Listen to the Podcast

• Guest Bio
• Show notes
• TRANSCRIPT

Kristopher VilamaaCEO, HealthCare Perspective, LLC & Senior Advisor to Mostly Medicaid

Kris has over nineteen years of behavioral health, health information technology and health policy experience. Kris has led major state system transformations including planning for Medicaid Transformation,  development of new behavioral health treatment standards, service definitions and leading large information technology system implementations. He has worked with state and county health departments, managed care organizations, community mental health providers, behavioral health county boards, federally qualified health centers, safety net hospitals and large health systems to enact meaningful initiatives.

Prior to joining HCP, he was Director of Behavioral Health for Germane Solutions and the first Chief Information Officer for the Alabama Department of Mental Health.

Highlights from this episode

Thinking about interoperability beyond just technology

How policy changes have been the drivers in our efforts

Prioritizing front line care delivery systems for interoperability first

How MITA impacted the push for interoperability

How the HIEs impacted our understanding of what we can do with interoperable systems

How old ways of thinking from legacy vendors hinders interoperability

How state agencies were the conduit for provider adoption incentives in the past, and how they need to think about their role in the next round of interoperability efforts

NOTE: The transcript below is a rough approximation of the dialog and has not been cleaned up from the automated transcription service. It is meant to help listeners search/find for key topics. 

0:03

Hi everyone. I’m clay Ferris to practice lead for Client Solutions and mostly Medicaid.com. You’re listening to our special series on interoperability and the healthcare industry. This is part of our ongoing project called critical conversations in Medicaid.

0:18

We interviewed experts from a wide range of roles to get a key perspectives on this topic while there are new regulations and rules by both CMS and onc our discussions deal more with the broader issues and challenges related to interoperability. I hope you enjoyed learning from these experts as much as I did and don’t forget to check out the related issue brief. We did on this topic at mostly Medicaid.com.

0:41

A quick bit of housekeeping first, we would like to thank our sponsor for this series intersystems graciously made this project possible. If you’re not familiar with the intersystems, they provide a wide range of solutions to government agencies and Managed Care organizations to improve Healthcare outcomes and control cost. Please make sure to check out their work and learn more about what they do at inter systems.com slash Medicaid second. Here’s the disclaimer.

1:07

We intentionally interviewed experts with different perspectives and These they speak for themselves only and their inclusion in this series in no way constitutes an endorsement of mostly Medicaid or our sponsor. It’s also important to note that their opinions are their own and do not reflect the opinions of our sponsor now sit back grab a cup of coffee some headphones and listen to some of the most important insights. You will hear related to interoperability in Healthcare systems.

1:35

This episode features a conversation with Chris Vilma. Chris is the CEO of Health Care perspectives and a senior adviser to mostly Medicaid Chris and I covered a wide range of topics which makes sense. I’ve known Chris for several years and then we have a deep well to pull from in terms of our shared understanding of the Medicaid space. Chris is knowledge on it systems and how they impact care delivery of the state and local level is unsurpassed in my experience in this industry. I’ll look Chris give his full bio when we get into the conversation.

2:04

So here’s a few Car lights he has over 19 years experience in Behavioral Health Information Technology and health policy. He’s LED major State system transformation efforts including planning for Medicaid transformation development of a new behavioral health treatment standards service definitions and leading large information technology system implementations. He’s worked with State and County Health Department’s Managed Care organizations Community Mental Health Providers Behavioral Health County boards, fqhcs safety net hospitals and large hail.

2:34

Systems to enact meaningful initiatives Chris was also the very first Chief Information officer for the Alabama Department of Mental Health to give you an idea of the types of things you’re going to hear about. I want to give you some highlights from our conversation. We talked about thinking about interoperability more broadly and Beyond just technology and what that may mean for making different HHS programs more interoperable.

2:59

We also talked about how policy changes so far have been the drivers in our efforts we Had some good ideas, I think on prioritizing Frontline care Delivery Systems for interoperability first. He also talks about how my de impacted the push for interoperability. He also gives gives I think a really important look back about how hies and that experience impacted the industry’s understanding of what actually can be done when systems are interoperable.

3:28

Chris makes some good points about how Legacy vendors are have old ways of thinking sometimes that hinders interoperability. And finally there’s a pretty important part of this discussion where we talked about how state agencies were the conduit for provider adoption incentives in the past and how state agencies need to think about their role in the next round of interoperability efforts.

3:52

So sit back grab a cup of coffee and let’s listen to the conversation between Chris Vilma and myself about interoperability and Healthcare.

4:01

Hi everyone. Thanks for joining us for another episode in our podcast series all about interoperability. And today we’ve got with us Chris filma who’s done a lot of things in the space and has some some very important insights and opinions to bring for the audience. So Chris, if you don’t mind kind of give, you know a few minute overview of where you know your background where you’re coming from on the topic of interoperability.

