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Welcome to this week in Health IT News, where we look at as many stories as we can in 20 minutes or less that will impact health It. It's Tuesday News Day and we're gonna take a deep look into interoperability. The reason is there's six stories on it. Uh, it just in the past week, there's six stories, so there's a lot happening in interoperability.

We might as well just, uh, dive deep if we don't. Uh, there's, there's another four stories in here to talk about. Uh, the easiest one, apple Health Records available now for Allscripts clients. That's actually a press release, so I'm just doing them a public service to, uh, let them know that and, uh, I think that's exciting.

It's good stuff. Now the rest of the episode will be on interoperability. My name is Bill Russell, recovering healthcare, CIO, and creator of this week in Health. It a set of podcasts and videos dedicated to developing the next generation of health leaders. This podcast is sponsored by health lyrics.

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That's modern healthcare. Um, before you get all jazzed about that title, . Uh, I found nowhere in the article where CEOs are not, uh, supporting interoperability. So I, I wish it was there 'cause it would be a really interesting article. I think it's a little bit click Beatty, uh, in its, uh, in its development.

Um, but I'm gonna cover it because they have a lot of, uh, interesting stuff in here. So. Let's go into it. So they did a, uh, survey. And actually, here's, here's my thought on this. 'cause this could come off as a little bit trashing the industry. Uh, these two articles, uh, really talk about deficiencies. We're gonna start with the current state of where we're at in interoperability, and it can be a little, it can be a little harsh, uh, in terms of where the survey says we're at.

Even though one of the articles is on, uh, glass is half full. Where, where's that one? Stakeholders see glass is half full. At O C's third interoperability forum. Then I'm gonna read you some clips from that. And if that's glass is half full, these people are really positive people. Um, but anyway, with that being said, uh, my service to the industry on this is just gonna be to let the left hand know what the right hand's doing.

Right. So there's a lot of areas here where I'm not sure, uh, we know what's capable, what the capabilities of some are. We don't know what, uh, some entities are trying to do, what they're trying to accomplish. And, um, I think, uh, there's also some efforts in here that . Uh, that this survey pulls out that I, I think are interesting.

So, um, that's, that's what we're gonna try to do here is just sort of set it up and just ask some questions. We're gonna come back in with some interesting, uh, solutions and things that, uh, people are talking about. Hopefully we can get positive at some point, but, um, we are pretty early on in this. We shouldn't be, 'cause this problem's been around for over a decade, but we are so let's just

Call it what it is, and we will start with the survey. Survey of hospital and health Senior uh, executives has found that nearly a third reported their data sharing efforts are insufficient. It even within their own organization and fewer than four intents. So they are, are, they're successfully sharing healthcare data with other health systems.

Alright, so, so hear that. So a third say, it's hard to share it within their, uh, within their own four walls. And, uh, even more than that, say, uh, they are really struggling to share data outside interoperability. Challenges aren't new. But while previous studies focused on challenges with sharing data between hospitals, which is what we generally talk about on this show, a new survey from the Center for Connected Medi Medicine, a center jointly operated by GE Healthcare, Nokia and UPMC breaks down interoperability as data sharing with colleagues.

Payers and patients as well as other hospitals. Uh, and I'm glad they're doing this study 'cause this is really interesting, uh, to me. In that we're trying to create this whole patient profile. And in order to do that, we need to start bringing in social determinants data, but we also need to bring in payer data.

Uh, I don't know if you've ever played with payer data, but it is some of the gnarliest data out there. It comes in so many different forms and you have to . Essentially decompose it and then recompose it. And anytime you do that, you run the risk of losing the integrity of the original record. Um, so I would love to see some standards between, you know, between the payers so that I could get their data in a little better format.

Um, there is no real standards for how we're sharing it with patients. Uh, between hospitals, the standards are, uh, slushy at best. Uh, and, uh, colleagues, we have, um, you know, we're trying to share it with researchers and a, again, there's not a great set of standards for sharing that data. And so all these areas are really slowing down the development of healthcare and the progress of healthcare and the progress of health.

