This Week Health

March 3: Today on Townhall, Brett Oliver, Family physician and Chief Medical Information Officer at Baptist Health interviews Andy Truscott, Global Health Technology Lead for Accenture. Health Level Seven or HL7 refers to a set of international standards for transfer of clinical and administrative data between software applications used by various healthcare providers. What is top of mind for HL7 and how does it relate to the frontline clinicians and organizations taking care of patients? How does it relate to interoperability, cybersecurity and 21st Century Cures? What 2022 trends are we seeing in the healthcare IT space? 


Today on This Week Health.

Just because I've addressed COVID and done a reasonable job of it does not mean I've fixed interoperability. When we talk about this, I try to boil it down to three core principles. That of access, that of experience and that of outcomes. And infusing across that is good, solid, robust information that's available at the point of care for aggregate analytics, et cetera. And to improve how patients are treated and how they understand and make choices around that treatment.

Welcome to This Week Health Community. This is TownHall a show hosted by leaders on the front lines with ???? interviews of people making things happen in healthcare with technology. My name is Bill Russell, the creator of This Week Health, a set of channels designed to amplify great thinking to propel healthcare forward. We want to thank our show sponsors Olive, Rubrik, Trellix, Hillrom, Medigate and F5 in partnership with Sirius Healthcare for investing in our mission to develop the next generation of health leaders. Now onto our ???? show.

Welcome everyone. My name is Brett Oliver and I am a family physician and the chief medical information officer for Baptist health in Kentucky and Southern Indiana. And I'm happy and honored to be part of This Week in Health IT and the new show TownHall as one of the moderators. I'm really looking forward to hopefully amplifying some of the conversations in our community with some very bright and insightful.

And to that end, I am tickled to death to have as my first guest Andy Truscott. Andy is a global health care leader for Accenture and has a broad experience in that role. And I knew we'd have a great conversation. And so Andy just finished his second term on the federal health IT advisory committee, where I first met him and served as the co-chair for the information blocking task force. Andy is also the board chair for HL7. Andy great to have you on the show.

Thank you mate. Great to be with you today.

what trends are you seeing in:

Thanks. Brett. It's a great question. And it's one that there is no simple, straightforward answer. But I think the pandemic came at a time where healthcare was changing. There was a great understanding that health organizations were needing to create unparalleled human experiences that had easy equitable access and superior outcomes for their patients, that what the one hearts and minds of humans and, and build trust. And that was just kind of getting into full flow. When we had the, what we now call the pandemic. Capital T. Capital P, but it was cologne. And an emergence of something which had been predicted by some people previously that pandemics will come and will go.

But it was one that I think took the world by surprise with the speed and the severity. And we saw the world react in ways that we, none of us have seen, or very few of us have seen in our lifetimes. And with that now became a cessation. We stopped dead in our tracks from a lot of the things we were working on.

So organizations were working through how to create better human experiences in the United States. We were using pieces of legislation like the 21st century cures to drive that level of access to information and standardization of information to enable better experiences for patients. And that kind of all of a sudden was like we have to go and at COVID. And we have to enable both the delivery of care for non COVID activities to continue where it's essential. But also to that delivery of care where possible to take place in you know more virtual channels. So we saw a shift from how to create better experiences to a, how do I use technology to have an experience and how can I manage to keep engaging with my patients?

How can I keep providing them good quality care? Meanwhile, I've got a whole slew of patients appearing who have got this thing, which we don't really know that much about. And, and very, very quickly we all became armchair epidemiologists. But the the information about what this thing was, was still very indeterminate in places. And there was lots and lots of proper learning individuals with apparently conflicting advice and guidance, et cetera. And, and that caused confusion. And I think underlying a lot of what we saw through the pandemic was a realization that whilst we had previously been talking about unparalleled human experiences and creating great stuff for our patients, we realize that actually there's a backbone of information, and information and communication, which just wasn't quite there. And we've seen that globally with the ability to both detect and report COVID, let's quote unquote outbreaks, as different variants are taken hold, there's always that lag of data. And then when you do have a data, what does it really mean?

And those kinds of surveillance networks, which we'd all assumed were in place. And they were in place and are in place for communicable disease where, you know, smaller scales, as soon as you've got something like Corona virius COVID-19 came along. They were really put to a test and I think we found them wanting in many places.