4:29

Sure. Thanks Clay and I appreciate the opportunity. My name is Chris Velma. I am the owner and CEO of healthcare perspective have also done a number of projects with with mostly Medicaid primarily in the behavioral health and health it space prior to getting into Consulting about five six years ago. I worked in healthcare it and state government. I was the first CIO for the Alabama Department of Mental Health and implemented a number of large it system projects including electronic.

5:01

as well as As well as Managed Care organizations and it vendors who are interested in interoperability as well. So I feel like I have a good grounding in this topic and have some expertise to bring thank you.

5:44

So and I think if you know, my gears are turning and this this topic of interoperability, I think a lot of times gets it for based on some of the other discussions that I’ve had for this series we are Don’t want to lose sight of it’s not just interoperability even just in a technical sense. Like it’s sometimes across programs menu mention Juvenile Justice and other programs that we don’t even necessarily think of as put together with a healthcare delivery system, but I think that’s come up time. And again in these things is not just how two different systems within say the Medicaid agency work but also across sister agencies, and it sounds like you’ve done done a good bit along.

6:29

Lawns yeah, okay. So how do you the first question we’ve been asking is kind of set the stage in the in the service of defining our terms have the you define interoperability and just sort of simple laypersons terms.

6:46

So I look at interoperability as the ability to provide care in a full knowledge environment where you have the information flowing from every care delivery point in the system to a single source of Truth and then have visibility on that that single source of truth that all of the points of care.

7:04

So to me perfect interoperability is perfect access to information across the various aspects of the Care delivery system, so you I think the You just described it. It’s I don’t want to say it’s unconcerned but it’s less concerned with the means of getting there and more about the outcome you I think you called it a full knowledge environment something like that. So it’s more along the lines of having that access a goal based definition of interoperability versus a features functions details specifications. Is that is that fair to describe your answer? Yeah. Yeah.

7:40

I think that’s fair certainly the the technical specifications and the means of getting their sixth Really important to make it happen. But to me it’s interoperability is really about access and how people are able to get to the information that they need when they need it at the time and you just so one. Another question that has been pretty helpful. Especially folks like yourself who have been doing this for a while. Is this one about how long do you think we’ve been trying to achieve interoperability?

8:13

I know personally I’ve been involved in this for Going on 20 years out of town which angle you look at it being on data standards groups way back in my Hopkins days. Yeah, but I know a lot has changed as the technology has changed. But so how long do you think it’s a multi-part question? So how long do you think we’ve been trying to achieve this thing called interoperability? And once you kind of lay out the history of that what’s different now, you know, what do you think has changed? What have we been stuck on what we’ve been trying to fix?

8:46

You know, what are the fundamental challenges of this from your perspective? So that several questions, but if you’ll start out with the history the how long would that would be good? Yeah. Yeah, so and I actually have a little bit of evidence for this one. So I would actually put it right at 30 years and maybe a slightly longer and evidence I have for that was that when I first became the Chief Information officer for the Alabama Department of Mental Health.

9:10

I found a report on the on the Shelf in the office that I had taken over so Took over for a long time director of it have been there for a very long time decades himself and on his shelf was a report that have been drafted in the late 80s that involve trying to bring together. The various data sources around justice-involved kids from across the state government though, even then when they had very minimal capabilities, they were trying to figure out a way to do that and it was a funded Grant under one of the federal agencies for the state to look at trying to bring those those days.

9:45

Resources together and they weren’t successful for a lot of the same reasons. We can’t be all that successful today. They were able to do it at a one-time point. They were able to take data extract from various systems and bring them together at a point and say okay we can say at a point in time what was true, but they were not able to build anything that was interfacing or interoperable over a long period of time.

10:08

So that was that was kind of my point of evidence or how long this has been going on, but I had an interesting report to And the challenges that they faced even in the late 80s and trying to do some of the same things that were talking about now and that would involve public health and mental health and the justice and Department of Juvenile Justice department the state court all trying to work together and had a committee and all that great stuff.

10:34

So in terms for me what’s different obviously the technology in the speaks to that human technology changes very rapidly and the the drivers from the the system that we have now really have come much more into alignment. So one of the reasons that we couldn’t do a lot of this time for a long time was that there really weren’t the drivers there there weren’t the financial incentives there weren’t the real policy pushes to try and make this happen or the desire from a lot of the players to make it happen. So I think that’s that’s what’s different there.

11:10

There’s definitely, you know, the policy have the new has changed the technology has Use the capabilities of changed and the desire of the players I think has changed in some fundamental ways. And so what we’ve been stuck on it is still being very held up by some dumb old ways of thinking from technology companies that the sharing information as not advantageous to their business. I want you to say old ways of thinking there may be there are real reasons. They’re there are real challenges.

11:39

They are about how much information to share when and and having business models that are based on proprietary data and proprietary structures of things and I think there has been substantial erosion in that over the years, but they’re still that belief and still that Challenge from from companies that have built their business models particularly those that have built their business models on proprietary Data Solutions on ways, but that they see are very unique in the market and don’t want to turn that over in any way to competitors or to those that might be better able to Advantage of it in different markets. So the the fundamentals for me are using standard protocols. So this is where I do get into you know, the more technical aspects of this. I think the fundamentals are that we need to use standard protocols there.

