for us. Now it’s a matter of getting the right use cases built and getting the right products developed to support our health systems along their journey to transforming the way they are providing care to their patients.

HIStalk Interviews Julie Bonello, Advisor and Former CIO

September 26, 2022 Interviews No Comments

Julie Bonello, RN, MS is a career CIO who is now offering advisory services for integrated care delivery models.

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Tell me about yourself and your career.

I began as a pediatric intensive care nurse. I got my bachelor’s at Rush. I also had an art background. I went into research after that, and I found through using all the statistical packages that I was interested in computer science. While I was still in nursing working in research, I completed my master’s in computer science.

At that point, I jumped into health IT and then went into consulting for several years. I became a CIO in 1990 and have had five CIO positions throughout my career, mostly in the greater Chicagoland area, except for recently with Presbyterian Healthcare Services in Albuquerque.

Did your nurse background make your CIO job easier or give you a trump card to play when sorting out priorities?

I guess it was known that I’m a nurse, but I didn’t often bring it out. Not only was I a nurse, but I also had the opportunity to be oversee medical records and rev cycle. Over my career, I had strong operational knowledge. My depth of knowledge in terms of how the business actually operated and how care was delivered was always my greatest strength as CIO and understanding how technology could be used to support the business in a way that didn’t overly complicate and didn’t fragment care. I could speak with the clinicians in a way they could understand.

Sometimes as a CIO or when you’re in IT, you can step into other people’s swim lanes because you are just trying to help figure out how to leverage technology successfully. Sometimes that would happen to me, maybe more so than other people because I understood the operation so much.

How have you seen the CIO role change?

IT has become several areas within a health system. Often you’ll have a digital team. Analytics has grown significantly, so how you divvy up the data side and the analytics side has become important. As you move to cloud, it is important to figure out a consistent IT service model for all IT areas.

As we have parsed out different IT responsibilities into some other areas and as we have also changed our operating model or our IT service model, it is important for a CIO to understand the business, how care is delivered, and health IT. You’ve always had third-party relationships, but now with population health and the move to the greater continuum of care services, many health systems are partnering with third parties that have very different technology platforms. The need to understand how they can all work together simply to improve care is important, as is your relationship with your payers and understanding how your contract strategy impacts your technology strategy and interoperability. It’s very complex and has many stakeholders.

Some health systems bring in technology outsiders who have no healthcare experience, while others prefer hiring C-level IT people who understand the business and how IT can support it. How do you contrast those approaches?

It depends on how you want to structure IT. You can’t leverage technology within healthcare unless you understand healthcare and healthcare IT. If you bring in someone from the outside and make the CIO a technology position, more like a CTO, then you need someone else to help translate how the functional side of your application strategy can meet your business goals. You’re going to have to figure that out. It all depends on how you want to organize all the pieces, but fragmenting IT makes it hard to ensure cost efficiency and consistent service levels while minimizing security risk.

We’ve already seen that with a lot of the technology startups. If they go too far into using technology people without knowing the business or healthcare IT, they’re not going to be able to meet their goals. There’s a balance. You must find out how you can get it all, and there are a lot of different ways that you can do it, but you need to leverage technology to meet your business. To do that, you must understand the business and healthcare IT while driving forward with technology innovation and measuring as you go. Healthcare and HIT is complex.

Health systems have gone from running innovation centers and investing in health IT companies to acquiring and running for-profit companies. What is the impact on the IT department?

There are a lot of avenues that health systems are taking in addition to investing in startups. As someone who has been in the business a really long time, you have to figure out a way to provide healthcare simply. If you can figure that out in a way that you can pull all your partners together into a service model that is integrated and supported by an integrated technology platform that you measure, everyone’s on the same page, and their goals are the same in improving care, then great. But if you’re not all on the same page, then you might not be simplifying care.

How did you, as a C-level health system executive, see value-based care?

I focused on provider-payer integration, leveraging technology for clinical redesign and aligned with the contract strategy. You have a partnership with all your payers. If you design your care, your reimbursement, and your measurement of that and design your contract strategy to go along with that, with your payers included, I’ve seen an improvement in quality. Payer-provider integration is important.

My last three CIO jobs have been focused on understanding payer integration. That can move the needle. Now I will say that often when we design our care and measure our care, it’s not done through integrated clinical workflow with payers and providers together. They’re separate workflows.

What kind of integration or cooperation do you see between health systems and payers?

In 2015 when I was at Rush Health, I was the CIO of the clinically integrated network. The clinically integrated network oversaw the entire contract strategy for the network. We worked closely with the payers on our technology and interoperability strategy. We received information from our payers and then derived intelligence from that. We worked on what was then a rudimentary system to get the derived intelligence back into the record for follow up by the providers and care coordinators.

When you have a feedback loop getting follow up information to the providers and the care team and you’re working on interoperability, bringing information into that record so that everyone has access to it, that’s where I started to see real change.

What are you working on now?

Provider-payer integration, implementing interoperability to support a longitudinal patient record, deriving intelligence from the shared data, and getting that back into the record to improve care. My focus continues to be in these areas because I know it can really improve care. I’ve spent the last three CIO jobs focusing on how you include IT in working together with the business in designing the different governance structures that you need in place and the different service models for integrated delivery.

As we start to think through how we want to provide care across the continuum and we establish new partnerships with new companies, you’re changing the staffing model. You’re changing your care team. You’ve got a lot of different providers, but you need a consistent service model, because your patients don’t understand how you’ve now organized across many different groups of people. You must come up with an integrated clinical workflow and an integrated service design and then ensure the design is built and integrated across the entire technology platform with technology services to manage and monitor across all as well.

Both our clinical/business operating model and our IT operating models are changing. With a shift to cloud modernization, we have new third-party IT relationships, so we are changing the IT operating model, too. A change in the operating model requires new integrated governance, structures, processes. and services to ensure success.

How are you going to manage and monitor that in your health system to do that? Because it’s not just going to be within your clinics now and within the inpatient environment. It’s going to be in your home. It’s going to be all over the place as you establish new third-party relationships. That’s what I’m really trying to do, because I see that there’s more fragmentation now than ever before, and it concerns me. Interoperability or sharing data and getting it into the longitudinal record will be key.

What reflections do you have on your long CIO career and what you hope to see in the future?

I hope to see an integrated care model with a technology platform and interoperability that supports it. When we look at how we manage our healthcare in the future, we will have leaders and management structures that manage across the continuum for all that we are doing for that patient, across all of our partners in the integrated delivery model and ensuring that an interoperable technology platform is managed and monitored across the entire continuum. It requires a more integrated approach across the continuum and one that includes our payers. I think we are getting there.

I’ve been a CIO for over 30 years on the front lines. I’m at the twilight of my career, so I decided to step back and devote my time and expertise in the areas I have mentioned, where I can make a difference. I want to help improve care.

HIStalk Interviews Erkan Akyuz, CEO, Lyniate

September 21, 2022 Interviews No Comments

Erkan Akyuz, MS, MBA is president and CEO of Lyniate of Boston, MA.

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Tell me about yourself and the company.

I’m a software developer by trade. I started in the PACS world, the imaging world, at a small company called Mitra Imaging in Ontario, Canada. I was a developer on a product called Mitra Broker, then did some display work, and from there I went into management.

We started Lyniate as a carve-out of Rhapsody, our flagship product from Orion Health in New Zealand, in November 2018. Shortly after that, six months or so, an opportunity came to merge Rhapsody with Corepoint Health out of Frisco, Texas, and we did that merger. A primary driver behind the merger was being able to provide a more full solution to the market in all the segments, with the ease of use of Corepoint and the extensibility and the multiple platform strength of Rhapsody.

We’ve been running the company in that mode for a while. Earlier this year, we also merged NextGate’s enterprise master patient index solutions into the portfolio. In late July, we also merged CareCom, which is a terminology services provider out of Copenhagen, Denmark, into Lyniate.

What is the current state of interoperability and what challenges remain?

When I started as a developer on Broker in the late 1990s and early 2000s, we had an interoperability challenge. As developers, we used BizTalk from Microsoft. Then Orion came up with Rhapsody. So even 22 or 23 years ago, there was a core technology issue about interoperability and being able to exchange messages between EMR and the PACS systems and the modalities.

In the years that followed, I would say that thanks to companies like Corepoint and then Orion Health, the problem of interoperability has almost gone away. Even though HL7 standard adoption, or its implementation in a standard way, by healthcare was challenging, companies like Corepoint companies and Orion Health provided solutions to make integration and interoperability more efficient.

Fast forward 20 or 25 years. We still have interoperability challenges. They are less in technical nature and more semantic in being able to help people interoperate with each other. Not only to send the right version of HL7 and then receive the right version of HL7 back, but to help a doctor prescribe a prescription accurately. Then on the pharmacist side, to receive that prescription and administer the right pills so that we minimize mistakes and we improve efficiency.

Interoperability issues are much, much less technical in nature. I don’t think that we have the issues of being able to exchange data now, It is more of a multi-organizational workflow. We hear about data blocking or a site that doesn’t want to share data, but that’s an easy way out by blaming the vendor, blaming the EMR vendor, blaming the hospitals, etc. And at times, our healthcare ecosystems — from payers to providers, multiple payers to multiple providers — introduce such complexity that one vendor, one provider, cannot really solve it.

In my view, we need, as a nation or as a globally, better motivation to make data available to the systems without any hassle, without any struggle, so that it can be used in care settings where the data is not produced. If the data is produced in an acute care setting but now needs to be accessed in a social care setting, that should be easy, without many bottlenecks.

Unfortunately today, we sometimes see legal, sometimes affiliation-related, bottlenecks. A social care worker will not be able to get access or even identify where the data that they need for the patient, for the baby or the person they are providing care for, is available, how they can find it, and how they can access it. We need to do better from every angle, every stakeholder in this picture – vendors, providers, and payers — to create a federated environment by providing our data, making it available to everyone who wants to access it. From the consumer side, we need to make it easier to consume this data from federated, basic data suppliers.