Really as you look at it, so let's see what they say. Um, nearly 60% of the survey respondents cited moving to one electronic health record as an organizational step being taken to overcome interoperability difficulties. Uh, in fact, one hospital down here is spending 170 million. Dollars, uh, to go to a single EHR and, uh, to move from one EHR to a different EHR.

And they said interoperability is one of the main reasons, um, that is really an incomplete strategy. I just, I, I just have to point that out because most health systems, when you go in there and you do, uh, an audit and you do a survey of the number of applications, uh, even if you are a small health system, let's assume you're $500 million health system, you still have.

200 applications. And of those 200 applications, three quarters of which have clinical data, uh, that need to be a part of the, uh, of the medical record. Of the legal medical record. So . You haven't, you've solved it. You solved like 60% of the problem, not even 60. You solved like 40% of the problem. If you get onto a single EMR, and I'm not knocking that.

If you can get onto a single EMR across your entire health system, uh, there are gonna be significant benefits. I'm just saying that interoperability is somewhat of an, somewhat of a benefit in that, uh, but not, uh, not the primary driving benefit in that. So, um, . But that seems to be one of the primary drivers.

Uh, 40. Uh, so 60% said, you know, that, Hey, we're doing that. That's one of our big drivers. Um, again, very incomplete strategy. 44% said they're hiring new people. That's interesting to me. I'd like to see what kind of people they're hiring. Maybe we're going outside the industry, maybe we're looking at, uh, new kinds of data skills and data wrangling skills.

I don't know. That could be interesting to look at. Uh, a little bit on the disappointing side. 38% h said HIEs, 37% said, uh, fire and other interoperability standards. Uh, I wish those numbers were higher. Uh, the HIEs are still kind of spotty, uh, but we're gonna talk about . One that's pretty interesting, uh, in a story, um, in a little bit.

So the other article, so the Modern Healthcare article gave a little bit more detail. Let's see what else they said. UPMC, chief Medical Information Officer, Dr. Robert Barr, who is not involved in the recent survey said Pittsburgh Health System uses separate EHRs for its ambulatory, acute ambulatory oncology spaces.

The health system isn't looking to move to a single EHR. Interesting. In fact, I had a conversation with the CIO o. Just last week where we talked about is it sustainable? In this m and a, uh, process to continue to think that we're gonna be able to bring in the EHR and we sort of postulated that it takes, uh, 12 to 18 months to take a health system that you just acquired.

And by the way, we're being very aggressive and generous here. 12 to 18 months, take them from their existing EHR to a new EHR and integrate them into what you're currently having or you currently have. And so we're saying that, hey, the primary health system is gonna drive the standards. And you go in and you, you bring them in.

Now we all know , I'm not naive here. I understand how, how difficult that is and how these mergers happen. And uh, and then negotiations that are done at the table around . Uh, workflows and processes and those kind of things. And, um, and it, and, um, it's not always that easy, but let's assume it is that easy.

It takes 12 to 18 months. Let's assume you do three or four acquisitions a year. Uh, you've just tacked up, you stacked up a whole bunch of work for it for the next four years where you're not really making too much progress beyond where you're at today because all you're doing is integrating existing systems.

And, uh, we both sort of shook our head and said, I don't think that is gonna be a long-term viable strategy. So, um, uh, UPMC, he is, he's saying, Hey, we've, we're not trying to bring all the EHRs together. Uh, we've had to leverage different tools and technologies to help us share information. That includes, uh, document management tool that allows clinicians to move progress notes between EHRs and data aggregation tool that pulls data, uh, from across systems.

And I think that is gonna be the strategy that sort of wins out. Uh, e especially if we get more standards, we're gonna be able to move things without, uh, switching out EHRs. Not to say that. Not to say that there aren't significant benefits in getting to a single EHR. I just wanna make that clear.

Hospitals in the survey were most successful at sharing medical data within their own organization, which makes sense. It's your control area. Um, and, uh, said organizations were highly success. Uh, only 50% said they were highly successful at sharing medical data with payers and their patients respectively.

Think about that. 50 some odd percent are successful at sharing their data with their patients. Um, as you've known from previous episodes, that is really an unacceptable number for me. Um, I'd like to see the entire medical record be in the hands of the patients, the entire, um, legal medical record in their hands.

