HIStalk Interviews David Lareau, CEO, Medicomp Systems

David Lareau is CEO of Medicomp Systems.

Tell me about yourself and the company.

I’ve been the CEO of Medicomp for about 15 years. I originally came from a large network background and then started and owned a billing company. I met Peter Goltra, who founded Medicomp in 1978, in the 1990s.

We’re actually a year older than Epic. Epic does many things and Medicomp does one thing, and that is to build a clinical data engine. The Quippe Clinical Knowledge Graph works and thinks the way that clinicians do, so that they can use it at the point of care. It has almost half a million clinical data concepts across all domains. We have worked with clinicians for more than 40 years so that when you are thinking about a specific problem, what are the things that you want to see in all the clinical domains — symptoms, history, exam, tests, diagnosis, therapies, comorbidities, sequelae – so that the clinician can consider any condition or diagnosis and immediately see all of the information that their peers and colleagues over the years have told us they would want to see.

Those half a million clinical data points are both computable — because it has a common data model underneath it — and human readable at the point of care. It has over 10 million mappings to the standard terminologies and accommodates all the downstream processes like CQMs, adequate documentation for HCCs, E&Ms, diagnostic view of the record, and things like care management protocols for nurses, physicians, and affiliated health professionals. We’re starting to get into home care.

You’ll start to see over the next six to nine months some of the significant vendors coming out with a hybrid model that uses large language models and ambient listening to capture information, but then uses our Clinical Knowledge Graph to process it, present it to the clinician, and allow them to navigate it and trust it. It’s evidence-based. It’s linked to sources. 

Once you’ve removed the burden of documentation, how do you accommodate the way a clinician thinks and works in supporting all of the requirements that are now being piled on in terms of HTI-1 and now HTI-2, CQMs, et cetera?  We are pretty pumped about the next two or three years and the way the industry will develop from transaction based to clinical care from a data-driven perspective.

Strong point-of-care technology use cases involve surfacing relevant EHR information and connecting the clinician to medical evidence. How will physicians benefit?

It will help with the acquisition of information with the patient’s involvement, what the patient says and then getting that into the record in some form. Ambient listening stuff is doing it in text. Large language models are good at synonymy and summarizing information. But the clinicians at the point of care are some of the most highly educated and trained knowledge workers on the planet. Most of the time, they know what they want to see. They just don’t like looking for it in the record.

The hybrid model that I was talking about a few minutes ago is to remove some of the burden of entry and documentation, perhaps using AI ambient listening, but then giving the physician transparent, citable, and authoritative comfort with what the EHR is giving back to them among all that information that is in this patient’s record – here are the things that I found related to that problem. That’s that Clinical Knowledge Graph that we’ve been building for years. 

Even though the burden of documentation is lightening, the need to find what you need, work on it, and support all those downstream processes quickly, trustworthy, reliable, predictable — that’s where we fit into this whole puzzle that the industry is trying to put together.

Technologists sometimes miss the significant point that physicians don’t need or want automated help for 95% of their patients, who have a relatively small variety of conditions that they treat all day long. Can personalization or customization give physicians what they need rather than what someone else thinks would be helpful?

You have hit on something that we used to say all the time. Tell me what I need to know, when I need to know it, don’t slow me down, and don’t get in my way. If I need help, I’ll ask for it, and it had better come back quickly.

I’ll give you an example. We’re working with a company that is using ambient listening, AI, and large language models to capture documentation. Certified EHRs are required to have a problem list, which is usually in SNOMED or perhaps ICD-10 in older systems. If the clinician is treating a patient who has a known problem, we can use our Clinical Knowledge Graph to tell them what’s in the record that pertains to that problem, symptoms, and history. Give them their standard presentation so they know where to look – they don’t want each encounter to be a new and exciting experience. It’s formatted the way they want. They can find the information that they need that is related to this patient’s problem. 

If there’s a new problem, like the patient has been  having difficulty swallowing, go to the Clinical Knowledge Graph, type in “difficulty swallowing,” and get a list of things and filter the record for that so they can see it. Do it in a format that the clinician has personalized to the way that they practice. Cardiology is looked at something different than an audiologist, for example, or a nurse. There’s customization of presentation, but there’s diagnostically connecting the information, filtering it, and putting it back to them the way they need it when they want it. I’ll call on that knowledge resource when I need to, which as you just said is maybe three to 5% of the time.

You have said that you stopped using the term AI even though Quippe gives the appearance of applying it under the hood.

I was doing a major presentation for a large medical group in Southern California years ago. I showed a differential diagnostic presentation of a complex patient. One of the 200 docs in the auditorium got up, and before he walked out, said, “Why did I go to medical school if you’re going to tell me what you think this patient has? I already knew it before you even started that. We want real intelligence, not artificial intelligence.”

After hearing that a number of times, we said that we aren’t going to talk about that any more. We’re just going to talk about presenting information that works and thinks the way clinicians do, because we have been working with clinicians for over 40 years to build this thing. We took artificial intelligence out of anything that we said, because people found it hard to believe, and physicians particularly found it offensive.

What are the challenges in using technology to reduce physician burnout?

I think having reasonable expectations. If you set the expectation that large language models and artificial intelligence will remove any need to interact with the EHR because EHRs are just a chore and not a tool, you are bound to be disappointed. Approach it as, “What can this technology be used for that lightens my burden and helps to make the EHR a tool, not a task?” One aspect is summarizing the information that is already in the record. It’s starting to do a decent job doing that as opposed to actually entering data in the record. 

If you use the current versions of this technology to enter data in the record, you have to review it, because there’s still a pretty high hallucination rate. It wouldn’t kill you if it was used in an Amazon warehouse and they ship you the wrong product, but if you put a wrong piece of critical information in a medical record, it can have serious consequences. 

Summarizing it for review, great. Specific things that ease the burden not only on providers, but on people who are building solutions for providers. We are using it to reduce the work we have to do. We have 10 million mappings of our half million concepts to the standard vocabularies. That’s a lot of work, a lot of what terminologists would call in-the-trenches grunt work. AI can help reduce the amount of time it takes to find possible matches and then have somebody look at it.

We approach the point of care the same way. Let’s use our engine to filter the stuff coming out of these models, sort of a hybrid model, and make the best use of our evidence-based Clinical Knowledge Graph, along with the output from the large language model. In that hybrid approach, AI is not going to do everything. It will do some things, such as specific point solutions related to a task or process, but it’s not going to completely take care of the patient. Our role in that is giving the clinician a tool that allows them to find what they want, review it, take action on it, and then use AI for the things that it works well for – summarizing a record and looking in it for occurrences of something.

It’s still early in this. You’re going to see a lot of these companies hit the wall when their initial funding runs out. Then you will see some big players succeed and maybe dominate the industry. There will be a couple of new ones, too.

How about technology that addresses burnout in nurses?

We have always thought that in terms of care delivery, a hospital is a high-tech facility that is run by administrators, but operated by nurses. For the actual, on-the-ground patient care, the nurses are the ones who first notice what’s going on with the patient. The nurses are the ones who call in the physician expert when they need to. They are the ones on the front lines.

Holy Name Medical Center in Teaneck, New Jersey — which was on the cover of Newsweek as an epicenter of the initial COVID outbreaks back in April and May of 2020 — put Quippe in during COVID in the emergency department and the critical care units of the hospital, the intensive care units and the cardiac care intensive care units. They noticed that within two weeks, the nurses had more than two hours a day of time freed from documentation, because we had the data points that are needed to support their processes. We had tools that they could use to design what they were doing in accordance with the processes that were already in place. It was just astonishing to us that they were able to do that.

We learned a lot from that, too. We learned the difference between diagnostic care of a patient and coordinated care team care of a patient, because that’s really where nurses operate. They operate as the eyes and ears of the enterprise on the patient, helping to coordinate the care of the whole team. That made us start improving our design processes that people could use with our Clinical Knowledge Graph to accommodate coordination of care among members of a care team, which is now a big topic for HTI-2 coming down the pike in a couple of years. Every time we go into a new environment, we learn what we didn’t know and adapt accordingly.

What are the next steps in interoperability, especially in data quality and interpretation?

Years and years ago, a senator named Ted Stevens from Alaska said, “The internet is nothing but a series of pipes,” and everybody made fun of him. When I read that old quote from him, I thought about interoperability. We now have a governance structure through the QHINs and through TEFCA. We have built the pipes, and the pipes are available. You will be required to send stuff down the pipe. You will be required to receive stuff from the pipe. The challenge will be how you keep from getting overwhelmed by what’s coming down through the pipe. How do you filter it? How do you present it?

You said before that clinicians will tell you that 95% of the time that they know what they need to treat a patient. That same statistic could be applied to that tsunami of information that is coming down as text, codes, pictures, and all kinds of stuff. Filter it so that I can find what I need. We’ve been working with FHIR and other things for about eight or nine years – and now NLP and large language models – to quickly find the information that is needed in that for the particular patient that is being treated. We are excited that the pipes are in place and that the information will start flowing. That gives us a unique opportunity to show what you can do when you have a Clinical Knowledge Graph with 10 million mappings to the standard vocabularies and hundreds of millions of diagnostically connected data points inside an engine. 

It will be interesting to see how the industry responds to this deluge that they are going to get. It’s an exciting time. I think the HIMSS Interoperability Showcase is what, 15 or 20 years old? Finally, it’s real. But it will take some time to iron out the wrinkles to get the exact information that a clinician needs to the point of care so that they can benefit from the content of those pipes.

How will AI affect your products and competitive position?

Our approach is that we are a good solution for the hybrid model that I talked about earlier, for using AI to acquire the information, bring it over, and then allow it to be formatted, filtered and presented. I get a lot of inquiries about using content as training data, partnering with us, acquiring us, or licensing our intellectual property. We are  too busy right now to respond to that, but we see our role — and HTI-1 kind of covers this — as the evidence-based, trusted resource for source information that has been reviewed by clinicians to handle output from large language models and AI.

It’s not clear to me how quickly people are going to believe that AI can do what we do. The people who have looked at our stuff and tried it have said, you guys have something special here. We have a solid, consistent clinical data model underneath it. It’s not just words linked together. We like the opportunity that we have over the next five years.

The big picture is the industry has not yet come to grips with the tools that are needed for an enterprise, or even an individual clinician, to effectively manage chronic conditions like the Hierarchical Condition Categories that Medicare is using for compensation. There’s lots of money and attention flowing into that. If you look at ICD-10-CM diagnoses, about 9,000 to 10 ,000 are relevant and apply to these Hierarchical Condition Categories for value-based payment.  A huge opportunity for us over the next two to three years is that we can review and filter a record to make sure that the documentation is appropriate, is complete, and that product conditions are being identified and effectively managed and adequately documented to pass a Medicare audit.  

Requirements are piling on the industry. HTI-1, HTI-2, TEFCA, CQMs, and quality payment programs. They are all tied to very specific clinical data points, and that’s really our strength. We’re pretty excited about the next three to five years.

HIStalk Interviews Cyrus Bahrassa, CEO, Ashavan

Cyrus Bahrassa is founder and CEO of Ashavan.

Tell me about yourself and the company.

I’m somebody who would not have imagined being here talking to you. When I was a kid, healthcare IT was not on my radar. I’m not sure if anybody really does have it on the radar. I wanted to be a commercial airline pilot. In college, though, I found a passion for education. I thought I would be a teacher and eventually a principal or superintendent. But then a little company called Epic reached out to me in my senior year and said, you probably haven’t heard of us, but you should check us out. I did and I liked it enough to join the company, thinking I would be there just a couple of years. Instead, I stayed for seven, and somehow have been in the industry for my entire career.

Ashavan is a healthcare interoperability consulting company, or at least that’s what I tell people. But truthfully, that’s not the full story. Fundamentally, we are a company that is focused on choices. Our mission is to make the best choice the easiest one, and everything that we are trying to do is in service of that mission. Today, we’re focused on interoperability, and that’s going to be our focus for a while. But the pie-in-the-sky vision is that 50 years from now, we are helping people and businesses make optimal choices in other areas, things like sustainability and money. When we can make it easy to do the right thing, that’s where I would love or Ashavan to play a role.

Are the big non-healthcare companies surprised by the complexity of getting and using healthcare data?

Yes, especially the ones that are newer to healthcare. Maybe they have experience in technology in other ways, but they’re jumping into the healthcare side and saying, why is it so hard and complex and convoluted?  At the end of the day, it feels like a jungle. That’s what we see and hear from our customers. We are helping them carve a path through the jungle and helping them understand that this is the right way to go about this. You will be able to move as efficiently and practically as possible.

That doesn’t mean that it will be easy. It will still be hard. We can’t claim to have magic bullets that make everything push-of-a-button automatic, but at least we can help you move faster and more efficiently and have that certainty and that clarity that you might not have if you didn’t have that guide with you.

What is the incentive for a software vendor or provider to share information?

It’s a hard question to answer, because the incentives probably aren’t as strong as they could be. What I would preach in idealistic fashion is that we have to look at this from the perspective of customer service and doing the right thing for people and for their health. Sharing data and providing greater interoperability is an important piece of that. Do those entities have a vested interest in those things? Probably not, unfortunately. I hate to say that, but the reality is that they may not maximize their individual potential when we’re working in service of that common good. But that is a North Star that we have to have.

Unfortunately, that’s why government plays such a big role in healthcare IT and in interoperability. Sadly, the pace of innovation and interoperability is mostly dictated by the pace of change from the government side. You have USCDI, for example, and that’s a great thing. It allows for a certain floor in terms of API-based interoperability and retrieval of data. But that floor has remained stagnant for a while. It’s been at the Version 1 of USCDI for a few years now, and it won’t be until 2026 that that floor moves up to Version 3. Then it won’t move again until the ONC decides to make that change at some point in the future, which of course is dependent upon the circumstances in the industry, the political circumstances, and what kind of administration is in power. The challenge here is that we are working at the pace of government.

Where does the patient fit in?

The patient plays a huge role. First and foremost, they absolutely have a right to their records. They have a right to obtain records when they have the appropriate authorization for a family member. That is super important and something that has to be enforced strongly. 

I look at it like personal finance. We probably need to teach people to a level of literacy as they are growing up and as they are in young adulthood to help them be better healthcare consumers. More and more states are mandating education around personal finance in middle school and high school. Having individuals be knowledgeable of what their rights are, understanding the importance of having access to their data, and helping them understand the value of that access and that data exchange in practical terms.

When I explain interoperability to folks who don’t really know about it, I talk about smartphones. Imagine that you’re an Android owner, but you want to switch to an IPhone. You love everything about the IPhone, you can’t wait to switch, but then you find out that there’s no way to get all your photos, contacts, and messages pulled over automatically onto your iPhone. At best, you’ll have to manually key in everything, or at worst, you won’t be able to move some stuff at all.

That would be really, really bad interoperability. Thankfully, we don’t have that, but that’s a practical example of the power of data exchange and interoperability. Then, helping someone understand in the context of healthcare why that’s significant. You want to be able to switch your doctor, you’re moving to a new location, or you’re traveling and you need care in a new place. Having the ability to move that data and make things seamless, easy, and powerful is so important.

Apple Health was all the rage when it was announced, even though Google and Microsoft had failed in trying to do something similar. Has the uptake of Apple’s health-related capabilities proven that demand exists for patients to manage or transfer their own record?

There was a moment where personal health record apps had this big shining glow around them and everyone was pretty hyped about their potential. They are important, don’t get me wrong, but it’s this problem in healthcare and interoperability where you can get the data, but then how do you use it? It’s one thing to have it there, but it has to be usable and actionable. 

Allowing patients to pull their data through Apple and through other services is wonderful, but do they have that literacy and empowerment to use it? Do they have the ability to connect it somewhere else so that they can switch to a new provider or switch to a new location and have that data be equally understandable and actionable? 

The ability for these personal health record apps to pull in that data, showcase it, and surface it to the patient is good for them and for their ability to navigate the healthcare ecosystem.  But some folks are not going to pay attention to it as much, especially if they are relatively healthy or their health stays pretty constant and they don’t necessarily think about healthcare very often. Some folks, again, are just not going to have that literacy or that capability to be able to work through that. We have to do things as an industry, as a society, to help them navigate that better, to empower them, and to safeguard them.

My last thought here is that a lot of folks don’t understand what HIPAA truly covers and that some of these digital health applications — unless it’s as a business associate of a covered entity – aren’t subject to the HIPAA requirements. I’m not sure that most people will ever understand that. That means that it’s even more important for us to craft the laws and regulations that provide a suitable level of privacy protection so that the protection of their information is automated, no matter who the holder of it is. Again, this is all about choices and making the right thing the easy thing. If we can update those laws so that your information is protected in all these different situations and apps, that’s better for everyone.

Is the answer to update HIPAA or to implement general privacy protection?

It would be pretty comprehensive. I say that because of a couple of factors. What will prompt some sort of action from Congress, whether it’s in two years or 20 years, is these challenges around social media now also AI and the way that our data is used and monetized. I see that as being a big driver for some sort of action on privacy legislation. 

Unfortunately nowadays, there’s a tendency for Congress to take a long time and then do this big sweeping package when the time presents itself. I can see them getting to this point where privacy legislation is going to happen, and then healthcare and healthcare apps become a component of that larger bill. Like a lot of humans, I’m terrible at predicting the future, so I could very well be wrong and I’m going to be willing to admit that, but that’s what I see.

As someone who has worked both for and with Epic, do you see them as an interoperability friend or foe?

I see them as simply a self-interested player in the market, just like any other entity out there in our industry.

I believe a few things. Epic has a lot to offer when it comes to interoperability. They and Athena are at the forefront in terms of the different options you have and capabilities that you have for integrating with them, whether that’s HL7 interfaces, both FHIR APIs and proprietary APIs, Kit, etc. They have lots of available options that several other EHR vendors cannot claim to have.

At the same time, Epic is guilty of certain practices that are either common in the industry or that are unique to them. The common thing is high fees. I’m a big believer that we have to crack down on the fees and just charge for the cost of interoperability without making it a profit center, but simply a pass-through of the costs.

I also think that we need to address things like exclusive marketplaces and exclusive programs. You have the Epic Vendor Services program and Epic on FHIR, but you also have through Cerner what is now their Oracle Partner Network, which used to be their code program. You have the Athenahealth Marketplace. Similar to the Apple App Store and Play Store, those are the exclusive venues that you must go through to publish an app and use it with the particular EMR. I think that’s wrong. You should be able to have additional marketplaces. You should be able to pull down apps and list apps in multiple places. 

Those are the general things that I would say for Epic. A specific thing that I was concerned about was their Partners and Pals program. I spoke out about this several months ago when it was first announced. To me, that was the wrong move, because it at least implied — and no one ever denied this — that Epic was providing exclusive integration options to certain Partners and Pals that would not be generally available to everyone. I think that’s wrong and anti-competitive. For interoperability, the same capability should be available to all entities at the same time and at the same cost. That’s an important piece, because interoperability goes hand-in hand with competition, with a freer market, with allowing people to have better choices and to minimize the switching costs between those choices.

AI companies are desperate for data and will likely bring their own ideas about interoperability. How will that business need influence the technical side of interoperability?

It will increase the demand for sure. The key challenge is that when we’re talking about healthcare data, it doesn’t all live in just EHRs. We’ve got the ONC’s certified health IT program to ensure that these EHRs have this minimum level of data. Certainly they are a wealthy repository for that, but you’ve got data living in all kinds of other systems, whether it’s an uncertified EHR, a behavioral health system, a system used by a long-term care facility, PACS, and lab systems. It’s his big, hairy beast and the fragmentation problem in healthcare technology is a real challenge in interoperability, because you’ve got data that’s living in all these different places.

With regard to the business side, there will be demand, but the challenge is how you target that demand to the right entities. If you’re a pharma company, you will have to take it one by one in terms of where you want to get that data and get those capabilities to pull that data, because it’s not like there’s one source and one a one-stop shop.