What interoperability needs are coming from payers and life sciences companies?

When it comes to technical connectivity, they are able to access the data. But they don’t understand how the data is stored and structured as well as a provider. If you’re a provider, you developed your EMR structure and made decisions about how to store patient data, so you have a very good idea of how it’s done. When you access a different provider, you can’t figure out how to navigate through it. If you are coming in as an outsider, if you have never been a hospital, if you never seen an EMR, understanding this data structure is not that easy.

You are interested in one bit of information. Let’s say you have a clinical surveillance system. You would like to monitor certain diseases, and they are spread in the hospital. Let’s say you are interested in getting a notification every time a patient is diagnosed with sepsis. In today’s world, in order to get that notification, an external party — let’s say in this case, life sciences or device companies — need to have good understanding of how to find the data and create an alert so they can get a notification. Our EMR systems were not designed to create those alerts. They don’t understand it as much.

We need to make accessing and consuming data much easier than it is today. We use money exchange, like ATMs, as our goal internally. Lyniate will be done when exchanging healthcare data is like paying an electric or gas company bill, riding in an Uber, or using Venmo. There are no barriers. You can pay someone independent from what that someone does, in multiple formats — check, cash, Venmo, PayPal, Wires, Zelle, or whatever. These different protocols and mediators are able to move currency. It’s so easy that we don’t even know how gas company accesses that money, but they do it. Unfortunately in healthcare, when a life sciences company is trying to get a imaging data, sepsis data, or clinical trials data, they need to have a deeper understanding of where that data is and how they can get it.

SWIFT’s [Society for Worldwide International Financial Telecommunications] currency exchange protocol is an example. We need to be able to provide services like SWIFT to the multiple providers of that currency — with healthcare data as the currency, and multiple consumers of that currency — without being held to understand too much in the intrinsics of how I keep the cash, how you keep the cash, and how we are going to use it. We need to bring it to the fidelity of the healthcare data and make that easily accessible, independent from the affiliations between organizations. We need to implement a SWIFT-like environment to manage those transactions. I don’t think we are very close to it yet.

Who would lead the charge for a SWIFT-type exchange in healthcare?

I think it has to be a shared effort, but bringing a group together around that solution is going to be difficult. As an example, I really admire how RSNA succeeded as an organization in providing leadership, and then came DICOM. I started my career as a developer in the DICOM world. RSNA came up with the IHE [Integrating the Healthcare Enterprise] idea. Their thing was, we are not going to reinvent DICOM. We are not going to reinvent HIE. But we are going to bring the parties together who are stakeholders to use standards when it comes to exchanging data.

I was a technical representative of my company. I would go to Chicago once a year, where we would spend a week around the table with different vendors and different providers. We would discuss, how are we going to do patient information reconciliation? Let’s say the modality acquired this study and then patient information changes. Which bits and bytes of the standards are going to be used? How we are going to populate it?

IHE and RSNA led this effort to create these integration profiles, saying that if this is a workflow, then all the EMR player actors are going to do this and all the modalities are going to do that. Representatives from vendors, providers, and standards worked together to define how that integration profile will do the job. We changed our code in Connectathons, we tested all that stuff, and it worked.

Today, when you look between the modalities, PACS, RIS, and whatever systems are doing their job, then exchanging data and who’s going to do what, quite honestly, we don’t. But now it’s a system. Every year we have Connectathons. Every year we are testing integration profiles.

They need something similar on the EMR side. Let’s say HIMSS can take this leadership since they’re a strong player. They need to bring life sciences players, device manufacturer players, EMR vendors, payers, and anyone and everyone who is interacting with patient information. How do we do this? What is the integration profile? Are we going to use HL7, FHIR, or DICOM?

Let’s say there’s an integration profile called Accessing Patient Information for Clinical Trials. The life sciences players should define what they need, how they want to use it, and what format they want to consume. The EMR vendors can describe how they can access the data. Providers will offer the legal structure they require.

It needs to be a joint effort and organization. HIMSS may be a good one, or it could be the American Hospital Association. An organization needs to take the lead to pull these players from the different corners and bring them together for a common cause. IHE is a stellar example of how it can be done, and right now, IHE profiles are working like SWIFT.

I did a little bit of research about SWIFT, asking why these competing banks don’t worry about losing – or let’s say “leaking” – customers to a different bank. We always hear that patient leakage makes providers not want to share their data to protect their customer base. I learned that SWIFT is a legal entity and all its shareholders are the member banks who are using SWIFT for money exchange. Every time then there’s a SWIFT exchange, banks pay a transaction fee, and at the end of the year, they basically receive a proportion as dividends. The bank that contributes the most funds into SWIFT receives the most funds from SWIFT at the end of the year.

So in the bank world, they created the SWIFT organization and they own it. There are no third parties. In healthcare, TEFCA may be a good example. Maybe we create an organization like that and mandate it jointly by a membership, a paying membership by the life sciences, payers, and saying that we want this organization to be the SWIFT of healthcare.

Where do you see the company going in the next three or four years?

We put a vision in front of us to implement an infrastructure layer that helps not only data exchange, but also helps manage the identity of data. That’s why we merged with NextGate. Then also to help translate the content of the data so that the consumer of the data doesn’t need to worry about the format the data was stored in and the data itself will be translated for them in the unit that they would like to consume it. We also want to expand it even more than being able to store that data so that our users and other healthcare IT providers like the vendors can access this infrastructure as a platform that they can use to exchange data. Then make sure that the data that they are exchanging is trusted — coming from a trusted party and belonging to the person that they believe that it belongs to — and then interpreting it to the format that they would like. If they would like to also store it more in perpetuity, they can also store it.

Our vision is staying as an infrastructure provider for healthcare interoperability to provide a more multifaceted features, such as what we did with Rhapsody and Corepoint in data exchange, identity management and identity assurance with NextGate, and terminology mapping services in and expanding that even to the coding services with CareCom. We will continue to invest in them and expand the infrastructure based on what we are hearing from our customers.

HIStalk Interviews Luke Bonney, CEO, Redox

September 12, 2022 Interviews 2 Comments

Luke Bonney is co-founder and CEO of Redox of Madison, WI.

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Tell me about yourself and the company.

I’ve been working at Redox, on Redox, for just about seven years. That’s a long time and a lot more gray hair. Redox is the platform to make healthcare data useful for healthcare’s builders, the people building and scaling healthcare technology.

What have been the most significant interoperability advancements of the past few years?

Our world at Redox is all about how to make healthcare data useful for builders, who to us are the people building and scaling technology and healthcare. We obsess about these people, because through enabling the people who are building technology, everybody will benefit. Patients will benefit, providers will benefit, and you and I will benefit. Great builders build great technology that drives incredible experiences. Those experiences are what drive outcomes. That’s where we need to see meaningful change in healthcare. How do we drive and inspire outcomes?

At Redox, we are constantly obsessing about imagining a world where people can build and scale healthcare technology and be completely unencumbered by the nastiness and complexity of healthcare data, which I know sounds crazy because it is nasty and complex. But we think about a world where with a couple of clicks, people could compose experiences for their users. That’s what we obsess about.

Over the last couple of years, we have continued to focus on healthcare data access and integration. Today, working with Redox means that you have access to existing connections to over 2,500 healthcare organizations across the US and now in Canada. We have integrations with dozens of major payer organizations. We have expanded to not just be focused on clinical data, but financial and payer data, connections into existing clinical networks like Carequality, CommonWell, and a whole bunch of HIEs. We are now connected to 50 out of 50 state public health departments.

We have a lot to be proud of that we’ve focused on in the last couple of years. When we talk to our customers, they say they work with us because we help them focus their engineering efforts and their product efforts on building a truly differentiated product by taking all this nastiness off their plate. We also help them accelerate their sales cycle. We help them get live and implemented faster at all these different locations.

Today, it’s all about data access and integration. As we look to the future of Redox, we will focus on additional problems where we can make healthcare data useful and valuable for builders.

Looking at the industry, I would go to the pretty exciting impact of regulation. I know that might sound weird since regulation is almost always a nasty word, but when it comes to 21st Century Cures, I am definitely in the camp that 21st Century Cures is a game changer, and in a good way. It is definitely not perfect, like any regulation that runs 700 or 800 pages, but it absolutely redrew some of the major goalposts and expectations around healthcare data. The requirements around info blocking and enabling FHIR are good. I think they are incremental. Access is only one component. Standardization and normalization of data are equally if not more important when we think about downstream use cases. We have seen a huge amount of positive change in the impact in the payer world and the payer landscape.

The saying we use at Redox is that what Meaningful Use was for providers, 21st Century Cures, and specifically the CMS patient access rule, is for payers. It has been a major forcing function for payers to modernize their technology. 21st Century Cures is fundamentally making healthcare a friendlier place for builders and innovators by curbing a lot of the power of major incumbents. From where I sit, that is fundamentally a very good thing.

Explain TEFCA and how it changes your business and the industry.

Where I’m super excited about 21st Century Cures, I think TEFCA is a different situation. Had TEFCA been regulated in a way similar to 21st Century Cures, with clear incentives and/or penalties,  we would be a huge fan, because we are fundamentally aligned with the world that TEFCA imagines.

To just state what that is, TEFCA has two core components. It’s a technical framework and a legal framework that allows networks to communicate with one another. It imagines what they think of as a network-of-networks environment. We love that. We think that that would fundamentally change the landscape.

However, as it stands right now — and this is where I think there is huge opportunity — TEFCA completely optional. It provides the framework. In an industry where large change is so typically aligned to hefty incentives, reimbursements, and penalties, TEFCA doesn’t have any of that. Maybe the long story short there is that we believe in TEFCA, we believe in the future it imagines, but we don’t have strong confidence that it’s going to meaningfully shift the industry because of how it is structured.