I'd like to see their social determinants record be in their hands. I'd like to see their payer data be in their hands. So, um, that's the goal from where I sit. Uh, it's not necessarily financially backed by any, uh. Anything other than I believe people will be more engaged with their health, with the more information they have and the more decision making they're able to make.

Um, let's see. What else did they have to say? . Uh, I'm spending a lot of time on this article, so that's, that's the state of where things are at. Uh, they also go on to talk about the, uh, only 27% said that there, they believe that, uh, the federal government policies are going to help in any way. Um, uh, you know, this is one of those areas where I'm gonna have to agree to disagree in that, uh, I think there's too many players out there that are, uh, not incentivized to share data, uh, for various reasons, for competitive reasons for, um.

For, uh, you know, positioning within the market reasons, uh, for, I don't know, there's, uh, the cost, the cost is too great for the benefit that's being received. Um, that I think the government, this is one of the areas where the government may have to step in and push, uh, the standards, uh, across payer and provider data.

And making it available to the patients. Um, uh, next story stakeholders. See, glass is half full. Uh, I'm just gonna read you some of the quotes. I I'm not even gonna, you know, it's, uh, what's the article from Healthcare Innovation Group? David Wraths. And so somebody from one of the payers says today it is largely canned reports or claims extracts we send, uh, send to each other on a monthly basis or quarterly basis.

It's not real time enough to be actionable, and on the member side, it is even more limited. He admitted the information members receive is more about policy than about member health. Often the data is not understood well enough to be trusted. If the data is not trusted, then it won't be used effectively.

By the way, this is, the glass is half full crew. Okay. This, this is what they're saying, which, uh, is kind of amazing. So somebody who's, uh, running one of the, uh, . Rios is talking about regional health information exchange, uh, regarding social determinants of health data. We're doing it a little differently in our state.

Um, how do you accept, you know, how do you engage the state agencies that have never been asked to share data? He asked, as we talk about social determinants, all of our federally qualified healthcare clinics have adopted the the prepare assessment tool. He explained. Care managers are using it to assess individuals to better understand their nonclinical challenges.

But once clinicians determine someone has a housing challenge, are they responsible for finding someone, uh, a house? The plan is to connect them to a state agency. Um, goes on to say it is shocking how little communication happens, uh, around these issues until it boils up to the Attorney General's office.

Again, glass is half full. , I'm, I'm just reading you what it says. I was reading this article going, okay, when is somebody gonna say something that . It makes me feel positive about this. Um, let's see. Uh, noted that, uh, um, oh, the fire standard ha has fairly good standardization. Unfortunately, some EHRs still have proprietary APIs and aren't using the fire standard.

So, you know, once again, uh, let's see, just is going from the patient side. There's very low awareness that they have the ability to get access to their data. Patients aren't asking for it yet. This makes it difficult for app developers and it's an awareness problem. So, I mean, this is, the glass is half full, uh, point of view.

So if this episode sounds a little down on interoperability, I apologize, but some people are down on interoperability. And it's not necessarily me, it's the study and it's some of you. Let me tell you some of the positive things that are going on the VA and other, uh, pioneers of the e-Health Exchange, health Information Network infrastructure, healthcare IT News, bill Sowicki.

So the e-Health Exchange, the largest nationwide health information network connecting the public and private sectors has announced the go live of a new gateway technology that is designed to simplify connectivity for its patients via a single connection to, uh. Uh, across the nation. Okay, so when you think about the cost of interoperability, one of the biggest problems is you, you're still connecting to multiple systems.

What this is saying is you're gonna connect to one system. Okay? So how many, how many interfaces do you have to manage one? How hard is that? Not that hard. Alright, so that's, that's, uh, that's benefit number one. The benefits to the members of the exchange said will include reduced the, uh, information share expense, which we talked about.

Further expansion of the national footprint and faster implementation of innovative capabilities such as real-time, content quality validation, and a national record locator service. So we have a whole group of people chime and I just got another email chime saying, Hey, write your senator. Get them to do a national patient Id.

