Healthcare Suffers Because Health IT is Lagging. We Can Do Better

Episode 184: Transcript - February 17, 2020

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

[0:00:04.7] BR: Welcome to this week in Health IT News where we look into as many stories we can in 23 minutes or less, that will impact health IT. My name is Bill Russell, healthcare CIO coach and creator and creator of this week in health IT, a set of podcasts, videos and collaboration events, dedicated to developing the next generation of health leaders.

It’s Tuesday news day and I’m going to tell a story. My healthcare journey for the last week, what I saw, what I learned and what we can do better. This episode is sponsored by Health Lyrics. I coach health leaders and all things health IT. Coaching was instrumental in my success and it is the focus of my work at health Lyrics. I’ve coached CEO’s of health systems, startups, CIO’s, CTO’s, you name it. If you want to elevate your game in 2020, visit healthlyrics.com to schedule your free consultation.

[EPISODE]

[0:00:43.4] BR: All right, let’s get to it. I had a gentleman who used to work for me, his name was Mostafa Khairzada. We referred to him as the mad scientist. He was a site director for a hospital and one of the best sources of ideas, new ideas that we had in our health system. He did crazy things. He did things like he spent the night in a bed just to get an idea of what it was like just to feel the experience. 

He asked the patient if he could be with him the entire day while he went through his series of appointments. He met him in the parking lot and followed him through that day to understand his experience. He has watched surgeries and done a million other fun things. You see, Mostafa understood the power of walking in someone else’s shoes for a day.

You will actually hear from him on February 28th as I just interviewed him and David Baker on the topic of innovation. Fascinating person, great show. Well, this week, I got to walk in the shoes of the patient. As many of you saw on social media, my 87-year-old father in law came down with pneumonia this past week and we had to take him to the emergency department. I’m going to tell you about the experience, talking about how he and my wonderful wife experienced it, make a few observations on what we can do better and hopefully will still give you a bunch of things to think about and to talk about.

All right, here’s how it sort of went down, he started to shake uncontrollably, vomiting, we decided to drive him to the ED which is the closest hospital which is a very good hospital, good reputation. I know a ton of people there, tons of philanthropy. I’m not going to give you the name. I’m not sure it’s really all that important to communicate the story. Valet car service wheelchair is right there. He was in the room within minutes of the time we pulled up. 

Just give you a little background, he had moved out to live with us in the spring of last year. He is an accountant by trade, religious about his appointments to see the doctor. He has a ton of records at two health systems back in Pennsylvania. Both of these health systems are Epic shops and I would have consider them both to be really well run IT shops and with excellent implementations of Epic. One of their CIO’s has been on the show several times and it’s someone I greatly respect. 

The health system we were checking into was a health system that I was also extremely familiar with as I said earlier. I know many of the people who work there, CEO, CIO, former CIO, CMIO. This is going to be relevant in a minute. You know, he already had records at the health system, we just checked into from urgent care which we visited several times before we changed insurance carriers and he identified a new PCP and actually ended up with a different system.

You know, that made the collection of information easier in the ED but easier than amazingly hard. So, still extremely cumbersome. What happened is they stationed a nurse practitioner at the keyboard which she only left a few times, I kid you not. Just a few times while other nurses came in, took vitals, through labs, did all the busy work of bringing in new patient in.

You know, I really marveled at the process. It was really well orchestrated and I could only imagine what it would have been like in a hospital with less staff. This is a pretty affluent hospital that we stepped into. 

You know, I just sat back, I sat behind her watching the screen intently. She would ask about medications. We have gone through this a number of times. We had the list. We just handed her the list. She asked about pain and she clicked on a certain pain and it popped up a whole new series of questions. And I could feel her hoping that he would answer no to the next questions so that the number of fields that she had to fill in would be lessened. 

The staff was really amazing. Empathetic, helpful, informative, willing to do whatever to ease the situation. You know, I’m very aware of the fact that we work alongside heroes.  Some more than others. But all really have the best intentions. When I’m sitting there, I’m trying not to divulge anything about who I am in these situations. I find people to be more forthcoming if they don’t think I’m interviewing them or collecting information which I wasn’t. I just wanted to understand a few things about the process and how they were feeling. 

You know, she started asking questions about his history and I asked her if they have pulled up the care everywhere records whereas the health system he saw in Pennsylvania was also on Epic and you know. Her antenna went up and she said, “how do you know about epic? Are you a doctor?”

“No, I just follow the health IT industry.” She said she had already looked and there was no records.

[0:04:51.3] BR: The doctor then came in. I said, “you know. He has records in Epic from Pennsylvania and they should really look for them.” He asked name, date of birth and then he said, “There are no records, okay?”  

This is the point at which I sort off wanted to play out the scene from Saturday Night Live.  I don’t know if you remember these, these are a little ways back but they had the tech support person who would jump up and say, “Step aside.” They set up the keyboard and they would do it but I relented and I did not do that. Although I could tell, my wife really wanted me to do that. She was really growing tired of answering the same questions over again. 

You know, at this point, I put a post out on Twitter and LinkedIn that stated the following, “Checked my 87-year-old father in law into a hospital tonight. Moved from Pennsylvania to California earlier this year, records from one Epic hospital to another, not available. You know what was available? A patient’s mobile phone which could have easily stored the record enough already, time to free the data, we can do better, we can do better.” That was the end of the post. 