Having said all that, there’s a number of products we support, connectivity to Carequality, CommonWell, and other networks that we support. But we’re just not convinced it’s the game changer.

ONC is reluctant to apply a heavy hand and instead wants to clear the way for market forces to drive advancement. Where would that market pressure come from to make TEFCA universal?

TEFCA has the framework around what’s called a Qualified Health Information Network, a QHIN. Without going into the tactical details of what qualifies as a QHIN, a couple of networks fit that mold at a high level. CommonWell and Carequality would be classic examples. They support a use case, which is the treatment of care or the transition of care use case, where data is exchanged. The classic example is that your primary care doctor is in New York, you’re in Florida, and you get in a bike accident. CommonWell and Carequality allow that record to get pulled from New York to Florida so that the doctors treating you there have your medical history. That’s a clear use case with appropriate incentives for hospitals and clinics to participate.

It’s harder to imagine future use cases where those alignment of incentives occur, where people would meaningfully come to the date table and agree to share data. There’s some compelling stuff around payments and patient payments where there could be meaningful market pressure.

Your question is a really interesting one because while the painted future is interesting and exciting, it’s hard to imagine a path to get there simply through pressure from market conditions. This is where we need to think about the actual incentives of these organizations, their willingness to share data, and whether they see it as the right thing given the specific use case.

Has the original interoperability idea of paying those who contribute data and then charging for its use gone by the wayside?

I don’t think that model is off the table. I just don’t think it has seen a ton of traction. Where there is traction involves life sciences companies that want to pay for large, de-identified data sets for R&D purposes. But beyond that, there just hasn’t been a ton of traction. That is not at all me saying that we should disqualify that or put it to the side. If there was, I think that would be super exciting. Those are the questions that will be interesting to track. Is it going to enable that world or not? Do we see the early signals that something like that could emerge?

Technology vendors, startups, and health systems themselves are finding it profitable to broker a data connection between providers and life sciences companies. Will additional use cases emerge?

I think we are early days. There’s a ton of opportunity. Costs are high to administer clinical trials. The match rate, how easy is it or hard is it to identify patients to enroll in the clinical trials, is still super high and inconsistent. The data itself is part of it. Another huge part of it is decentralized clinical trials, where there’s a ton of innovation. 

We are early days. That’s a fun and interesting spot to look for for innovation. Drug companies have lots of money that they are willing to put to work.

Do we have now, or will we have in the future, a healthcare technology ecosystem?

There has always been an ecosystem. It’s the question of how big and how impactful that ecosystem is.

Going back to the conversation around 21st Century Cures, you can look at a lot of interesting data. Look at the total amount of funding over the past five years that has gone into digital health. It has been one of the fastest growing categories compared to any other technology sector over the past five years. That’s an incredible sign that people everywhere see healthcare as not just a place where innovation is needed, but for anybody who has been a patient or provider, that innovation is needed and possible.

We’ve been saying for a long time and with a straight face that there is an ecosystem. Now it is probably more apparent to a growing audience. But we also think that it’s necessary. Like many other industries, there isn’t a single person or a single company that will meaningfully move the needle. It needs to be many people working on many problems.

That is one of the fundamental viewpoints we carry. It’s about empowering this entire class of builders. It hasn’t happened overnight, but it’s much more significant than it was yesterday, and I think three years from now, it will be twice as big. It is super exciting.

Now that cloud has finally found its healthcare footing, including technology companies like Oracle and Microsoft acquiring big health IT vendors, where does it go from here?

I’m glad you asked this question. Big tech is making serious moves in healthcare. For those of us who have been in this space for a while, we’ve seen different moments where bets were getting placed. I now have conviction — and not just me, but others — that fundamentally, healthcare delivery in the US is going to look different three to five years from now because of the impact of Amazon, Microsoft, and Google.

The other thing I would say is that it’s not just big tech, but also groups like CVS, Walmart, and others that are making big moves, such as Amazon buying One Medical and CVS’s purchase of Signify. An interesting detail that stuck out to me when Amazon purchased One Medical is that alongside that, they announced that they are winding down what they had previously been calling Amazon Care, which was their initiative around a nationwide telemedicine offering. That tells me that that Amazon, in this case, is moving out of testing different hypotheses, having multiple bets, and solving for optionality and they are moving into a more unified, aligned approach now that they have been in market for a little while. This is a trend that I see across big tech. They have spent some time studying healthcare and now they are making their big bets.

It’s not just the cloud. It’s the technology companies that offer the cloud that are super interesting. When it comes to big tech and the ongoing shift to cloud infrastructure, this has been a core part of the Redox thesis from the very beginning. Hospitals, clinics, payer organizations, and life sciences groups are all right now making massive investments in their cloud infrastructure. It’s because what they all have is data, and what they are realizing is that these big tech companies and their cloud infrastructure has the most robust functionality when it comes to driving value from that data.

I see big changes. The dollars being spent will threaten some incumbents in the space, because change is always scary. But I also think if we all take a step back and look at it from the viewpoint as a patient, I’m incredibly excited, because this is what has happened in other industries and the end result is ultimately a more user-friendly, consumer-friendly experience. It’s real. it’s big. We are in the midst of it right now, and three to five years from now, healthcare is going to look different.

How will  today’s financial market activity change the industry?

On the one hand, healthcare is, and will continue to be, relatively resistant to recessions. As we know, the demand for healthcare doesn’t closely associate with the state of the economy. I would say that overall demand hasn’t changed a ton. Where we do see impact is more specifically related to capital markets and the fact that valuations have come down significantly. Companies that need to fundraise in the short term are finding it harder. This is concentrated in some of the startup and SMB folks. This means that a category of customers and builders in the space that are tightening belts to extend runway. There’s some of that in the short term.

In the long term, I don’t see it having major, major impact. Any time we have a cycle like this, in some ways, it’s pretty natural. It will impact some more than others. We are watching it closely, but overall impact to us hasn’t been significant. We have it pretty balanced. We support SMBs all the way up to the Fortune 5.

As we all know, this story is also not done. It will be interesting to see how this unfolds over the next couple of quarters and year because there are tons of investment dollars available. It will be interesting to see when those investment dollars start to come back into the market. History can help us learn from other experiences, such as recessions, 2008, and the dotcom bubble bursting. It’s not totally uncharted, but we are paying attention to it pretty closely.

What will be important to the company over the next couple of years?

Most important for us is to continue to obsess about our customers. You heard me refer to them as builders. We are early days with the impact that builders are going to have in healthcare. It has never been more apparent to me that now is a great time to be a healthcare builder. We will continue to obsess about the people we support and continue to obsess about the use cases that we support. Doing that means we need to continue to power broader and broader sets of data to exchange. 

We’ve broadened from being clinically focused to many types of data. Today, Redox is focused on data access and integration. As we look into 2023 and 2024, the interesting opportunity for us is to start to support more and more of that healthcare data journey on its path to ultimately being useful. We are working on some exciting things that you will start to hear from us later this year and early 2023. It will enable a whole other class of builders.

With all the craziness going on in the world right now, there has never been a better time than right now to be a health tech entrepreneur. Now more than ever, healthcare as an industry is primed for change. My closing statement is to all of the builders out there. Don’t wait on the sidelines. Come on, let’s do it. There’s plenty of work and plenty of opportunity for impact.

HIStalk Interviews Anders Brown, Managing Director, Tegria

August 22, 2022 Interviews 1 Comment

Anders Brown, MS is managing director of Tegria of Seattle, WA.

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Tell me about yourself and the company.

Tegria is a 4,000-person healthcare technology services business. We are focused almost exclusively on the healthcare provider market, but we also service the payer and insurance markets across both the US, Canada, and increasingly Europe, specifically the UK, where there’s a lot of activity happening. We were founded by Providence in October 2020. I’ve been with the organization for about four years since the inception after working most of my career in technology consulting services.

What is the strategy behind a health system acquiring and operating health IT companies?

It was quite exciting when I got the opportunity to talk to the Providence leadership team and join it. Providence is one of the largest healthcare systems in the nation, a 175-year-old organization with a mission-driven idea of creating healthcare for everybody, better healthcare systems for everyone.

The idea was, what if Providence took a lot of their learnings and a lot of the investment that they were going to make to transform their own systems and expressed that to the rest of the nation, to a certain extent, through an organization like Tegria to try to help everybody move forward in the current landscape and environment that we have? For me personally, it was a great opportunity to look at healthcare. I’ve been in many, many other industries and joined something at the very early stages that I thought could make a huge impact over time in the healthcare market.

How do Providence and Tegria work with each other?

The first important piece of context is that we have grown Tegria through both acquisition as well as organic, ongoing growth. We now count well over 400 customers in our active customer base, Providence of course being one of those. We are an independent organization, so we have to compete for work at Providence, like any other folks would compete. But certainly being close to them and having connections to them gives us some insight into how someone like Providence is trying to transform their healthcare system so that we can take those learnings out to the rest of the industry.

Does Tegria have Providence-created intellectual property?

We certainly have the idea that we would like to technology-enable many of the things that we take to market. Tegria is one of the commercial efforts that Providence has. You might have seen recently that Providence also spun out Advata, a software organization that is almost a sister company of ours, and we work together. But right now, Tegria is focused more on technology services and technology consulting.

Several big health systems have recently outsourced their IT services, revenue cycle management organization, or both. What is behind that trend and how will it impact Tegria’s strategy?

In some ways, that trend is exactly what our business strategy is and plays into. Our fundamental thesis over time is that many of the healthcare systems are better served by putting all of their capital into taking care of their communities and effectively building better healthcare for the nation. To the extent that Tegria can work with them to not only improve those on a project basis, but over time take over some of those operations so that we can essentially gain some efficiency and hopefully reduce costs for those healthcare organizations, that gives them more capacity and more capital to improve really their care delivery, which is the priority and the focus of many of them. We see the same headlines that your readers see and we are certainly are out there doing what we can to win our fair share of that work.

