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Democrats and Republicans from three administrations spanning decades delivered a HIMSS keynote discussion where they declared bipartisan agreement on consumer centric interoperability. Aneesh Chopra helps us explore what this means for Health IT.

Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 Welcome to this week in Health it where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is Bill Russell recovering healthcare, c i o, and creator of this week in Health. It a set of podcasts and videos dedicated to training the next generation of health IT leaders.

This podcast is brought to you by Health Lyrics, helping you build agile, efficient, and effective health. It. Let's talk visit health lyrics.com to schedule your free consultation. We are recording a series of discussions with industry influencers at the Chime Hymns 2019 conference. Here's another of these great conversations.

Hope you enjoy. Here we are again from the HIMSS floor. We have Anise Chopra here. Nice. Always a pleasure, bill. Thank you. I see you're, uh, partaking from the, uh, various booth that are out here. That's right. It's the benefit of himss. It is amazing. So, uh, hey, great keynote. Thank was, that was, uh, that was phenomenal.

Thank you. Um, three administrations. Yeah. Democrat, Republican, um, what, multiple decades. It's, it's, it's unbelievable how long, and, and we've been talking about this for a while. Yeah. So a lot of big things happening in interoperability. That's right. Why don't you give us a rundown of just some of the things you guys talked about.

Out on, uh, on the keynote and, and go from there. So there, there are really three things that Captain, that I think are gonna make. I, I don't wanna say that this is the year that we see material progress. 'cause it may feel a little bit like, well, everyone says that, right? I genuinely believe it. Three things we spoke of.

One, the new default and interoperability is that the patient and the apps that they choose will be the destination for health information in a standardized format. So patient-centric interoperability. That's right. That, that, that was the default and that came through not just in . Spiritual language, like aspirationally, we should do this.

It even came out of economics. Uh, the rules now say any consumer app, uh, with the, uh, consumers, uh, opt in will have free access to the data. No fees, no burden, no special effort. So that was point number one. Consumer at the center. Point number two, and this is interesting, the decades we've been at this have been about EHRs, doctors, hospitals.

We've now introduced regulation on the health plans, right? That's a pretty bold statement. And now we're gonna have standardized claims data to combine with standardized clinical data. And I think it creates the momentum that basically says we're gonna be unfettered in, uh, moving all of healthcare data towards a common language that's available to consumers via open APIs.

And that will cover social determinants of health. It'll cover prescription data, pricing data, quality data, a whole range of topics. That's 0.2. And then last but not least, and this is the interesting one, and I'm gonna float this idea with . You bill and you're gonna react way or the other. I think we're entering into a net neutrality era for healthcare data business models.

And so what that means is, uh, that the rules, information blocking rules allow that if you're holding data and you have to invest in a p i technology in order to release the data, you can recoup those costs by charging fees to the applications at which to connect, not the consumer's fees, uh, apps, but the uh, uh, physician's, apps and other apps.

But those fees have to be tied, . Tied to the marginal cost of the program. And that also means that you are allowed to provide value added services, but they have to be non-discriminatory and they're likely to be competitive. So you can't have the fact that you're in possession of the data to be the sole source of said value added service, a prediction model, a service here, there or the other, but rather others should be able to compete to deliver that last mile to doctors, to insurance companies, to anybody else.

That's a powerful concept 'cause it puts in place a . Nice rule of the road for what's been a gray area about economics as we move to an a p I based, uh, uh, interoperability marketplace. Alright, so I'm gonna, some of what you say is policy speak. Yes, it is. So the first two is very easy. The third. The third one.

Complicated. Alright, so again, we're gonna be talking to IT organizations predominantly on this podcast. Yep. So, um, let's assume I have an innovation arm. Yes. We're gonna develop an application. The application is, uh, I'm gonna use blue button 2.0. I'm gonna get that data. I'm gonna get the data from the health plan.

I'm. Data from the health system. That's right. And I'm now gonna have a consumer based application. Yes. That they put all that data in there and it's gonna identify where they can go for durable goods, where they can go for Awesome. You know, it's, it's almost like a, uh, like an Uber for Care navigation.