12:32

We need to take advantage of the apis and fire and other standard protocols to ensure that system changes and upgrades and as technology companies are thinking about future planning and new development that we’re I keeping this idea that our operability and sharing information in mind and I’m hearing that from the vendors that were working less than and vendors that I have regular conversations with that there if they don’t have a lot of that capability now that’s in their plans and what they’re thinking about and I think that’s largely because of the policy changes that people recognize they’re going to have to do some of these things that maybe they put on the back burner to really be able to work on standard platforms and Your protocols to transmit and transfer information and become interoperable.

13:21

So I say you’re saying you feel like as far as what’s changing the we feel like the policy changes is at least driving for those that are planning ahead realizing they’ll need to have a pivot from their current model. If we’re talking about the ones that are like the incumbent vendors, right?

13:41

Right, right and it and I think later on we’ll probably get in when we talk about stakeholders because I I agree so, you know who wins who loses all that type of stuff because I agree a lot on the current business models based on not only sort of holding up information based on proprietary information itself, but also and I think a lot of people don’t think about this all the consulting services that go with these technology vendors that is really kind of based a lot on being able to control that information access to and we are that learn I think people think of You know certain vendors is only technology vendors, but if you look at their actual revenues, you’re talking about, you know, 50% of them are also from related Consulting that uses those systems. Okay. So let’s let’s move on a little bit and if this is a magic wand question, so and let’s put yourself in the role of State.

14:49

CIO or c2l? Whoever would make a decision in the state about which which systems need to be made truly interoperable in your in your definition from from your earlier definition, which one should be made interoperable first. Let’s say we can’t make all 30 of them interoperable at one time which one should should play together and be fully interoperable first.

15:14

And then after that which one will be a sort of a fast follow which the critical path are Yeah, and I think for me the critical path I follow is thinking about it from a care delivery standpoint. So I start with the the systems that are documenting their delivery and and and are critical at that point of care. So the ones that are being used at the point-of-care heard of to me the first ones that need to be brought in Under the Umbrella of some sort of interoperability structure and whether that’s you know, Care Management systems or electronic health records or you know, whatever.

15:49

That platform is that’s being used at the point of delivery to a member or to a citizen or however you structure from a state standpoint of Managed Care standpoint planning standpoint.

16:03

However, you look at that individual is receiving Services you want those systems that are as close to those folks as possible to be integrated first and to be brought under that interoperability structure first and then add in those those items that provide more flavor and and more information about the the types or or you know, the other relevant pieces of information I can come in. So I start with those multiple structured and the unstructured data that’s been the challenge has been thinking about unstructured data and how we try and bring some of that information together for acute outpatient and Behavioral Health primary care Specialty Care pharmacies and Labs.

16:45

We’ve done a better job list of being able to bring those in under health Should exchange structures or other types of interoperable structures and then we’ve got all the social determinants of Health work that’s going on to try and bring some structure around that as well. So I think getting that critical client level member level patient level information into an interoperable environment first and then worrying about you know, the the kinds of you know claims data and other you know, eligibility information and those kinds of things kind of come next.

17:19

Next to me and sort of flavor the system and then whether you bring into their social service social services or Health and Human Services data and how to bring that in it kind of comes behind that that point of care point of touch point of of dealing with an individual. So so start out with if clay member or clay patient was sitting in the ER or the counselor’s office or the pharmacy or whatever everything right there.

17:48

That’s actually Like in that it care encounter those systems right there and need to make sure their interoperable first and then whatever the next handoff is backing up away from that encounter. Is that that factor? Yeah. Yes a lot of sense. So let’s kind of talk you no longer view again. What do you think have been you know, we’ve been trying this 20 30 years. What’s been some of the successes?

18:19

Has some of the failures what can we learn from those if you can think of you know particular efforts or initiatives, right?

18:28

Yeah, when I think about success those I really look at the you know, the more forward-thinking health information exchanges the regional health information hubs that were around even before the health information exchanges, and there was some head-butting when you know, things were rolled out in a way that the state was expected to kind of bring those Regional organizations along with them and some It was that that was a leverage point in that worked. Well, in other places the region stuck to their region and said we’re going to we’re going to do our thing you guys do your thing. So I think from a success standpoint. I think the health information exchanges are success point in pocket so wasn’t successful and we can talk about it as something that wasn’t successful as well on the flip side of the question, but I think in specific instances there have been, you know some some real successes around Regional information.

19:19

Herbs around accountable care organizations that are Regional so acos that has that have stood up and been able to build a data platform or acquire data platform that works for everybody within that Accountable Care Organization. I think those are the Avenues where I’ve seen some realist success where everyone’s part of the network everyone’s part of the same platform. They’re they’re exchanging their interoperable their, you know, their system talk to each other they’re able to pass information back and forth.