As big health systems get bigger and expand beyond a regional footprint, how will that change their use of technology to scale and become more efficient?

The scaling of healthcare, or the growth of some of these healthcare systems, provides an opportunity to standardize and modernize the platforms, which can now be at some scale and offer increased efficiency. That efficiency leads to reduction in costs and then an increase in capacity to deliver healthcare for people’s communities. The opportunity for smaller hospitals is to continue to look towards the larger healthcare systems for direction and for partnership. We talk to both of those kinds of organizations and are focused on delivering that kind of value across both of those segments.

How will digital transformation change the relationship between healthcare organizations and consumers?

Our position is that we are at a unique point coming out of the pandemic. On one hand, we have consumers asking for more and more convenience and are willing to change their healthcare provider for that convenience. On the other hand, we have the providers themselves, the clinicians and doctors, who are frustrated with burnout and trying to understand how technology will make their lives better. 

This idea of transformation comes up a lot in conversations that we have. The challenge with that word is that it means something different to everybody. Our perspective is that you have to meet people where they are. For some folks, transformation can mean simply moving some data to the cloud. For others, that could be full-blown EHR replacement and implementation. It’s important to move forward, but the pace and speed at which you do that will depend on exactly where our customer is in that journey.

Health systems that mostly competed only with each other are now facing big companies such as Optum and CVS Health that blur the line between insurer and provider in trying to attract the same consumers. What influence will those companies have?

You see a number of interesting trends, and you commented on a couple. One is this payer-provider connection. The idea of retail being a connection point for healthcare. The third, which just was announced, is big tech, in this case Amazon, entering these markets with their acquisition of One Medical.

Change is afoot. There are pressure points on these healthcare systems to respond to these external new entrants. Our viewpoint is that technology can help, but the idea is that people see the opportunity to create efficiency and see the opportunity to deliver better patient care. Our goal at Tegria is to help all of those organizations do that.

What is the future of deep-pockets technology companies like Microsoft and Oracle entering what seems to be an appealing healthcare IT market?

It goes back to what these large organizations, whether it’s Microsoft or Oracle or Amazon, see, which is the opportunity for technology to make a huge impact in healthcare. At the same time, the healthcare providers themselves will benefit, in theory, from some of the scale that these organizations can bring and take advantage of that technology. So again, they can focus on what they do best, which is the clinical care, having the doctors and clinicians that can take care of the patients and their communities.

Our view at Tegria is that we will continue to partner with these large organizations and help deliver some of the best solutions out there to these healthcare providers. But it’s certainly a trend that has started and that I believe will continue to move forward for a long time.

How will financial market conditions that have driven down company valuations impact Tegria’s participation in mergers and acquisitions?

Tegria is totally focused on continuing our growth. We have aspirations to continue to grow not only the service offerings that we provide, but also the geographies in which we provide them. To the extent that he macroeconomic environment changes valuations, we’ll just be there with everyone else looking for opportunities. We’ll continue to grow organically as well. But for us, it really doesn’t change our strategy as much as it continues to support where we want to take the organization.

Where you see the company in the next three or four years?

Tegria is founded on this idea of trying to bring the best technology solutions to our customers. We will continue on that trajectory. We are excited about the next decade of technology and transformation that we think this industry will go through. We want to be there arm-in-arm with our customer base to help them move forward. It’s exciting times in healthcare and will continue to be so for quite a while.

HIStalk Interviews William Febbo, CEO, OptimizeRx

August 17, 2022 Interviews No Comments

William J. “Will” Febbo is CEO of OptimizeRx of Rochester, MI.

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Tell me about yourself and the company.

I’m CEO and director of OptimizeRx, going into my seventh year. I’ve been in healthcare technology for about 25 years. Early on, I decided to put myself between industry and healthcare providers and patients and try to use technology and data to make that relationship more seamless. That’s obviously a challenge, but both groups need each other. I’m excited to be part of OptimizeRx because It helps me down my personal journey to get those two groups communicating better with technology and data and doing it all compliantly.

OptimizeRx is a health technology platform that enables digital engagement among our clients, life science organizations, healthcare providers, and patients, particularly at critical junctures through the care journey. We reach about 60% of healthcare providers and millions of their patients through this platform that we’ve built over the years, which we call Digital Point of Care Network. We like to say, as a team and in our culture, that we are helping patients start and stay on their medication.

Pharma marketing used to involve aggressive sales reps and buying lunch for doctors. How has that changed?

Even before the pandemic, acts such as HITECH and Sunshine made it nearly impossible to continue the usual lunches, entertainment, connectivity, and building relationships. Then the pandemic hit and made that even harder. The industry is going through a pretty big change right now. Everyone woke up in January 2020 thinking pretty much the same strategy — we’ve got our reps, conferences, and speaker bureaus and we’re figuring out this digital thing to try to make it all smoother.

Then obviously we all had to stay home. What we saw as a company — and I think my peers did as well after talking to other CEOs and team members – was that all of a sudden there were a lot executives from our clients in meetings around digital enablement of connectivity. How to communicate, how to leverage call centers using technology, and how to communicate at the point of care, the point of dispense, and in the waiting room. Obviously digitally, because we were all staying home.

Then in 2021, we saw a lot of micro trying. Pharma tried, either through agencies or directly, lots of different solutions. OptimizeRx has been in the market for a while. This is our seventh year. We like to say we re-founded the business to have a broader platform to approaching communication between industry and doctors and patients. But the pandemic helped awareness and adoption happen. One of the challenges was that a lot of solutions stepped up. They all sound terrific when they’re presented. When you can’t talk to your clients, you’re going to try anything that’s compliant. 

What we have found lately is that pharma is seeing some terrific digital technology and now wants to see who can scale. They are looking at the whole country and then beyond the states as a way to communicate, and not just micro populations and pilot tests with different solutions. 

The pandemic helped pharma lean into digital more, to put continued pressure on the model of people and gatherings, but certainly didn’t kill it. There are lots of questions every day that doctors have for reps in their territories, especially as we’re seeing so many specialty medications come to market. If you think of how many medications people are on and the type of conflicts those can have, then there are questions. So that infrastructure is needed, but I think we’re going to see a wonderful hybrid of digital enablement and people working together and pharma helping that move as fast as possible.

In a perfect world, pharma marketing would benefit the patient, the prescriber, and the sponsor company more than just blasting ads to increase product use.

That’s right. We focused in on two solutions. TeleRep is a connectivity point in the workflow of EHR that the doctor can click on and connect to their local rep to either email or text a quick question. We found in a newly launched six-month case study, and this happened to be in the autoimmune area, that 89% of the brand reps were contacted. It’s a button in the workflow.

There’s not much hard about that, other than getting it there and making sure the doctors are aware of it, but we saw a 42% increase in the engagement over the baseline. It was relevant, timely engagement and support at a time where people had questions and the reps couldn’t be in the hospital. We think there’s some real benefit that’s coming out of the connectivity, but the key is being in that workflow and being present because doctors are on EHRs a big part of their day.

We also launched a real-world data evidence solution that addresses the lack of interoperability between EHRs. We gather data on a patient cohort from various sources. We then build an algorithm around a mechanism of action so that we can compare a patient in workflow to a set or cohort of patients and trigger the appropriate message to the physician at the right time. Targeted, data-driven, and highly relevant. For our clients, we uncovered a significant opportunity and saw an increase of their addressable physician audience of about 200%.

We hear a lot about the newfound effectiveness of inserting information into the clinician’s workflow. How will companies and organizations avoid the clinical decision support dilemma, where users get so frustrated with unwanted or unhelpful interruptive messages that they tune them out completely?

We work with our partners. Their clients are physicians. Through our Innovation Lab, we partner with these EHRs and hone in on the pain points or friction points that frustrate physicians when in the care journey.

Trying to come up with a platform that tells a doctor what to do clinically is not wise. They can do that. The key is giving them tools that help them get information that is highly relevant. Not tangentially relevant, but directly relevant is the key. We also heard from talking to physicians and our partners — no more clicks, no popups, don’t disrupt the workflow. That’s key to keeping the noise out of that care journey.

People with good intentions have come up with lots of solutions, but there’s always a sentence at the end that says, “They just need to go to this app or just need to go to this website.” That’s the hardest part of those models. Physicians aren’t looking for another app. They’re not looking for another website. They really don’t like working in the EHR, but they have to. The key is focusing in on reducing friction, actually reducing time on the tech, and bringing the right tools and information at the right time. That’s hard to do if you’re not integrated, because otherwise, you’re asking them to go somewhere else, and frankly, they don’t want to.

How can technology support the increasing use of specialty drugs and their associated information burden?

It’s a huge problem. You have awareness prior to prescribing, but then a whole host of problems post-prescribing. Pharma has used specialty pharmacy contracts and also hubs to try to make that better for the patient. We had a partnership with a company called EvinceMed last year, which built technology to give an alert about which specialty pharmacy should go with a prescription. They did some of the prior authorization work between the EHR and the specialty pharmacies and the hubs.

We ended up acquiring that company earlier this year because we saw such a friction point, so much frustration with the doctors and the patients and the hubs, and the whole ecosphere. This was a really elegant technology. A couple of other companies are doing it as well, but it’s a big space with so many new medications that have different distribution channels.

Specialty drugs are expensive and complex and involve a lot of questions. Just calling through the pharmacy is not going to do it 100% of the time. The technology that we acquired and that others have is trying to take that friction out, focused on specialty only, not the general meds or the volume meds through retail. We’re pretty excited about that space. And the same way we help agencies help pharma, we see an opportunity to help the hubs help their clients. Technology is going to be a friend to that problem.

Many digital health companies have taken a hard fall in share price along with layoffs. What factors will determine which ones succeed or even survive?

We and our peers have all taken it on the chin. There’s different reasons for different sectors, but what the pandemic did to the investor base was get them excited about solutions that can help with health. That’s happened in fintech and in the consumer world and it rushed into health. There really aren’t that many public companies that can scale.