That's right. Alright. So we just drop that up. They get the easy pass where they can connect to all those source systems at no marginal cost. Right. But who, who do I have to pay? So one of the, nobody, nobody, nobody on the consumer side. So you talk about an incremental cost and an incremental value . I, I heard cost.

Yeah. So here we go. So, if you're the supplier of the data, if you're the health system and you've just made this investment to upgrade to stage three meaningful use, what we used to call meaningful use, promoting interoperability, and you have this, uh, a p i gateway where consumers can connect apps, you've gotta find a way to incorporate that cost into your delivery model.

Right? However, if an application developer wants to connect to an insur, an insurance company wants to grab information on behalf of the whole population. Or maybe a, a value added service that wants to sell into the organization that wants to maybe offer a prediction model or some other value added service.

Those applications may pay either the hospital or the e H R vendor a reasonable fee to access the data to perform their service, right? That is what's regulated. I call that net neutrality because there is a cost of running multiple applications in the enterprise, and if it's tapping into the data, Database that's been built, uh, for, uh, meaningful use or for the consumer use case, that extra cost of managing it will have to be recouped somewhere.

No one's gonna just say, this is all un unfettered access. Now the question is, can I charge one price for Bill 'cause you're my buddy and another price to Susie who's a competitor and may do things that I don't really believe should be done or is gonna undercut me for my service. I see. I cannot discriminate on the fees

That we charge to recoup the costs and nor can I discriminate on what the value added services I have to be able to compete in an open marketplace. So even if I'm not in the innovation arm of said health system, correct. I can just develop you and I could go off, develop this app and then go, Hey, we're tapping into your data.

That's right. And the beauty of it is there's no BAAs, no business associate agreements, no data use agreements, right? 'cause it's going to the individual, the consumer has the right to pull the data out of a HIPAA covered entity or a hospital or a doctor's office and move it to . An application that they trust to use in whatever manner they wish.

What about between me? So I'm, I'm developing it. Yeah. And the health system is doesn't the health system? Nope. They're not required to make sure that I'm gonna protect the data. So if I am no responsible for making sure I protect the data, and in fact, you're onto an important subject, which is how are we gonna regulate all of these applications that Bill's making in a garage, or Suzy's making a startup in Silicon Valley.

And the answer is, right now they're unregulated apps. But we are working through the . That I have the opportunity to serve as co-chair of, to work with other stakeholders in the industry on making sure we have a code of conduct so that these applications behave in a certain manner and that they communicate to patients are gonna behave in a certain manner, and if they lie or mislead their customer, they're gonna be regulated by the Federal Trade Commission.

So will there be a certification process for these? We have to see that happen. We are waiting to see what the right model is. One short term example would be we announced a collaboration with, uh, . Uh, smart, uh, platforms.org or the Ken Mando and Zhan team at Harvard where they already have an app gallery, the smart app gallery.

There might be a badge that says, I endorsed the code of conduct, and that may be a way of communicating that they're gonna honor this. And if they lie, then that could be the basis of a So you kept talking about a Roku box? I did. Is that like just a fire server? Is that essentially what you're talking about?

Yes. What I'm describing here is that, uh, there will be a set top box at every doctor's office in every hospital, and the person that logs into that set top box is a consumer. Tumor with an app in her hands. And so now the question is today, what channels can she subscribe to? Right? And I was jokingly referring that the common clinical data set, I referenced it to be the P B Ss without doubt, Abbey.

Right? And the comment there was that it's okay and it's useful, but if you're trying to understand the clinical progression of my cancer, right, you might wanna have access to the underlying notes. We need a need more, a lot more clinical data. Right? So now the question is how quickly can we add channels to said Roku Box?

Yep. And I believe we will be adding channels at the pace of industry consensus. They may be outside of the E H R consensus process. It may be the cloud vendors in agree to things. It may be, uh, specialty areas like imaging and others. But the pace of consensus is what will drive the provision of those, uh, uh, standards based open channels.

So I'm gonna bring you back Yeah. Because again, Roku box, so I'm, I'm talking, we're talking to a lot of people who are gonna have to implement this. Yes, they are. And we say, okay, it's fire. Yes it is. But, uh, when you describe a Roku box, it sounds like, oh, it's Apple tv. You just plug it in. All of a sudden it's pulling the data from all scripts Yes.