19:49

And work off the same care plan and those kinds of things are happening. They’re not happening nearly enough, but there are successes that people can look at and say hey there’s you know, there’s a model that my community is replicator. There’s a model that my steak the replicate in general the states that have been successful at it or relatively small and we’re able to go and you know, sit down with every, you know, real player in the system and say, okay we’re going to do this and you guys are going to be on board and what do we need to get you on?

20:19

I’m bored, you know they were able to get everyone who needed to be on board in a room or a series of rooms and get that done. It’s the state for communities that are much larger that have a lot more players where they can’t even get their hands around everybody. That’s a player that makes a bit more challenging but I think there are lessons learned from those successful efforts. We can you know, we can look at you know, those that moved with me and dates and those that moved without without a mandate.

20:49

There was movement, you know before there were policy drivers or financial drivers and there was movement after their work obviously drivers and financial drivers and I think there’s value and in comparing those and saying okay, can we can we scale some of these efforts, you know, whether they were policy driven or financial driven or not, you know in our in our setting, you know, you can find an example and say are these things that can scale are these opportunities that we can bring to our community or our state?

21:19

Just spaced on the want to you know, can we bring it to the table? Because we have the people who want to do those without a policy driver or do we have policy and financial drivers that are making us move and that you know gives you another lover to bring people to the table. So I think regardless of where your where what position you’re coming from. I think there are models out there that you could replicate it’s just, you know are the right pieces and place are the right players in places the want to there too.

21:49

Get it done. And then remembering that health information exchanges is not the end-all be-all.

21:55

That’s not you know, the end of interoperability just because you have some ability to exchange admission discharge transfer data or Labs or Pharmacy that there’s always more that can become interoperable and that can create that that single record or that full knowledge for somebody who is providing care to that individual or providing some sort of service to have access to the Information that’s relevant and and true at that point. I think so. I’d like to kind of like add my thoughts about the exchanges because I think they are so much richer than people realize that are kind of only on the payer claims and then a straight of data side. And then also it’s going to hold that thought for a minute and then also this idea of how you’re breaking out.

22:49

What movement there was sort of before-and-after financial incentives and how we look at that now because I think that that’s another kind of car. That’s another thread that came up in another one of these podcasts, but on the first one, you know, I look at and I’m much more knowledgeable about what has occurred in the hies in the last year or so that I was before and I’m Blown Away with the richness of data available, right?

23:17

So it I had no No idea things like there probably is a very detailed clinical record of clay available in the state of Alabama are whatever, you know, depends on which state I live in totally independent of payer status, right which is which I think that’s the game changer because it’s it’s payers that bring by their nature bring policies that kind of do certain things that make information.

23:49

To get or change it up or whatever that makes sense from their perspective as a payer but it’s not like providers, you know to the extent that they’re not also a payer like a health system, whatever they’re not creating. Hey, we’re all going to process this in this way. They’re just practicing medicine. All right or whatever care. So I think the point you make about the a Chinese is a good one.

24:13

I almost look at them at least in The Shining examples that I’m aware of and I’m sure there are others that is not not almost look at them as a very impressive proof of concept for this whole interoperability thing, right and we’re still stuck with that challenge, which is the one that I was always stuck with even when I was in one of those large analytics vendors that it’s one thing to say. Oh, yeah, we can integrate the clinical data in the claims data. That’s so much more complicated than people realize for it to mean something right for to be actionable.

24:47

So I think we’re still Of at that Cliff or that juncture, but I know it’s there but and then my other the other thing I want to react to where you were talking about before and after there were policies or financial incentives, you know, this came up in another podcast and it was really interesting because the other the other guests was talking about, you know back and say 2011 or whatever. This was Medicaid agencies basically found themselves as the contract vehicle distribute a bunch of cash to providers.

25:19

Us to do things along these lines, you know for EHR adoption or whatever the different incentive programs were for this and they never really had the time or stop to sekai. What do we get out of this other than being an access to the funds and I think that’s an opportunity that maybe those in the audience listen to podcast now, they’re in a Medicaid agency or similar agency.

25:44

You know, how can you use this upcoming policy push that Talk about now to accomplish some of your own goals other than just sort of being used for your financing mechanism abilities. Any thought on that last Point Chris. Yeah. No, I agree. That’s extremely important.

26:02

And I think they’re there’s parallel tracks going on there with you know, that that experience of having gone through the responsibility of you know, having providers adopt ehrs and meaningful use and that whole exercise and then At the same time going through this process of the modular mmis. So, you know, once that came on the scene and became something that Medicaid agencies needed to start planning for a need to start thinking about I think that those pieces coming together of hey, we went through this experience and didn’t really understand, you know through the meaningful use process what we could have gotten out of it and now we’re in this process where we’re trying to replace our Medicaid management information system.

26:49

With more modular systems that are potentially leverageable to other programs and other agencies that opens up opportunity to that wasn’t there before so I think there is this process that that Medicaid agencies and post within Medicaid agencies are going through of hey, we you know, we’re not just you know Medicaid were, you know, we have a lot of other, you know value here and we have a lot of potential to get value from these various partners.