You had a real rush of retail and institutional investment. In the exuberance, there were some mergers and acquisitions that frankly just either didn’t make sense or couldn’t sustain what was promised. The investor base, at least the one I talk to, is looking at who has a long-term, sustainable competitive advantage. Who’s your client? Is it pharma? Is it a payer? Is it the government? Is it providers? There’s just so much more awareness now.

As pharma leans more towards digital, they are going to look for clients that scale. That makes it a good opportunity for investors. They can look at companies that are public and private that have true connectivity to an HCP or patient and can improve care and not just be a website.

I’m excited about the space. Most of us get into healthcare to actually make a difference and don’t get too caught up in stock price. That’s what I tell my team. Our culture is not about the stock price. It’s about helping patients start and stay on therapy. If you just delight the client and focus there, you’ll build a great business. We’re all getting over the drop in valuation and are focused more on the clients, doctors, and patients.

What will be important to the company over the next three or four years?

We are focused on our clients being connected digitally to doctors and patients wherever they are. We want to help patients start and stay on therapy. We want to get rid of friction. We’ve made huge progress in the almost two years since you and I last spoke. We have enhanced the leadership team, won all sorts of really cool awards around that RWD solution, and added some great people in AI and just great team members. The issue of communication has only gotten more challenging. It’s still a fragmented way to get to people. We will not only have the platform to facilitate that, but it will be omnichannel as well. We’ll be able to get to them wherever they are, whether that’s in the hospital setting, at home, on their cell phone, or in the pharmacy.

HIStalk Interviews Matt Roberts, Healthcare Industry Practice Lead, Juniper Networks

July 25, 2022 Interviews No Comments

Matt Roberts is global practice lead, healthcare industry of Juniper Networks of Sunnyvale, CA.

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Tell me about yourself and the company.

I’ve been in healthcare IT for over 20 years. Right out of college, I started working in network closets, doing desktop rollouts as part of an internship with Health Midwest back in 2000. I was supporting one of the first Cerner Millennium projects in Kansas City, which led to them offering me a job that I accepted. I worked for Cerner for 10 years, living in hospitals and clinics. I helped them set up one of the first HIEs at the Tiger Institute at University of Missouri. I had an offer come my way to take my healthcare expertise over to the networking industry and I joined a company called Brocade. I led their healthcare go-to-market for roughly six years before we were acquired.

I’m now at Juniper, which is a pure play networking and security company. We are absolutely focused on delivering simple and secure experiences for those who run the networks, and even more importantly, the patients, the clinicians, and the staff who depend on the network.

What are the biggest network challenges of health systems?

We see a lot of Band-Aided networks. I’m a big fan of treating the cause, not the symptom, so when we  look at what happened through the pandemic, there was a lot of stress. It was a dark place for all of us. We all have our own experiences, but it was tough. Through tough, we find ways to innovate.

During this time, many providers discovered that their network should have, and could have, been a more strategic asset, probably more so than originally perceived. We walk up to a water faucet, we turn it on, and we expect water to come out. That was the perception of the network. Until it goes down, nobody really cares. But we have seen the whole delivery model shift, so we have moved to a more virtual model and distributed model, Everything is Internet of Things.

As things continue to shift, you have to take a look at the network. It has become more important. A healthy network puts the organization in a position to scale, to integrate emergent technologies. The chief nursing officer walks in and says, “I need this technology connected today.” IT has always been a “no” center. It has to become a “yes” center and say, “We are going to be able to accommodate that for you and figure out how to integrate it into the workflows.”

How extensive is the need to re-architect health system networks due to consolidation, where new care venues of all kinds need to be brought into the connectivity fold?

Consolidation and acquisition play a major role in being able to integrate the technology seamlessly. As seamless as some of it sounds, you are also often acquiring organizations that don’t have the same standards that you have. How do you rely on integrating proprietary technologies and the way things have been architected at a technical layer from a topology standpoint? You may have to unwind some things to get that new system on board, whether it happens to be multiple hospitals or multiple clinics. It plays a critical role.

Open standards, or standards-based technologies, are important for this exact purpose. Being able to onboard quickly, to integrate seamlessly, and to provision your networks more efficiently, as opposed to having to wait weeks, months, and even sometimes years when you start to get into the project work.

Is it challenging to bring those new locations and networks up to security standards?

Yes. Security gaps are everywhere. The harsh reality is that no one vendor does it all. When you start to look holistically at the security posture of the organization, we are doing something differently at Juniper. We treat the entire network as an enforcement domain, looking at every connection point that exists within your network. It’s not just next-generation firewall, DLP, or an ATP appliance or software. Cyber criminals are getting smarter, where minutes, much less days and hours, aren’t fast enough. How do you identify and mitigate a threat immediately as it comes in?

I use the analogy of how many locks you have on your door at home. You have deadbolt, a push button, an extra lock, a Ring doorbell, and maybe a German Shepherd behind the door. You have multiple layers of different protection. When you look at your security posture, there’s not a one-all, be-all.

Healthcare is among the top industries, maybe number one, for cyber criminal activities because the information is so rich. You have to look at new ways instead of just throwing a bunch of firewalls out. Protect the entire domain and know what’s going on in the entire domain. Then be able to identify something that looks fishy and shut it down so it doesn’t propagate through the entire network.

What changed during the pandemic?

The network is the lifeblood of the healthcare enterprise, like the vascular system of the human body that pumps our blood to and from the heart. The network is your vascular and immune system. If you don’t have a healthy network, the organization is at risk. The pandemic created gaps. But we see positivity as people understand how strategic the network is. It’s not just watching how the packets pass and getting bits and bytes to their destination without latency. You have to look at the whole thing, the hard and soft costs around the economics. Are you buying the same brand because that’s all you’ve known for the last 20 years? Look at what’s fit for purpose. Look at what molds well to what your organization is trying to do. Are there better organizations out there that are leading edge about trying to help also make you more efficient?

That’s where we come in. We are focused  on experiences. If you’re the IT operator, on the network or help desk teams, or an end user such as a doctor or nurse or a radiologist sitting at home, how can that network work for you? Or how can you not have to pick up the phone and call the help desk if you’ve got a really crappy connection? We are starting to see small, medium, and large entities, from smaller hospitals to larger health systems, looking at the network. It’s exciting because they are looking at newer technologies that are different from what they have done over the past 20 years. 

The industry has evolved so much. It involves AI. It involves a lot of capabilities that have moved beyond the marketing hype that allow you to focus on not only delivering a 24/7/365 experience, but to put you in a position where the network is working for you versus having to dig and spend hours trying to troubleshoot issues. That’s where we can help as well.

How are organizations using indoor location services?

When I talk about location services, everything is built into our access point. Think w-fi. We use what’s called virtual Bluetooth low energy. We have a patented array that sits in the access point. We are the only one in the industry that does that. In the Gartner Magic Quadrant for indoor location services, we are in the leader quadrant far over to the right. We are the only networking vendor in that particular space.

Delivering location services is a journey, to be fair. An organization has to have a strategy around that. It starts at looking at the use case. Maybe you want to greet people as they walk in the front door and offer them a turn-by-turn indoor navigation experience because of late or missed appointments or people getting lost throughout the facility. Maybe you want to track critical medical assets because wheelchairs and pumps are getting lost – studies have found that 20 to 30% of mobile medical equipment is lost or stolen. You can deliver these location services directly off of wi-fi now instead of buying a bunch of different pieces and parts and overlay RTLS systems.

However, we integrate seamlessly with those. We’re an open standards-based company. The value for healthcare is to look at open API strategies, to look at exchanging SDKs and other software defined kits, to integrate into other entities like Stanley and CenTrak so you don’t have to do a rip and replace. Cost preservation is big in healthcare. I’ve been in healthcare 20 years and I want to save healthcare a lot of money and make it more efficient. We seeing an uptick in all the different types of location use cases to get a consumer engagement platform in place. Hospitals and health systems can engage with patients and guests while also helping their staff become more productive.

What about proximity alerts involving visitors or employees?

It is opening more opportunities. It creates this platform for IOT, but it also creates a platform for at least understanding who is coming into your facility. We don’t record PHI. We’re just looking at devices. If you walk in with a  Bluetooth capable or enabled device, such as a phone, it  can be detected. You see this in retail, hospitality, and a lot of different industries. We can get within one to three meters, or even closer to the one-meter mark by using  BT11 devices.

That lets you understand what is happening with your facility’s foot traffic. It came more important in the heat of COVID for proximity tracing and dwell times. If a facility needs to disperse a hot zone, they can push a notification out to everybody who was congregating when they shouldn’t have been. We can do these directly out of our dashboarding capabilities and the integration work that we can do with engagement type devices over mobile.

What healthcare developments will we see in the company and the industry over the next few years?

We literally are changing the game again. The accolades are out there. Everybody can go look and see from a lot of the analyst community and industry recognitions that we truly are improving the end-to-end visibility. Insights into users, devices, and applications creates a fine-tuned experience for clinicians, patients, and the people who are running the networks.

We are dramatically simplifying the operation. Using AI to proactively notify IT when there’s a problem, provide a fix, and automatically open up trouble tickets in ServiceNow or whatever your ticketing system is. Imagine not having to chase a doctor or nurse to ask them to re-create an issue. We are eliminating all of that.

Nobody has seen this in healthcare. It’s a foreign concept, and it sounds too good to be true, but the reality is that we are changing the dynamics of how we make people more efficient. Talk about provisioning all those acquired clinics and hospitals as we mentioned before. We can use the cloud and microservices so that the AP and the switches are ready. As soon as you acquire somebody, and you have plans to basically roll out a new network, with single-click activation it literally can be plugged in as soon as you ship it to that device. Or let’s say that the clinic is two hours away and somebody can’t travel there, you can have somebody do this over distance, reducing the truck rolls, the touches, provisioning networks by 50 to 70% better.