When I explain interoperability to folks and some of the challenges, I talk about Uber. With Uber, you can see a map and a timing for your ride. Why is that possible? It’s because Uber has integrated with Google and their Google Maps functionality to be able to provide that information. Uber only had to integrate with Google and that’s it. They get everything that they might need.

But that’s not the same thing in healthcare. You can’t go to one single place and get everything you need, even as a patient. Our information is in the EMR, but also in the PCP’s EMR, the hospital’s EMR, in the Walgreens where we got our flu shot last year, and in the urgent care. Being able to source the data from all those different places is something that is going to be really challenging, whether you’re a business or a person.

How does Nashville’s innovation and digital health environment compare to that of Silicon Valley, Route 128, and Austin?

I’m biased. I love Nashville. I tell people that it’s the greatest city on earth. I’m sure lots of folks would disagree with me, but it is a wonderful place that I hope lots of people can at least come and visit, if not move to.

In terms of the entrepreneurial scene and the technology scene, it has really flourished. I’ve only been here five years, so I can’t say that I have a perfect window into everything that has gone on. But a lot of people are focused on making Nashville a wonderful place. There’s a lot of positive energy around technology, innovation, and entrepreneurship.  We have a really thriving entrepreneur center, a couple of them actually. We’ve got great programs and accelerators that support these different startups. There are certain people out there who are trying their best to attract investment, attract attention, and build that culture.

We’re a tightknit community in the way that we come together and support each other. I’ve always felt like people are out there willing to help, willing to lend a hand, and meet or introduce you to someone, which I think is really great. That supportive environment has made it a wonderful place to have a business and to live. We’re doing the right things.

It always helps when you have a big name who is drawn to the city, like Oracle. I know there was the announcement about moving the headquarters here. I’m interested to see how that plays out and what it looks like, but even just having that campus here and what they’re doing to build that up and build up the East Bank of Nashville is really special. That drives attention and creates that network effect, because more and more organizations will now take a look at us and say, this is a cool place, we should check it out, we want to be here.

What are the company’s plans for the next few years?

I have to get better as an entrepreneur. That’s the thing that’s top of mind for me. We are three and a half years in. It’s gone well, but I’m still learning. I’m still improving. I probably will be every day of my life. Even right now, I’m trying to figure out how to be a leader and not just a hero. That’s a really important thing on my mind.

In terms of the company, healthcare will always be a focus area, but we definitely want to expand beyond that. Interoperability is a big deal in a lot of industries. You’re talking financial technology, manufacturing, logistics, etc. I was at a conference recently on smart transportation and mobility. There’s a huge need for better interoperability so that the streetlights, stop signs, vehicles, and scooters can all talk to one another. That’s going to be important for a modern transportation infrastructure.

What we want to do at Ashavan is earn a seat at the table in those industries. We want to be a part of bringing about that change and bringing about better interoperability in those areas, because when we can make the best choice the easiest one for those consumers and those companies, we’re going to feel like we’re making a positive contribution to society, and that’s going to be really special.

HIStalk Interviews Trip Hofer, CEO, Redox

Trip Hofer, MBA is CEO of Redox.

Tell me about yourself and the company.

I joined the organization in November of last year. I’ve been in healthcare for approaching 25 years now, and throughout that time, we’ve always talked about the ability to get data easily from one system to another, from A to B. A to B can be from an EMR to an EMR, from a digital health vendor to an EMR, from an EMR to a cloud, or from an ecosystem that has been built specifically in a payer environment. I’ve seen various A to Bs, but throughout my career, what seemed simple verbally and logically got complex and became undoable. That was always frustrating when trying to serve patients better. 

Especially at the time with value-based care, I thought that Redox could be interesting since it has been moving data for 10 years. Redox was primarily focused on enabling digital health vendors to interact with an EMR, to both read and write into and out of an EMR. That is incredibly important for digital health vendors and for the providers who are working with their EMR to have access to other methods for serving a patient.

The company has expanded to not only do that, but also to move data from anywhere, from point A to B. With AI and machine learning, an important need is to get usable data quickly in large volumes safely. We are at a remarkably interesting time for the company and for the industry as a whole.

How do you see interoperability evolving, specifically with FHIR APIs?

It will continue to evolve. It’s top of mind. I was at a health plan a week ago with a bunch of cloud vendors. FHIR usage is proliferating, being used and applied by any healthcare entity. That’s great. You wish it was like, “Just adopt FHIR, it will be easy, and we’ll move forward.” The fundamental challenge with healthcare data, which is unique to any other industry, is that the data is extremely messy and it continues to change. That is a symptom of workflow.

For example, follow a claim from initial generation all the way through adjudication. It goes through a ton of changes. You can call it maturations, but changes or evolutions or whatever the term you want to use through that process. It seems simple, but it gets updated, it could get rejected, more information might need to be added. It is messy. It could include the wrong diagnosis codes or the wrong name. That’s just a claim that flows through, and there’s a lot of discussion on prior authorization.

While the advent of FHIR is really important, getting data from point A to B in healthcare is difficult because it’s messy. FHIR helps with that by having a standard format that is being adopted, but it’s the workflow that makes it so complicated.

How does the company work around that messy data?

I’ve learned that the idea that you can just go buy a piece of software off the shelf and plug it in can be used for the simplest of of tasks. But getting more creative with data, or using it for other purposes — especially with large volumes of data — that’s not enough. We’re a technology company with services. We have people who work with each of our clients to make sure that the integration meets their needs. We apply use cases. What problem are we trying to solve specifically?

The beauty of Redox is that each integration implementation leverages usable technology, meaning that we don’t have to start from scratch. We have over 7,500 connections established across the country that we can leverage. Implementation can be extremely fast. The national plan that I just visited took three months. If you ask any health plan about how long a typical data integration takes, it’s not measured in months, it’s measured in years. We can  get stuff up fast, but we also apply a combination of usable technology and people who know what they’re doing because they live it daily. They help with that integration implementation and ongoing maintenance and monitoring of the technology.

What changes will 21st Century Cures and TEFCA require?

I am a fan of 21st Century Cures and TEFCA. Their general objective is to make it easier for patients to get their information. I don’t know how anyone isn’t a proponent of that. We all want it. I want it as a consumer. I want to be able to get my information as fast as possible during my care journey. It forces organizations to think about how they’re going to make that easily accessible.

The problem with TEFCA is that it’s optional. There are no incentives or penalties for organizations to adhere to TEFCA. You can if you’d like, but you don’t have to. You’ll see adoption without incentives or penalties, but not at the level there would be with a mandate. If there was going to be mandate around it, we would have to carefully think about what that means. How do you ensure that what is written and regulated or mandated is appropriate? If it’s going to be a true game-changer, especially TEFCA, you have to see incentives or penalties and take away the optionality.

We’ve seen controversy over companies using data for non-treatment purposes. How will that evolve?

That’s going to be very interesting. I’ve been following the same cases and situations and the companies that have been impacted by that. These are treatment use cases are flowing through here and ensuring what treatment means. An act like TEFCA or 21st Century Cures can be so good. But other organizations are bad actors in this environment who want to use that data for alternative purposes. You think that this is treatment, so it should be easy, but data has been leveraged for other reasons. 

When you  get into something around payment, that gets even more interesting when it comes to how people might inappropriately leverage that data. That’s the concern. I still think that those use cases should move forward and should get access, but it has to be in a way that ensures that those bad actors or actresses can’t perform the way that they want to, and that’s difficult. That’s really hard. I wouldn’t even have thought on the treatment side that you would have seen what you’ve seen, but I think I was being a little naive. 

People think about these things and figure out ways to exploit them. That’s what we have to be concerned about, especially when we get into the money side of things, beyond treatment use cases that will proliferate. How do you try your best to put measures in place to stop that from happening?

How will AI to affect your business and your customers?

It doesn’t come as any surprise that AI is discussed at every industry conference. When we talk to our clients, AI either comes up or is the focal point of the meeting. I was at one of the large cloud aggregators two weeks ago and their request of us was, we have a lot of tools that can consume information that can do some really interesting things, but we need that information in a way that we can consume it. That’s where we come in as Redox. How can we move data, and large volumes of data, securely?

I want to make sure that those two points aren’t missed. We aren’t talking about moving small amounts of data. These organizations are asking for a large amount of data, billions of transactions. We’re now moving over a billion transactions a month at Redox, and I’m thinking that by the end of the year, we will probably move up to a billion and a half per month. That’s a lot of data, and you must have a platform that can move that data. The platforms of some organizations have just not been able to do that. They can’t handle the data.

OK, you have to be able to handle data, but quickly on top of that, how can you handle it securely? Challenges around security and all the breaches are major concerns. How do you ensure that you have the security? It’s funny that when we get into AI discussions, we typically lead with how we think about moving secure data, and I had organization say that they appreciate that we talk security first because it is so top of mind.

But that’s what we do. We are an enabler. We don’t run the tools at the end of the pipe to take advantage of it. We pride ourselves on providing the data that is necessary to enable those tools. We are enabler of machine learning or of artificial intelligence, and as I continue to remind our team, we are also the enabler of value-based contracting and value-based pricing. Having been in healthcare for so long and seeing fee-for-service not work, we have to move more quickly to value-based arrangements. The only way you do that is to provide good, clean data to expedite that. That is top of mind for us as well.

When it comes to our own company, we actually just sat down and had this conversation, which is funny that you ask. I said to the team, not only how do we use AI, but if AI were to make Redox obsolete, what would that look like? The reality is that there are parts of the ecosystem where we perform — if you think about a pipe or a highway, what that looks like along the journey — where AI is very applicable, but there are other parts where it’s just not, not now at least. 

A lot of that has to do with the manual intervention based upon workflow, things that make AI something that you can’t put into that part of the ecosystem at this point. But we’re constantly looking at that, because we want to make this as efficient and effective for our customers as possible. Wherever we can leverage AI to do that, we will do that. Where it’s not leverageable, we won’t. We are truly trying to enable our end users with usable data, and if AI helps that, we will implement it, period.

Your other job as a venture partner gives you frontline exposure not only to AI, but to what companies and investors are doing and thinking. How would you characterize the health tech investment marketplace?

There’s a couple of things that will probably come as no surprise. The first is the general environment today, which really started last year or maybe a year and a half ago when venture capital money seized up and the spigot stopped flowing. There was a lot of what you would call tourist investment going on in 2022, where people who didn’t really know what they were doing in healthcare were throwing a lot of money into healthcare and into companies. It was great to receive the money if you were one of those organizations, but also now you’re feeling the effect of where it has seized up and you don’t have that money any more.

We face a lot of consolidation. In the industry where we sit, there are a lot of players where they are not 100% overlapping in what they do. There are concentric circles, but the overlap is not at 100%, meaning that there’s no real true competitor, at least in our case at Redox. Other organizations do some of what we do, but there’s no one that you would say overlap, where someone might say that they could pull Redox and and put in A and it does the exact same thing. What that suggests, if you look across the industry, is that there will be consolidation.

There will be forced consolidation, where companies will go to market because they literally run out of money and they can’t raise any more. Do they close up shop or are they able to merge with other organizations? You are going to see that. It’s a ripe time for companies to get together and start to talk, especially the companies that are in this space, these small fragmented companies, to come together. 

You’re not seeing a lot of these companies being acquired by health plans, payers, and providers like you were several years ago. The way to make yourself more enticing is to come together with somebody else and merge those capabilities that you could have if you think about ecosystem horizontally, where you add pieces to it so you become more desirable and you’re able to do more as an entity.

You will see this year that companies will come together and further their value proposition horizontally. There may be some vertically, but a lot horizontally. You’ll be able to do more across the data ecosystem because you’re bringing together different groups of people. I am 100% confident that you’ll see companies coming together, and a lot of that is a reaction to the VC marketplace, both the funding but also the acquisition, the buying of the assets by those who would behave that way.

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

The company has been in existence for 10 years. The vast majority of that time was establishing itself as the leader connecting digital health vendors to EMRs. In doing so, it created what I would say is a tremendous opportunity to to expand to other types of organizations outside of just EMRs and digital health vendors because of all the connections that the company made during those first, let’s say eight, years. Thousands of connections into healthcare organizations into EMRs, working with over 90 EMRs, for example, in 7,500 healthcare organizations, moving a ton of data. 

The priorities for us are moving agnostically. When a healthcare entity wants to move data from A to B, that could include the cloud, where we have relationships with the cloud aggregators. Those aggregators can then do advanced analytics for their customers. Over the next several years, a couple of years, it’s how we continue to evolve into the payer market, provider market, and life sciences market and complement what we’re doing today. What we do today, but do it for more and more entities and continue to scale. 

Then as we talked about that horizontal view of the ecosystem, how do we continue to build out capabilities, partner, or even acquire? That is the typical thing you think about as a leader, which for me, is build by partner. How do we continue to think about that and do that horizontally, so that when you come to Redox, we can do more and more for you? 

A lot of that will be driven by the ask of our clients. When one of our clients says, “I wish you could do X,”  that’s where I perk up. What would you like us to do? We consider that on our roadmaps about about how we move forward.

Our core DNA is that we enable. A lot of clients say, “You do this stuff that we just don’t want to do.” They want the data so that they can then go do something with it. We enable that. We are an enabler, and a very key enabler. We want to continue with that DNA, but enable more and more people with more and more data at a very secure and fast pace.

HIStalk Interviews Jeff Richards, Co-Founder and COO, SnapCare

Jeff Richards, MS, MBA is co-founder and chief development and operation officer of SnapCare.

Tell me about yourself and the company.

I spent the first 19 years of my career as a clinician and administrator in anesthesia at a large public health teaching hospital here in Atlanta, Georgia. Grady Hospital was connected to Emory University, which where I went to school. I educated clinicians that came in. I eventually moved into a leadership role, where I dealt with the complex balancing act that every administrator does — providing some clinical care, overseeing a staff of almost 100, and doing the schedule, which was the seed for launching this company with my partner in Atlanta.

When I went back and got an MBA in 2016, I wrote a paper about a mobile healthcare staffing app. Out of the blue, a classmate of mine from 19 years before reached out and said, hey, can you help me with my startup? It’s called SnapNnurse. I had not intended to start a company when I went to MBA school, but I teamed up with her and we went out to raise capital. We talked to lots of VCs who said, this is a brilliant idea, healthcare often lags behind, and creating a mobile-friendly platform for clinicians to sign up and for facilities to book staff is right on time, in 2017 anyway. We ended up raising $1 million in seed capital in the summer of 2017, launched the company, had good success here in Atlanta, and created a marketplace with about 60 facilities and 10 ,000 clinicians. 

Two and a half years into our entrepreneurial journey, COVID hit. We couldn’t have known that the platform would scale the way it did or predict the benefit of how we interact with social media to sign up clinicians. We pointed it at that situation, turned into a rapid response company, and essentially grew to a billion-dollar company in 2021 and 2022, deploying thousands of clinicians in all 50 states and scaling into a different entity.

In the last 10 months, we’ve rebranded from SnapNurse to SnapCare because we’ve become a broader workforce solution, not just a contingent staffing mobile application. It’s also well past nurses and goes into the entire healthcare clinician continuum other than physicians, which we don’t staff, but do subcontract.

How has the clinician labor market and the use of contract resources changed in the past year or two as healthcare organizations tried to resolve the pandemic-caused, unsustainable labor cost trajectory?

That unprecedented demand was what was needed at the time. You needed to move clinicians around the country as fast as you could from the different hotspots, sometimes happening simultaneously. As the pandemic waned, that demand went away and went below many of the pre -pandemic levels. 

As that was happening, we had evolved from a technology platform. Our orientation and what we had built changed. We said, why don’t we put the technology that we use to mobilize clinicians, engage them, match them, attract them, onboard them, credential them, and deploy them, in the hands of clients themselves? Why not empower them by plugging them into the software?

As that demand was waning, we were in the midst of rebranding into the company that we are today. Facilities are struggling from contingent staffing. There’s a lot that we can offer them as a company to help them manage their internal staff and attract, credential, and onboard candidates more efficiently than they do today.

The moving around of clinicians was like a shell game, where the supply was limited and the demand for their services was at least temporarily unlimited, which predictably sent pay rates up. Will we ever have enough clinicians to avoid ever-increasing compensation as organizations poach them from each other?

When we started this company, my research in MBA school was in the state of Georgia. In 2007, the Georgia state legislature commissioned a study to better understand and predict the healthcare workforce shortage. What they predicted was that without a massive change in the number of school schools and the number of educators – which is a huge piece of this puzzle – and the investment to support all of that, there would be a healthcare healthcare workforce shortage would begin to peak in 2017, which was when I was writing the paper. The legislature did the right thing and was correct in their assessment, but they did not fund the initiatives that would would have alleviated the problem. 

To your question, the answer is a decade-long investment across the country to enable the number of clinicians who are going into school and the number of educators that are needed. A lot of resources got pulled away as facilities attracted clinicians out of educational roles to work at the bedside. It is a complex problem in the sense that that’s a decade-long fix, with lots of steps in between.

AI will probably play a role in the solution. It’s in telehealth. It’s in the way that you manage the internal staff. We recently did an acquisition, a company called Medecipher, that has a machine learning and AI algorithm for predictive analytics. It helps deploy internal staff across a six- or eight-week schedule to better match the acuity of the clinician, their specific certifications and qualifications, to the census and to the acuity of the patients. They are in different departments throughout a facility. There are absolutely tools and technologies that are on the table to help manage it, but the big picture solution is to increase the supply of clinicians.

I think AI is the future of this industry. It’s often an overused buzzword, but there’s a there’s a fast-paced change going on. Artificial intelligence has changed the speed with which technology keeps doubling the capacity. Moore’s Law, which was established by Gordon Moore in the 1960s, says that the number of transistors in a microchip doubles approximately every two years. Somehow through technology innovations and the number of chips and the way we make those chips internationally, we’ve maintained that.

Everyone thinks that AI has only come along in the last couple of years, but it has been decades in the making. But in the last 12 years, the speed with which the capacity for AI — which is software, it’s not hardware — has been doubling at a rate of every 3.4 months. It gets a little geeky to get that specific, but the highlight is that at the end of the year, it’s 400% more capable. Every quarter, things are getting faster and faster and faster. 

I think we are in the beginning of a two-ish year run where the way facilities and clinicians engage will be heavily driven by AI. The companies that figure that out and leverage it will be the leaders ,and clinicians will be attracted to them because of how they can interact, get access to jobs and onboard, and maintain their credentials. All of it will be significantly easier than it is today.

How are organizations using an internal resource pool and related technologies to reduce their reliance on higher-cost outside resources?

The internal resource pool for us is a natural, the other side of the coin of the Medecipher acquisition. Number one would be to deploy Medecipher and use no contingent staff whatsoever, just better utilizing the staff that you have. Then combining it with our platform, which has a shift booking engine and matching algorithm to ensure that every facility has a pool of PRN type candidates, often without benefits at a slightly higher rate, who do that for flexibility. Maybe they work at two or three locations around town.

Most organizations don’t have the technology to send out the shift requests, send reminders, and ensure that once they do work, they get notifications to submit time cards and things like that. This is basic technology that we have used for years, and that is the offering to take that and use it to develop internal resource pool. We think that the smartest combination is to combine that with a predictive analytics scheduling solution.

Moving people around to unfamiliar facilities with different practices must create some degree of patient safety risk, plus it seems logical that a clinician would prefer to pick up extra shifts at their home organization rather than moving around. Are employers trying to create an environment to support that?

Absolutely. The facilities as employers want to ensure that. The larger part of their workforce is made up of full -time employees with full-time benefits and the facility is working well for them. But there is always a sizeable percentage, five to 10% – which is hundreds of people when you’re talking about 4,000 or 5,000 clinicians — who want  to work in a more flexible way and may opt out of benefits. It may not be that they’re moving to different facilities across town. It could be that it’s a system that has two or three hospitals that are in relatively close proximity. For the option of the flexibility, to have a little more control over their schedule, they are willing to opt out of benefits.