27:19

That maybe we had good relationships with or maybe we haven’t had good relationships with that.

27:23

Hey, we’ve got a lot to offer with these systems that were potentially bringing that, you know can bring interoperability, but can also, you know reduce maybe some some burden of management or what various issues that are going on within state government that Medicaid can bring a lot of value to and and as an agent of Satan can provide opportunity, so I do think there’s that Process of having gone through ACA and all the changes that came with it and having gone through the meaningful use process and having gone through health information exchange than then coming to this idea of having to replace, you know, large a large system that potentially could you know produce some more interoperability just by sheer fact of its existence. I think there’s a lot more, you know recognition of the opportunity that’s there because of the experience of having gone through some of these other things.

28:19

Yeah, I’m glad you brought up effectively mighta because I mean if my does not a giant push for interoperability, you know, at least within the Medicaid information system Enterprise. I don’t know what it is.

28:31

But you know, that’s probably a good place for us to look for Lessons Learned I didn’t and I don’t want to dive into that right now because I think we still I think we’re still in the early stages of seeing truly modular, you know Medicaid Enterprise systems, but I’m glad you brought the brought that up because that’s something to kind of be on the lookout for Because it’s clearly another way of exploring and implementing interoperability.

28:59

So let’s kind of Turn the Page a little bit and talk about providers. Then we talked about this usually from payer perspective or a program perspective or technology vendor perspective. What do you think providers think of this? Like do they actually believe this is going to change much or do they think you know, I do my thing and I’ve got my system and I’m pretty good are they resistant as that changed in recent years which and you know providers means a lot of different things. So you might want to kind of unpack that.

29:29

It what is your thought on the provider perspective of interoperability to the extent? You know, that’s on their radar. Yeah, and I will unpack it because I’m coming from a you know, kind of a unique or different perspective and that respect. So as a consultant I’ve worked a lot at the provider level with community behavioral health federally qualified Health Centers hospitals and health systems, and they do have somewhat different, you know perspectives and thinking on things but I think they get that the opportunity that’s there.

29:59

They get that, you know bringing together this information, you know having access to more interoperable systems that are talking to each other, you know could really drive and improve outcomes. They want access to information. They want to be able to get everything they can get and they’ve been to but they’ve been disappointed so many times by the promise of things going unfulfilled or taking a long time.

30:24

So I think going back to your example of the health information exchanges and and everything that You’ve learned about what’s there? I think what happened with a lot with the rollout of health information exchange was the promise was made at the front end that all of this would be there and when people went in and you know got their logins and went to go try out the the health information exchange. First of all, they had the, you know, get a log in log into a separate system, you know, maybe look at what was there and the first time they went in maybe all that information wasn’t there and there wasn’t a whole lot of value and then that’s what it became.

30:59

So then was well, you know, there’s not a lot here and this isn’t of any value to me and they walked away and never went back to it. Whereas if they took that same login, you know for years later and went in and use it. There’s there’s a wealth of information there.

31:12

There’s a whole record there of that that person’s history regardless of payer as you were saying in the state like Alabama where you have a single Giant commercial insurer and the and a single Medicaid agency that have when they just put their data together, that’s a huge, you know record and a huge database of Raishin, but that wasn’t there on day one. It took a long time to get to that point. And so a lot of the self the salesmanship has done to Providers early on was not you know delivered on early on and so when people were looking at wasn’t there, so I think dealing with providers they really see the the ability and the opportunity that’s there for interoperability whether their system can support it is a big challenge particularly with Behavioral Health practitioners.

31:58

They don’t have the systems that are really set up right now to be interoperable in a lot of cases. Some of them are headed down that road and thinking that they need to change the system that they’re on so they can be more interoperable and some of that’s coming from the policy drivers some of that’s coming from, you know, working in accountable care organizations or other types of environments where they’re working with the health systems, and there’s also been a push from the vendors of saying hey we can provide more to you if you get your purse.

32:29

Is on board with this as well, so I think there’s there’s definitely belief that from the provider said interoperability would be great and they see where the outcomes could could be improved if systems were more interoperable, but the failed promise of so many efforts in the past whether they be local or state or coming from the federal government. They’re just you know, they haven’t seen it and and they’ve been promised it many times.

32:55

So I think they’re they’re getting there and understanding that maybe this time is going To be different and that the technology has changed and that they need to go through grow with the technology when hospitals and Health Systems more so have got them and and understand their deficit has been bringing the partners into into the network or bringing the partners into their interoperability.

33:17

So they have the wherewithal to get the system to get the platform, but they’re their deficit is being able to bring the other providers into that into that same world and Some of them have done it by trying to go out with their own electronic health record and say hey, we’ll give you you know our health record or will bring you in as users on our health record and then you’ll be on our system or care coordination platforms for certain populations. But trying to really make the network interoperable has been more of a challenge and so I think Health Systems have been more of a leader hospitals and Health Systems have been more of a leader in that role in trying to bring interoperability.

33:57

So the communities that they serve Whereas other providers have felt like there they’ve been promised a lot from interoperability, but haven’t really seen the proof of that come to pass yet in a lot of places, right?