And there's that recognition and realization over the last few months, right on this day that we need to be investing in mitigating, which brings us very neatly back to kike Like I said the 21st century cures and the things we were doing in the US the things that within HL7, we've been doing globally around data standardization and fast healthcare interoperable resources, FHIR.

That actually wasn't saying, this is going to be a great thing to take this wonderful new stuff for patients is actually, we just need to fix some of the stuff we thought was fixed already.

ocused on COVID back in early:

As the organizations you worked with are going back through this queue that had built up on regular projects. Are those looked at differently now? Do you see that? Is it a different filter? Like making sure this backbone of information that maybe we assumed was there and wasn't, is that part of now a standardized process as you're going through to make sure that that happens or are you seeing ooof okay, now let's move on and go back. And it doesn't, we're not even considering what we just went through.

It's varied. It really is varied. Some organizations absolutely get it. They're like, okay. We know those gaps here. Let's go and work it out. Some organizations are more of the we've done the COVID now, that's just business as usual.

Not every organization is the same. So it's difficult to put like a brush plus everything. I, I think reality is that we, we, as a society were found lacking and we were found with gaps and we do need to throw them. And actually we will do a better job of providing patient care in the future if we do take a deep breath and refuel.

That's fair. That's fair. So I would see that as a threat to an organization that does not learn from that the ones that want to paint in broad strokes, they didn't learn anything. They see COVID as just an outbreak that we're done with. We didn't learn from. That's obviously a threat to that organization moving forward because the information sharing that you're going to need for any, anything else is going to be imperative. What other threats do you see out there in the health IT space for organizations, if they're not looking at? I would think obvious ones would be maybe cybersecurity, but are there some other pieces out there maybe in broad categories that you see as threats?

Well, let's just, this is, rewind back to the COVID statements just because I've addressed COVID and done a reasonable job of it does not mean I've fixed interoperability and information. The two are not the same thing. They have implications upon each other. There's are some level of symbiosis between them, but they're not the same thing. And organizations, when we talk about this, I try to boil it down to three core principles. That of access, that of experience and that of outcomes. And infusing across that is good, solid, robust information that's available at the point of care for aggregate analytics, et cetera. And to improve how patients are, are ,treated and how they understand and make choices around that treatment.

And, and when we're talking about like I said before at the beginning, of the pandemic where organizations were skating towards this unparalleled human experience. Okay. That's all around access experience and outcomes. And equitability, et cetera. And we saw manifestations of this through the pandemic.

So that sort of, that stuff is still pretty broken. And needs to be addressed and we've, might've addressed it for COVID-19, but there's a whole world of access, experience and outcomes and needs doing this way wider than that. You mentioned cybersecurity. Yeah cybersecurity is top of mind for pretty much every C-suite that I know. Both in the US and globally. But they've asked some particular nuances of concern inside that.

So ransomware is something which every now and then we see hitting the media headlines. But the reality is that ransomware happens far more than any of us care to admit happens. Most organizations don't want to publicize it for obvious reasons, but ransomware does happen. And the purpose of ransomware is that of disruption. It's not an attack. So you know, many of the traditional tenants around why cybersecurity issues, you know, access to information, withholding information, et cetera. But those are slightly to one side. Ransomware is all about disruption. And our we've invested massively and we're in approaches to actually combat ransomware and work all the main electronic health records providers have pretty good strong solutions in this regard.

But there's always something, and there is always a weak spot inside any one sort of posture. So ransomware, I see as a, as a very big issue. And that so as a subset of cybersecurity, something which you know, to, to marry together interopability and cybersecurity with the internal hoodie mandates here in the US through 21st century cures and similar expectations globally, they need to actually understand the patient's desires.

Now they may have expressed those consents, but they may express them as wishes. We have, we talk about consent in a very structured way with consent for particular purposes. Sometimes it's simply a patient saying I want these people to see, might be able to see my information if they provided me care, but not that or that group, but not this group. Or everybody could see my information. And if they're providing me care. Or if you're not providing the care, it has to be for research and it has to be pseudonymized or something like that. And that's where it touches upon cyber security and access control. And I think there isa need and I see this in pockets already, but there is a need for a broader understanding and sharing of what an individual's small C consents are.

And that's a gap because as organizations we'd go and collect this stuff routinely, we understand what patients capitalistic consented to. We understand generally what a patient wishes and we have a policy that tells a patient what they want. Now, with giving the ability to share information about our patient's care clinical and financial broadly with the patients instructions for want of a better term around what's going to happen to that information and given the patients that power.