To move them around and to mobilize them in the smartest way, you need a technology platform that can help distribute the shift requests, send reminders, and support an on-call backup auto notification that can go two or three levels deep into those who didn’t get the shift but have opted in to be in an on-call capacity.  Those are basic bread and butter techniques to ensure that you have the staff when you need them and where you need them. That technology, whether its sounds staggeringly innovative or not, is missing in most facilities. We offer it as a platform.

What are the benefits of your transparent pricing promise?

We hear from facilities the same thing that I felt myself as an administrator at Grady. I’m paying this high bill rate, but what are you paying the clinician? Inevitably, somebody will get it out of the clinician. Administrators are already frustrated because they don’t want to be using contingent staffing, so they do it in a somewhat begrudging way. But it should be transparent. You should know where the dollars are going. When you’re hiring someone at a premium, dollars also go to the stipend, because you’ve relocated them. If it’s a local contractor, then you’re going to see what that margin is. 

It’s a promise of trust to our clients that when when they use contingent staff, they know what it costs. We have such trust and confidence in our technology that we have driven the cost down. Those margins are much lower than a traditional legacy staffing agency, which often has brick and mortar buildings, a larger group of staff, and lower utilization of technology that require it to maintain a higher margin to pay for all of that.

Why do health systems use your services to recruit for making direct hires?

Some facilities need to make 300 hires and their HR department is not up to do that, so they seek us out. The way we differentiate ourselves is twofold. Because of our cost structure as a technology company, we can do it for less and have some of the lowest one-time costs for permanent placement when you’re doing direct hire. Then, the way we combine the our platform with social media to reach out to candidates is a broader way to access them and whatever pools they are in. The message leverages what the facility wants to do, whether they want to have an incentive like a sign-on bonus or speak to the benefits that they offer at their facility. Our reach and the interactivity of the platform with social media is another differentiator. Overall, it’s cost and the technology platform itself.

Where does the company go from here?

It’s really the shift from external contingent human capital management — the contingent staffing world whether technology enabled or not — into an increasingly pure SaaS product, where significant elements of the business are dedicated to predictive analytics. That’s the reason for the acquisition that’s only two months old. Leveraging the internal resource pool, and only when they have exhausted those techniques as well as permanent placement and have decided to use contingent staffing, to use a best in class marketplace that can aggregate PRN contract staffing, leveraging the technology across multiple different agencies to leverage the cost, get it down. We differentiate ourselves from contingent staffing competitors by seeing ourselves as constantly transforming further down the pathway towards a technology-only company.

HIStalk Interviews Russ Thomas, CEO, Availity

Russ Thomas, JD is CEO of Availity of Jacksonville, FL.

Tell me about yourself and the company.

Availity connects health plans and providers for their critical business workflows. Most people would call that a clearinghouse, but we think of it as a 21st century clearinghouse because we add a lot of intelligence around the workflows that we facilitate between providers and payers.

We’ve been doing that for almost 25 years. The company started in 2001. Today, we serve well over 3 million providers around the country. We will process $3.5 trillion of claims through our network this year.

We are big believers in what we call multi-modality. We take providers however we find them. If they are sophisticated providers working in their Epic environment, we love that. We are deeply integrated with Epic with our revenue cycle product. At the same time, we have literally millions of providers who access their payer information through Essentials, our real-time, multi-payer portal. That gives them the vast majority of the information that they need, day in day out, to run their business. It serves all types of providers, not just physicians, but anyone who’s providing healthcare to a patient and getting reimbursed by health plan. Think about Medicaid, which includes atypical providers — ramp builders, transportation companies, or somebody’s aunt or uncle or mom or dad who is getting reimbursed for providing care to them.

What are the most urgent opportunities in improving communication between providers and payers?

The most urgent opportunity is quality of information. We are very good at building and deploying technology to facilitate the exchange of information in a timely way to the right person with the right information that they need. The underlying quality of the content has to continue to improve. Authorization workflow is facilitated today between most health plans and providers. Trying to figure out that translation of provider-speak to payer-speak often involves phone calls and faxes, and wait times for authorization are still long.

In that example, we have found a way to automate that workflow. We acquired a company about a year ago called AuthAI and have implemented that with one payer, with others in process. We are literally creating a real-time exchange of authorization information, facilitating that authorization workflow in under 90 seconds, all the way through a medical necessity determination. It’s a huge provider satisfier and works great for the payers as well, bringing value to both sides of the equation.

Right or wrong, I assume good intent. I assume that providers only want to perform procedures that are appropriate, medically necessary, and good for patient care. I assume that payers want to pay the fair contracted rate for that care. If the administrative workflow is slowing that down, creating obstacles, or getting in the way of good medical practice and good reimbursement practice, it can be more trouble than it’s worth.

We focus on eliminating those administrative workflows that just get in the way and aren’t providing any value. They were put in place with good intentions at some point in the past, but now they are not helping to improve either patient quality or the relationship between providers and payers.

What impact will patients see from federally mandated payer-to-payer APIs?

We have launched that. We have our first cohort of payers implementing now. I think it’s three or four that we’re starting with and our second cohort is right behind it. Transparency, right? Interoperability.

Availity is in Jacksonville, FL. We have been a Florida Blue company for a long time for our health coverage. If we decide to move to somebody else, my data shouldn’t be siloed in the Florida Blue environment. There’s tons of opportunity to improve patient care, to improve transparency, and to make the provider’s job easier by mandating the exchange of that information between payers when either I individually or my company makes a decision to make a switch. It’s freeing up data, which is what I love about it.

What are your biggest takeaways from the Change Healthcare cyberattack?

I anticipated that question, but I still don’t know that I have the best answer to but a couple of things.

Security is paramount. We talk about it in terms of resiliency. Resiliency means that you have a you have a really good Plan A, which is to maintain the highest possible level of information security to protect your network. You’re going to see us advocating for this as a company.

The bar is higher for firms who do what we do. The bar for clearinghouses needs to be higher, for both the level of information security that we maintain and for the resiliency or redundancy of our networks, because the alternative to that is to try to figure out how to protect millions of endpoints. I don’t think that’s a fair burden to put on providers in particular, who are already stressed and trying to run businesses that are financially struggling in some cases.

We have been advocating aggressively in the last couple of months with CMS. Congress has gotten involved and should be focused on hardening the network itself, so that physicians and payers can continue to collaborate effectively.

Information security has to be your Plan A. You have to be world class at it, and it needs to be a culture within your organization. It certainly is for us.

Then, candidly, you need a redundancy plan. Your Plan B that assumes plan A fails at some point. When there is an attack, and when there is an impact from attack, you have to be able to bring the network back to full strength in time periods that are measured in days, if not hours, not in months or quarters.

The takeaway for us is that as good as we think we are from an information security perspective, we have to continue to get better, better, and better. Invest more and bring more resources to bear. Challenge ourselves to think differently about how to protect our network. We have to make sure that our redundancy plan remains strong. We’re doing things today to make sure that we are fully cloud migrated, so that when or if something happens, we are able to move environments really, really quickly and have as little impact on our clients as possible. Those are the key takeaways.

I’m at a large health system today where we extended the Availity Lifeline. Not to brag, but I think we’ve done a really nice job of helping providers get back in business. We’ve stood up 300,000 providers in the last 65 days and moved over $160 billion of claims that would have otherwise been stuck. As you can imagine, that has allowed us to make some really good relationships. One of the things that we are hearing from these providers is that we have to have a backup plan. Being on our own and having one system has worked for a long time, but we really need to think about how to create redundancy in our own network with a solid backup plan. That’s a takeaway not just for Availity, but for a lot of providers.

We were at our annual client conference in Arizona when the cyberattack started on February 21. We took the correct immediate step to disconnect from anything with a “U” in front of it, not just Change, but all of the Optum environments and all the UnitedHealth Group environments that we were connected to. We then said to ourselves, we don’t know how long this is going to last, but there will be providers and payers who need some help. We created this program called Availity Lifeline to bring claims and remits back up. We stripped down our revenue cycle product into a really simple, fundamental version of it that was just claims and remits, which are the lifeblood of the business relationship between a health plan and the provider.

We went out to the market and said, we’ll make this available to anyone who needs it, free and with no strings attached. You can terminate it with five days notice. You never pay us a nickel, but in the short term, this at least will help you as a health system to get claims and remittance flowing again so that you can continue to run your business while you figure out what you want to do. It’s been very successful, with 300,000 providers and 150 or 160 actual systems that have implemented Lifeline. As I mentioned, we have moved $160 billion of otherwise stuck claims between payers and providers.

UnitedHealth Group paid the hacker’s demanded ransom, but was still down for many weeks. Oracle’s Larry Ellison said that they could have come up quickly if they were running Oracle Cloud. Is it harder to recover a complex network than to restore a health system, and does cloud provide a lot of extra recovery benefit or just a head start?

Cloud gives you a ton of extra benefit. If you listen to UHG CEO Andrew Witty’s testimony to Congress, there was a lot of older technology behind the scenes of Change. That created some real challenges, based on what they have said, in terms how the bad guys got into the network and had the ability to root around for a week and half before they actually pulled the lever on the actual ransomware attack.

Being cloud-enabled absolutely is advantageous in getting networks back up faster when there’s an event. I don’t know whether Larry’s right that it would happen in minutes. From the Availity perspective, we are completing our cloud migration. We run two data centers, but we never have them both processing transactions at the same time for that very reason. One is primary and one is redundant.  If we had to move from A to B, we can do that in three to six hours. We also do some other things to protect our core data with things like immutable backups that nobody can touch. It’s a journey, but we are absolutely counting on our cloud migration to give us even further redundancy and resiliency against a cyberattack.

You’ve acquired Diameter Health and the Olive’s utilization management business since we last spoke. How did those acquisition round out your portfolio?

The first thing that we do, even in due diligence, is cyber audits and cyber reviews. Before we close, what do we need to do to bring an acquisition up to our standards for information security? We don’t do anything to combine, from a technical perspective, those kinds of capabilities until we have brought them up to standard if needed.

Diameter was a great acquisition. The best analogy that I can give is that it’s a refinery for clinical data. Unlike administrative data, a lot of clinical data has no structure. There are no standard terminologies that everyone uses. You get a lot of data in, but aren’t able to use it and apply it to business workflows in an automated fashion. Diameter upcycles – we use that term – and refines clinical data from a lot of different sources into consumable data elements that can then be implemented in an automated workflow. We are very happy with that acquisition. It is really core to our broader clinical data, clinical interoperability standard today.

AuthAI, likewise, has been great. We bought it with one client. We’ve now sold it to multiple clients. It is a true delighter. The difference between AuthAI and Diameter is that Diameter is more of an internal technology, while AuthAI has a user experience. We can walk into provider’s office and say, “We we have automated your auth workflows for the vast majority of the ‘ologies’ that you work with. Now you can get a response in 90 seconds, all the way through medical necessity determination.” That’s a difference-maker to a provider.

How will AI affect your business?

AI is going to give us new capability. We are pretty committed to it at this point. AuthAI is built on the premise that analytic AI is a great tool to apply in complex healthcare workflows. We’ve certainly seen that with our AuthAI solution. Internally, we are leveraging AI to simplify both our own workflows and our relationship with our providers and health plans and other customers.

I’ll say one thing as an example. I got demos yesterday from two really cool companies, not startups, but sort of earlier stage. One that is on the provider side is leveraging AI in clinical documentation to help providers by essentially transcribing their clinical conversation into an application, then leveraging AI to create a true clinical note and applying what the AI believes are the proper billing codes, ICD codes, to that note.  Great. That could be a real time saver for providers.

The other demo later in the day was an early-stage AI company that was building what you and I would call, from our experience, fraud, waste, and abuse capabilities for payers. They use AI to look at the pattern of how claims come in and the documentation behind a claim to make sure that the claims are appropriate and medically necessary and therefore should be paid.

If you think about those two conversations individually, on both sides, they are cool, save time, save energy, and drive efficiency. However, you have to make sure that you achieve true transparency and enhanced decision-making to get to the right result. I don’t want to arrive in a year or two at a scenario where payer AI and provider AI are arguing with each other over whether a claim should have been a denied or whether a code should have been paid.

To the extent that AI can be applied like we’ve applied it with AuthAI to automate a workflow, in the end, between a payer and provider, where everybody’s agreeing to the rules of the road and you are leveraging the AI to drive a more efficient, effective process, the promise of that is just spectacular. That gets me really excited.

CMS’s pay-and-chase policies and perhaps its lack of sophisticated technology allow seemingly obvious fraud to take place over years before someone might be brought to justice. Couldn’t technology detect outliers more quickly?

I think there’s a great opportunity there, 100%. We sell our Advanced Editing Services product into Medicare through the MACS. It is built in with as a real-time editing capability so that you can continue to learn where games are being played or where there’s potential for fraud, waste, or abuse. You can build new edits in real time and deploy those prospectively. Why are you paying this and going after it? What you should be doing is applying the rules prospectively to deny the activity or to prevent the activity in the first place. That is 100% where we are focused as a company.

I don’t think that’s just to protect from bad activity. We are focused on it in terms of shifting left. Availity serves as the gateway for payers that are representing well over 100 million covered lives in the US. Generally, all claims and all activity flow through Availity. We believe that through the application of technology, including AI, we can make our gateway smarter, so that by the time we pass a claim onto the payer, It can be screened for nefarious activity, but it can also be screened for clinical appropriateness, proper documentation, and all the things that are required to pay a claim accurately and in a timely fashion.

What are the key points of the company’s strategy over the next five years?

We have a good thing going at Availity. We have a pretty unusual capital structure in that some of my largest customers in our health plans are investors in the company. We have a really good culture at the organization, with people who really believe in our mission. In the next five years, we will continue to do what we’re doing today to drive better collaboration, better partnership, and more transparency of information between payers and providers.

Then, to eliminate some of these lagging, complex, administrative problems that drive hundreds of billions of dollars of inefficiency in healthcare and just piss everybody off. No patient wants to stand at the MRI counter waiting an hour for their auth to be approved or to be told that even though you have a scheduled appointment, you have to come back tomorrow because I can’t get your auth approved.

Good, bad, or otherwise, we have just scratched the surface on some of these super complex challenges in healthcare. Availity has in important role to play over the next five or 10 years in simplifying the process of healthcare.

HIStalk Interviews Paula Scariati, DO, Physician Informaticist and Author

Paula Scariati, DO, MPH, MS is a physician informaticist, EHR governance consultant, and author of the book “EHR Governance: A Practical Guide to User Centric, Consensus Driven Optimization.”

Tell me about yourself and what you do.

I’m an preventive medicine and public health doctor. I fell in love with the promise of what technology could do to make patient care and access better, so much so that I left the private practice that I had in San Diego 15 years ago to formally retrain in informatics.

But nothing that I learned in my academic studies really prepared me for my first job as a physician informaticist in a large, enterprise healthcare system. Providers were frustrated by poorly designed software, inefficient workflows, and low-value tasks. EHR governance was immature, and was often driven by well-meaning executives who didn’t really use the EHR. End-user requests were low priority and frequently lost to follow up.

In short, the processes were slow, poorly coordinated, and had lots of bumps, detours, and do-overs. It was intense. The tipping point came when a large region that was part of the enterprise threatened to return to paper, and there was a crisis. Out of that crisis, a methodical, user-centric, Agile approach to EHR governance was born.

How has EHR governance changed now that most health systems have chosen and implemented an EHR?

Governance has matured organically over time. In the beginning, back when most organizations went live, it usually meant that a process was stood up at the end of go-live, where that critical mass of requests that were made during go-live, but not necessarily addressed during go-live, were handed over into a queue.  That was the focus of early governance work, the robust adoption of a new system with well -integrated workflows.

But once those I’s were dotted and T’s were crossed, the focus of governance then shifted to optimization. That work included end users adopting new tools and refining interfaces. This organization was looking for more effective, efficient care. It took probably several years for that to unfold. 

Then the organization moved on to the next phase of EHR governance, which I call transformation. It’s at that point where the organization’s governance framework would be well established and trusted. It has become part of the cultural norm of organization. There’s now a pathway, hopefully an Agile pathway, for conducting pilots or proof of concepts, which allows the organizations to quickly vet new technologies, modules, and features. There’s also an established system for communicating and socializing change.

I’d like to believe that over these last 15 years, many organizations have found a level of transformational maturity in their EHR governance processes that works well for their healthcare system and their culture. However, I’ve also spoken with so many leaders and organizations where EHR governance never got a strong footing, or where well-designed governance processes were fouled by mergers and acquisitions or major leadership changes.

Do health systems incorporate the participation of medical staff technology naysayers in addition to the “friendlies” who will reliably support most executive decisions?

EHR governance needs to be led, and it needs to be led by somebody who is well respected and has the power to make changes when they need to. That right person needs to be embedded in a consensus-driven governance process. That process needs to listen closely to everybody. People who say they’re doing a good job, but especially the people who tell them that they are not.

Sometimes that negative feedback is more representative of the truth. Sometimes it isn’t representative at all, but it’s the canary in the coal mine, meaning that that person has the unique ability to see a real problem before others do. Occasionally, it might be a disruptor who has a less-than-kind intention, who can in good faith be ignored. 

But it is important to remember that a solid EHR governance structure is a two-way street. Communication goes out, but communication also comes back in. You need to be listening to the voice of the end user. Because when that is done well, a responsive governance process can throttle and balance an organization between that need for change and that problem with inertia or the status quo. Every organization has a different level of tolerance. A good system will recognize that and reduce the amount of fatigue and burnout that an organization will have because it is keeping to close on what’s going on.

Early EHR decisions were often made without thorough physician involvement, or by departments that wanted to make their own jobs easier by using the EHR to push more work onto physicians. Are some of those decisions being revisited or are physicians being asked directly how the EHR hurts or could help their work?

I think it’s safe to say that every organization that adopted an EHR back in 2009, which is when HITECH was enacted ,would have been thrilled if the software was mature and user friendly. But we have to remember that every vendor’s core EHR product was initially designed to meet Meaningful Use metrics, and that went on for seven years. Nowhere in there was a mandate for the user interface to be friendly or for the user experience to good. 

That exists even today. Our former Meaningful Use metrics have now morphed into the Promoting Interoperability Programs and eCQMs. This is all the basis for driving value-based care, but it took a number of years for that emerging body of literature on the unintended consequences of EHRs, note bloat, provider fatigue, and burnout to elevate the importance of the end-user experience and push it to the forefront. Physicians were rightfully frustrated and local decisions were made, decisions were made by the vendors, but they weren’t made with the idea of how to improve the user experience. They were made, how do we meet this metric? How do make this quality metric or safety metric get reported so that we can obtain Meaningful Use dollars? 

There was also a lot of frustration on the part of physicians because they were now being asked to play well with others in the sandbox. They were asked work with their colleagues and other teams to come to a consensus on how to design their user interfaces and workflows. This was a difficult task for some specialties, such as cardiothoracic surgeons who might be used to having their own unique way of doing things. This is where having fair, transparent, equitable governance processes is incredibly helpful. It levels the playing field and it sets consistent expectations.

Physicians are just about the only professionals who are expected to enter data into a computer system while doing their jobs, and often the data that they are recording doesn’t benefit them or their patient directly. Is AI or the use of scribes likely to change that?

Forcing physicians to become data entry clerks has been one of the greatest failings of EHR adoption process being driven by Meaningful Use. AI will get the keyboard off the physician’s lap, which will go a long way toward restoring the doctor-patient relationship. In fact, the highlight of HIMSS24 was the latest iteration of ambient voice technology married to artificial intelligence. These types of software capture the doctor-patient encounter verbatim and then use AI -driven logic to digest that information into a succinct, readable node. It’s amazing, and I think it’s just the beginning of what AI that is thoughtfully utilized in healthcare can do. 