34:12

So for the providers that got the Maybe not quite ready version. We need a do-over but the good news is we’re making new doctors every day. I’ll be back on ones never had the bad experience and they can come on today exactly the not beta version in something and I know there’s successes and failures in that story just like with anything. So let’s kind of get let’s go I mentioned earlier we’re going to get into this part of the conversation, but let’s get into this stakeholder question.

34:45

And in let me let me full disclosure. Let me give my my angle, you know having worked in the technology space for quite some time and doing a good bit of Market intelligence work. Just kind of looking at I think looking at I think the health care Market in particular the Medicaid market with the somewhat.

35:07

I don’t want to say cynical but business I I’ll say I believe there’s winners and losers in this and you know, I think some people Little guy a little gal or yeah interoperability. Let me plug into that big giant system that’s been close to me essentially and then the Giants like epic or Cerner or IBM or DXE or whoever, you know, not not too particularly cast aspersions on any of those but just the giant technology companies. It doesn’t make sense to me logically that they would truly want interoperability.

35:38

If you were to ask say Africa Cerner what is interoperability mean and we did try to get some On this series, so maybe we’ll get some later but was not successful. But if you were to ask some of them what is interoperability mean they would probably Wayne consent. Well, let’s just get everybody on our system and then and then it’ll work great. But you know, I’m I’m so that’s kind of my disclosure of I’m cynical. I think there’s winners and losers. I think the incumbents are the biggest winners and I think that’s a big part of why all this has been slow rolled. But what’s your take on that question who’s incentivized for interoperability? Who’s not?

36:15

from a financial perspective Yeah, I think you’re exactly right and I look at it. As you know going back to my framework and way of thinking about if we’re talking about full knowledge. I look at those players in the system that are relatively information for right now benefit the most from interoperability.

36:32

So those who would definitely have retracts us to information be plugged into systems that they hadn’t been previously plugged into, you know, the ones that already have that access and have the bulk of the information now and are You know going to be sharing that with others who are information poor are going to be on the losing it or at least see themselves as being on the losing end.

36:55

So I do think the Giants are starting to make some movement and for me it was seeing, you know, seeing participation on panels from epic and Cerner around around trying to transmit, you know information and trying to work on some expansion of the direct protocol and thinking about and this The Cerner in particular not so much epic social participation from Cerner on that project of trying to pass more information through the direct protocol and have more closed loop referrals. They’re piloting that now, you know, it’s going to be a big effort in 2020 to try and push that out to more people but having you know vendors come to the table and have Cerner be one of those centers. I think it’s a positive step.

37:43

I think DXE to is thinking about you know, how to how to you know, make interoperability reality particularly as this this modular mmis rollout is happening to so I think there’s a lot of drivers and a lot of factors at play but it certainly did make sense for a long time to really, you know, Slow Roll to lock it down to try and keep as much in house as you possibly could but with the combination of the policy drivers in the payment drivers, I do think the the Giants are having to to find other ways to keep their their possession of the market and keep their clients but by not resisting interoperability, so I think they’re seeing that that that that we’re going to you know, we’re going to at least start messaging that we’re not you know, we’re not resisting and and maybe trying to find ways to leverage what we have and keep our clients and and you know keep a And of our of our core system infrastructure, and those kinds of things so I think you know again looking at protocols and thinking about data as data is data and being having it be less about the functionality and more about the information flow. I also like how close are approaching social determinants and thinking about it from the standpoint of I want the education information. I want the employment information. I want the housing information. I don’t really care. What tool you use to get there.

39:17

I don’t really care. You know, what what you’re what you’re doing in your system to try and figure out what the what role does social determinants play and what should be addressed and how it should be addressed and how you use that in care planning. I just need that information from for me because I’m providing care to this individual and I need to know what you know, but I don’t need to know everything. You know, I just need to know, you know, those basic pieces of information. I don’t need you know, all of the analytics and all.

39:47

things that you have that are system proprietary that maybe you know telling you what risk level to assign to that person or you know, there’s things that that there’s value that vendors can still bring to the data that can be proprietary while at the same time being interoperable and sharing during a piece of what they know or the critical elements of what they know without sharing all of the until without tearing all of the business intelligence, but they have so I think that’s where We’re going to get into those push poll is how much to share and you know, how much to be interoperable. That’s not going to include the analytics that’s not going to include the business intelligence necessarily that’s not going to include artificial intelligence necessarily, although I think that’s where you’re really going to start getting into. The rub of things is what you know, what happens with those those platforms that have significant investment in analytics and business intelligence in artificial.

40:47

Intelligence and how much of that information are they expected to share or not? Share I think is where the next real growth is going well and that’s you know is particularly I said that just to make up an entire case say Clays whiz-bang AI widget, you know can predict, you know, based on all the conglomeration of eating up all the data available for clay clay is going to have you know some major.