There already are national patient IDs. Uh, this national record locator service. So it's right here in this thing. Uh, your social security number is one. I understand there's a lot of people, in fact, our health system, uh, better than, um, . You know, 15% of people, uh, didn't have social security numbers or didn't provide social security numbers, and we're not really supposed to use social security numbers.

I get it. But, uh, but it still acts as such and then there's a lot of other ways to get it. So I'm not a huge fan of the, uh, national patient Id mostly 'cause it already exists. We're just recreating the wheel. We're gonna spend a lot of money, uh, doing it. Why does it already exist? It already exists because a lot of players have been already been working on this problem.

Uh, when the e-Health Exchange was formed more than a decade ago by the ONC, uh, the government opted for a federated exchange approach, stopping short of creating a, a required gateway. As the proposed National Network for Health Information Exchange, the government favored an open market and decentralized approach that would support further innovation.

Much like the internet, the eHealth uh, exchange leverages . InterSystems platform integrated with eHealth exchanges, fast healthcare, interoperability resources, healthcare directory as the basis for the hub model. The hub will make it dramatically easier for organizations to connect to each other using connect once model, uh, to reach any other member of the network.

The exchange contended. If you're a small health system, I, you should look at this. You should absolutely look at this for interoperability, and you should connect to it. Because it's gonna be based on fire. Your, um, your EHR provider's gonna be required to provide this, uh, connectivity so you can lean on them and not encourage much of the cost yourself, and you can connect here and get ahead of the curve in terms of sharing it.

The other thing I'll say is InterSystems technology platform. It's phenomenal. A lot of health systems are already using it. Uh, it's, it's . The InterSystems is also the basis for some of the largest EHRs in the country. So it can handle scale, it can handle massive scale. Um, if through their architecture, which I, I was able to, uh, take a look at, I, I don't own their stock.

I, I'm not a. Player with InterSystems. I'm just saying the technology's good and it, and it can scale and it can handle this kind of stuff, but they're not the only ones. I mean, there is, there's heart, there's clear sense. There's, uh, M-P-H-R-X. Um, you can see, uh, health Catalyst could also do this. Now I do own Health Catalyst stock.

I, at least today I do. Um, but they could do this as well. As they aggregate that data, they then they, uh, provide a set of APIs. They're already in the cloud. They're already in Azure. Uh, I'm not pushing them specifically. I'm saying . There's a whole bunch of companies that have been doing this for the better part of the last eight or so years, and I still hear health systems stepping back and saying, we've gotta create this.

We don't have to create this. This already exists. There's companies that have already created this and already do, uh, patient matching and already have mechanisms for providing a set of APIs for people to bill on. I, again, left hand, right hand. You just need to know what the left and right hand are doing, and if you're waiting for your EHR provider to do this, don't.

They're not gonna do it. Uh, in fact, I've heard stories of EHR providers sending other EHR providers, uh, c and desist letters for moving data into their system. So they can't do it in their own system because it violates, uh, something in the agreements that you can't move stuff from one EHR directly to another EHR.

Now you can as the system, but those providers can't do that service, so they have to . Figure out a third party way to do it. So when you look at their strategies, it's generally between themselves. And then the government required regulations for sharing data. So these kinds of systems, they work, they work and, and they work really well.

And you should look at 'em. And actually I rattle off five or six. There's like 12. There's, there's a whole bunch of 'em, and, uh, some of 'em have great architecture. Uh, this approach leads to faster access to correct patient records, lower implementation costs. The exchange said the eHealth Exchange, uh, modernization approach.

Also help organizations to prepare for pending regulatory changes such as information blocking centers for, uh, CMS, uh, interoperability rule, as well as meeting expected ONC pending trust. Again, if you're a smaller system, if you're a billion dollar or less, you should plug into this. Uh, it gets you. . Where you need to get to on teca and other things, and it just gets you over the hurdle.

Uh, something, something worth, uh, looking at, um, a nationwide trusted exchange framework that has an estimated 600 physicians already on it and 36 million clinical documents a month across it, uh, among disparate networks. The exchange reported, um, I think this has this, this may have some legs. So, uh, uh, it looks like the last story.