However, there’s a lot of pressure on AI to solve all the problems that we have. It would be very nice if it can do that. I’m waiting and hoping that that will be the case. Some people say five years. I am a big fan of following Eric Topol’s voice in the matter, and I think he’s more optimistic than most in terms of how quickly this will unfold. But either way, I think it’s going to go a long way to help correct a lot of the problems that we’ve encountered as a result of how our initial work with EHRs has happened over the last 15 years.

How does the art of medicine coexist with the use of technology to standardize processes and guide medical decision-making?

When we first started digitizing medical records, a good deal of folly took what was on paper and just made it digital. We didn’t really use the knowledge that we had of how to make the EHR better, stronger, and faster than paper ever could be. But now, we see that the science underlying medicine grows exponentially every day. Just look how much medical literature is published each day. Then there’s the patient’s genomic data and now their phenomic data and so much more. It is absolutely impossible for any one provider or provider team to keep pace without using electronic tools that can securely capture, store, and make some good sense of it all.

What I see on the horizon is that good clinical decision support tools and analytics are going to expand the horizon of the physician. But the road to getting there is going be bumpy. We haven’t really taught our physicians or given them tools in a way that are user friendly. That’s where governance comes in, helping us to figure out how much we can change, how quickly we change, and vetting stuff ahead of time so that we determine what kinds of problems it may have and then deploy it using that group of early adopters who likes to do that type of initial pilot or proof of concept work, and help them to become the agents of change within our organizations.

Epic’s implementation model involves a rigid methodology and the assumption that C-level hospital executives will follow the recommendations of vendor employees who might have been sitting in a college classroom a year or two before. Did that level of prescriptive vendor involvement change the way that hospitals implement technology?

I gave a talk yesterday and user experience with Epic.The takeaway is simple — incentivized behavior change is more effective, and Epic was very smart. Early on, they recognized that organizations didn’t know what they didn’t know, and so they led. They were prescriptive. They trained and deployed resources. They didn’t nickel and dime their customers, but the level of support that came with them had a larger price tag and, in the end, better customer satisfaction. I’ve spoken with a number of organizational leaders that have used Epic and other EHRs, and they consistently they tell me that they find the Epic model to offer added value.

The takeaway is that incentivizing behavior change, being prescriptive — especially in an environment where people are learning something new, where they don’t know what they don t know — is a valuable way to deploy something. 

Is governance different in Epic-using health systems, either because they are self-selected as large, academic medical centers or because they are influenced by Epic or its other customers?

Epic had its origins in the ambulatory world. A number of Epic installations are organizations that have brought together large groups of ambulatory providers. We used to call the ambulatory world the wild, wild West, because in the inpatient world, a large, complex go-live has a lot of moving parts, while the ambulatory world, each individual practice has its own way of doing things. When you try to bring that together under a governance structure, it’s a little bit more challenging to get people to talk to each other or get them to agree on a certain interface or workflow.

In my experience, maybe not in everybody’s experience, taking the time to draw on a group of leaders to represent a specific region or practice and bringing them together to drive the change that you call governance is critical. 

Another good example of that is watching what is happening now with the go-live for the VA. Very, very bold. They are trying to have the whole VA system and the Department of Defense be on a single instance of Oracle. That’s a bold undertaking from a governance perspective, in terms of having everybody work together and use that same platform in a similar fashion.

Implementation of AI is more of a blank slate than bringing up an EHR since health systems can set up just about any logic and workflow they want, good or bad. How will AI governance work?

I wouldn’t necessarily say that we have a blank slate today. We’ve now been through over a decade, almost 15 years following HITECH, of doing EHRs. Some organizations have been on that same EHR, while others have gone through a second go-live with another EHR. Some have gone through mergers and acquisitions.  

What I see, and what I keep hearing from the different organizations that I speak with, is that physicians and other healthcare providers and users are tired of that “unlearn something old, learn something new” unlearn-relearn technology cycle that we’ve entangled our healthcare providers in. Our human nature is more inclined towards inertia and the status quo than it is to these iterative cycles of rapid change. For example, I may offer a physician a better, more efficient way to do something, but it’s not that unusual for them to decline, saying they would rather keep their current process and workflow even if it is broken. 

I see what’s coming forward with AI as incredible. It’s going to be another technical revolution. But I’m concerned that we now have a large amount of change fatigue, and in some cases burnout, from all of the change that we have been throwing at providers for the last decade and a half. They predict that the way we practice medicine will completely change in the next five years, and that is both exciting and frightening. But solid AI governance processes are the key to helping organizations throttle how they unfold that technology so that we have a legacy of innovation and equity, not burnout and the dissolution of the doctor-patient relationship.

More physicians on the medical staff are employed directly by health systems now instead of being based in the community or contracted through an external company. How has that affected the integration of physicians into technology decisions or their ongoing technology training?

I always found that group of community-based doctors to be an outlier in how we handled them during our lives. Their office often used a different EHR than the one in the hospital where they worked. It wasn’t a given that you would automatically just bring them up in their practice on the same EHR. They would use some sort of interface in their office to be able to use their office-based EHR that was interfaced to the hospital EHR. That was a clunky way of thinking about things, and something that I really had wish we had been more forward thinking about in terms of continuity of care across the continuum of care in medicine.

I would not say that it’s a big difference in terms of how we engage with them. Often they were powerful because they brought  lot of money into the organization, so there was a high level of sensitivity to making sure that their EHR worked well for them. But engaging them in governance and in consensus was the same as it was for any other group.  Again, with that added caveat that when we were looking at workflows, it was the hospital-based workflows and not necessarily how it would always work for their EHRs within their office.  But we often would go out and do a visit into their offices just to make sure that there was something that was working well and that it wasn’t double entry, or that something was inclined to making more errors than not.

How do you see the role of the CMIO changing?

I am hopeful that CMIOs over the last decade and a half have shown that they are strong leaders. I would love to see them elevated from what is oftentimes a “small C” in the organization to a “large C,” where they have a seat at the table with the CEO, CMO, and CIO. They do in some organizations, and some they don’t. But there has been recognition of the expertise that they bring to the table, as well as an evolution in what the CMIO is expected to be able to do, that has caused that role to be elevated to a higher level. 

As we move towards more AI -driven technological revolution in healthcare, that voice, that person, and that expertise is going to be critical. Over time, roles have been renamed. They have become the chief digital officer or chief AI officer. It may go that way instead of just changing the world of the CMIO to embrace a broader swath of what is technology. They may create these other roles that are more specialized. Either way, the CMIO has been elevated in stature and importance within every organization that is seeing just how much technology touches every aspect of healthcare.

HIStalk Interviews Kelly Boyd, SVP/GM, Sonifi Health

Kelly Boyd, MBA is SVP and general manager of Sonifi Health, the healthcare division of Sonifi Solutions of Sioux Falls, SD.

Tell me about yourself and the company.

I’ve been working in healthcare technology for about 20 years. The bulk of that time has been in product development and operations. I have spent time with the customer success and sales aspects.

Sonifi Health is a wholly owned subsidiary of Sonifi Solutions. Our parent company serves hospitality and other commercial markets. Sonifi Health focuses exclusively on the healthcare market. Within Sonifi, both the parent company and our subsidiaries, we have an underlying theme that our goal is to simplify the delivery and operation of technology so that our customers can accomplish all that’s possible when technology works. Technology is great, but it needs to complement the organization where it’s being deployed. Our role and our goal is to simplify that process, make it seamless, and make it valuable to the organizations that deploy it.

We still fundamentally align ourselves with the Triple Aim initiative that was launched by IHI back maybe 2007 and later modified to the Quadruple Aim. We want to enhance the patient experience, improve health outcomes, and drive operational efficiencies. That translates to both cost reductions and staff satisfaction. That is where we live. All of our technologies — smart room technology, staff technologies — are built fundamentally to go after those initiatives. 

You emphasize that healthcare is hospitality. Do you think that most hospitals see it that way and invest accordingly?

I do. We’ve doubled down on this, because in technology and healthcare tech, we can get so caught up in technology itself. The hospital’s mission is patient care, and at the root of that is compassion, comfort, and health outcomes. That essentially is the real meaning of hospitality.

We have launched with that messaging, both to remind ourselves internally and also message to our clients that we get that technology doesn’t exist for technology’s sake. At the end of the day, everything that we are doing is about the human experience. Creating an environment that is comfortable to the patient and that reduces anxiety has a direct impact on outcomes.

Patients aren’t necessarily capable of judging the clinical aspects of the care that they receive. Does the hospitality aspect of their stay carry an outsized importance in their perceived satisfaction?

It’s interesting, because patients aren’t able to perceive different levels of true clinical care. They can attribute that “I survived that surgery, therefore it was good,” but they can’t really assess where that surgery ranked on the spectrum. What they can definitively create is the perception about how they felt were treated and the hospitality side of the care that they received. People can articulate those things more than they can the true clinical aspects of healthcare.

Patients sometimes complain that technology, such as a physician charting in the EHR, is distracting. How do they see in-room technology and smart rooms?

There is no downside to the technology from the patient perception side. We have seen bumps in hospital patient experience scores simply from bringing in smart room technology. Patients translate high tech, cutting edge, state-of-the-art automation technology to better care. Whether that is a fair translation or not, it happens.

People are human, and investments on the hospitality side impact our perception of the quality of care that we are going to receive. Is my room nice? Is the furniture nice? Is the TV nice? Anything that a hospital does to to move to a smart room to enhance the environment impacts the patient’s perception of their quality of care, and to some extent, how they will perceive their outcomes.

Your website cites a study that found that patients who use an interactive, in-room system are more likely to also use it to follow education recommendations. How can hospitals use that finding?

We found that the entertainment side of it draws people into the system. You want to watch that movie, listen to the music, engage with spiritual content, or whatever those entertainment pieces are that bring the patient into the system. The system is then designed to capitalize on the fact that the patient is engaged with the system.

We will strategically prompt the patient to engage in their care as well. That can be learning about their condition, how the recovery will go once they go home, things that they should watch for once they leave the hospital, and what they need to do to plan and prepare for their discharge. We leverage the entertainment side as a way to pull the patient in, but once they’re in the system, you have all kinds of opportunities to put the important information in front of them.

Do you engage family members in that process?

We love involving family members. When you’re a patient, there is a little bit of anxiety. You’re unsettled. Your ability to grasp the information is much different than a family member. We encourage the family members. We know that the the information lands and and sticks a little bit better when the family members are the ones participating, especially when you’re talking about young children or the adult caregivers of their elderly parents. The family members play a big part of it.

As a parent, I’ve been in the hospital with my kids and I was starved for information. What’s next? What should I expect when I take my son or daughter home? We see a lot of engagement with family members with the system.

How will patient engagement technologies be used outside the four walls of hospitals, such as with hospital at home or virtual hospitals?

This is a trend based on initiatives to reduce costs. It’s clear that the more comfortable the patient is, the better healing, recovery, and outcomes that you’re going to see. The challenge for everybody in healthcare — healthcare tech providers, payers, all of that — is educating patients across the board on health literacy, recovery, lifestyle changes, behavior, and all those things. Companies like Sonifi are trying to increase the engagement and activation of patients so that they can be successful in a home care or hospital at home environment.

How widely are hospitals using digital signage and way-finding?

Most hospitals have some type of digital signage in play. There is a need to continue to get information into the hands of patients and visitors. This could be population health content, where you have people sitting in waiting rooms and have an opportunity to get the right controlled messaging content in front of patients and family members. Signage is everywhere. There’s a lot with branding and marketing of the health system’s mission and vision.

With way-finding, you’re talking substantial institutions that exist on campuses and multi-building setups, where they are trying to make it easier for patients to navigate the campus and get where they need to go.

For Sonifi, we have the nationwide field service organization. We are already providing technology, the breadth and depth of our knowledge of infrastructure, and these type of messaging tools. This becomes a complementary solution for us that we can deliver alongside our more clinical applications.

What are your thoughts about having worked for the same company for nearly 30 years?

When it comes to Sonifi and Sonifi Health, I really love the people that I work for. We’re based in the Midwest, so we have an organization of people who are really committed and care. That “Midwest nice” thing really comes through with the group. I have people in my team who have been here 30 years as well. I have people who have been here 15 years and they joke that they’re the newbies. 

The group believes in what we do. They care about the patient. They care about the the nurse and the clinician. They care deeply about the operations person who is trying to run and manage the distribution system. Everybody is behind what we’re doing, which makes it easy to come to work every day and makes it easy to stay and commit with the organization.

What factors will be important for the company over the next few years?

We are tracking the movement away from inpatient new construction dollars to the outpatient side, with more short stay-focused, hospital-led home initiatives. Interoperability, security, data exchange, and seamless experiences across multiple facilities are big on our radar as well.

HIStalk Interviews Gene Scheurer, CEO, Optimum Healthcare IT

Gene Scheurer is co-founder and CEO of Optimum Healthcare IT of Jacksonville, FL.

Tell me about yourself and the company.

Jason Mabry and I started Optimum Healthcare IT in 2012. I had started CSI Tech, which we sold to Recruit in 2010, so we put the band back together in 2012. We were primarily focused on EHR implementations and rode that wave. We were #1 in KLAS in multiple overall services for a couple of years. We grew the business exponentially during that time.

We spun off Clearsense in 2016. That’s a data aggregation, data platform play. I went over to Clearsense in 2018 on a full-time basis to be the CEO. I promoted Jason Mabry and then Jason Jarrett into the CEO role at Optimum. I’ve been at Clearsense since. We signed some of the largest healthcare systems in the country as a data platform company. UPMC is a client and investor, Cleveland Clinic, Trinity, CommonSpirit, et cetera. We grew that business and started getting into the payer market as well.

As we made the transition to more of a product company and going into the payer market, I came to the realization that that isn’t really my strength. I went to the board nine months ago and told them that it was time for me to pass the baton and for them to find a CEO who has a product and technical background and payer experience.  We did that in January of this year and now I’m back at Optimum as CEO on a full -time basis. I was always executive chairman at Optimum, so I had kept close to the business.

In 2020, we sold a majority interest to Achieve, which is an educational fund out of New York. We weren’t necessarily looking to sell, but their business model is to tap into their network of university partners. We created CareerPath, where we take kids out of college or with one or two years of operational experience and put them through a six-week healthcare IT curriculum and certification that is operated by CHIME and is exclusive to Optimum. They get a healthcare IT certificate through CHIME and then we put them on a track to get certified in Epic, ServiceNow, or Workday. We also do project management and BI.

It was a good opportunity to add talent into the marketplace from a supply and demand perspective and to lower costs to our customers by offering up-and-coming resources. We can reduce those pay rates to those individuals and ultimately pass that along to our customers.

After we did that transaction in 2020, we did an acquisition of Trustpoint Solutions, which focused on cybersecurity advisory. Then we added ServiceNow and cloud migration services and earned Workday certification.

How do you deploy both experienced resources as well as those you have developed through CareerPath?

We still do Epic implementations and we have 600 employees, so we still are providing opportunities to those consultants who have been in the ecosystem and have experience for 10-plus years. The CareerPath model, with more junior resources, was an option to offer a hybrid. We can marry highly experienced team leads with junior-level resources from an analyst perspective, and they can do some mentorship. It’s a way to drive down implementation or optimization costs for our customers while creating a new talent pool for ServiceNow and Workday.

What areas do health systems need help with?

We have new clients that are doing new Epic installs and there’s a lot of Cerner to Epic migrations happening. We also have some Meditech to Cerner customers that are doing new implementations. We have opportunities for new installs, training, go-lives on new-new implementations, and optimization.

A lot of healthcare systems have financial headwinds. They have made a large investment in the EHRs of their choice. They are optimizing those to make them as efficient as possible. We are asked to do a lot of workflow redesign and revenue cycle projects.

On the ServiceNow side, we have become the only Elite partner in healthcare. They are looking more from a vertical perspective right now. Healthcare is so nuanced in terms of understanding the landscape and workflows and everything that goes into healthcare. It’s probably one of the most dynamic and involved of all the verticals that they have, so they love the fact that we are healthcare focused. We bring to bear a lot of advisory around the healthcare landscape in conjunction with the ServiceNow and Workday implementation.

Where are we in the always-swinging pendulum between healthcare outsourcing and insourcing of IT and revenue cycle?

We are seeing a lot more insourcing, as opposed to outsourcing. Those cycles always change, but within our customer base, we are seeing a lot of insourcing, coming back into the revenue cycle space. That is good for us because we can partner with our customers to help them bring in consultants to stand up those revenue cycle initiatives as they get operationalized and then get to a steady state.

Are you seeing any impact from AI?

The software partners that we’re working with – Epic, Workday, and ServiceNow – have incorporated AI into their software and technologies. Everybody is using AI to some degree, and it’s typically use case specific. It’s a lot of buzz, but as it matures, you’ll start seeing AI’s true ability to demonstrate real results. A lot of it is embedded into the software, behind the curtain in a lot of ways, and people are using it one way or another even if they don’t realize it.

AI will drive efficiencies to your customers where they are becoming reliant upon whatever technology is within their ecosystem. Companies are learning how AI can make their software products more valuable to their customers.

Going back to your comment about preferring to run a services business rather than a product business, how do the required skills and abilities differ?

The services business is more transactional in nature. It’s more volume. You can create value through a different lens on the services side, because any services business is in professional services and it’s providing human capital. You need policies, procedures, and enablement for your consultants to thrive within a given customer. They need to feel supported, so there’s a high touch, high customer service aspect to it. You’re working with human capital, so you want to make those people feel valued.

That also drives how your customers and clients view Optimum and our competitors. It’s how you handle situations when things don’t go exactly according to plan with a particular consultant, They have lives. Things happen. They have families. A particular consultant might be going through something that doesn’t allow them to perform at their best, or they have issues where they can’t be on site.

While you are dealing with employee or consultant issues, you have to offer white glove service to clients. You make sure that the client understands that we will do everything we can to backfill someone who doesn’t work out. The onus is on a professional services company to have a system in place that supports your consultant so they can do the best job. They shouldn’t have to be worried about whether their expenses are going to get paid or payroll will be on time. Then, do they have a support system and mentors internally?

In comparison, on the software side, you are selling a multi-year, enterprise-wide data platform product. That sales cycle can take eight to 12 months. It’s very much a consensus-driven sale because you are touching multiple stakeholders within the healthcare system. You need to get the buy-in from the CIO, CFO, CMIO, and sometimes the CEO. There are multiple sales points.

The other side of it is delivery. Once you sell the deal, the difference is on the delivery of professional services. You are reliant on the human capital and their knowledge base.

On the technology or SaaS data platform side, you are reliant on the technology. That incorporates a wholly different set of challenges and people that you are working with. I’m not technical even though I started the business. I still have a great team over at Clearsense. When technical issues hit my desk, I don’t have an answer, and that’s a humbling experience. Whereas on the professional services side, I’ve been doing this so long that even if I don’t have all the right answers, I have a good idea of how we should overcome certain challenges within the business.

What factors will impact the company’s strategy and performance over the next few years?

Growing those emerging service lines. We have a history of great delivery on the EHR side of the house and we are proud of that. With Jason and me coming back, we are infusing a culture of celebrating our wins, us against the world, and driving the type of growth that Optimum had in the early days. We are demonstrating that through high quality work, great relationships, and accountability.

We are proud to have become an Elite ServiceNow partner in a short period of time, and we are excited about the growth of that business.

We earned Workday certified partnership late last year and we are in the infancy stage of kicking off that practice. We hired our first practice director. Workday’s presence in healthcare is similar to Epic’s back in the day, with great software. They are starting to verticalize their offerings, having specific healthcare-focused salespeople and enablement, and looking at healthcare differently than their financial services customers.

