An HIT Moment with … Michael Christopher

An HIT Moment with ... is a quick interview with someone we find interesting. Michael Christopher is CTO and senior development analyst with Healthcare IT Transition Group.

Healthcare Transition Group has an interesting mix of reference, educational, and consulting products. Give me a short summary of your offerings.

When we put together this new version of our company three and a half years ago (we had been set up as a straight consulting operation for about ten years before that), we had all this on-the-ground expertise in healthcare IT, software development, and capital development, but we wanted to start creating scalable products. Billable hours are about the least scalable business model on the planet, next to maybe cattle ranching.

The kinds of research and analysis we had been doing for clients seemed to fit nicely into packaged business intelligence products, comprised of documents, tools, and video of us splainin’. Consulting had always been mostly about learning and teaching, and now the videos teach what we’ve learned from all those gigs. And instead of paying us $20k over several months, our customers can order a package for a few hundred bucks and have it now. It’s way more scalable and frees us to go out and find fresh heroics to get up to. So far we’ve done "BI Packs" on real-time adjudication, getting ROI from HIT, funding, and various topics related to maximizing reimbursement, including one on the new Denial Engines.

To support that, we began to grow a media side. We had been doing the HIPAA Transition Blog since the birth of the HIPAA era, so we renamed it HIT Transition Weblog and developed some related channels. We started doing lots of Webinars and developed a complete media studio.

Then it was time to leverage our NPI and NPPES (National Plan and Provider Enumeration System) chops and all that new computing power to expand into data products. We had done NPI remediations, working with the official enumerator Fox Systems and others, so we knew some ropes that maybe hadn’t dawned on everybody yet. Like greasing your 837s to glide through adjudication and maximize reimbursements by updating your NPPES record with every legacy identifier you’ve ever used (taxonomy codes, UPINs, Medicare PINs, OSCARs, license numbers …) 

You’ve written extensively on funding for RHIOs and other IT projects. What are some creative ideas that most people haven’t figured out?

Taken together, our backgrounds are split between in-the-trenches HIT implementation, software development, and capital development. I owned a software company in the early ‘Naughties that built finance and constituent management applications for the human services sector, so then I got to do it all at once, develop the software, implement it, and the raise the money for the company (and for our customers, too). A large part of my finance side has been with nonprofit organizations, as executive director, director of development, or marketing VP, and as a consultant in fundraising. So RHIO made immediate sense to me and I started following it very early on. Marty Jensen, our COO, suggested the initial study. We did the first deep analysis on RHIO business models and funding sources based on the RHIOs’ own data, and updated it a little over a year later. We’re considering whether and when to revisit that research in light of changes in mission at the federal level.

What we found and reported was actually shocking. Nearly all RHIOs are constituted as nonprofit organizations under the IRS "charitable" rubric. Logical, since they are in the business of doing public good. But only two of the fifty RHIOs we studied had developed private foundation grants. All but one in our sample said they plan to be self-sustaining through earned revenues, but more than 80% said they expected to rely on grants into the foreseeable future.

Doh! Where do they expect the money to come from? One word: Government. No, three more words: And Big Hospitals. Private philanthropy is responsible for the vast majority of the money for public projects in this county, a 180 flip from Europe and elsewhere, where government has that task. So it made no sense to us: here was this nascent public good looking only to government and its members for its survival while leaving vast quantities of philanthropy untapped. RHIO leadership still seems frightened of the word "fundraising." That’s what drove us to create the Health IT Grant Resource Directory. As far as we know, it’s the one resource that will take you directly to the prospects for private involvement in health IT funding.

I recently sat on a panel with Jack Anthony of Beacon Partners and Cheryl Austein-Casnoff of HRSA to hopefully give the industry some guidance on health IT funding in light of the new Administration. They asked me to talk about strategies, so I picked two: the "Study/Meet/Case" method of capital development (don’t Google it, I made up the name) and vendor Grant Assistance Programs. The latter is where a vendor develops the fundraising/grant writing resources on behalf of its customers so they can buy their systems.