41:17

The event in seven days right right hand we can it really ethically be withheld. I mean it isn’t isn’t the result and I don’t want to go on this trip. I’m just kind of pontificating but isn’t there it’s the result of that AI investment right? It’s a resulting. Hey, this is going to happen.

41:37

So I would think that piece of information is is the property of that company, but at the same time really, you know, are we really going to say unless you Me $100, you can’t get this data point or whatever. I mean that it’s a pretty interesting thing. I think and that’s just a made up example, but I think there’s others too. I mean, I think you’re right. I think they’ll be okay. Well, here’s here’s what we can still keep secret and what we can but what about things like CPT codes, you know, a lot of people forget the AMA owns this that’s proprietary to price and that price pretty that’s pretty key to knowing if that’s like information.

42:15

You can’t not have Have you know the CPT and what is it? What is it nine? Nine, two one three. Well, by the way, it’s an office visit and I probably just broke copyright law just by saying but you know, there’s other examples to of these reference things. There’s I can’t ever remember if it’s red book or orange bar. Whatever Merc one of them if I’m getting it wrong forgive me somebody riding in the comments for the podcast, but you know, one of them doesn’t the how they group The therapeutic classes.

42:47

Proprietary so some of this stuff is not just like nice to know or additional insights, but actually impacts care to know that information.

42:56

I think that will be some of the more challenging things the things that are so clearly have been for so long like cptn am a proprietary information but becomes needed more so in this new interoperable system, I mean if you look great if you want to react as fine, but that was just kind of my thoughts on a couple of Specific examples, I don’t think they really change the the overall sort of gravity of what you’re saying. But I think there will be some specific ones. We’re have to work through before others.

43:28

Yeah, and I think the only thing I would add to that is that you know, the importance of whoever is holding the you know, the responsibility for that or the risk whoever is going to carry the risk for that individual at that point in time. That’s you know, that may be a determining Factor about what information needs to be shared with who when you know, who’s who’s at risk if this event happens, you know who’s at risk for for that payment. You know who’s going to be paying?

43:57

I’m through that that terrible event that we think is going to happen in seven days running who’s paying for it. And and do I share that information with that person because it benefits everybody or you know, not and and what are the incentives to mozzie though? I agree. I mean try that that’s a good a good way to start to kind of pick it apart. You know who’s going to pay for the service? Also whose liability insurance is going to hit exactly.

44:23

Yeah that type of thing so magically we’re still Back to payers, but I guess that’s the way the world Works. Let’s let’s kind of clip through a couple more of these a couple of these questions. So let’s think about a patient perspective, you know part of and I’m I’m sure I am grossly abusing the the recent Rex. I’m not I’m not trying to be the perfect expert on that.

44:49

We’ve got others that are doing that but part of the Part of the I think the vision and the dream and the concept of interoperability from a patient perspective is member clay ought to be able to walk up to anybody in his health care delivery system be that a hospital maybe even as Pharmacy his health plan certainly as PCP and say I want all my clinical information right now. I want all my health care information right now and you know, push the do button give it to me so on so forth, you know, there’s a lot of questions.

45:22

That like how how meaningful is that? What form does it have to come in? You know what like reading level, you know member education all that kind of stuff. But how long do you think it is before were there before Chris patient can walk into wherever and say, you know law says you have to provide this to me easily. I would like it. How long do you think it is till we’re there. Yeah, and I think before I answer the how long question I will throw out there to the other.

45:52

The thing that I’ve been in dialogue with a lot of people in the space about is what happens if people don’t want it, you know, I think there’s a big question out there of you know, we’re doing all of this to try and get to that place where people who want access and get it what percentage of people really want that access what percentage of people really want that information but I think you know going beyond that and answering the question how long I don’t think we’re that far off in some market.

46:21

So there are there are some So this now where you could go into to Health System who has a robust regional health information Hub or has a robust a CEO where you could get that information where wouldn’t be a huge lift for the for them to provide you with a pretty broad spectrum review of all the data that’s available about you and the health information exchange or the Hub or whatever they have.

46:45

We may be close to that in a lot of places but for some not a lot in a few places for someone in any Town USA were quite a bit further away. And and I’d say that the majority of people. I mean, I I always has I’m always hesitant with timelines because it was all of the stuff it’s taken longer than people expected it to and it but it happened and and the like I said, I think the problem has been over promising things when the legislation is passed or when the regulations are put out, you know, we’re going to do this and you’re going to have this and it’s like well, yeah, but not today and not tomorrow and not thing.

47:22

Here you see how it’s going to it’s going to take some time. So I think you know, it’s setting that expectation from the outset of if we passed this regulation and we’re saying this is what we want to achieve but it’s going to take you know, seven to ten years to get there or five to seven years to get there. I think that seven-year time window to me for to get to the Tipping Point is probably realistic. I hope you get there faster.

47:48

I certainly think a lot of places will get there faster, but I think setting or more Realistic expectations about how long some of these things can take to really change systems to really, you know, make things interoperable. That was one of the reasons I love state government was just you know frustration with either the the willingness to or the the ability to or the resources to really share information and Grand and all those roadblocks. You know, I did everything I could do to pull data at a state at an agency law.