On the cloud side, we are an AWS certified partner and a Microsoft partner. We are building that capability, whether it’s moving your DR to the cloud or moving an Epic instance to the cloud. We did the first one with Baptist last year, and we’re touting that as a use case.

We will be able to cross-sell into a healthcare system with these multiple offerings, essentially becoming more of a digital transformation professional services organization than an EHR implementation company as we have historically been.

It’s important for us to make that transition and stay relevant in today’s ecosystem with the technologies that our customers are using. We want to be able to help them through the process of being successful with their implementation of those products. We need to give our message concisely, understand how each type of software impacts the other, and make ourselves a vendor of choice for our provider clients, a trusted partner, whether it’s Epic, Cerner, Workday, ServiceNow or cloud migration.

HIStalk Interviews Jason Brown, CEO, MRO

Jason Brown, MBA is CEO of MRO of Norristown, PA.

Tell me about yourself and the company.

I have been in the healthcare technology space for almost 20 years. I have been working at the intersection of providers, payers, rev cycle, value-based care, and payment integrity, with an eye toward solutions that help take cost out of the healthcare system, move data, drive interoperability, and support value-based care.

At MRO, we think of the business as driving clinical data exchange among providers, payers, patients, and other third-party requesters at scale and driving health care interoperability across the ecosystem.

Is the term “release of information” still valid?

The business started in a document management style release of information. That’s still a core part of what we do and will continue to be. As we look at it, we are expanding out from that platform and taking perhaps a wider view of the opportunity. That opportunity is, how you make clinical data available on time, every time, to the right, credentialed user? The minimum necessary information available in the purpose fit format. 

Digital and release of information is a component of that, but not necessarily the totality of that. It is our core DNA where the company started and is still a big part of what we do. We built off of that capability and solution set to do a number of other things, and we will continue to advance those capabilities.

How has the demand for data exchange changed as providers captured more data electronically?

That’s a big part of the thesis that the demand for clinical data, in addition to claims data or maybe in replacement of claims data, continues to grow at a fast clip. The healthcare system places the burden on hospitals and providers to manage that clinical data and make sure that it gets to the right user, even though it sits in a bunch of different formats all over the place. 

As we see demand growing and complexity of data growing, there’s a great opportunity to be that middleware in between, partnering with providers, payers, other third parties — it could be pharmaceutical companies or patients themselves as legal requesters — to make sure that the minimum necessary data can get to the right place in the right format. On time, every time.

Life sciences companies seem to be the highest-profile data consumers, to the point that companies and provider groups have made a business of selling them data. How is that market progressing?

It is in an early stage.The appetite and demand from the pharma companies, life science companies, probably outstrips the supply or the ability to satisfy that data today. But there’s a lot of strides in interoperability, commercial models, etc. that is increasingly spinning up opportunities to be able to meet that demand, to do that in a secure way, do that in a way that is beneficial to the providers to allow them to participate in some of the economics, and then to make sure that we are ultimately helping to use the data that we have available to create the right type of pharmaceutical solutions for patients.

It’s early innings for sure, but that market has a long runway in front of it in terms of opportunities as we are able to meet that demand from life sciences companies.

What about data related to valued-based care, quality management, and care management?

I would say that is more mature than the life sciences market, but probably moving slower than all of us would hope. Part of the gating issue or pacing issue on more value-based care adoption is having that clinical data exchange between providers and payers. As you start to see a lot of the push and pull there, it is most acute in situations where there is some sort of value-based care relationship, where the provider needs to share data with the payer and vice versa so that they can both be successful in those risk-based relationships. 

That’s an area that has picked up a lot of traction for us over the last couple of years, but that market still is mid-innings. We would love to see it grow a lot faster, and I think it’s great for the overall healthcare system as well. As we enable more high fidelity, low latency, longitudinal clinical data to be available, I think you’ll see a step-function increase in value-based care arrangements, because both parties will feel that they can be successful in those relationships.

Does provider data still need a lot of cleanup and transformation to be understandable by the outside world?

That is certainly still the case. Strides have been made for sure. How you normalize standardized data, and in some cases tokenize it, to make it usable on the other end is still a big part of the healthcare value chain. Our solution set and capabilities is all about data extraction, digitization, ingestion, normalization, and standardization, and then you draw insights and intelligence from that. To make it useful, so that you can get it to whomever is requesting it in a format that they can consume it and have that data in a way that can drive the downstream insights and actions that you want to be able to power.

How is the market for patient registries that have been created or endorsed by professional and specialty societies?

That continues to be a very active market. It picked up a lot of traction over last 10 or 15 years. We have seen the evolution from value-based care type measures and quality reporting to now getting into some of the things we talked about earlier, which drive bigger clinical quality opportunities and opportunities with life sciences and pharma. That market is active and continuing to advance and innovate because they are sitting on large corpus of clinical data and deep clinical insights around certain specialties. Now they are looking at things in addition to their legacy work in value-based care around more quality stuff and partnering with life sciences firms in real-world data and real-world evidence.

Do you see company opportunities from using AI?

We are certainly digging into it now, looking at ways to leverage it across our entire book of business. We are actively developing a couple of AI solutions to power and automate parts of our workflow today that allow us to do more faster around quality insights, etc. We have big efforts around that. 

The other side of that coin is that of the vendors a company works with, all of them are developing AI solutions. We are actively working to evaluate those and understand how to move those into our workflows and into how we do things, whether that’s Microsoft Copilot, solutions from our telephony vendors, and even to back office systems such as HR and Salesforce. They all have different AI capabilities. 

We think it’s going to touch every part of our organization, not just the stuff that we can deliver to our clients and solutions that we can build, but also how we work with our vendors and automate different parts of our company. We are excited about that and are actively pursuing various initiatives right now. We have a lot of experience in different aspects of creating, running, and selling businesses in healthcare.

Is the business environment improving overall?

I think that the market is getting better and starting to normalize. People are a little bit more bullish about where the rate environment is going to be. We are heading into an election, and in any election cycle, healthcare tends to be on the ballot in some shape, form, or fashion. We keep an eye on all those things from a macro perspective. 

For our business more specifically, the tailwinds continue to be quite strong, as the demand for clinical data continues to grow at a pretty exceptional rate. That’s driven by a whole host of things, not the least of which is demographic factors. Ten thousand people age into Medicare every day, and a third or more of those go into Medicare Advantage. That’s a big tailwind for our business. Value-based care is big tailwind for our business. Demand for clinical data from sophisticated requestors, like life sciences, continues to be a tailwind for our business.  

Macro environment notwithstanding, we like all the trend lines of the need for clinical data to make healthcare decisions, treat patients, and drive better insights. We think that this is a long-term trend that will go unabated for at least a couple of decades.

What impact do you expect to see from the Change Healthcare cyberattack in terms of financing, healthcare policy, and antitrust concerns?

I’ll start with the last one because that will probably be the biggest. We now see where Change, United, and Optum touch every part of the healthcare system. This situation exposed the fragility of some of that and showed how connected some of these pieces are. Greater thought needs so be given to those aspects.

If you’re a provider, you have to think about who has your data and who you are connecting with. How do you make sure, as a provider or payer, that they have the highest standards of security, probably beyond HITRUST? We at MRO pride ourselves that we have been delivering secure, compliant data for 20-plus years, and we understand the sensitivity of that. Heightening those standards will increase. Every provider and payer will take a closer look, not that they weren’t before.

I also think about diversification, making sure that you don’t have all your eggs in one basket. That will have implications in how both providers and payers think about deploying technology and vendors. 

What are the key parts of the company’s near-term strategy?

We are in the early innings of a digital transformation. We want to continue to deploy technology across every part of our business. That will be a big part of our strategy.  We need to continue our client centricity and make sure that we are widening and deepening our relationships with our clients. We operate in a multi -sided network and need to make sure that we continue to deliver value to all sides of that network to continue to drive network effects across our business model.

HIStalk Interviews Russ Richmond, MD, CEO, Laudio

Russ Richmond, MD is co-founder and CEO of Laudio of Boston, MA.

Tell me about yourself and the company.

I’m a lifelong entrepreneur. I’m also a physician, and through that and other activities, I’ve walked the halls of over 100 hospitals and I understand how they run. I have focused my life on building solutions software for hospitals.

I’m the founder and CEO of Laudio, which is an AI-enhanced platform for the frontline leaders or frontline managers in health systems. We support these frontline leaders with workflow that saves them time and drives improved employee retention and engagement, operational efficiency, and improved patient experience.

How much health system employee burnout and turnover can be tied to manager-level behavior rather than organization-wide policies like compensation?

Our best guess is that 60% to 70% of the employee’s engagement, which is the proximal metric for turnover, is influenced or driven by their direct reporting relationship with their manager. Health systems assume that it is always compensation related. I’m not saying that compensation isn’t a very important thing, but we know that frontline workers attach much more to their managers than they do to the overall organization. We know that by improving the bond between a frontline worker and their manager, we can greatly influence their propensity to stay engaged and employed at that organization.

People often say that they love the company, but can’t stand the boss.

People don’t quit jobs, they quit managers. Managers have a tremendous amount of influence on the mental wellbeing of their employees, and anyone who has had a bad boss knows that well.

But what we have learned inside health systems is that they have a special issue, which is that the frontline managers have very large spans of control. It’s not uncommon to see team sizes of 50, 70, or 100 direct reports into a manager. That really stretches the bandwidth of that manager to do traditional management.

The biggest lever is to increase the frequency of timely, relevant connections between the managers and their teams in a way that feels personalized, in a way that makes a big team feel smaller. That in and of itself can drive a tremendous improvement in engagement and retention. If a manager takes the time to have a one-on-one interaction with their team member every month, the likelihood of that team member quitting falls by over 40%. It’s just that the managers sometimes don’t have time to do that.

Beyond that, it’s the intuitive things, and a few counterintuitive things, that make a difference. First, managers showing that they care about the wellbeing of their employee when they do interact with them. How is their schedule? Have they worked too many shifts in a row? Are they forming relationships on the unit and inside their teams? Celebrating or recognizing good work done? These are the types of actions that managers can take that can make a real difference. 

Then somewhat counterintuitively, even when managers interact with team members on accountability-related issues — like corrective action with a worker who is always coming in late — that actually drives an increase in retention. Because all of a sudden, the frontline worker knows that someone is paying attention to them, that someone cares about whether they are there on time.

It can be a wide array of interactions, but the key is that they have to happen, happen regularly, and happen in a way that’s not a bulk email, not pro forma, but in a caring, personalized way.

What is the disconnect between what executives expect and what managers do?

Many executives don’t appreciate the challenge these frontline managers are up against. Huge spans of control, extending to the number of systems that they need to interact with and operate, the administrative burden that they face, and just getting their regular work done in terms of documentation, getting data into the right place, and setting the schedule. Because they are disconnected from that everyday reality, it’s harder for them to support and coach these frontline leaders. It’s harder for them to connect their agenda, which may be system-wide performance improvement, with the everyday actions of the frontline leader.

Laudio solves for that. It connects the overall system wide agenda — say, improving retention of full -time employees, reducing contract labor, or improving HCAHPS scores — with specific daily actions that frontline managers can take that and that fit into their workflow in an efficient way. That’s where we have focused our efforts on solving that problem.

How does a health system define its goals and then package up individual tasks that frontline managers should be doing?

We have live API integrations into the systems around these managers. That includes the HR information systems, like Oracle or Workday. That includes the time and attendance systems, like UKG. That even includes Epic, where we get patient geolocation information. The data aggregation is handled through our platform. 

Once we have the data in one place, it’s just a matter of working with the senior leaders in the health system around their priorities. Some of them have priorities, especially in today’s day and age, around reducing turnover or reducing incremental overtime. In that case, we are pushing those types of actions through Laudio. Some of them have priorities in saving their frontline leaders time, because they can see that they are overburdened. In that case, we are working with the frontline leaders on automating their work and creating more operational efficiency. Some of them have priorities in patient experience or quality, and in those cases, we are emphasizing those workflows.

Because we are a platform that surrounds the frontline leader, it’s just a matter of, from an organizational level, determining what to emphasize first and foremost. Then once we are seeing good results there, we can move on to the next area.

I’m still thinking about a hospital manager having 100 direct reports covering a 24-hour schedule. Is healthcare unusual in that regard?

Yes, it is unusual. I have not seen another industry like it. Normal executive span of control is between six to maybe 12 people. Even when you get to 20 people, which is a low span of control inside an acute care facility, you are way beyond that. 

I think it comes from the guild-based practice of medicine, where practitioners were meant to be individual contributors in an era that wasn’t as team-based and wasn’t as technically challenged. We live with it today, and it has become a more or less a permanent part of the economics of health systems. They have a hard time affording span-breakers and hiring more managers, because most health systems are working to reduce their labor expenses. It becomes what can we do for our managers to give them more capacity to take on these larger team sizes and to still drive the results that we need in the system.

I would assume that a lot of those folks were promoted into management because of their own job performance among peers rather than having managerial aspirations or talents.

That’s correct. Managers in health systems are almost never hired horizontally from other organizations outside of healthcare, and very rarely are they hired horizontally inside a facility or organization. What you see almost all the time is individual frontline workers getting promoted into being a frontline manager when their manager leaves, which we call a battlefield promotion.

In the context of a battlefield promotion, it’s difficult to ensure that that new manager has acquired all of the management best practices, skills, and training that will be needed to be good at that job. It’s a very different job than the one they had been doing. This is where we believe that software can at least be part of the solution, and that we can hardwire a lot of the management best practices through our system and also introduce best practices as they are discovered so that they can become immediately diffused to the managers versus waiting for them to go to get a master’s in healthcare administration or to take some type of a training program that that health system may offer.

Software has a tremendous advantage in supporting especially new managers, but all managers, to quickly acquire some of the skills they need to do a great job.

Do managers get adequate employee feedback from hallway conversations, or is a formal feedback mechanism required?

It is very difficult for a manager in a hospital to get accurate feedback, because they are managing a unit that is working 24×7 while working 40 or 50 hours of the week. They are not regularly interfacing with the entire employee base. When they are, it’s often in the context of putting out a fire. I put that in quotes, such as handling on a patient issue, a physician complaint, or a near-term operational priority like a staffing gap. 

Employee voice tools effectively gather feedback regularly and efficiently. They help managers understand their unit better by highlighting only the key issues that require action. This saves time and enables quick responses to important matters. It’s a great use of technology.

What are early warning indicators for burnout that an overburdened manager can detect so they can at least take action to retain an employee?

Health systems are collecting a lot of employee-specific data continuously all the time. The problem is sorting the signal from the noise, figuring out what is relevant, and then in the context of a busy unit, finding the right way to connect on it. 

Our software helps prioritize and identify the individuals who need the manager’s attention most, using AI and risk models. Then we connect the manager to the evidence-based best next action with that frontline employee. That can vary dramatically, depending on the core issue. It could be helping them iron out their schedule if they have an unusual working pattern where they are always on weekends or something undesirable. It could include helping them think about their promotional pathway and clinical ladder to give them a longer-term view in the system. It could be reviewing complimentary feedback from their patients and recognizing them for a job well done. It really depends on the situation and the individual worker. 

Where Laudio has a real advantage is that since we are collecting all this information, we are understanding what the managers are doing with it and the actions that we are taking. We have created an evidence-based dataset of which actions can support the workers the most. We publish a new use of evidence every week in a part of our website called Laudio Insights, where in a non-commercial way, we are trying to promote the practice of what we call evidence-based leadership. Everyone can benefit from what we are learning around what makes the most difference for managers and how they can use this evidence to practice differently.

What are your company priorities over the next few years?

Continuing to focus on helping create management actions that will drive new levels of impact in health systems. We can handle the data aggregation and analysis that is done automatically in our machine. We are starting to turn our frontline managers into super-powered frontline managers and make them more efficient.

In the future, we want to continue to pull new and different data sources into our system to help them to achieve new horizons of impact. This could include things like the supplies that are used inside each unit. It could include all of the sensors that are in patient rooms around handwashing or whether the patients are being rotated on their beds. We see a future where more and more of this data and information is integrated into a single source of recommendation for the manager so that they can make the impact happen without having the analysis, risk modeling, and data aggregation get in the way.

HIStalk Interviews Larry Kaiser, Chief Marketing Officer, Optimum Healthcare IT

Larry Kaiser is chief marketing officer of Optimum Healthcare IT and its sister company Clearsense.

Tell me about yourself and your work.

I have been in healthcare IT for just over 20 years now. I started with Keane, which was acquired by NTT Data in 2010. They sold two EHRs. I started as the RFP manager and then moved up to running the marketing department. In 2016, I shifted to Optimum Healthcare IT, where I launched the marketing function from the ground up, built that, and helped grow the organization to about $160 million in revenue. I left Optimum to go to our sister company Clearsense for a couple of years. Now I am back at Optimum as we look at the next level of growth in the organization that is not centered on core EHR services. That includes ServiceNow services, Workday staffing and implementation, and cloud migration and cloud services.

How would you describe a marketing organization to someone who doesn’t know much about it?

Marketing is something different every single day. That’s what makes marketing interesting. That’s what makes it exciting. 

In the case of Optimum, where I was building an organization, I could look back on my experience at Keane and NTT Data over 10 and a half years. I saw how things were done from a corporate perspective and from a divisional perspective, how different people did different things, and learned from that. When you’re building a marketing department from the ground up, you have lots of examples of what worked and what didn’t work. You need to start very basic.

When I joined Optimum, it had a logo and a website that was built on the 2012 version of Drupal and had never been updated. This was in 2016. The first thing we had to do was to look at our public-facing presence and determine what we wanted to be. That started all sorts of internal conversations with many subject matter experts on how we should portray ourselves, the services that we offer, and start molding those together in a fashion that had never been done.

We worked on the website and the website content, getting it to a modern platform. Then we focused on pieces of collateral and slowly worked our way through that. Then we worked on thought leadership and exploring different types of white papers and case studies to allow us to show that we know what we’re talking about and to promote the successes that we had as an organization. From there, it goes off into many different areas, such as partnerships with industry organizations such as CHIME and HIMSS.

It’s really just understanding and taking an inventory. The marketing plan I put in place focused on several things across the board, looking through all of those, understanding from an organizational perspective and having all of those conversations, and then taking all that knowledge and executing it. Every day, I was doing something different. Having never been on the services side versus the product side, every day was an education for me, and I would learn something every single day. That allowed me to work through this process methodically to strengthen the brand position, promote that thought leadership, fuel that demand and lead generation, and ultimately educate the employees on what we would be doing  to grow the organization.

Have shortened attention spans changed the way that you create content?

Analytics plays a big role in that. If you talk to any marketers, whether it’s healthcare or any space, it’s all about the analytics. If I’m producing articles for a blog that will be mentioned on LinkedIn, X, or HIStalk, I have the necessary coding within those URLs to understand how many times it’s being clicked and who is looking at it. That helps drive the kind of content that we create. If we create infographics and find that traffic to those pages, clicks, and downloads are high, we will shift our attention to that.

White papers have traditionally been that lone piece of gated content that an organization will put up on their website. The challenge with that is when people fill out a form to download it, they will put Mickey Mouse for a name or a fake email address, because probably nine times out of 10, the form doesn’t check the email address and just opens the PDF for any entry. Emails sent by your marketing automation bounces back, but that person has already obtained that piece of content. It’s a challenge, in this day and age of cybersecurity threats and people’s phones and emails being hacked.

Social platforms are doing different things. LinkedIn offers newsletter capability. At Optimum, we have found that over the last couple of years, fewer people are filling out a short form that asks for name, organization name, and email address to subscribe to our thought leadership in their inbox. People don’t want to give their personal information.