You are doing some interesting work to make actionable data available to providers for billing and for targeting service opportunities. What products have resulted and what ideas do you have for the future?

Two product lines here: NPIdentify Desktop Provider Directories and CarePrecise Data Services. NPIdentify is available as a free download and it looks like it’s starting to go viral. The idea was to put state-by-state NPPES data in a fast, cool application that would fit on your own computer and that your average non-technical office manager would find user-friendly. But since just anybody can download it, NPIdentify is being used across the industry in practice management, health plans, marketing, and even scientific research. You would not believe the customer list. We figured out that we can sell ads (hint, hint) for mad money.

The newest line, CarePrecise, is just now starting to roll out in tests. It will leverage our provider experience, software and data management, and research assets to offer not only provider data sliced and diced for various systems and applications, but also to pull business intelligence out of it. Let’s say you’re planning a clinic expansion. What specialties will thrive there, and which will shrivel? Where should you site a new group practice based on a given stable of specialties? Or if you want to reach a particular underserved population, we can map where they live. We’ll be rolling these out as standard products over the coming months. One product, CarePrecise Access is already available. It’s the complete, huge NPPES database in a form you can easily manipulate on a laptop in Microsoft Access. Way cool for people who want to develop their own products.

Give me some predictions on the healthcare IT industry for the next 1-3 years.

When the numbers start flooding in on IT-driven patient safety and more effective care that go hand-in-hand with cost reductions and revenue increases, we’ll see a rapid expansion in our industry like little else that’s gone before. I would be the first to agree that there’s plenty of evidence here already, but it has yet to begin steering the provider zeitgeist like it will in a year or two.

We need to make better arguments for health IT. Actually, we need to learn how to argue all over again. Health IT has never enjoyed the same focus as that new MRI, and now that could be changed. Sitting in the hospital basement all morose about how we’re being treated like the light bulbs never got us anywhere. We need to organize, bone up on regional strategic initiatives in healthcare, get to know all the players and make them know us, and hit the ground. I want to see a poster that says "HIT Workers Unite: Take It To The Suites!"

I think if I say the "I Word" one more time, I should have to wash my mouth out with soap. But the babble of interfaces and other short-sighted proprietary interests are still the huge barrier to adoption of HIT. Systems that can talk to one another fluently should be the simple, no-excuses objective. Cooperation, or coopetition, needs to be the deep green valley for all our roadmaps in this space. Everything we build needs to plug into what everybody else is building. Whether you are an open source fiend or not, I think that open sourcery, and especially FOSS, is drawing the maps right now, and you really have to look at them.

The NHIN seems to be stirring awake with the recently announced SSA application. RHIOs won’t look the same in a few years, but there will definitely be a network of essentially egalitarian, provider-agnostic information exchange that starts winning goals (i.e., reducing medical errors, containing costs resulting in expanded access to care, and boosting profits across the board) on a game-changing scale within three years. And there will also be rapid growth in proprietary exchanges — possibly faster than the community-based RHIOs — as we watch the technology fragmentation get sorted out. We might see those perceptions of maturity shift enough within a year to start looking for a few hockey sticks on a two- or three-year horizon. I’d like to promise more, but our most recent RHIO data suggest that the dollar size of the RHIO vendor space is still in pancakes.

What’s it like working for a small, agile company and what do you do for fun?

I never want to work anywhere else! … unless the money’s right. Seriously, at HITTG we can be basically autonomous, sprouting new stuff that we see as a need in the industry whenever we like. And when we get opinionated about something, we can just say it out loud; I don’t need to scream at anybody (although that can be fun!), I just make an animated cartoon when I need to vent about HealthVault and the patient privacy folks. Or I draw a comic. Now that we’re shifting to these really scalable products, I can also see a heavier consulting load, and maybe we, too, like our friends in the financial industry, can become as obscenely wealthy as we were truly meant to be.

Never been to the Googleplex, but we’ve decided that our corporate culture must be a lot like Google’s, only a little bit more compact for now.