Nobody has seen it in healthcare, and this is where we get excited. This is where I get excited sharing my message with you on what we’re doing. We are at an interesting time where people are coming out of the pandemic and doing digital transformation initiatives. The network should be considered when you start throwing all of these other things on top of it. That’s your foundation, and we want to make sure that you have the most modern foundation that is possible, one that can scale for many, many years.

HIStalk Interviews Diana Nole, EVP/GM, Nuance

July 18, 2022 Interviews No Comments

Diana Nole, MBA is EVP/GM of the healthcare division of Nuance, a Microsoft Company, of Burlington, MA.

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Tell me about yourself and the company.

I’ve been with the company just a little over two years, but I have been around healthcare IT for about 15 years, which makes me a little bit further along than just a novice, I like to say, because it’s such a complex industry. Since we last spoke, Nuance has become a Microsoft company. Nuance is a technology pioneer, focused on conversational AI and ambient intelligence and working on how to put things into the intelligence, into the workflow. We are heavily focused on reducing the administrative burden of clinical documentation. Our offerings are used widely throughout the US and globally.

Microsoft’s Cortana doesn’t have the adoption of competing voice assistants from Amazon, Apple, and Google. Was that part of its interest in acquiring Nuance?

There were probably a few levels of interest. We are heavily into the deep workflow of clinicians and the patient experience. We try to understand heavily with our customers and our partners what’s going on in terms of patient care and this focus on the Quadruple Aim. We have a deep presence. We are in 77% of the US hospitals and I think we were quoted as being in 80% of radiology. In healthcare, it’s about how the technology is being used to actually enhance patient experience, physician experience, et cetera. There was the actual technology that we have, but even more so, the relationships that we have and the clinical care. Then, the deep relationships that we have with our EHR partners and other partnerships were very much of interest to them.

Now that Nuance and Cerner are owned by highly competitive technology giants, how will Nuance’s relationship with Cerner customers work?

We deeply value these relationships, as you can imagine. Our solutions have to work within the workflows that our physicians, nurses, and radiologists use. We have had ongoing conversations with Cerner since the acquisition. Clearly, we are deeply committed. We have continued to advance our solutions, such as DAX integrating with Cerner’s virtual scribes. There’s a lot of opportunity here, and certainly we don’t want to disrupt that.

That has been a very key theme of our conversations with Microsoft, that they value that. They are deeply committed to their partnerships and the systems integrators that they work with. That’s a core backbone of who they are. We continue to advance — whether it’s Cerner, Athenahealth, Epic, et cetera — these relationships, because the only way that we can be efficient in the way that we deploy our technology is to do it with them.

Oracle says that it will use its own voice AI product as the primary user interface to the Cerner clinical systems it now owns. What challenges do you see in that approach?

We obviously always know that there will be competition out there. We have been at this for a long time. Medical technology and terminology is very different from just straight conversation. We have invested deeply over many, many years and have many years of experience. We respect that others will come along, and that’s why we constantly are working on our own technology advancement and why we have moved from our medical technology and things like Dragon Medical, which is used by so many people, into more of the ambient environment, which is even more complex. You have to keep pushing yourself, and competition helps you move along because you need to stay ahead of that if you are going to survive and be effective.

I can’t speak specifically to what Oracle’s plans might be, but certainly for us, we are deeply invested in continuing to advance our Dragon portfolio, our DAX portfolio, and other things with our partnerships that we have and investing in the technology. Now we have a phenomenal owner in Microsoft that can help us advance those solutions while also having the cloud infrastructure and cybersecurity infrastructure that they bring to the table to help complement the first-party applications that we have.

What new capabilities does the cloud bring to healthcare?

We have deeply been invested in cloud. The big reason that we are trying to help our healthcare customers move into the cloud is that, historically, we have had a lot of on-premise solutions. It as always challenging to do upgrades, and you want to get the innovation out there as fast as possible. But we also know healthcare has significant worries about privacy and security. We are evolving at a good pace. Certainly with someone like Microsoft, we have deep investments on that side. Once you get everything in the cloud, then we have a good infrastructure to start to unlock other kinds of use cases for the information that resides within the cloud, under the constraints of doing what we’re supposed to be doing as good stewards of the data.

As we have started to think about the combination of our two companies, we think about analytics, reporting, and how you do communication. A lot of things in healthcare are about getting the communication to the right player and the care team. How do you use communication tools to be able to do that? 

Also, things that help enable different kinds of care settings. I’ve heard people talk about the hospital at home. We certainly have seen virtual care advance during COVID, not just with telehealth, but other types of thinking and capabilities. That is helpful because it tries to get at a better physician experience, a better patient experience, while also hopefully reducing cost and not sacrificing quality at all.

Hospital consolidation that creates larger, more tech savvy health systems has generated ideas around scaling patient engagement, call centers, and other centralized consumer-facing technology. Where do you see that progressing?

I think we learned a lot during COVID about what people would accept. We have a tremendous ways to go with consumerization and what you can do to engage patients while also recognizing that you have to deal with accessibility. Not everybody has access to things such as the internet. We also have learned that, so we have to be careful. We have made advancements in basic blocking and tackling, such as outreach around reminders. As a patient, come in and get your mammogram, get your annual exam, get your preventative care. That makes a huge difference. But other settings are starting to be considered, such as better management of clinical trials with a virtual patient clinical trial cohort.

With regard to the care setting, not just telehealth, what can you do in monitoring a patient with a more chronic condition at home? Maybe that is more integration with med tech, home devices, and things where you can identify if and when a patient needs to come in for a visit or to have follow-up. Always trying to prevent that rising risk of issues with the patient. There are definitely opening thoughts around other areas beyond just the typical reminders and telehealth. more sophisticated things that are going to be coming.

Voice assistants are being enabled to support consumer health needs at home, including remote monitoring. How do you think that will progress?

Voice assistants, definitely. We probably have seen more initially on the roadmaps with physicians. The physicians can use “Hey, Epic” or “Hey, Cerner” or “Hey, Dragon — bring up this, bring up that.” It’s much quicker than clicking, because you can speak faster than you might type or click certain things.

But you are also right that in a conversational way, it is easier for a patient who doesn’t know exactly what they’re supposed to be looking for, or how they get basic information. We’ve had some solutions where it’s just simple things that the patient is looking for, such as, “Remind me about this situation that I should be taking care of,” or “Where is the valet parking at the appointment I’m going to?” Just basic interactions that used to flood the healthcare system with basic conversational questions. Those kinds of things can be done now through easy to use, consumer-oriented types of applications, but specifically for healthcare.

DAX has been out for a couple of years. How is it being used and what work remains?

It has been about two years since DAX was announced during COVID. It almost matches the exact timeline. Definitely we would view it as being at the Slope of Enlightenment, where our customers and partners are proving the benefits and use cases within their organizations. Initially, people would start with groups of 25 physicians. Now we are starting into the hundreds, and we have implementations that are well into the thousands. What they are trying to prove is who the right user for it is and where the most opportunity is.

We started out with certain specialties where we thought it would be easy to use and produce a good ROI. We have seen that family medicine and internal medicine have more of an opportunity to use the system than anywhere else. That is where the burden of clinical documentation creates the highest levels of burnout and where we have a shortage, either already in existence or coming.

We published some great opportunities with our customers on what they are seeing. They get better patient experience input, since the patient feels like the physician is talking to them face to face and focusing on them. They understand what they are supposed to do when they leave a visit. As to the physician experience, they are less burned out. They have more of their own time. They can get home. They can take on more patients if they want. Even though it has been two years, we are still in the early days, but definitely have proved a significant ROI for those who are using it.

What has changed in the months since the acquisition closed and what changes do you expect?

I would say that not a lot has changed. At Nuance and at Microsoft, we continue to remain focused on our customers. We continue to deepen relationships with our EHR partners. We are now part of the Microsoft organization. We are a Microsoft company. What we have done since the close in March is to focus on what our shared vision looks like. Our customers are looking for that. They are optimistic. They realize the big, complex challenges that face healthcare, and they really want to have Nuance and Microsoft look together at how can we enhance the ability of clinicians to care for their patients and deliver better outcomes, where technology helps to enable it instead of getting in the way.

We are focused on that right now, and we are involving customers and partners in those conversations. When you think about the combined power of Nuance and Microsoft, where do you see opportunities, and where do you think we should work on this? That’s what we’re focused on, so that we can begin to unlock some of the opportunity that spans both of our companies over the course of the next year.

Another thing we are excited about at Nuance and Microsoft is a partnership with The Academy around an AI collaborative. It’s early days, just announced recently, but it’s an effort to bring together clinical and operational executives not only from provider organizations, but from payer, med tech, and life sciences. We will create a dedicated sandbox for us to experiment with AI and have them, as users of AI, tell us where it will work or not work to guide some of this collective vision that that we are working on.

HIStalk Interviews Ashwini Zenooz, MD, CEO, Commure

July 11, 2022 Interviews No Comments

Ashwini Zenooz, MD is president and CEO of Commure of San Francisco, CA.

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Tell me about yourself and the company.

I’m a radiologist by background. I’ve been a practicing physician for most of my professional career. I made the switch a few years ago, officially, to government and policy. I worked on Capitol Hill and then moved on to continue my work in government at the Department of Veterans Affairs as an executive, then continued my work from there into tech.

Throughout that entire process, I’ve been an avid lover of what technology can bring to healthcare. From my first days as an attending or fellow, I remember all of the things that you could do to have more efficiencies in healthcare, and technology is at the core of it. I believe in the power of technology and I think we are at a great time at the intersection of tech and healthcare, so I’m excited to be here.

I joined this company because the single theme that I’ve been seeing throughout my career is that we have a lot of point solutions and they are continuing to increase. COVID just blew that out of the water. That’s great, because it brought a lot of access to patients and a lot of great solutions, but it became an even more disconnected system. The premise of this company is, how do we bring all of that health tech disconnect to make it work and empower the healthcare workforce? I love that idea, so I wanted to come here. 