And making it available. Yes. But they probably have some work to do. It's not, well, you're onto an important subject, and this is where the question between e h r vendors and third party Rokus come into play. That's why I refer to it not as Apple TV or Amazon Prime, which are tethered to things that are, you know, fully integrated packages.

But Roku, which is an open platform, the issue for me right now is, uh, every hospital that goes live on the 20. 15 edition of their certified E H R. They are going to get combined the heavy lifting that their vendor had done to convert whatever the proprietary data model was inside their organization, into the fire data model, which is open, and then through a gateway to connect to apps that register and are securely managed.

Now you can have your E H R vendor own that entire stack from the set top box all the way to the convert. Earning of the data to create the channel. And a lot of CIOs will, I think that's the default. But there should be enough competitive pressure that if that does not behave the way they wish, or if they would like to move faster or they would like to have some other role to play, that there may be an opportunity to substitute kind of gelb, jailbreak your, uh, Roku so that you could have your own version that sits, uh, on top of what all that heavy work was done.

So if I've converted the data to the fire data model that . The heavy lifting that you're getting from the E H R vendor now, how you manage access to it, that's a p i management. Now, am I not gonna get ahead of the, the standard if I do it, you are onto something really important. Here's the gap today, right now.

There is a draft specification. It's essentially final for a fire based scheduling resource. Right? But you're gonna do this in all these areas. Well, let's start with scheduling. Okay. It's live. How many hospitals are in production on the fire based scheduling module? It's, that was published a year ago. I wouldn't imagine that matter.

Well, now how many hospitals pay a third party vendor X hundred dollars a month to allow online scheduling on top of their systems? Majority. And how many of those CIOs knew ? That they could have asked their vendor for the fire scheduling option, right? Potentially lowering the cost of integration. Maybe they did know or they didn't care.

Maybe they didn't really see the value and they were happy to pay the price. So this is the conversation. This, this is great. 'cause this is like the conversation we had over drinks. Yes, it is. It's uh, these, these CIOs are so busy. I know. You know, they come to this conference and they, they hear some, somebody from Exponential medicine talk about AI and they're like, oh crap, there's something else I have to get in front of and I've gotta do fire and I've gotta do, I've gotta do all these things.

So what if this wasn't the, CIO's job. Alright, well, and we're seeing that, right? We're seeing the c I O become, uh, CIO's, chief Digital Officer and Chief Innovation Officer. We're seeing it break out. You hit the nail right on the head. If I'm the c e o of a health system and I say, okay, I have to negotiate a value-based care contract.

I gotta extend my clinically integrated network. I wanna do a better job of engaging my patients. I have all these goals and aspirations for my organization and they're all on top of technology. and they are built on the assumption that I can move the data to where it's needed to do a job. Yeah. If I'm told by my IT department that you can't, you have to wait, you gotta pay extra, I will fail.

Right? And so CEOs are asking the question, am I getting the advice that I need to maximize the value of all this infrastructure? And I would argue there's more to be done. Right. And this is great conversation. All right. So, so Governor Levitt, last thing. Yes sir. Call to action. Yes. Uh, and I thought it

This great call to action of Alright. Policy's in place. Yes it is. The floor is set. Floor is set. Let's raise the roof. But we've set floors before and people didn't go to it. That's right. So what's it gonna take for that call to action to really take roof? Well, to me, I think there's now a new sense of urgency and new business models, new actors on the stage and new infrastructure.

So the marginal cost of adding a channel on the Roku box will be a heck of a lot lower now than if we tried to add the channel, uh, a year, two, three years ago. And that lower . Of costs, emergence of new business models, they're all converging at this time to say, let's move faster. So you're saying the field is set?

Yes, it's ground is fertile. And with yesterday's rules or the rules that we announced this week, we have a much clear perspective about where we're going. We're not having a debate about is it this format or that format. And that's, and that's great. We are going because we work, we used to be. So thank you, sir.

Thank you as always. Pleasure. Hey. I hope you enjoyed this conversation. This show is a production of this week in Health It. For more great content, you can check out our website at www.thisweekinhealthit.comortheyoutubechannelatthisweekinhealthit.com/video. Thanks for listening. That's all for now.

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