This week, we launched Optimum Pulse, our new newsletter. That goes out to our 55,000 followers, and we’re up to 4,200 subscribers. Our strategy on our website now is that instead of asking you for your personal information to subscribe, we will put a link out for people to subscribe to our content on LinkedIn. Each week, we will publish a newsletter with a little preview and a link to our website. That link will be appropriately tagged for tracking. That will give us insight into what pieces of content are working.

From a white paper perspective, we haven’t published one in several years, for similar reasons. We didn’t have the bandwidth, because we’ve been so busy. They really weren’t being downloaded too much. We shifted to more case studies, blog articles, and when we had the bandwidth to do it, more video. We did lots of spotlights on some of our Optimum CareerPath students, and that has resonated in the market. Our target market of CIOs for the Optimum CareerPath program likes to view those videos of the people who have gone through and have had success.

It’s a challenge and it’s a constant struggle. It’s a constant monitoring of all those analytics to figure out what content your audience is reading.

How do you differentiate between brand awareness versus lead generation?

First and foremost, I don’t think brand recognition ever really goes away. That’s always going on. I’m of the belief that your public-facing website should be touched at least once every 18 months to update the look and the feel of that website to keep it fresh. That’s something that we’re doing at Optimum right now.

From a lead generation perspective, or demand generation perspective, for our basic core EHR services, our brand is recognized so much that we don’t really have to do demand generation in that space. People come to us, and that’s fantastic. But in the new areas of growth — ServiceNow services, Workday implementation and staffing, and cloud migration services – we are having to start from the ground up and focus on demand generation programs and developing those, because we’re not known for those things right now. That has been ongoing for the last several months.

For our ServiceNow practice, we hired a specific firm that specializes in ServiceNow demand generation. They are helping us develop the necessary content to start doing that demand generation.We will learn from that and probably do a little duplication of what they’re doing for the other practices as well. It’s definitely a shift as the organization grows into new areas and needs to focus on demand generation for them.

I’ve noticed on LinkedIn some health tech folks whose title involves “growth marketing.” How is that different from marketing in general?

That’s a toughie right there. A growth marketing individual is someone who is 100% focused on doing the B2B strategic, data-driven approach to building a pipeline in conjunction with your sales team. I’ve seen that same title a lot out there as well.

At Optimum and Clearsense, we have not necessarily had that individual. The marketing department is working with sales to generate the pipeline, qualify the leads, and make sure that everybody is doing what they need to do to move that opportunity through the buying cycle of the pipeline. Every organization will have a different cycle it goes through. I think it’s an extension, similar to saying that you’re a social media marketer or an influencer. It’s a small piece of the overall picture. It’s probably more like an inside sales rep, ultimately.

How do companies plan their involvement with health tech conferences?

I’ve been doing HIMSS for 20 years. For 16 or 17 of those years, we had one conference in healthcare IT, and that was HIMSS. If you didn’t go to HIMSS, you really weren’t relevant in the space. 

Because of COVID and how some things were handled, CHIME and HIMSS were no longer associated, and they went off and did the ViVE conference. The second year was much better than the first year. Clearsense went into that conference in 2021 in a rented booth from them and we really didn’t know what to expect. As a young organization promoting our SaaS product, we didn’t know who was coming. It was a little bit smaller, but year over year, it grew. Having CHIME associated with it brought our target market to that.

HIMSS was really struggling. I think that had a lot to do with how they handled the 2020 show. It wasn’t until last year when, all of a sudden, HIMSS appeared to be relevant again. At Clearsense, we had no idea what to expect at HIMSS last year. We were very pleasantly surprised. Our booth traffic was just as robust as it was at ViVE, to the point that we had a wait list to get demos of our product.

Clearsense is a product company. We are heavily invested in ViVE from various sponsorships. We built our own booth because financially it made more sense to build it and store it than to rent a booth every year. HIMSS is less of an investment, but I could see that investment growing in the future if the trend of growth and recovery for HIMSS continues.

As to HLTH, I have never personally attended. We explored the possibility of exhibiting at HLTH this year. I sought the opinions of many people. The folks at HLTH and I are friendly. They shared the breakdown of attendees. It’s more tailored to provider and payer now, where the angel investors aren’t as prevalent. But then when I have conversations with people, they tell me the exact opposite from their attendance. We chose not to invest in HLTH.

We are a main sponsor of ViVE, but we don’t have a booth. We have a pretty hefty investment in ViVE. Several years ago, we were no longer a HIMSS sponsor, but with these new areas of growth, it’s an area that I think we need to start investing in again because all the players are at HIMSS, such as AWS, ServiceNow, and Workday.

For both of our organizations, ViVE is number one, HIMSS is number two, and HLTH is a distant third, just based on the attendance.

Have you received any early indication of how the HIMSS conference will change now that Informa Markets is running it?

It’s too early to tell. The running joke in the industry is that maybe the aisles will have carpeting again this year.

Most of the HIMSS people that I was friendly with have moved over to the new company. In the questions I’ve been asking and the conversations that I’ve been having, we won’t see major change in HIMSS until 2025. What that change is, I don’t know. They haven’t really said what it will look like. Apparently HIMSS is still dictating the education at the show and Informa is doing the show itself. We’re all sitting back and waiting to see how it’s going to change.

HIMSS24 is too close to the acquisition to make changes for this year. It will be interesting to see what it becomes and whether they can return it to its glory of many years ago. I’m not going to say that it’s not relevant now, but they are playing second fiddle to ViVe now, unfortunately.

Companies reduced their spending to weather the investment and economic downturn. How will they restore the marketing function as conditions improve and companies have to reestablish their competitive position?

2023 was a tough year in general for healthcare IT companies, whether you sell services or products. Historically, marketing is usually the first to go and the last to get rehired. Organizations that had a strong financial footing may have done some some RIFs, some layoffs, but they didn’t eliminate the department across the board. I have seen some organizations cut their entire marketing department, which Is interesting to me because you still need to maintain your brand. You still need to maintain the marketing activities that you were doing in order to grow pipeline. Marketing and sales go hand in hand.

This year and going into 2025, I think you will see a slow reinvestment in marketing. A number of articles from well-known publications have said that from their research and conversations, providers are opening their purses up again. When providers start buying again, an organization has to have marketing to successfully engage with them. Probably by the middle of this year, I think you’ll see an uptick in healthcare IT marketing expenditure to bring teams back in. It will happen methodically. An organization that cut everybody will probably bring in a leader first and have that person assess where they were before, where they are now, what needs to be addressed, and what roles need to be brought in. Then you’ll see a trickle down effect of them slowly ramping up their marketing departments again.

I’m very much plugged into the healthcare IT marketing organizations. I can open up my my browser to X and I have a chat with about 15 other healthcare IT marketing folks from various organizations. We have a chat every day, and just this morning, someone said their entire team was let go. We are seeing that a little bit, but by mid-year, you will see a real push to reestablish those teams.

HIStalk Interviews Aasim Saeed, MD, CEO, Amenities Health

Aasim Saeed, MD, MPA is founder and CEO of Amenities Health of Dallas, TX.

Tell me about yourself and the company.

I’m a Texas native and I live in Dallas. I have a medicine and public policy degree background, but I never practiced clinically after medical school. Instead, I went the route of management consulting at McKinsey, where I was almost exclusively focused on US healthcare and US healthcare systems specifically. I wanted to make an impact on the healthcare provider side. That remains my passion today. I was at McKinsey for a few years and then started getting into technology and jumped out from my first startup, which was an early stage fintech company that was acquired by H&R Block.

For the last four years, prior to launching Amenities about two years ago, I led innovation at a large healthcare system here in Dallas, Baylor Scott & White Health. It was an interesting time to be there from 2017 to 2021, when I left. Obviously COVID happened, but we also made massive investments in digital health, and I think we were pretty much leaders in the field from a health system side. That has a loaded connotation onto itself, but I did a lot of cool things, part of which sparked the ideas and opportunities that I wanted to explore at Amenities.

At Amenities, we help large healthcare systems build a much better patient experience. Specifically, we think that the digital consumer is dramatically lacking in US healthcare, and that health systems have a huge opportunity to shift the market experience and then hopefully get rewarded for doing so by moving patient volume.

We call our platform a digital front door and patient loyalty platform. That last part is important, because our bet is that if you not only improve patient experience, but do so in a new business model that rewards you with loyalty, that could be game changing. That’s the idea behind Amazon Prime, where you went from occasionally shopping online to basically shopping online exclusively. I have hardly set foot in a Walmart again because two-day shipping and free returns solved all my concerns.

Part of what we are trying to do is help health systems figure out how to be more compelling and exciting to their patients. That’s why we’re called Amenities, literally.

Healthcare consumers have a high lifetime value. Why don’t providers compete on customer experience?

I don’t think there’s a single answer, if I’m being blunt, and I’m definitely not the smartest person in the room to have a perfect answer for you. They don’t compete on it because nothing changes your decision-making as a patient. If you’re in an ambulance, you’re not typically choosing where you’re going. If your doctor says go to Baylor, THR, or Medical City, you follow those instructions. You only find out what it costs afterwards. You are picking based on a vague idea – what’s a good doctor or good health system? There is an abundance of reasons that patients aren’t able to discriminate health systems.

If you’re being fair and say, why aren’t health systems more motivated? It is because to date, if they have done something, it hasn’t resulted in more volume. They might have experimented with doing something for the patient, but it didn’t move enough volume in a specialty that mattered financially. There is a massive missing ingredient, which is a business model that rewards them in a metric they care about. I think that is membership, loyalty, and lifetime value of a patient, instead of just saying that we offer this concierge primary care practice, we signed up 100 patients, and that’s it. It doesn’t result in downstream loyalty.

Patients want to know what it’s going to cost. I spent four years at Baylor trying to figure out how to do meaningful price transparency. Frankly, it’s not really a solvable problem right now, based on the infrastructure we have and the multitude of players. 

There have been both handicaps for health systems, as well as that they haven’t had a financial business model that gets them excited enough about doing game-changing things. It’s sometimes unfair, but I think accurate, to say that this industry is known for conservatism. They don’t take big risks. They don’t swing for the fences. They don’t do this. We are trying to show them an opportunity not to do things for incremental cost reduction or try to find a use case for AI for AI’s sake, but rather let’s swing for the fences and change how healthcare is delivered here. Incentives around a membership could be a big activator.

Do health systems that launch innovation and digital teams have specific ideas of what they want to accomplish and establish metrics to track results?

You will find, unfortunately, some variation of the Triple or Quadruple Aim as the mission, just reworded to sound fancier, like reduce cost, improve quality, provider satisfaction, patient experience. At Baylor, when I was there but I think it’s changed now, we had value-based care. We had operational excellence. There was cost reduction. We had consumer digital, which was  patient experience. 

Again, they might call it something different, but we haven’t seen much that’s materially different than that in different innovation teams. That’s because we haven’t accomplished those goals. That’s not a knock on health systems. Those are the things that we are all trying to achieve.

The question is, how is it going to scale? Where health system innovation teams struggle is that everything feels like an experiment, with death by pilot or a dozen little pet projects. We very much started out that way. You have to get to the core of the health system and what’s it trying to do. You can’t experiment for experiment’s sake.

Unfortunately, we’re seeing a lot of that. We get asked a lot, what’s your AI strategy? What are you talking about? That’s such a weird thing in healthcare. It’s like, what’s your cloud? I mean, I understand why people care in the IT arena, but that’s not a business case. If McKinsey taught me anything, it was to start with a tangible outcome that is undeniably important to the overall business, and let your strategy, especially your technology strategy, stem from that. 

The time that we had the most clarity at Baylor, and the digital health office that I ran, was during COVID. It was like, oh my God, patients can’t access virtual appointments and we’re not serving our patients. There was immediacy. But even immediately after that, our strategy became specific, to double the number of Texans served. That was so helpful for the innovation team to focus. We stopped doing things that just came to us, and we said, is this going to move the needle?  

That’s a level of focus that I left with for Amenities, to say that we’re not an app for app’s sake. Building a prettier app is not going to fix healthcare. If the app helps a patient register in under 30 seconds, find a doctor, and book an appointment, now we’ve done something. If AI can help, great, but 90% of those problems do not require AI. We have refused to create the operational systems, the scheduling systems, or whatever it is. We fix those things. We don’t try to do big, shiny things. We’re trying to help the health system attract new patients, make it incredibly simple for them to become a patient, find a doctor, and book an appointment. 

The fun really starts when we think, what would keep them loyal that doesn’t exist in the market today? When we think about loyalty, you have to be better than One Medical. You have to be better than than what’s out there in virtual health like Teladoc or whatever they can find on the street. There are creative opportunities to do new services that patients don’t know to ask for, but that they really love, based on our research.

What is the current and future state of the digital front door and patient portals?

For me, it’s absolutely clear. If your digital front door doesn’t add new patients simply and immediately, what is the point? That’s where patient portals are good. It’s good to have a patient portal, but they are completely lacking in imagination of what a comprehensive consumer experience should look like. 

Starbucks doesn’t say, I would just like an app to review my history of orders. It is a transaction tool. Starbucks would never in a million years go to the Coffee.com app with Joe’s and Pete’s and everybody else all using the same app, that’s no big deal. Like it or not, health systems are competing. The fact that they defer their most valuable digital asset to another company is just beyond me. It is an acquisition tool. That’s what it is. That’s what it should be. The fact that it’s not viewed that way is a gross oversight, full stop. Are people getting into your system and are you adding new users?  If not, then it’s lacking in what it could be, and how it could be financially ROI-backed in all of your investment.

At Baylor Scott & White, during COVID for 2020 through 2022, we added half a million net new patients through the app. That number for most other health systems, nine out of 10 of them, is zero. That’s crazy. That’s like health systems just now realizing that they need a website. That’s the equivalent of the app. In five or 10 years, we’ll look back and be like, that was crazy. Why would we limit use of the app to current patients or current customers? 

I don’t know how that happened or why, but it’s a lack of imagination to say, this is a digital commerce acquisition and loyalty play. Once we earn a place on their phone, what are we doing to keep them using that? Why do they love that? Why are they coming back to us over and over again? That’s how every other business thinks. I don’t know why healthcare doesn’t think that way.

A simple healthcare problem is that someone can’t get in the app unless they are already a patient. We found that nine out of 10 people threw their hands up and said, “I guess I can’t get into the app.” Why can’t they register? Oh, we don’t want to create duplicate accounts. OK, great, then we need to ID verify them. How do you do that? There are only really crappy systems where you have to take a picture of your ID and wait for HIM to review it. We said no, we want to automate all of that, and that’s what we do. In 30 seconds, we can full ID verify someone better than literally Experian can, with no data entry required. 

We don’t create any duplicate accounts. If they don’t have an account already, we register them into Epic in MyChart. We don’t have to make these sacrifices. The tech can do this. You just have to build an experience. Start with the experience that you are trying to create and then get it there. We got the idea from fintech and built that experience. The other one is airlines, which are the king of loyalty programs. No airline would ever say, here’s our loyalty program app, and you have to download this other Sabre app to actually book flights. That’s where health systems are. They haven’t forced these things to be the same. They haven’t said, “This is our brand and this is how we interact with everyone.”

Lack of transparency on pricing from a patient standpoint is a massive problem. I spent four years trying to figure out how to create meaningful price transparency for consumers at Baylor Scott & White, and two things went wrong. One is after like four years, we could tell them if their co-pay was going be $20 or $25. No one cares about that. That’s not the thing that they are worried about. They are worried about bankruptcy. They are worried about a surprise bill. Somebody’s out of network. The doctor who is wearing your scrubs, who has your ID badge, who is located inside your building, somehow doesn’t work for you. That’s the surprise.

We tested this and came up with a feature called no surprise billing guarantee. It was the number one feature wherever we tested. It’s an example of a feature that consumers aren’t asking for, but when you test it and you put it in front of them, it goes off the charts. The No Surprises Act exists, but patients aren’t understanding that, so let’s build a product around no surprise billing guarantee. That’s one of the primary things that Amenities does.

Health systems struggle to show their true pricing everywhere within a system. Baylor would direct you towards ambulatory surgery centers and not the main hospitals, because we all know that the pricing is cheaper for the same procedure at an ASC, but health systems aren’t really incentivized to do that. There was always this internal struggle. But I believe that health systems should embrace that and say, get on the patient side. Get on the consumer side. Because once you become a consumer advocate like that, that’s how you think big, not playing these games of, is that good for our hospitals, and what will that hospital president think? My push is to be on the consumer side completely.

Customers like to feel that the business knows them. Health systems people can look in the EHR for your medical history, but do they use technology as customer relationship management way to accommodate preferences or non-medical lifestyle information?

I was there when we brought in Dynamics and evaluated Salesforce as a CRM. CRMs are fine and definitely a tool, like cloud, that any modern company and architecture should be built on. It always comes down to, have we started with a use case? I see so many health systems, including ours, saying that we can’t do anything until we have a modern CRM that connects the website to the contact center and to our data. That’s just not true. That will take like four years, and if you don’t start with the use case, you won’t have the funding by the end of it. Everybody would be like, why did we just spend $50 million to do this thing and nothing has changed on our website? 

You have to start with the basics. Can we register a new user? OK, great, and then to your point about preferences, what are all the different communications channels that they get, and how are we letting them set those preferences so that they are not getting a bunch of phone calls when they only want texts or other things? There’s a lot of little, immediate things. What often happens in healthcare is that once you start talking about CRM and big legacy platforms, it becomes a five-year journey, and you don’t know if you’ll make it with the same team by the end of it.

Amenities is keen to say, you can try to build what we built, but Baylor Scott & White spent north of $25 million trying to build the MyBSWHealth app. It was wildly successful, even at that number, but that’s insane. Why is every health system doing this? Part of why we left to do this is that we built this at scale. We can be live in a matter of weeks, if not months, whereas we’ve never seen a health system spend less than $5 million a year and take two to five years to build something custom. Why would you do that? It’s not a good idea. We have to do something with the health system industry experts, like what we’re trying to do, which is custom build. Not take a generalized platform like CRM in every other industry and then try to spend two years plugging it in to get value out of it.

I’m not saying that’s not going to be required for the long run. It’s just that any large infrastructure investments are going to take two to four years just to get implemented, let alone the payoff period. Why not do something immediately that differentiates your health system from the consumer experience tangibly in a matter of months? That’s what we’re trying to offer and say, it’s really not about the technology. What is top of mind for those patients? We’re finding that it’s cost. It’s the worry of financial ruin. It’s a lack of transparency on any sort of quality metrics. 

Patients ask us in our research for things like no surprise billing guarantee, satisfaction guarantee, transparent cash pay pricing, or things like best surgeons. I don’t know a health system that’s willing to show their own data on who’s the best surgeons, but I can tell you that patients would love it. Those are the types of things where we have to get out of a conservative mindset and start offering consumer-centric things that make us uncomfortable and take a bet that it is going to pay off. Because if we are really on the consumer’s side, they will pick us over any other system. 

I don’t think that’s a crazy bet, because what would you want as a patient? If you or your parents need a CABG surgery and you have no information on any doctor about how good they are or their mortality rate, what’s it like? You’re just out there in the blue hoping that’s a good doctor over there. I hope they treat me nice. I wonder if I can get in the patient portal to track the progress? Doing little things to be on their side could be massive and saying, that’s really differentiated.

People want to self-schedule appointments with a provider who accepts their insurance, is conveniently located, has a good background, has time slots available, and accepts new patients. How well have health systems met that expectation?

It’s paramount. We gave a hype factor around AI, big data, and intelligence. I want to know, how many doctors do you have? Which ones are accepting new patients? What’s the earliest I can get an appointment? So few health systems in the country can answer this question. 

Until you’ve done that, you haven’t earned the latitude to go build AI tools. If you couldn’t build a online scheduling platform correctly that is meaningfully used, if you aren’t doing 25% to 50% of your volume in online scheduling, what are you doing? What are you doing on the other stuff? Because that is such low-hanging fruit. It saves you money in contact center. It delights patients who don’t want to call for any of these things. It’s a massive opportunity to shift volume in the market share. There’s so many reasons to do it. 