We are building the first health tech operating system. Our goal is to bring in and unify multiple data sets and data services so that it is meaningful for the clinicians during those micro moments of care, help with the performance of the organization through these applications; innovate; and give the tools for the systems that are using us to have a platform for innovation that is unifying. I love that concept. We always talk about interoperability from a technology perspective, not from, how does it impact users and how do we make it work for them?  I love that we are actually bringing action to interoperability.

Who are the company’s competitors in data aggregation and API services?

The first thing I would say is that I don’t view data aggregators and API companies as competitors. In order for us to be a functional platform and operating system, it’s important that we bring multiple vendors and last-mile integration companies together. That’s important for us so we can have the data unified in a single place. That’s the first component.

When you reference data integration and APIs, some of that, especially the data integration, has different components. We don’t do the last mile of data integration. It’s once the data is coming together with all these different sources, how do we provide that unification and the unified view? For those, I would say that you could have platform companies as competitors that are out there, anything from a Microsoft or one of the other companies, but they are also partners for us because we build on top of them. Microsoft, Google, Amazon, et cetera.

I don’t think we are yet in a space where we have a competitor because we are the first health tech operating system that is actually bringing FHIR and non-FHIR data together. We are enabling different data structures and sources, and we have a solution where you can actually build on top. I don’t think that solution exists in the market as a whole. If you break down the individual components that we could have for each category, there’s a competitor.

I’m still not getting a picture of exactly what you sell and to whom. Can you give me an example?

We predominantly work with healthcare systems today. If you think of the healthcare system, they have on average somewhere between 10 to 16 electronic medical records or systems of record. They have radiology, laboratory, their main clinical EHR, and they have other data sources. They also work with multiple third-party point solution vendors. 

A lot of times, the healthcare system has to do the work of continually doing point-to-point integration with these third parties to make them effective with the vendors. By bringing in an operating system in the middle, they have found that they can scale those applications across the board by a single plugin. Once you integrate with Commure or you build a solution on Commure, the data automatically flows to anything that is connected with the Commure operating system.

Think of a switchboard, where multiple plugs are connected in. If you are connected into each other, then the data is set up in a way, structured in a way, where it has a common architecture, where you are able to communicate and have data. You have a clinician who has an EHR, they have patient data coming in from the glucose monitor, and you have third-party data that’s coming in. The system has built an algorithm, let’s say on top of Google Cloud for analytics. We can connect the dots and have a system of action. We can bring the algorithm to life and bring it to the forefront for that provider to make the decisions at that moment of care. We’re a transactional system. It’s not retroactive review of analytics. That’s who’s using us, and that’s one example for clinical.

Another example on the platform is using location services. Think about a nurse who is delivering care where there is violence in the workplace. All she has to do is push a button on the badge and we do the work on the back end, where we connect the dots between her to security and nearby employees so we can say, “Here’s the person that needs help.” We can engage. And all of this happens on the back end on the platform, whereas before, you would have to go to a nursing station, pick up the phone, call somebody, et cetera. We are able to connect the dots between clinical, operational, and financial through any app that is connected into the platform.

How do you bring EHR vendors to the table to make their data available?

For the operating system to be functional, you have to work with partners. EHRs are part of the partner ecosystem. It’s not going to work without working with the EHR partners. We have to be able to bring the data together and we have to make it useful. For us to bring the data sources together and for it to be meaningful, we have to work with the developer ecosystem that is building these incredible point solutions in the digital health market. We have to work with the existing laboratory and pathology systems that a health system might use. We have to work with the EHRs and the HIEs that are out there so that we can actually have this data come and for it to be meaningful.

With the PatientKeeper acquisition, we inherited two decades of great clinical experience and workflows that are adding to our vault of solutions. But the overall Commure operating system is going to require PatientKeeper solutions, other vendor solutions, and Epic and Cerner solutions to come together. To me, it’s all about figuring out how to collaborate and not remove these systems that are in existence and bring more cost to the healthcare system. I don’t think we should be kicking out the EHR because the services and functionality that Commure provides are additive and should be enhancing the EHR and enhancing the operational efficiency of the company.

There are a lot of things that the EHRs don’t do that a health system needs, and that a clinician needs. Those are the areas that we are providing a platform for innovation, where you can say, “You have this data. We have these templates for you.” You as a health system can work with your own team or you can work with third-party developers. You should be able to use a low-code or a no-code platform that we have to spin up the workflow that you need within a matter of weeks that it is integrated and connected to the EHR. You have an enhancement of your EHR. I don’t think we should be dislodging them. They do a great job at what they do, which is being the electronic recordkeeping system.

What will the industry look like in five years as startups build products that use existing health system data?

I think it’s fabulous. No one company can be the end-all, be-all in healthcare. If you have a monopoly in healthcare or you think that the EHR is going to be the source of all of your clinical workflows, all of your operational workflows, and all of your financial workflows, one, that’s going to be difficult.

Two, it’s not going to give the system any flexibility to think about new ways to innovate and work faster. COVID has opened up the ecosystem and has allowed for innovation. Health systems in particular realized that there is so much more that they need for a more efficient, better way to engage their patients and their providers. They saw that when we started shutting down and going to a virtual environment or hybrid environment with healthcare. That accelerated the innovation in healthcare, and I think that’s fabulous.

The only issue with that is that with so many point solutions, the healthcare system has to do the job of integrating all of those to make it meaningful for them to use it. We’re working with a healthcare system now that has over a 100 third-party vendors who provide point solutions, and some redundant solutions are being used across departments. That adds to the cost of the healthcare system, which goes against what we should be trying to do.

This is simplistic example, but if you think about the IOS or the Android ecosystem, they create a way for seamless consumer experience through this core data integration platform. Then they enable an easy app development platform and a robust suite of pre-built, ready-to-launch apps. Apple comes with Apple Maps, Apple Calendar, and Apple Mail, but that doesn’t mean that you can’t download one of the new innovative maps or scheduling apps or Waze or whatever that you want to use as a consumer. It is auto integrated. Just because you use Apple Calendar and Gmail for your email does not mean that those two don’t work together. 

I’d like to see that simplicity. That’s where we are going to head with a platform approach in healthcare, where you can have the best-of-breed solutions available to these health systems. But there’s not going to be the issue where interoperability and tech is a blocker. They will function together to reduce the friction for the user.

Has consolidation into bigger health systems enhanced demand for services like yours, as tech-savvy corporate offices connect systems that came with acquisitions?

The short answer is yes. It’s not just the EHRs when you see system consolidation. As we are moving into a new model of work, you’re going to have a lot of non-health system parties that work with the inpatient system. For example, you’re going to have multiple cardiology practices that refer patients and take care of patients inside of a central healthcare system. They are now part of the system. They don’t use the same EHR or billing or operational systems, but you need to give them the flexibility to work with each other. Solutions where you’re able to help with the network of innovation to bring all of this together so that the patient isn’t bothered when they’re going from their external cardiologist into an internal vendor — that’s where I see a lot of change.

It’s not just at the level of the EHR. It’s between the inpatient systems. How do you provide these seamless experiences for these providers, not just the patients, as they are caring for patients and they are traveling between these outpatient systems that are part of a network into the inpatient system? How do you provide the same flexibility as those providers are interfacing with the insurance companies? How do digital health companies refer in and out of a health system where they don’t belong?

That’s the new age of healthcare. It’s this hybrid model of care, the “click and mortar” system. That’s where the platform innovation is going, and we are going to see a lot more of it. It’s great for us because we truly believe that patients should have the flexibility and clinicians should have the data available when they need it without having friction from technology, which is what we enable.

What are the company’s priorities over the next few years?

Right now, we are really, really focused. You probably don’t see a lot of info from us because we are hyper-focused on working with some of our lighthouse customers. We have defined a few focused customers and we want to make sure that we are learning from them and partnering with them to come up with the best solutions. I don’t foresee us changing much from that course, because we are learning a lot and it’s helping us build our product roadmap and introduce new solutions to the market. I would say that we’re going to continue along that path.

We are seeing a lot of requests for payer-provider collaboration and how we can enable that, so we will think about how to extend our platform and the operating system to help connect the dots, as clinicians are working not only across other healthcare systems or across their networks, but also with the payers in the ecosystem.

I don’t think that there’s a silver bullet in healthcare, “one size fits all” solutions. We have to be open to the approach of collaborating and working together, including multiple EHRs working together and multiple competitive companies working together, to help provide the best care for patients and the best experience for providers.

HIStalk Interviews Kyle Kiser, CEO, Arrive Health

July 6, 2022 Interviews 1 Comment

Kyle Kiser is CEO of Arrive Health of Denver, CO.

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Tell me about yourself and the company.

I’m CEO of the recently minted Arrive Health, which until a few days ago was known as RxRevu. I’m part of the original team and have been with the company for almost eight years. We have built a network that delivers cost and coverage information into the e-prescribing or ordering workflows of providers and advocate for real-time, patient-specific, location-specific, moment-in-time-specific insights to help connect effectively marketplace information with clinical decision-making at a high level.

We can all share stories about inconvenience and aggravation due to prior authorizations, prescription coverage and cost surprises, and the increased difficulty in shopping prescription prices with the move away from paper prescriptions, none of which can be easily measured except indirectly on provider satisfaction surveys. How do you think that frustration manifests itself?

There are absolutely mountains of anecdotal evidence. The way that we have structurally arranged the system is that on one end, healthcare providers make decisions based on what they perceive, how they have been trained, the clinical guidelines that exist, and maybe some influence based on the system that employs them. On the other end, health plans and PBMs have developed rules that are intended to guide the right decision to a best-cost decision. Those best-cost decisions are usually behind a curtain, to some degree. There’s a lot of mystery or maybe unique intellectual property in how those things happen and are derived.