We kind of need to record that. And what better way of giving patients more consistent experience for care and receiving care is actually by routinely sharing those decisions by our patient. So we're not constantly asking patients for the same information. And that just seems to make sense.

Yeah, we're not, I don't feel like we're close to that granularity to your point. It's either yes or no. Everybody or nobody. And then when you throw in and say know, a behavioral health note or something, that's got legislation around it that just throws the whole results routing scheme into, into a tizzy.

Those decisions we made about what takes primacy there. Those decisions are going to be made by policy masters. But for 99% of the population, it should be very straight forward. There's always going to be exceptions you're right. And very important exceptions that we need to be cognizant of. But the generally for the jobs of the population is actually, this is what I want. Tell everybody who might be involved in my care. That's what.

Yeah. Makes sense. Well, maybe, maybe in a parallel to that as board chair of HL7, I'd like to get your take on something. Until I got into health IT, I had heard of HL7. I knew it had something to do with interfaces and still probably are pretty naive in all of the things that you guys are involved with, but I would love to understand for HL7 what's top of mind. And how does it relate to the, the frontline clinician or the frontline organization taking care of patients?

Sure. So yeah, to many people, HL7 is this kind of slightly esoteric organization that's very, very technical. And it's history that's been defining and constructing the lifeblood standards for health IT systems to communicate with each other. And it's mission is fundamentally focused upon improving patient care and improving patient outcomes globally. I think what people, some people realize many people don't is that if you're working in a hospital or employment clinic or any kind of technical setting, anywhere in the world, it's highly likely that the systems you use use HL7. Okay. So when you send a lab order off to be fulfilled, okay, that's going to be HL7 that communicates between, your computer pretty much physician order system on your EMR through to the ramp system. And then when it gets processed and the result comes back, that's going to be HL7 with that result as well. You send the prescription off to be filled. That's going to be an HL7 as well .And other standards, but HL7 is normally there as well. When you have an exam and you've got a image in front of you as a DICOM format, which is the image and an HL7 report.

So, and that's the structure of it. So, HL7 infuses everything we do, in every clinical system. So, but many clinicians don't realize that. Should clinicians realize that? Actually, I don't think that. I think understanding there is this standardization is good to know because it means you can trust the systems.

Physicians don't need necessarily to understand the details. There are some things such as yourself who really fully understand these things and understand how important they are and how it is important to have clinicians involved as you're defining those standards. So standards meet the clinical need.

And over time, HL7 has advanced those standards. So there's different versus standards over time. Version two, version three, CDA. And now we have this thing called FHIR, which fire has captured the imagination globally because it's much more accessible as a standard than some of the earlier ones were, which did require a certain level of physical understanding to to work with them.

And so FHIR really has, as I said, caught imagination and for clinicians. I think what we get with a FHIR is an understanding that we can trust the data that's presented to us by our systems. And with FHIR we actually can also communicate the providence of that data where it's come from so that you can actually make an informed decision.

Nothing is trying to stop clinicians from making the best possible decision at the point in time that they got a patient in front of them. Whether they're physically in front of them or whether they're virtually in front of them, based upon the information you have. And you're always going to treat upon presenting symptoms, but having full of information where you can have it understanding the context information, it is frightfully important. And can talk about much more than I can. And the HL7 standards allowance do that. Now recently, and I publicly stood up at the HL HL7 work group meeting late last month and said, this, my entire focus as the chair is a modernization of HL7. So preserving all the great stuff that we do, but also making sure that we lean in on the implementation of those standards. So it's far more than just defining these standards. It's actually making sure that they can be realistically implemented and supporting vendors, clinical organizations in those implementations. And we've actually created an entire implementation division within HL7 and to help with that and to drive that. So HL7 is about standards and the implementation of those standards.

That's fantastic. It really brought another question to mind because you're right. That the implementation of these things, it can't be, if there's an AI algorithm that uses an HL7 interface that I want to use, for me in my organization, it's likely a six month project at minimum. If it's a new vendor, all in all the different processes you go through. Are you seeing whether from your HL7 viewpoint or just from Accenture and all the different organizations you've come in contact with, more of a greater looking for a platform approach for this? Where you can do a little bit more plug and play for an overused phrase. But where I can, if someone comes to me with a new algorithm and says, Brett, I think this could really help in the care of your pneumonia patients or your diabetic patients.