Uh, Mayo Clinic, CIO, discusses data sharing interoperability HL seven Fire Standard. So Chris Ross at Health 2.0 is gonna talk about, uh, what they're doing in this space. Uh, we have had and continue to have systemic problems in making data available for patients and the clinicians who take care of them.

He explained this is not a problem that any single institution can solve. It is not a problem that any single vendor can solve. I agree with that. No single institution can solve this. Every institution has to decide that it is important to share data for the good of the community that they serve and the good of the patient.

And they have to make it a priority. If they don't, it's not gonna happen and it's gonna continue to falter. Uh, and they have to be able to push the EMR providers. They have to be able to push the payers. They have to be able to push in a lot of different areas. Otherwise, we're gonna have an incomplete medical record.

Just even the healthcare systems have an incomplete medical record. You need the payer data, you need the social determinant data. Uh, you're gonna need the genomic data. I mean, we are gonna have an incomplete record until we figure out a way to bring all this stuff together. So he is right. It's no single institution.

Um, or, and really no single vendor can solve it, uh, which is also true. Now I rattle off a couple vendors, so it might sound like I'm talking outta both sides of my mouth. Uh, but I'm, I'm talking about vendors have, that have the capability to house that data, to, uh, unify the medical record to, uh, with identifiers to make sure that all the records that are in there are pointing to the right, uh, person.

So, he's absolutely right in that, uh, this is a problem that requires that we extract very complex and large amounts of data from one system and find ways to insert it into another system. That uses a different database schema and a different user interface for all these problems, I found the best systems, to be honest with you, do not try to shove it back in.

Uh, when you try to shove it back into another EMRI, I just find that to be a losing proposition. Uh, you should just, uh, move the pay me data back in. And, uh, the, the medical rec or the, the records that are coming from outside systems, uh, just certain data elements are brought back in. Um, again, I've spent multiple years incubating some companies, working with some companies on this, uh, specific problem.

We found that just, uh, creating a, uh, user interface that, uh, that had links from the EMR into that data was efficient. Uh, and in areas where we absolutely had to decompose the data and, and break it down, uh, say for research or other things, uh, we would do that NLP and other technologies. So, uh, those opportunities do exist.

The only way to effectively answer the problem is to figure out how to extract all the complicated data and share it in a way that is neutral with respect to the database. Absolutely. Great. Uh, to me the most important activity we have in our community right now is the advancement, advancement of these kinds of data sharing arrangements in which almost all are using HL seven fire.

Agree. Uh, the fire work is not just the specific technology, but also a way of thinking. Agree wholeheartedly. Um, CIOs should be thinking, how do I drive, uh, my vendors towards using the fire standard? How do I work with the government to drive the fire standard? A way of acting, uh, most of the problems that, uh, me and my fellow CIOs encounter are no longer problems we can solve by ourselves.

We need to solve them as part of the broader community. Uh, couldn't have said it better myself. It is 23 minutes into the episode. I'd love to talk to you about the data breach at, uh, Massachusetts General, 10,000 patient records out there. Uh, also have another story. You know, I'm gonna come back to this, uh, maybe next week.

Um, 'cause you know, you have that, uh, data breach and then you have, um, close to one third of healthcare employees have never received cybersecurity training and report shows. And, uh, it's no wonder we're having, uh, data breaches. I'm not sure that's the reason for that. Uh, Tampa General launched a NASA mission style, uh, control command center, which I think is, uh, really cool and I think is, uh, the future.

I think, uh, that we are gonna be able to drive costs down by implementing, um, ways to deliver care over the wire. Uh, the bar is rising in consumerism and healthcare, but providers are still playing catch up. I will cover that story again 'cause that is a really interesting story. Uh, but that's all for, uh, that's all for this, uh, for this week's, uh, new show.

Every Friday, check out our interviews with industry influencers. Uh, keep the comments coming. Bill it this week in health it.com. Good, bad or indifferent, it all helps. Uh, this show is a production of this weekend. Health It. For more great content, you can check out our website at this week, health it.com.

Or the YouTube channel at this week, health.com. And you can click on, uh, YouTube at the top of that, uh, top of the website. Thanks for listening. That's all for now.