48:23

But and then be ready to share information with other agencies and for various reasons that that just doesn’t happen. And so I think even the policy drivers in the financial drivers being there. It’s going to take some time but it’s going to happen and I think that’s the message that we need to keep communicating is we’re putting it out there. It’s going to happen. It’s just going to take some time to get there and people need to be realistic about how long it’s going to take and then I do think it’s worth asking the question what happens when we do get there how many people are really going to want?

48:52

At that information and what are they going to do with it? And how do you put it in a format that really means something, you know, do we come up with and I don’t remember if this came up. I don’t know and see conference or some other discussion that I had with people but I think it was at the at the onc interoperability Forum this year where we talked about the idea of a credit score, you know, do you have something like a health score that that means something to people, you know, like a credit score mean, so instead of just giving them.

49:22

You know information. Is there something you know that that could be, you know a value around, you know, their their data and what is this data actually tell you or is there some you know again a i solution or other you know application or an app on your phone that would tell you more about what that data means than just here’s the raw data of every visit you’ve ever had every medication. You’ve ever been prescribed every lab result. You’ve ever had. You know, what what does that tell?

49:52

Oh the average user. I don’t know I think and I’ve kind of made this point and I’m not sure if I’ve made it in this series or not, but another conversations, I think I think the vast majority of people want care that much until they need it. Right.

50:10

So, I mean there will be some data nerds like me, you know, I walk around with all my the health information on a thing that I’m tracking for lab value or whatever, you know, I just like data but for the most part Most people want won’t care about it or ask for it until they need it and when they need it is going to be when they are, you know, trying to navigate the Healthcare System probably for a sick grout. Like my prediction has been Medicaid members in particular will be the last to really engage with this but what will happen is they’ll be some medically frail kiddo some special needs kid.

50:48

Oh that is really really sick and the Mama’s not Not getting much needs and she’s getting the runaround from different doctors offices and say hello when I will go fax this copy of this or this or pay 17 bucks get our whatever all that stuff and somebody will find out what a man is supposed to be easy, then they’ll be a lawsuit and then you know that type of thing but to I think you make a good point about you know, not everybody’s going to want this anywhere. What do we do when we get there related to that?

51:17

I kind of want to jump to and this we can kind of kind of use this to start to lean the plane but I think there is some person I think there’s some tension between this idea of make the information way easier to get and protect the information under HIPAA. What what are your thoughts is are those two things at odds or not.

51:37

They are they are a night and I throw in the added element coming from a behavioral health perspective of the additional protections that are still in place for substance use data as well as mental Mental Health Data Federal level and state level there are different laws and and the requirements But all under the idea of we need to protect this information, I do think in a lot of ways.

51:57

We need to really rethink, you know HIPAA in in the standpoint from the standpoint of the way people share information today and how much information people share about who they are and what they are and where they live and where they work and all of the things that social media has brought to bear in the internet is brought to bear where we share a lot more about ourselves now and whether we need to rethink HIPAA Sure, that that rubric of the people just don’t protect their information like like they might have and I do think there’s value in protecting us. There’s value in looking at you know, how information is shared and making sure that we’re doing it in a secure way but protecting information from the people who are responsible for providing care.

52:45

I don’t think that was ever the purpose of hip of there’s always been provision for care coordination and and other languages HIPAA that allows for people to share information. So from an interoperability standpoint, I don’t think Hitler should be restrictive and we should make sure that there’s lays that that is that it’s clear that it’s not restrictive in terms of how the the delivery of care is done.

53:09

I do think there needs to be protection for research there needs to be protection, you know, and how information is used and shared with anybody outside of the Care delivery system and and you know penalties for people who do That but whether you know, we open some things up till allow for better interoperability within the care delivery system. And those who are responsible for paying for her care is another question. So I think the bigger challenge is the you know, the additional protections around Behavioral Health and how we break some of those things down so that you’re getting the complete picture but the desire there’s definitely a tension there.

53:47

There’s the desire to share and the desire to free up patient information and make sure that their delivery system has access make sure the patient themselves has access the den locking everybody else. It’s like that’s that is attention. That’s a hard thing to accomplish but I do think that’s that’s the goal. I think the goal is to make sure that the patient and their and their authorized caregivers have access to the information and that the care delivery system has access to the information but that is protected from any one who shouldn’t have access to it outside of those those Catholic.

54:21

Thank you a great great. Great discussion great insights anything you feel like we haven’t covered that you would like to make sure we get out there for the audience now. I think we’re I think we covered the landscape pretty well. Excellent. Thank you very much. That’s Chris villemarette everyone and we look forward to kidding comments and thoughts back from this episode of the of the series. That’s it for this episode in our series on interoperability.

54:49

Be in Health Care. Thank you for listening. Don’t forget to check out more of our great content at mostly Medicaid.com including the issue brief and other interviews in our critical Medicaid conversation series, and don’t forget to visit enter systems.com to learn more about our sponsor until next time.

​