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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 covering 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 HIMSS 2019 conference. Here's another of these great conversations.

Hope you enjoy. All right, here we are from the, uh, hams floor and, uh, go, go ahead and introduce yourself. Hi, am I'm Ksi. I'm the founder, chief Medical Officer and Chief Technology Officer at hie. So I love grabbing chief technology officers 'cause we can get down into the, uh, technology. But before we do that, tell us a little bit about what, uh, HIE does.

So HIE is a population health enablement company. Uh, we basically enable population health and the way we do it is through our devices. Um, in, in the community. We have about 10,000 of these devices in the retail pharmacy. . C community centers, homeless shelters, churches, and different other locations that our customers would want them in.

And we basically enable consumers to interact with the data, with this, collect structured data through measurements as well as patient reported outcomes, and then feed into analytics platforms, EHRs, and other, uh, you know, clinical workflow applications that as needed. We also provide software solutions to activate patients on the kiosk as well as do gaps in care closures, uh, for our population that are at risk focusing on, uh, Medicaid.

Medicare Advantage, uninsured populations. So you, so we can actually talk about two different topics, can talk about interoperability. 'cause somehow you're getting all that data, which is phenomenal. And then the second is we can talk about the consumerization of healthcare. Absolutely. And getting it out there.

So let's, let's start with the, the data silos, uh, to start with. So, uh, you've been a big part of the interoperability showcase here that the rule just dropped. I'm sure you read all 300 or whatever pages of it. Absolutely. Absolutely. Um, so, uh, what, what is the state of. Interoperability right now. I mean, what are we looking at is, you know, do you guys use fire?

Are you bringing in, I, I mean, what, what does it look like? So we've, we've been proponent, our patient owns the data and we are custodian of the data and we allow them to move data wherever they need to move with patient consent, right? That's our philosophy from day one. We've done that from, you know, we've been, we've had open a p i available for five years plus years through our, uh, through our HAE platform, uh, as well as now as fires come out providing the identifier resource format also.

So there . Multiple levels of, you know how I think about interoperability? There's what I call the envelope of how you wrap a content around, and then I call the letter or the content inside that envelope. So everybody's come to this, uh, web services based standards to how you move the data around, right?

So the plumbing plumbing's in place, plumbing is in place. And we've been using that, you know, that's robust and having fun, but still, what are we moving through those points? What is moving through the pipeline? Is what, what, uh, what now all the discussions that are happening. So, um, so I think, I think that is, uh,

What needs to be figured out. I have a philosophy that, that you need to identify the use cases on what those needs to be and how people actually implement that. It's fine, uh, because if you look at how web standards are one or done, people have not created structure of the content inside web services, but more on how the protocol is and keeping the data in a structured format.

So define the structured format, not the template on how the format should be added. And that's how kind of we've focused on, uh, from our side of things. So like what data do you have access to in your Sure. So, so obviously we collect data, uh, through measurements of devices, the blood pressure weight, b m i, body composition data from our devices.

Uh, we also collect patient reported outcomes, but through validated tools as surveys on the device. Plus, we connect to 80 plus variables, home monitoring devices to bring data into clinical workflows. And then through patient consent, we also for pharmacy data to select partners who, who work with us, who need that data into that, uh, into that, uh, patient record and then push back into clinical workflows as needed.

So, um, . So a health system as an E H R, and they, they like to deliver it to the, uh, clinician in the workflow through the E H R. Absolutely. You can push that data back through. Absolutely. Let me give you an example of Rush Health System in Chicago. So they have two big use cases with us. So they're at risk for, um, um, hypertension population.

So they have a hibernation clinic that they have to deal, deal with, and then they have a homeless population because being in a west side of Chicago that they're at risk for. So SHA is one of the, the C I O. Visionary, c I o over there came up with this idea that instead of dealing with these patients when they show up in the er, how about we engage them in the homeless shelters?

So they actually put HIE station in homeless shelters in Chicago where they screen the patients and then do care coordination with there. They need social services, any kind of other services needed, and then triage them to the right care as needed instead of showing up in er. So for example, when we implemented the kiosk in homeless shelter, 9% of those population were in Habern Nation crisis, a single uncomplicated admission.

Crisis $24,000 single. Right. And most these patients have cardiovascular complications, neuro complications, which goes 50,000 plus per admission. That's a huge cost that, you know, that ha that system. And if you identify those patients earlier on, treat them in an outpatient setting, you reduce all that cost that they would have if they showed up in the er so that, that their incidents in having crisis in homeless shelter has gone from 9% to 1%.

Wow. Right? So they've been able to show that, uh, difference in that, uh, by using Higg as a two device. So not only do that, but they also collect . Such determinant data on the station. So understand what the patient's needs are and then be able to direct them to the right services, uh, through care coordinators in at the homeless shelter.