The amount of due diligence I have to do because of the investment of time and resources to get that live in our system and using the patients is tremendous. There has to be a way that we can, I don't even know what the correct term is platformatied. I just made one up right there where I can have a platform that I've already vetted.

I vet once. I vet annually, whatever it might be, I'm connected there and I can plug Andy's new diabetic algorithm in there. Try it out for three months. See where my patients land and if the data holds true for them. It helps with some of this equity and some of the, the fact that a lot of our data pools come from the coast in the United States and not where I practice and things like that. I'm just curious to your thoughts on just sort of this platform approach. And if, if you, if there's other solutions to that from a technical perspective to get around it?

Somebody knowing the argument between, is it AI or is it complex processing.

Fair enough. That's fair. Yeah.

So I, I kind of ask you the question. What would you trust?

I would trust something that I could try. Let's say it's with it let's say Andy Truscott's got a brand new platform. Your company. And I connected to that. I've vetted it. My relationship is with you and your company. That's where the trust comes in. And then you have a basic level of vetting that you do with any company that comes with their machine learning, what algorithm, their AI, whatever it might be.

And I still want to do my own vetting, but from a technical perspective, I don't have a new project. You do. You figured that out. And so my vetting from a clinical perspective can actually be done, whether it's in the background or alive in production with my own patients. Does that make sense?

Oh, I understand what you're saying, but why would you, why would you want to vet something with production patients when you're trying to provide them the best care you can? This is still untrusted. You haven't proven it yet.

Yeah. I guess what I'm saying, I would run it on production patients, but in the background, it wouldn't be.

Enough time to run things in parallel.

Correct. It's certainly better than doing a six to nine month project only to find out this isn't this isn't working. I would like to have three months where I could easily connect there really wasn't a much of an IT project. Determine that yeah, this is great, or this is not great because it's with my own data. Does that make sense?

I understand that point. The major question in my mind is actually providers who are able to run these things in parallel. Okay. Because there is a time overhead from doing it. And that always causes me concern because we don't providers have more than nothing to do that day without experimenting with the stuff that like. Something, something we're doing, we are doing right now is we're one of the platforms we have inside Accenture, our health and human insights indicators and models we actually embedded inside it. So when you're cutting and slicing patient data, it shows you a diabetes score. And a diabetes risk score, right. Whether or not your ask is just sitting there in the corner and you can choose to pay attention just like you would any other clincial decision support. And I think that's probably the good approach for getting adoption of some of these new quote unquote AI type algorithms is actually there are existing clinical decision support channels out there.

Okay. There are existing ways by which we can display risk information around patients for on whatever dimension. I don't know. And we are trying to develop new ones as well around, especially things like social determinants of health, but also around other clinical risk, et cetera, as new models come out.

So augmenting that, but making it more accessible and there's some great examples around the world in that kind of risk data is made more accessible. If it's going to look at say Norway. So normally Norway actually use and I call it a rose, but it's a, it's a idiogram that I'm based around the EMR symbol. And each leg of the symbol actually means something different and Norwegian clinicians are literally from the first day they walk into medical school are trained with this. If it's on paper is printed in the top right hand corner of the medical record and their systems reflect that too. So it's a, idiogram is the right term. It's that interesting diagram that you just instinctively know what the arms mean and when they're a certain color or shading or, or hatching this is an indicator that you can then go and drill into. I think it's fine to reduce the level of overhead upon clinical practice of adopting these things. And if a clinician wants to ignore it, they can ignore it.

Has to be in the, in the existing workflow, or you have to show them a workflow that's then more efficient in the end. When I talked to start up companies that want me to go just one click over to our dashboard might be a lost me. You lost me, that's it. Nope, not. It does. It sounds like a very simple thing until you actually are on the other end doing it.

Actually with another one of your podcasts you should go and hook up with a Norwegian and actually get them to talk you through this because I think.

Yeah if you've got a connection. I'd love to learn about it. That's that's fascinating doing. I'd like to switch gears. Just last question. We're running out of time, but because of your role. I'm curious from a leadership perspective, I kind of want to understand sort of a leadership question. What are the challenges and do you have any tips or strategies in building a team in this new hybrid or maybe totally virtual for some of your team members world? Because I think you've been living in that much longer than a lot of us, just with your travel and all that kind of stuff that you have to do. Any, any thoughts on that around?