The net of that is there are rules on one end developed by health plans, there are rules on the other end being adhered to by clinicians, and those two sets of rules are entirely disconnected. We connect those two things into one experience, because in today’s state, it’s up to the patient to manage the in-between. They have to advocate for themselves with their health plan. They have to advocate for themselves with their provider. Ultimately, their trust is with the provider. If you have a question about something that’s health related, if you’ve got a question post-visit about something or you’ve got a question about a med you’ve been prescribed, your first instinct is pick up the phone and call the clinic where you went, where the decision originated. We are empowering that provider who already has the trust and the leveraged relationship to drive the right decisions, to ultimately take the preferences of that individual’s health plan and put it into the hands of a decision-maker who is already making that decision.

As far as measuring the impact and maybe even the size of the problem, we are finding about 20% of the time when we present other options, providers are adhering to that. That’s just with the workflow intervention. That’s not with a care team or a patient intervention. Just by providing this information in a relatively passive way in workflow, providers are accepting those options about 20% of the time, which is meaningful. That means that one out of five patients aren’t having to show up at the pharmacy counter and realize that their claims have been denied. They aren’t having to call their PBM or their health plan to understand if there’s a prior auth required, and if so, how they resolve that prior auth. They aren’t having to call back the clinic and say, “I can’t afford that medication.” All of those things are resolved in that moment in time.

The way the world is moving, there’s just not a future where providers are not going to be considering cost. High-deductible health plans are ubiquitous now, and patients are bearing a price for healthcare that was never intended for them. The in-network negotiated rate was used in a calculation before, but now patients are faced directly with that out-of-pocket expense, first dollar. Clinical decision-making and cost and coverage decision-making are now one and the same. They have to become integrated, clearly not emphasizing cost and coverage over the right clinical choice, but making sure that the clinical choices that you are making are the things the patients can access and afford. Patients are demanding that.

How much inefficiency is involved with the provider making a clinically appropriate decision and then having to redo that decision without compensation for cost reasons, through no fault of their own?

I think the number I saw in a Health Affairs article years ago was 65 million calls a year to provider offices to resolve exactly what you just described. There are three therapeutically equivalent drugs. You chose A, we wanted you to choose C. The provider doesn’t necessarily have a strong opinion on one of those three options. They just don’t have the information they need to understand that choice and how the health plan is contracted to derive that preference. There’s an absolutely strong efficiency argument for provider offices in general. Making the right decision the first time prevents reworking many of them.

Have you seen a comparison of patient satisfaction with the provider when their prescription process goes without a hitch versus when the patient is bounced around as the middleman?

We are just starting to look at that. Our focus to this point has been primarily on provider adoption, because in our belief, everything starts there. If we can’t compel a provider to use the tool consistently and to influence their behavior in an appropriate direction as a result of this intervention, then everything downstream of that becomes impossible. Most of our focus has been on the behavior change aspect of the tool.

That’s where that 20% or so number that I mentioned earlier is really important. It is many times higher than most of the other things happening in the industry. Multiple times higher than other behavior change measures in the industry. It has been a huge part of our focus, and the key to our value is understanding provider engagement and how and why they use the tool. That comes from being an organization that was incubated within the University of Colorado health system and having intentionally worked with health systems as strategic partners to better understand their world, to better understand the problems they’re trying to solve, to better understand how our solution can impact those problems.

Transparency would ordinarily create a more competitive market, perhaps among insurers, PBMs, or pharmacies. Are you seeing an effect on the pharma supply side of having patients know upfront where to get their prescription filed or what alternatives are available?

Real-time benefit is a mechanism to communicate the supply-side negotiations that have already happened. PBM and manufacturer have decided on formulary placement and what tier and what reimbursement is appropriate. Real-time benefits allow the mystery that was happening in the background to be provided in a way that makes sense to an end user, to a provider trying to make that decision. It will be some time before having that information at the point of care starts to influence, well downstream, the supply-side negotiations. Because in a lot of ways, we are just communicating something that has already happened between the risk-bearing entity and manufacturers.

But I do think that over time, the fact that this is happening at the point of decision is a massive opportunity to think about these things differently. Maybe future-state thinking about other forms of affordability being communicated at the point of care and maybe even directly to patients. That’s the key to all of this, starting to expand our purview beyond just the point of care, but also to care teams and also to the patient themselves. Making sure that we are leveraging our network — which is focused on driving the right decision the first time, whether that’s a med or something beyond a med — to influence point-of-care decision making, care team decision-making, and patient decision-making, all from a common source of information and one source of truth.

That’s where we can start to change systemic decision-making, but it takes all three legs of that stool to do that well. The impact then will be some of the things you are driving at, which is ultimately that adherence will be massively impacted, the patient experience will be massively impacted, and even ultimately how some of these financial decisions around which med and why will be financially impacted. Because we will have the data end to end, from decision to fill, to understand those things, to identify the cohorts, and to understand outcomes. That’s the groundwork that we are laying, this decision network and then the access network.

How hard is it for prescribers to advise patients, using available electronic information, where their prescription will be cheapest given available pharmacies, manufacturer assistance programs, coupon programs such as GoodRx, and insurance coverage? In the paper prescription days, patients could visit multiple pharmacies for prices, then choose which one to fill it.

Today, that’s a tough thing to do at the point of care. I think your point around empowering consumers is the most relevant one. Ultimately we have to put some of this cost decision – specifically, the decision around location of fulfillment and what methods to drive affordability that patient needs — in the hands of the consumer. E-prescribing 1.0 really limited patients’ ability to have choice and patients’ ability to be an active and informed consumer. 

Real-time benefit and price transparency, like the liquidity of price transparency information more broadly, absolutely represents an opportunity to return to that. We can put these types of insights into the hands of the care team that’s trying to support that patient and the patient themselves to potentially select the lowest-cost pharmacy, to select the lowest-cost path of care in general. For sure, that is the opportunity. That’s the turn we are making as an industry and we are making as a company.

Our transition from RxRevu to Arrive Health is part of that. We see our role expanding, both with stakeholders — so not providers alone, not prescribers alone, but care teams and patients — and also around the types of transactions and services that we are able to impact. It’s not just drugs any more, it’s labs and radiology and all of the shoppable things that are coming because of the No Surprises Act, price transparency regulations that have happened, and even the Cures Act to some degree, Patient data itself is more liquid and we are required by statute to engage patients with. All of those things net out to an environment where patients being empowered to make those decisions now is possible. The technology, for a number of reasons, wasn’t capable of doing it, and that has changed.

How will the lab, pharmacy, and radiology market, as well as the company itself, change once prescribers have access to cost and alternatives information during the ordering process?

Providers care a lot about patient out-of-pocket costs. The ability for a patient to actually afford care is usually motivating for a provider, because ultimately, they can only benefit from care that they can afford and access. In some of these more discrete medical benefit site services, the out-of-pocket impact is not quite the same as drugs. We lose some of the incentive for the provider to engage, because providers care a lot about patient out-of-pocket costs, but it’s much more difficult to get providers to pay attention to, or adhere to, plan cost requirements.

This is not a criticism of providers. It’s just that when you think about the way they are trying to make that decision, it’s ultimately doing the right thing for the patient. The right thing for the patient is, can they afford it? That’s where care teams become really important, the care teams that are doing access work, the care teams that are doing referrals, the care teams that are doing prior authorizations. That’s the opportunity that I see to influence some of that other medical benefit type decision-making that’s just more appropriate workflow. That’s where that work is happening and that’s where I think the value is, in concert with a direct patient outreach. Patients need to understand their options, but it’s heavily a care team utility in that case.

What will be most important to the company in the next few years?

The continued capability of health plans to expose price transparency information to their members is really, really important. Critical, even. The continued push for data liquidity as it relates to eligibility, the straight commodity stuff that you need to understand who the patient is. To me, pharmacy eligibility is a good example of that. That should flow freely, because ultimately all you do with pharmacy eligibility is you understand that I, Kyle Kiser, am a part of Health Plan A and Formulary A. That’s more or less like a user credentialing function. 

If you think about an Amazon login, that’s just a ticket to the game. Making that flow freely and as liquid as possible, accessible to any patient who wants it, accessible to anybody working on behalf of that patient that the patient has given permission to. All those things that Cures promises — the progression of that is important because the restriction of that information is a rate limiter to innovation, period. Those two things, from an industry level, are important.

For us, as we look to the future as a company, it’s ultimately how we more tightly integrate point-of-care decision-making, care team decision-making, and the patient themselves making these decisions. How do we create as tight a feedback loop between those stakeholders as possible, so that everybody is informed in the right ways and in ways that drive the right decision the first time? That’s us spending a lot more time in how we are engaging patients and engaging patients in ways that add significant value to the decisions they are trying to make. 

Creating a whole-patient experience for care team workflows. Those are highly fragmented tools right now. If you ask a member of an access team in any health system in America what they use, they’ll give you 30 answers. Really, the truth is those 30 answers are on sticky notes stuck to the monitor, all the websites they have to go to solve these problems — one for prior auth, one for medical benefit prior auth, one for affordabilities content, one for enrollment. Creating a more consistent workflow for that team has a huge amount of value and is low-hanging fruit in the industry. 

Then ultimately, continued focus on point-of-care behavior change. What really drives decision-making in an appropriate way for providers? How do we continue to become value-add to their workflow? Not another alert, not another thing that burdens them, not another of the overwhelming amount of information that we tend to throw at them, but how do you start to drive decision-making in way that is effortless for them to engage with?

Ultimately patients are demanding, and will only continue to demand, that clinical decision-making and marketplace information are considered in one consistent workflow. How do we do that in a way that consistently drives provider engagement and behavior change, and how do we measure all of that? What is our ability to stitch together that complete patient journey from point of care to care team, to patient engagement, all the way to fulfillment? What is the underlying data that allows us to understand when that is working and understand when that is not working?. That’s our future.

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