So, especially urban areas, this is a very interesting solution that health systems could look at. Uh, not to do a commercial, but the reason I like it is because it, it does blend. Uh, we're talking a lot about social determinants at this conference. We're talking a lot about consumerism still and uh, 'cause we're still at the, at the beginning we're trying to figure out where does it

Fit and how do we put it out there? And this is a great, uh, example of taking medicine to the individual and then having the, the individual be the locus of, if you think about it, right, half of the US population makes $40,000 or less also, and the cost of that population to care is twice as those who make a hundred thousand or more, right?

Plus the cost is higher on the elderly side of things. And everybody's focusing on building technology for affluent healthy , right? Or extremely acute. Healthy or Yeah, or acute, absolutely. Or acutely, chronically ill patient or post-acute, right. Nobody's focusing on what is the preventive monitoring space for the rest of the population, right?

You're focusing on the diamond, the pyramid on top. Tip of the pyramid when you're focusing on, you know, acute and um, that population. But year over year, it's that bottom of the perimeter that becomes in the top right, if you don't address it locally, so you know, how do you do it in a scalable manner? And that's how we do this.

Well, but here's the, I mean, I know we're doing this because yeah, we are non-profit organiz. Organizations that care for our communities. Yes. But what is the economic engine for putting these kiosks in a homeless shelter? I mean, that's probably one of the questions people are asking. Like how, how do you stay in those?

I think, I think the, the, um, um, so it's really, you know, it was Russia's need, the Russia's paying for those, uh, kiosks that goes in there because they understand their risk on those population and they show up. Oh. 'cause it's driving up their, their cross. Correct. Right. I mean, they, that patient shows, shows up in the er.

They have to take care of the patient in the er. Right. And the cost of that is much higher versus taking care of them at the homeless shelter and outpatient. Setting. So that's, that's the, the, the economic model on them is very clear on how they do it. And habitation clinics similarly, right? I mean, you have, you have certain, as an academic medical center in an urban city, they don't have, they're not designed to be primary care.

You know, extension of the question is do you build more brick and mortar and extend your primary care or do you use extension primary care into retail as a way to engage with these patients and continuously monitor them? So in Rush Clinic, when they enroll patient in hypertension, um, programs on Higg, , Have a higg sitting in their state in the clinic too, to enroll the patients.

Patient can go in any of the grocery stores or the pharmacy chains in the city, do their blood pressure monitoring data, goes back into the epic e H R where the care coordinator looks at it, and then based on the data, decides what the patient needs to do and can do a telehealth and monitoring, uh, to deal with it instead of the patient coming in, taking time off from work, paying for parking, paying copay to see the doctor.

You just reduce the entire cost from the patient side of things and from the provider side of things to manage hypertension at scale. So two implementation questions. So do you, uh, these, these, uh, kiosks, are they branded HIE or are they branded Rush? They're, they're branded hie. They are, they're branded hie, but all the digital aspect of, they can have a lot of rush messaging that is happening.

And Rush will have a tile on the kiosk where patient can send a rush patient and I'm gonna share my data with Rush. And then when they click that button, then what the question they need to answer are personalized and uh, . Based on what Russia's needs are. So we have some, we have some geek, uh, people who are watching the show.

So, um, let's assume they want to implement it in La, LA County. Mm-hmm. , um, and they're gonna put this thing out there. What does an implementation look like for a health system that wants to have their button on there? So, so one, first of all, it's very simple. We already have station deployed in 11,000, 10,000 plus location nationwide.

So you can just do an a p I integration and just get consumer to share data and do do anything. So it doesn't matter if they're, uh, epic, Cerner, Meditech doesn't make a difference, right? You're just pulling data through as a fire resource and you want do that stuff. If you want to do more gaps in care closure type of things, then you know, we have a software solution for that stuff.

And then what happens is there tile shows up for LA County, for example, on the kiosk, and the patient comes and self-identifies for it is, I don't, you know, whatever the LA county wants to know about the patient from a social determinant point of view or any other things that they're, they care about, we can customize those questions to ask.

Them in real time and the data goes back into either if they want into the analytics engines, they want to do E H R, or we have our integration in Salesforce Health Cloud, then we provide a turnkey solution to, to four care coordinators to look at data. So there's a new rule. I mean, what's your thoughts on the new rules that just dropped?

They impact, I mean, this is exactly what we've been doing for the last seven years, right? Right. That's true. Is patient generated consented data. So, so because of philosophy, a patient owns the data and they give consent to share. I mean, we are really aligned with how they've been thinking about, so, you know,

We partnered with Current Alliance really push this idea of patient-centered exchange of data. So when a patient gives consent and a patient wants data pulled from an E H R, from a claim system, from a peer, all of the hurdles of intra go away because patient generating that request. Similarly, patient generating request to send data exactly the same way.

So I think we are like, you know, there's Apple that is doing it for everybody that can afford devices. We are doing it for anybody that cannot afford devices, devices. Phenomenal. Hey, thank you very much for taking the time. Thanks. Great solution. Thank you very much. I hope you enjoyed this conversation.

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