Yeah, it's been, it's been curious for sure. The nature of my day has shifted fundamentally because and I speak, I think similar to many, many people in a similar situation may as consultants who get to engage with one or many clients that my days have shifted from being set hours spent engaging with a client in particular context to actually a series of small vignettes and snapshots throughout my day. And typically it would not be uncommon for me to have 16 30 minute meetings in the space of eight hours. Incredible. And it's a very different style of working. And in some respects it's much more akin to clinical practice where you're seeing snapshots of patient as being available there.

So I actually wonder when there's something to learn that I could do learning from yourself. But something I picked up is that I'm being very, very clear that as you start and engage with what your expectations are by the end of that engagement. So, and I've found as we all know that that's good practice to to start a meeting saying, this is what I'm going to get out from it.

And, and you did at the beginning of this session. the Talk to Andy and this is the kind of stuff I want to talk about. We don't do it routinely in our own meetings. And, and I actually wonder when, when a patient comes in and out, and it's part of a long series of treatments where they're with the patient, do you know what that outcome's going to be?

I definitely go into the exam room with a concept. Now it can get blown up pretty quickly, but yeah, exactly. I need to make sure they understand these three things. I've already looked at some lab work, perhaps it's been done before and I want to change. So, yeah, there, I turned it pre charting whether it's actually actually getting stuff into the chart, but I'm reviewing things and kind of in my head. Yeah, you're right. Or else it's it terrible. The only time it really verbalizes when I would have a patient with a list as long as my arm. And I'm like, wow we, we only have 15 minutes. What are the two most important things? And really that's what we need to focus on. You're right. We don't, do that with meetings.

Well, you should. I very consciously started doing that. I might be not verbalize it, but I'm actually really clear. This is what I want out of this meeting. But I am very clear and I do verbalize in the closing throes of a meeting. THis is where we've got to, these are the results coming out of this meeting. This is how we're going to measure that we're being successful and these are the next steps. And I think it's too easy for engagements to come to let's to finish. Okay. Every engagement needs to have a closing point. So you understand that actually, that this is, this is where it goes now. And if, and be very deliberate, if this is we're not going to meet again on this subject, we're done.

We've worked it out. Let's just say that and vocalize it. And then expectations when understood. In a virtual world, it's a lot, lot trickier to pick up the nonverbal cues that we used to pick up routinely inside meeting rooms. Now, how many times have you sat there in a meeting and you felt someone's different, two people down that there's a sense of something, or you can see some of that twinkle in their eye when you're in this flat screen.

You don't see that. So I I've learned, and I've certainly seen my colleagues learn to be much more vocal and to actually just check and seek, to confirm and be very deliberate. So, and I think that's a kind of a lesson for all of us, because I think everybody knew about teleconferencing. And then most people did phone conferences. Across any walk of life before the pandemic, but things shifted. I started talking to my parents through a FaceTime session. I started talking to my colleagues all the time to a team Chechen. And the other thing, and this is probably a personal belief is if you have the opportunity to see somebody. Do it.

Because it's good for the engagement and it's certainly good for the person because we, as a species, we are a social species. Yeah. How many tales have we heard about people over the last two and a half years becoming increasingly isolated about people who just felt caught up in their own home. Can't leave. There's lockdowns going on, or they're scared to leave and have felt increasingly isolated. And we should not be allowing that to happen. We have the tools to stop that from happening. So when you're doing a virtual session, turn your camera. Show that we can be truly human.

I agree. The intentionality that you bring out is this so important. It's challenging. It's easy to sit back on a Zoom call with 25 other people that you're don't have anything to present and zone out, try to multitask which doesn't work. And then, then those cues, those subtle cues that maybe you can pick up in two dimensions while forget that you know, that those are out out the window. So I appreciate that.

And on that point. If your camera's not turned on and you're on mute, why you there? If you're just there to listen, then start off easy by saying, Hey, I'm just here to listen. I ran, the cameras turned off. I'm not interfering. I'm going to mute, but I am listening Otherwise, are you engaged or are you not engaged?

That's a great point. Sometimes. I don't know why someone's on a meeting. Their camera's not on, they don't contribute verbally, at least. What are you just feel obligated or no, I wanted to listen because I want these three points. I want to make sure you get those three points then. If that's why you're there to listen. Right. Okay. Andy this is awesome. I appreciate it.

No problems. Good to see you.

Thanks, Andy. I appreciate it very much. Take ???? care.

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