The only reason we don’t is that we’re not eating our own dog food. I don’t know many health system executives that are having to go through their own online portal and their own online scheduling, because as healthcare administrators, we all have access to calling the office to get us in, or we know Dr. So and So and we text them to get us in. We get to cheat. If we had to use our tools to try to book an appointment, nine out of 10 of us would be pulling our hair out because it’s so, so bad. You wouldn’t accept that from a barber. You wouldn’t accept that from a restaurant where you are reserving a table. Yet we say, “Sorry, but Dr. So and So doesn’t agree to open schedules. They think it’s unsafe or want to screen all patients first.” Well, too bad. Are we going to be consumer centric or not?

The fact that that’s all locked up in the EHR is a problem. We’re one of the only platforms that we’ve ever seen that can aggregate 50 to hundreds of providers and show you all their schedules sorted by next available. But it’s really all of that for that last step, sorted by next available, because we fundamentally believe that patients are going to pick their doctor based on who is available the earliest. Baylor has had that up on their website for three or four years. We’re starting to see one or two other health systems do it, but that basic capability is so far lacking and something that Amenities can do in a matter of weeks and months for health systems.

Just start there. That’s not an AI problem. Just get the logistics out and make all of primary care available for online scheduling. No questions asked, no exceptions. It’s the first thing we tell every health system. We’re going to make an amazing digital experience. Great, do you have online scheduling? No, not yet, but we’re talking to our docs about it. Our first question is, would you download the Pizza Hut app if you couldn’t order a pizza in it? No one’s going to use that thing you’re building, no one’s thinking about adoption and usage, and what will promote this and why is it differentiated?

We’ve started to talk to various health systems about memberships. One thing that we hear repeatedly is, we would like to do a virtual concierge program. That’s been done. That was done four years ago. You have to be better than One Medical, because One Medical is being advertised now inside of the Amazon app. Everyone has access to it for $9 a month.  Are you going to be better than that and differentiated? Because if not, why even start? Would you use that? I feel like sometimes that we don’t want to ask this type of questions, and we need to, because that’s how we build something better.

What are the company’s goals over the next five years?

We would love to see a massive shift in the whole industry, ideally with us, Mission driven. We want to see the industry eliminate all of this friction. A lot of our products – provider scheduling, registration, and the digital front door – will help get the friction out of healthcare. Well within those five years, I hope we can start to demonstrate how market-making and how transformative memberships could be.

You’re seeing a ton of back and forth about too much MyChart message usage. “Well, I guess we have to to charge patients.” Let’s piss them off, because we’ve already pissed off the doctors. That is such an uncreative solution. Taking MyChart messaging away from patients is like now saying, “I’m sorry, it’s going to be 10 cents per text message” like when cell phones first came out. That’s literally where we are. The reality is that people want to use this.

This is a massive opportunity to create a new business model. I don’t know about you, but if I want to talk to my doctor exclusively, I would happily consider $9, $10, or $20 a month to say that I have unlimited messaging for them. They can actually create new services and capabilities. Now I would want more than that, but that’s the opportunity. That’s what I want to see us doing in the next five years, that we can point to a couple of core examples in the industry where they try something new and different, wrapped in a membership. We are seeing that mindset shift, where people are starting to say, that’s interesting. That could actually be transformative and move a ton of market share.Why don’t I try that first before my competitor does?

How do we massively change the dynamic? You have to go through health systems. Direct-to-consumer healthcare is nice, but health systems deliver the majority of care in this country. Two, you have to align incentives. We are not incentivized to compete on experience, but what if we were? Could that be a motivation to do a lot of new and different things?

HIStalk Interviews Jonathan Rosenberg, CTO, Five9

Jonathan Rosenberg, PhD is chief technology officer and head of AI at Five9 of San Ramon, CA.

Tell me about yourself and the company.

My job is to direct our overall technology strategy, run our AI engineering teams, and figure out how to apply AI technologies to the evolution of contact center technology, which is a super interesting and exciting space. I’ve been in the IP communications industry for approaching 30 years. I was previously the chief technology officer for Webex and for Skype before that.

How has technology changed the way that inbound telephone calls are managed?

It’s having a huge impact, and that impact is going to get even bigger over time. Probably the biggest thing is that we have been able to dramatically improve self-service, not having to wait on hold to speak to a live agent for tasks that users would prefer to self-service anyway. 

There’s tons of examples in the healthcare space, things like appointment scheduling and rescheduling, looking up and getting information on prior authorizations, answering questions about hospital visits, benefits coordination, cost estimates, and insurance verification checks. The list goes on and on. All of these things are relatively easy to support with self service. We can get the call to the right person and understand what the caller wants, collect information, and direct them to the right place. We’ve all experienced way too much transferring. You get to the wrong person, then you transfer somewhere else and you have to repeat everything all over again.

But it isn’t just inbound, there’s outbound as well, communication from healthcare providers and payers to their patients and customers.

Are technologists surprised that many people still prefer making a phone call?

The death of voice in the contact center, which has been predicted for 20 years, is absolutely, positively false. We are seeing an increased amount of usage of communication of the technology. It’s not that people aren’t doing other things. They are, but it’s the total amount of interaction that’s happening between customers and the brands and companies they work with. That has increased as these additional tools, like chat, SMS, and website have gone up.

But at the end of the day, there’s a lot of stuff where people still want to call and talk. It’s faster. It’s interactive. You feel greater levels of trust, especially when you talk to a live person. And in many cases, you want to speak to a real person. We don’t think that everything will go to self-service. That is best done with voice, especially in high-emotion, high-stress situations like we see in healthcare. A voice of empathy — nothing beats that.

What is the role of AI-powered virtual agents?

It has two sides. People understand less about what we call agent assist. In agent assist, AI is involved, but it isn’t replacing the human agent, it is augmenting them. It provides lots of benefits to the agent that help them do a better job and provide a greater experience for the customer. That includes things like coaching the agent to make sure that they perform their checklist of required tasks to the patient or to the customer. Helping provide information at the agent’s fingertips so they don’t have to put the customer on hold and go look something up — the information can just be put right in front of them.

Another really good thing that we have seen is that our agent assist application provides a live, real-time transcript to the agent. If they didn’t quite hear what someone said, they can just glance back at the live transcript.

That is one half of agent assist. The other half is self-service use cases, where a customer or patient calls in and they are talking or chatting with a bot to provide these self-service kinds of use cases that I’ve described. Both of these are powerful in the contact center.

Are health systems assembling all of their interactions with patients – mailings, outbound calls, fundraising, billing – so that anyone who interacts with them has the full story?

One of the hardest problems to solve in the industry is breaking down these silos. It is becoming more important than ever for companies that are providing customer service to do that. 

One of the interesting drivers that will accelerate the collection of all this information together is this emergence of generative AI and large language models. These things are incredibly powerful and highly beneficial to a lot of the use cases that we are talking about. They need contextual data to work. They need to know about the caller and the customer to provide the experience they want.

The more of this information that you can collect and feed to that generative AI model, the better job it can do to provide superhuman experiences, something that you couldn’t even hope to get from a human alone. We are excited about that, and we think it will drive a lot of the collection of all this data together.

Healthcare is powered by fax machines, photocopies, and clipboard forms, yet consumers interact everywhere else with chatbots, smart search, and voice processing. Will healthcare embrace these technologies?

I hope so. Customers in general are seeing advances in technology and how they receive service in other industries, and that sets levels of expectation.

For the benefit of healthcare, a lot of the rest of the world is becoming more sensitized to the type of issues that have traditionally prevented or made it difficult for healthcare to do this, related to sensitivity of data and the protection of personal information. With all of this, especially with this genre of AI technology, those questions are top of mind now for buyers of these products and services. They were top of mind for healthcare before, and now they are top of mind for everybody else. That will drive increased attention to solving those problems so that we can deliver solutions that are broadly adaptable in the healthcare industry. That’s the optimist in me that thinks this way and hopes to see this technology penetrate quickly across healthcare.

Health systems have grown by acquisition into regional or even national organizations that have a large scale and an increased technology capability, but that may create more bureaucracy. How will this affect their use of technology?

In some sense, centralization helps a lot of these things. It consolidates the buying power and the deployment of these technologies. You can deliver it out to your regional hospitals and practices so that everyone gets it quickly. Instead of every single doctor’s office or hospital having to do this on their own, you get to do it just once. That could be helpful in accelerating adoption of this technology.

How does a software company incorporate AI into their product when it changes every day?

At Five9, we have adopted a strategy that we call engine-agnostic. That means that we have built our software platform so that we can consume third-party AI engines, as we call them. These engines are the raw ingredient that do the processing.

For example, the thing that takes an audio file and spits out a transcript. Or the thing that takes a sentence of text and delivers the intent. What was the thing that the customer said? Or you send it a paragraph and it produces the medication name, the doctor name, and the dosage off the information paragraph.

These are like raw engines. We have designed our system to allow those to be pluggable, so that we can adapt and evolve as these technologies improve. They are improving at a lightning, breathtaking pace, and that has definitely made it challenging. In fact, we have already switched our underlying LLM engines a few times for different use cases. We have only been able to do that because of this engine-agnostic strategy.

How will the market respond to companies that add the simplest AI wrapper to their product with few actual benefits, just to be able to use the marketing buzzword?

Especially in the contact center, tons of little startups said, “We can finally build the chatbot that the world has wanted.” Then they throw a UI wrapper in front of ChatGPT and call it a day. 

That’s not what the market wants. The market, especially in the contact center space, wants a platform that spans all of the interaction modes – voice, chat, email, SMS, and social channels. They want powerful reporting and analytics. They also want to make sure that humans and AI are integrated together so that calls and chats can bounce between them, and all of that just works. 

That’s hard. You realize that the value proposition is delivering all of that, and then plugging in the AI to make it better. The platform plays are the likely winners in the in the contact center technology space, and we are one of them.

AI allows companies to create closed models of their internal documentation and processes to help a frontline person who is in the middle of a call or chat session. Is that creating new possibilities?

This is another thing that has taken a generational leap forward. Prior to large language models and generative AI, we would have to train a custom model on the different intents, as we call it, different use cases and things that would be discussed in the conversation that need to be detected that would then trigger information to be shown to the agent. That all had to be done looking at their existing conversations to go collect all that data to train and fine tune the model. 

Generative AI has changed dramatically the way that we can think about that. We used to need to enumerate every single use case, what might be said and asked, and then handcraft the model to detect it and handcraft the response that should be shown to the agent. Now with gen AI, we can just ingest all of this knowledge, processes, and documentation the same way a human agent would go read those materials. Then we can give written direction to the agent assist functionality on what we want to do. It can start to provide this knowledge and guidance.

We are seeing great initial results with this, and this is what we are building towards. It will be transformational in this space in the coming years. It is incredibly powerful and amazing technology.

What does the company’s strategy look like over the next three or four years?

With generative AI, three to four years is like really far away [laughs]. But it’s that thing, generative AI. It’s going to be incredibly amazing in delivering superhuman experiences to customers and delivering the kind of customer experience that the contact center market has always dreamed of delivering to customers, but that in many cases, fell short of expectations. Now we have the tool to deliver the kind of experiences that we have really wanted to.

I talk about the end of call hold. I can’t wait for the day when you can call the contact center, you want to speak to someone live, and they never need to put you on hold ever again. Because anything that they need, anything that they have to say, anything that they need to do, is instantly at their fingertips. That will be a great day, and we are working towards that day in the next two to four years.

HIStalk Interviews Jonathan Davis, CEO, Trualta

Jonathan Davis is founder and CEO of Trualta of Ottawa, ON.

Tell me about yourself and the company.

I started Trualta about six years ago. I was investing in healthcare education companies that provided training, continuing education, and certification for healthcare professionals. It dawned on me that there were so many great best practices for caring for loved ones, especially aging loved ones, that families didn’t have access to. For example, why did an aide in a nursing home know how to manage a particular symptom of cognitive decline, but a family member didn’t?

That inspired me to think about how we could adapt professional-level training to the families who need it most. That was the start of Trualta. We built a caregiver education platform with articles, videos, and modules to help families build skills and establish confidence to provide care at home.

Right away, we started working to demonstrate that trained, confident family members can provide better care at home. By proving those outcomes, we could partner with governments, payers, and providers to offer Trualta for free to caregivers. We always believed that the caregiver shouldn’t pay for support. We know caregivers are often already facing unexpected costs.

Since then, the business has grown to offer not just caregiver training and support, but also community and coaching.

People don’t always know in advance that the caregiver role is about to be placed on them. What is the most common training and support they need?

That’s very true. Many caregivers don’t even self-identify as caregivers. The training and support that is most effective is a mix of topics related to the caregiver’s own wellness and how to manage this often unexpected, challenging care situation. We personalize our content to the caregiver’s unique care situation and the conditions they manage at home for their loved one. At the end of the day, all caregiving journeys are different. We anchor on the training outcome. We want our caregivers to feel more confident and less alone, which we know leads to better care for the patient, the loved one they are caring for.

What is the blend of people, technology, and support that makes it possible to successfully send patients home for care?

On the technology side, we’re all about finding the right support for the right caregiver at the right time. Maybe it is post-surgery. Let’s say Mom or Dad got a hip replacement. We know that individual care situation and can target the caregiver with specific content. For example, a common reason for readmission might be a UTI or a bed sore.

Where the technology and the tech-enabled community and coaching come in is that we start to understand how the caregiver is feeling. They’re a bit lonely and isolated, providing care 24/7 for their partner who is recovering at home. We know that they would benefit from a support group, so we direct them to one. It is a virtual, tech-enabled support group, but it is facilitated. To us, that’s a healthy mix of technology and people. If the care situation escalates and we see a high risk of caregiver burnout, we can route that person to a one-on-one coach.

A national challenge is the large number of baby boomers who will eventually need care, but with fewer people to care for them. How will that play out?

This is such a tough problem on both the demand and supply sides. On the demand side, we have this aging population. Folks are also living longer, with a higher likelihood of certain chronic conditions or cognitive decline. We know that older adults prefer to age in place. Then we have government policy promoting home and community-based settings instead of the institutional setting.

Demand is way up, but there’s an acute workforce shortage, so supply is also down. That market dynamic is putting so much on the family members. It’s more important than ever that our healthcare stakeholders support families and people who care for loved ones at home with skills, community, support services, and coaching.

How do you work with partner organizations?

We are thought partners with the organizations we work with. Most of the payers and providers that approach us know that they could be doing more for caregivers, and intuitively understand it will lead to better outcomes for members and caregivers. But they don’t really know where to start. They don’t have a caregiver strategy. Often, they don’t really know who the caregiver is or have contact information for them.

We build that strategy with them. We provide the learning and support platform, and then make sure it’s integrated into the workflow and existing systems.

Do you roll it out broadly, or is it case by case?

Generally, our partners have specific populations in mind where we focus, but access to the program is usually available across the organization, because supporting caregivers is becoming an enterprise-wide priority.

We’ve always focused on high-need populations. We’ve helped a lot of folks in really challenging care situations, like parents of kids with intellectual and developmental disabilities, or caregivers for individuals with dementia, cognitive decline, or a recent stroke. These are areas of focus where a social worker, nurse, or discharge team might be more deeply ingrained with Trualta than in other service lines.

What are the company’s priorities over the next three or four years?

Our vision for Trualta is that caregiver support is as ubiquitous as patient education. At every point of care, any discharge, especially with our aging population and shift to value-based care, it is so important that families are supported.

Our vision is, let’s take caregiver support from being a “nice to have”, where a few teams are doing it with some populations, and make it a critical part of every point-of-care experience. If a caregiver is present, we need to identify them, engage them, and support them to ultimately improve outcomes for their loved ones. We need to make sure that they are not overwhelmed and burning out.

An HIT Moment With … Steve Shihadeh

An HIT Moment With … is a quick interview with someone we find interesting. Steve Shihadeh is founder of Get-to-Market Health of Malvern, PA.

Startups have been forced to adjust their strategies, execution, or expectations as investment activity dropped substantially. How will that change the industry over the next few years and how should companies prepare for a turnaround?

At the end of 2022, and throughout 2023, startups and most mid-sized companies shifted their #1 priority to conserving cash. Forecasts of possible recession and rising interest rates put a damper on spending of all types, and especially the more expensive industry events. Companies lowered expectations, cut staff, and tried to do more with less, or at least hold their own. In my opinion, industry momentum, risk taking, and progress on using tech to improve healthcare were all off course for the last 18 months.

2024 has a much different feel already, with several significant funding announcements and a renewed focus on growth. Digital health investors who showed lots of patience over the last year and a half are pushing for the returns they were promised when their funds launched. As a result, I expect attendance, new product announcements, and customer interest at the big national shows to be on the upswing.

The HIMSS conference has a new owner and competition from ViVE and HLTH, with an emphasis on hosted buyer programs by all three. How would you advise companies to plan their participation in these conferences for maximum return on investment?

HIMSS23 in some ways seemed a little dated. It was big as ever, but when compared to the feel of ViVE and HLTH, it needed a reboot. I guess HIMSS understood that, and I am really curious how the show will change this year under new leadership.

To get maximum returns on your tradeshow investment, I think my assessment last year mostly holds true. The top three of the top 10:

1. Pick the most important show for any booth investments.
2. Have a presence, even if just one key person, at as many shows that you can.
3. Send only your best, most committed people.

What has changed in health tech marketing since the pandemic eased?

The pandemic pushed people to hone great digital marketing skills and tools. That is table stakes today, and now we have the full return to strategic in-person events like trade shows and targeted regional and bespoke events. 

The vast improvements in marketing in our space continues to impress me. When I first started Get-to-Market Health in 2017, we presented to a CEO about how we would recommend he revamp marketing. He said something to the effect of, “I am going to just hire a grad assistant type instead.”

That was then. Now, to keep pace, most digital health companies have a strong marketing VP who is directly aligned with the sales VP. Awareness, public relations, lead generation, lead conversion, pipeline development, and deal closure are very much a team effort. Digital tools, social marketing, and micro-targeted outreach are mandatory today, and it is great to see companies taking full advantage of new ways to educate customers.

How will the increased healthcare involvement of big tech firms such as Microsoft, Oracle, and Google affect the ways that healthcare-only vendors run their business? 

I was able to see firsthand the impact of a big tech firm committing to healthcare when I was with Microsoft about a decade ago. The company made large-scale market development investments, engaged in key policy discussions that smaller companies just can’t do, and along with Amazon, laid the foundation for the cloud business in healthcare as we know it today.

I am bullish that the big tech firms that stay committed to the space — “stay committed” being the key point — can really drive change and make a difference. I would advise our clients and friends in the space to carefully evaluate who has the staying power before they go all in with one of the bigger players.

What is your advice for health tech startups given the business and industry conditions that you expect over the next two years?

Assuming the general economy stays strong, I see a great run for the companies in our space who have most of these attributes:

• Differentiated products or services.
• Demonstrable ROI that holds up to CFO scrutiny.
• Company culture that your employees enjoy and your clients can feel.
• Sales and marketing teams that work together.
• A thoughtful plan of how to work with or around the big vendors.

Healthcare delivery in the US is complicated. but when it works, is the envy of the world. Technology improvements need to be made in all facets to drive down costs — the US is not the envy of the world on this point — and continually improve care. Every hospital in our country can benefit from all that tech has to offer, which is why I remain so positive on the runway in front of health tech companies.

HIStalk Interviews Mark Burgess, President of North America, Agfa HealthCare

Mark Burgess is president of North America of Agfa HealthCare of Carlstadt, NJ.

Tell me about yourself and the company.

I’ve spent the majority of my career in electronic health records. I have worked with a startup and have done tours with Cerner, Allscripts, and NextGen Healthcare, with roles that included strategy, product and solutions management, and business unit leadership. I have enjoyed seeing the progression from the introduction of the EHR into interoperability, and now I’m on the imaging record side.

Agfa HealthCare is a global imaging software business that has been in the market for 25-plus years. We were an early mover in PACS. probably one of the first to bring that to market. The company started the transition into enterprise imaging, which is more of what we do today. We’ve gone from a single system to the enterprise system. That has contributed to the evolution of the image to the image health record.

We have 1,200 employees across the globe. We work with some world -class organizations. We have a talent base that is second to none because we’ve been doing it for so long. We provide diagnostic imaging software solutions to thousands of client sites who read millions of image studies each year.

What are the similarities and differences between the EHR application business and the imaging business?

Imaging software is a medical device that is governed by specific regulatory requirements, agencies, and rules. That’s not true of the EHR side.

With imaging, there’s a lot of work and thought that is put into the design of the technology and the way that the technology needs to show up, because you’re using it as an instrument to diagnose. You can obviously use the EHR to get to a diagnosis, but it’s even more intense with imaging, where you are putting it into the hands of a radiologist who forms a diagnosis with it. There are more regulatory components involved with managing a medical device and maintaining it from version to version. 

The EHR side is more governed by achieving regulatory guidelines or regulatory thresholds. The EHR side has to deal with things that surround the EHR, which we don’t see as much of on the imaging side, although that is changing with things like AI. As the imaging side starts to mature and reach deeper across the enterprise, it is getting more involved with those things, including the EHR itself.

What is the demand for accessing and exchanging the actual images versus the reports that are created to describe them, and how does that align with EHR interoperability?

You want all of that to show up in the EHR. You don’t want to have two systems. You are seeing the convergence of that in the industry. We work with all the major EHRs. The radiologists who use our system produce reports and studies that show up in the EHR for the for the physician and the clinical team to see, or in the patient portal for the patient to see, depending on how the organization makes that available.

The image health record and the clinical record are becoming fused. That fits the direction that we are going in healthcare with regards to IT and how patient records are being managed, which is more of the whole-patient care model.

The enterprise imaging decision is relatively new. It reminds me of the days before people started buying enterprise EHRs instead of those that were specialty based. The EHR  grew up in front of everybody, and then the goal was to create a single patient record across an organization. Organizations want to know how they can get a single imaging record across their organization. We’re spending a lot of time ensuring that organizations know how to go about making this decision.

How has the work of radiologists and radiology staff evolved as imaging volume and expectations have increased?

Diagnostic confidence is above all else. Performance and workflow are fast followers, meaning that radiologists prioritize a high-performing system with intelligent and integrated workflows that presents information when and where they expect it. We’re still in a world where performance is key. Radiologists are still focused on safe productivity where they make no mistakes. They want high-performing systems, so by definition, that includes workflow that gives them what they need, when they need it. That means point-of-care capabilities and the ability to pull a prior or to do a report.

Third is coordinated care and integrated care, the ability to see relevant clinical data when they are reading images as well as having access to care team members to share and collaborate.

Finally, we need little to no barrier to system access, bringing the data and information to the radiologist and not the other way around. Streaming data is the future.

Is it hard to develop a company strategy for incorporating AI when it changes every day?

The idea of formulating an AI strategy is accelerating among the radiology base, especially radiologists in the US. An extraordinary number of algorithms have been FDA cleared. Radiologists are starting look at where they can put those to work. It’s a partnership between their ability to operate at the top of their license in a high-performing way, but leveraging the goodness of those AI algorithms. Clients are 100% prioritizing AI and seeking the initial phase of production use, moving from the proof-of-concept stage to focusing on production clinical use.

We want our clients to have choice, so we are staying nimble. It reminds me of the early EHR days, when we started looking at patient portals, scheduling systems, and other applications that were hanging off the EHR. You wanted your clients to have choice and you started to build an ecosystem.  We are focused on the AI side with building an ecosystem, and that ecosystem will be able to go to the point of care or the point of need.

We make sure that as we bring more AI partners into our ecosystem, we hold them to a standard so that what we put in front of our clients has been pressure tested. But it’s fast and furious. The FDA has cleared more than 500 algorithms, with the vast majority of them targeted to radiologists. We have a team that’s in charge of that. But the most important thing for us is to stay aligned with our clients on where they want to put time and energy relative to AI. We are doing our best to curate those opportunities for them.

Do radiologists question how algorithms were developed or do they evaluate them on their level of transparency?

They are curious and have asked many questions about it. I don’t know that we are seeing as much of that healthy skepticism as before, now that we are starting to see some of these organizations gain track records of success. That is lending more clarity and confidence to the radiologist. They are starting to look at, how do I get a better experience with an AI algorithm? How can I improve it in another part of the body?

While we work with a lot of scientists who are always interested in how something was built, what it was based on, and how it was tested, we are seeing more curiosity around how it can be applied to a particular workflow or to a particular part of the body than we saw two years ago.

What is the company’s vision of a enterprise imaging solution?

As I mentioned,  this organization was an early mover on the PACS side. As organizations started digitizing images, they also started standing up multiple PACS. Health systems are coming together and finding that they have three, four, or five of these different systems, and they don’t really don’t talk to one another. It’s not very efficient.

We want to be that single imaging platform. We want to be able to serve not only the needs of the core radiologist user, but start to expand out into all of the different service lines that have imaging needs and imaging demands. We absolutely want it to be treated as a platform. We want to be able to put more capabilities into the hands of these different medical professionals to enhance what they do with medical imaging, and that’s starting to get into the reaches of analytics, research and teaching and how that incorporates into the medical record.

We want to be all things from an imaging software standpoint on this single platform, much like the way the EHR has developed. And then of course the fusion of those two things, so that medical professionals can look at an image with clinical data, or look at clinical data with an image. We don’t want limitations to that.

One of the final frontiers of imaging is digital pathology. What trends are you seeing?

This is one of the most complex parts of the hospital that is moving to becoming digitized. We are certainly seeing more and more of our clients that are moving in this direction. We have been tracking this with some of the largest organizations in the in the world, and certainly in the US, there’s a great appetite to start moving pathology into a digital state. They are hungry for more efficiency, the ability to do more with the slide samples and unlocking more of what they can do with that. Whether it’s data insights, driving better outcomes, or better synthesizing that data into the medical record, they are hungry to unlock more opportunity with what they are doing today.

I see it as maximizing the use of the data to increase efficiency and improving turnaround times, enhance clinical collaboration with the care team, increase access to care, and streamline workflow. Like radiology, pathology is seeing an accelerated
demand for services and a shrinking base of pathologists. Maximizing pathology resources through digital modernization enables the pathologist to better force multiply their expertise to accelerate and advance specialty care like oncology, decrease surgical time that includes reading samples during the procedure, plus comprehensive clinical collaboration through networking with specialists and subspecialists.

How much imaging volume has shifted to non-hospital locations, and how has that affected interoperability requirements?

As patients, we demand more. We want a better experience. We want more options. We don’t want to be tied down to going to one one place at a certain time. The idea of imaging becoming more pervasive in the community is popular and well documented.

The demand for medical imaging continues to go up year over year. In the US, we are hovering around a billion imaging studies annually. The aging population contributes to that. As you capture images, store them, and move them around, you want to make it convenient for the patient. You don’t want patients carrying images on a CD. I had scoliosis as a child and  my parents carried around a jacket of x -rays to different doctors. Those days are gone. It’s like the fax machine in the medical practice, where you just want to be done with that and build the network.

We think about it as an image health network. We want to connect all the different places that are using our platform, and other platforms to some degree, so that these images can be moved in an intelligent, safe, and a effective way. Physicians should not be seeing a patient without having access to the image that will help get the best outcome for them. The image health network is the key to that.

What will be important to the company’s strategy over the next few years?

In addition to our ongoing client success activities such as continuous engagement and collaboration, meeting the accelerated demand to replace PACS with enterprise imaging, and continuing to innovate and expand the utility of our platform and eco-system, we want to make a dent in addressing burnout. Burnout among radiologists is higher than in most specialties. That drives our work around curating high-performing workflows, leveraging AI, and building the next-generation imaging health network.

We are in a high-growth situation. We want to cover the market properly, continuing to serve those who have an interest in what we do and how we do it. There’s a lot of activity in this market, with a lot of interest in moving to an enterprise imaging solution. First and foremost, we want to be able to accommodate everybody who has an interest.

We are on this journey to cloud, which is essential for us. We recently struck up a partnership with Amazon Web Services and we are pretty excited about working with them. We are starting to move clients into our own AWS private cloud model. The level of interest in that is growing exponentially faster than even the upper reaches of the model we created a couple of years ago. We are excited about what that means from a modernization standpoint, getting organizations away from legacy worries about storage and compute power. We can neutralize that through our cloud offerings.

As we continue to build the ecosystem, we will continue to curate the ability to give our clients the most options that we can give them. AI will have a part. It’s all about continuing to serve across the enterprise, helping all the medical specialties that are in need of medical imaging, where it lives inside our platform that sits on top of this image health network and is connected to the EHR.

HIStalk Interviews G. Cameron Deemer, CEO, DrFirst

G. Cameron “Cam” Deemer is CEO of DrFirst of Rockville, MD.

Tell me about yourself and the company.

I was a latecomer to healthcare IT. I started my career in the ministry and didn’t get into this side of the industry until the early 1990s. I started working with PCS Health Systems in Scottsdale, Arizona. I did about a decade with PBMs, worked with NDC Health for a couple of years building what became Surescripts later, and then joined DrFirst in 2004.

When I joined DrFirst, I would have called it an e -prescribing company, which would have been easy to understand. But since then, we’ve developed a much broader vision. Today, the company is about making sure that patients have their best outcomes through their medication therapy. We do that through offering technology platforms that help providers work with patients around things like electronic prescribing, medication reconciliation, and population health. Our fastest-growing platform addresses patient adherence to therapy.

How has the original vision of e-prescribing expanded?

I had a front-row seat in the early days of e -prescribing. We did some seminal piloting of e -prescribing when I was with PCS. It has gone from essentially a record of what would have been written on a piece of paper to being a more fully informed decision support system.

As an example, we connect to all of the state PDMPs, the controlled substance registries, so that a doctor can consider that information at the same time they are writing the script. They have a much better idea of whether someone is drug seeking or legitimately coming onto therapy. Similarly, a real -time benefit check allows them to understand exactly how much the patient is going to pay. Then, bringing other information in from outside, such as formulary status and electronic prior authorization. Essentially e -prescribing has become an ecosystem as opposed to just a replacement for the prescription pad like it was originally started.

How does seeing cost and insurance coverage at the time of prescribing improve patient outcomes as well as patient satisfaction?

We view it as two parts. There’s what happens in the doctor’s office when they are  prescribing therapy, and then what happens after the patient is released back into the wild to act on the prescription.

In the physician’s office, we think that real -time benefit improves compliance with therapy, because it finally gives the physician a real idea about the impact of what they are prescribing. How much is this drug going to cost versus that drug? Or is therapy going to be delayed because you have to go through a prior authorization if you choose this therapy versus that therapy? It is giving the physician real insight. They already know what they want to write, so now they get insight into what the outcome will be from the patient’s perspective.

The reason that we started working downstream from there, on what happens to the patient after they walk out of the office, is that we often found that the providers maybe didn’t have time, or maybe they weren’t focused enough on the extra information, and weren’t necessarily helping the patient make a decision that would be ideal for the patient to then go fulfill the therapy. 

We try to hit the patient immediately after they leave the doctor’s office with more information. What prescriptions were written? Where are they going to get them filled? We have a call to action to pick up the prescriptions. We provide financial assistance information if the physician has chosen a drug that is extraordinarily expensive for the patient. We give the patient the tools to make up for what may have been missed when they were in the provider office, or to reinforce the decision the provider made.

Have coupon-type programs, such as manufacturer assistance programs or GoodRx, made displaying patient prices more complicated?

Systems have come a long way in being able to present all that at once. From a provider perspective, they wouldn’t be perceived as a set of different decisions. At least for our system, it’s all combined into one decision point, so the physician can consider them all at once. From a patient perspective, it would only really be one thing, because their therapy has already been decided at that point. Now they just have the one decision to either pick it up or don’t pick it up. The financial incentives can help them with the “pick it up” decision if they are available.

Has the prior authorization process, which everyone seems to agree is burdensome, improved?

Boy, I agree that it needs to be fixed, so I’m on that page. Prior authorization is widely recognized as a coping mechanism, a way to stem the flow of products that the payers feel are expensive. They don’t necessarily want to cover the therapy unless they are pushed to do so.

I’m not sure how much incentive exists to truly fix it. Truly fixing would look like the barriers make sense and they are readily overcome. What’s going on in the industry right now to fix it is that when the physician is confronted with a screen they have to fill out for the prior authorization, can we just grab that information out of the EHR, fill in the form, and let the physician have very little work to do to send that PA?

The whole thing is counterintuitive. They are intended as a barrier. Making it easy makes the barrier less effective. It’s an interesting problem that I’m not sure we are really solving yet.

If the prior authorization is a prescribing speed bump that payers hope will discourage the prescription, what interest would payers have in solving the problem? Why couldn’t they look at a prescriber’s history, even with AI if needed, and bypass the front-end work unless that provider is an outlier in deviating from accepted norms?

That would be a fascinating way to handle it. I’ve actually not thought about that before, but with machine learning and AI, you should be able to analyze, give the doctors some kind of performance score, and put a lower set of barriers in front of those who are good actors. There would be a lot of discussion about what equals a good actor from a provider perspective. I imagine there’s a wide range of thought on that.

An interesting development is Lilly’s program, where they are to some degree working around these kinds of restrictions with some of their new drugs for weight control and diabetes management. They appear to be sidestepping the process and maintaining pricing control rather than throwing rebates at formulary status. 

Rather than being told that your drug will go off formulary unless you can bring this price way down from a PBM perspective and that you will be faced with a prior authorization hurdle that will be a giant pain to get people on, they are essentially setting up a parallel system. Patients can have relatively simple access to the drug and they can help manage the cost for the patient without causing the kind of disruption to everybody that a massive rebate program causes. Good or bad, I think it’s a really interesting approach that was creative on Lilly’s part.

It’s also interesting that they are working with third-party companies for telehealth prescriptions and pharmacy fulfillment. Will other drug companies follow suit?

I want to reinforce that what they have effectively done with those third parties is sidestepped the plan design. Patients are being asked to go outside of the health plan that they are paying for, and instead participate in this other parallel program that’s been set up for these drugs.

That will make it a little more difficult for other drugs. Not many drugs have the demand profile of the weight loss drugs. If your expensive drug is less in demand, there’s probably less incentive for the patient to step out of their plan design. I’m paying for this insurance, I should use it, that kind of psychology, so I wouldn’t think that everybody will be in a position to follow suit. But it’s a creative model when the drugs fit the profile that would make this work. It’s brand new, so we don’t know yet.

Lilly is also potentially keeping some of the revenue that would have otherwise gone to PBMs or pharmacies while gaining control over pricing. Is there a DrFirst technology implication for manufacturers that sell drugs directly with patient discounts?

One of the things we are excited about is our ability to engage patients, let’s say five minutes after they leave the doctor’s office. Because of our position in workflow on the prescriber side, we actually know when the electronic prescription has been sent. At that point, we can reach out and engage a patient. We are four and a half million patients a week touching about one out of every four new prescriptions. Our scale has  gotten fairly large because of the number of EHRs that we work with.

As a result of that, we are in a position to work with somebody like Lilly to be an entry point for patients into their program who might not know about their program. In the event that the physician bypasses whatever opportunities Lilly has provided for them, we have an opportunity to talk to both the provider and the patient because we sit squarely in that workflow. So yes, I hope we can be a part of that. I really enjoy these creative solutions to persistent problems around cost in healthcare.

What is the state of medication history and its delivery directly into the clinician’s EHR workflow?

I would say not greatly improved. There may be broader access to records now, a more complete patient record. But not much has happened to clean up the dirtiness of the data, this kind of shady underbelly of the whole data space. We spend a lot of time on data optimization because we find that the data feeds still are not semantically usable by the people who receive them.

As an example, somebody who creates a record might be using Latin abbreviations, and somebody who is receiving it might use English abbreviations. No matter what abbreviations they use, they can still write the sigs [abbreviations for instructions] differently and you can make millions of different combinations out of any given sig, depending on how the one system prepared it and how the other system wants to receive it. A big part of our business remains matching those data feeds up. How do you massage the incoming feed to make sure that all the fields are discrete and all the data elements are ready to be imported into the receiving system so that somebody doesn’t have to manually retype it?

That kind of data optimization is still missing from the industry and still needs to be handled independently before a system can receive the records. The bottom line is that I would say that there’s availability of a lot of records now, more than there’s ever been, but they are still just as dirty as they were years ago and still need that cleanup.

What role do you see for AI in your business and the industry in general?

We’ve been all over AI for data optimization for at least six years now, and it makes a huge difference. Machine learning and AI provides a much more elegant and complete solution than, say, a table of substitutions. You can only anticipate so many errors that a person might make, and the ability of the AI to sort that out automatically is huge. We end up with much higher rates of cleanliness of the data than are available through traditional methods.

We call that augmented intelligence, meaning that we do the cleanup, but then we provide the clinician with both the original and the cleaned up version. If they’re good with it, they can just say, “That’s good.” Otherwise, they can tweak it if it’s incorrect in some way. We put most of our focus on trying to find practical problems in the workflow and provide an efficient solution so that providers can get more work done and get away from that burned out feeling of having to retype everything.

What are the company’s near-term priorities?

One of our major business lines is providing e-prescribing platforms for EHRs. We serve over 300 EHRs in that way. A major change is coming in 2027, when Surescripts is going to implement the 2023 version of the SCRIPT standard. We expect other changes to come along with that. That will make everybody stop and do major development in their systems again. A big part of what we’re going to do over the next few years is work on helping people with that conversion. Some will decide that this is the last straw and that it’s not worth maintaining their own e-prescribing channel any more and we’ll be able to do integrations with additional companies. It will be a major focus to make sure that the industry is ready for this big change in coming in 2027 around prescribing standards.

Another major focus for the company is to continue to drive our adherence programs. We believe that we will eventually get to one out of every two new scripts, and when we have that level of aggregation, we will be meaningfully able to address things like access to specialty scripts. The industry is moving towards specialty drugs at this point, and those have all kinds of access challenges. We’re going to be spending a lot of time cleaning up those processes for the industry and making sure that patients can get on therapy quicker and stay on therapy for specialty.

The last thing is perhaps a little controversial, but we believe that it’s time to take a hard look at what happens after a script leaves the doctor’s office before it gets to the pharmacy. We’ve been working since the 2000s under a 50-year-old technology, the switching network that we use to move scripts between doctors and pharmacists. It’s a lowest common denominator solution that lets everybody have a level playing field, but doesn’t give anybody an opportunity to innovate and try new models.

We’re going to be breaking out of that mold over the next few years. We are standing up a capability to provide real innovation in this space with a broader set of data exchange between providers and pharmacies to enable better business flows on both sides of the equation. Just think about when you write a script, knowing that the drug is in stock at the pharmacy you are writing it to. Or if you’re on the pharmacy side trying to do some primary care type functions, think about what it would mean to get a patient record at the same time the script comes to you. That kind of innovation isn’t available today. We’re going to make that a part of how the industry works going forward.

I got into this industry in 1992 and have been talking to pharmacists this whole time. They are always trying to find that a breakthrough to be able to work at the top of their license, but never getting there. We’re developing our pharmacy channel to get closer to pharmacy. That takes a while. It’s a big area, and you need to build some trust. But I’m hoping that we can finally help them practically get there where they’ve really struggled before. Since we have theses massive EHRs behind us on one side and pharmacy customers on the other side, we believe that we can finally bring them together so that we get this real collaboration around the patient that has eluded the industry for a long time.