You know, I post a fair amount on social media and so I know what an average response is, what a significant response is, I have about 7,500 followers on linked in. This was one of the most viral post I have ever put out there. It garnered over 45,000 views, most of those coming within 24, 48 hours. Over 150 comments, over 450 reactions to the post itself.

We’re going to look at some of those responses a little later in the show. When it was just the nurse practitioner and the doctor, I asked, how they liked the new installation of Epic. The installation they were working on is about two years old and they communicated some frustration with the system. What I heard from them was mostly around governance to be honest with you. Governance and training. But really governance.

[0:06:29.7] BR: What they talked about is how they had full autonomy of the system when they were on SCM, sunrise clinical manager and they were really the masters of their own destiny. But for various reasons, this large healthcare system, they had multiple sites was on community connect of a larger health system. And what they felt right now was really restrictive, they felt like they had to follow a set of rules dictated by someone else from afar.

I could really feel their pain. It would be like, buying a high-end kitchen and telling my wife, “Hey, you can only cook these meals in this way in this kitchen.” She would just look at me like I was insane. 

So, my father in law, back to that. His condition stabilized, they did the normal battery of test and determined that he had pneumonia which as you know, is not a good condition for an 87-year-old. They showed us the X-rays and explained the course of action. Here’s the next plot twist. The doctors come in and say, “Hey, our hospital is not a network. Our case worker is trying to determine if we can transfer him to a new hospital.”

The doctor said, “He has stabilized enough to move him to the new hospital so we’re going to order the ambulance.” At this point, it’s now approaching 11:00 at night. Ambulance comes around, they transfer him to another hospital. It’s part of a large national system and they’re running Cerner.  

You already know where this is going. I’m not going to try to explore wheat the ambulance that transported, I don’t really know what systems they were using and what information they needed or had. Although interesting topic for another day. It begins all over again. “Let me ask you few questions.”

[0:07:55.8] BR: I could see my wife just rolling her eyes. You know, consider also that we had never been to this hospital. My wife begins to answer all the questions again and then they go to order the chest X-ray. My wife says, “Wait, he just had one done three hours ago. Do you think it’s changed?” 

“No, not really.”

“Well, do we really need the chest X-ray?” 

She said, “Can’t you get it from the other hospital?” She says, “Okay, no chest X-ray, we’ll get it from the other hospital.” My wife finally leaves so her dad can get some sleep. Sleep is good, right? We’re supposed to sleep in hospitals. Well, at least, here’s how I’ll say it. It didn’t seem to be a priority, you know? 

He was at this point, it’s like one AM he gets woken up again at three AM, gets asked a series off questions. Every couple of hours, they wake them up to draw blood. But again, I want to reiterate, he received great care at this facility and we were really grateful. 

Next day, my wife hits back, she’s informed that they did a chest X-ray. She calls me up and she wants to know why they would do another chest X-ray when she specifically told them not to. And one had already been done at the previous hospital. I do my best to sound supportive. I do my best to try to explain you know, workflow and shift changes and all sorts of other changes. Can I just say without my wife in the room right now, there was no good reason for them to do another chest X-ray. 

At the worst, it undermines the clinicians and health system’s credibility with my wife. They went around her wishes. They didn’t really need to do it again. I understand how it happens but it was a bad idea. I might come back to that later. He got better. He came home two days later.

[0:09:24.6] BR: He’s actually doing really well. We’re grateful. He received great care from great care providers. I think I’m going to update this story again once we start getting the bills. I think that will be an interesting part of the story and something I want to sort of explore. That’s my 72-hour healthcare story. Here’s what I learned. Not all Epic implementations are the same, training is critical, I’d forgotten how valuable the experience of walking in the patient’s shoes is.

As a CIO. I got the chance to experience things that as a civilian if you will, I don’t get to experience as much. And I welcome that, it was again, it was great experience for me. I will really drive this point home. Interoperability should have the patient as the locus of data and as the locus of movement of that data.

My point on this is always, the patient is the only constant at the point of care. Epic isn’t Cerner, isn’t MEDITECH, each point of care could have a different HER. Each point of care could have a different physician. Each point of care, you name it. The only constant at the point of care is the patient. I think the patient needs to be the locus of the data movement. 

Other thing I learned. Duplicate task are prevalent. Clinicians need to listen to the primary care giver when they make request and one of my personal, parts of my personal mission statement is that healthcare suffers because health IT is lagging. It isn’t the only reason for sure but it is a primary contributing reason for duplicate tests, poor experience and lack of information at the point of care.

Let me tell you how my father in law’s visit could have gone with patient-centric interoperability. I want to explain this as it could have gone so I hopefully will do it as clearly as I can. 

So, record firmly in hand, in the Apple cloud or wherever it is on his phone. He presents. We pull out his or primary care giver, my wife’s phone and which we’ll have the record on it and we select a handful of things, emergency, a few parameters, how long they can have the record, how they can use the record and it generates a barcode. I present that barcode to the hospital we’re checking in at. They scan it and the record goes into their EHR.

[0:11:30.5] BR: They view and add to the record during the visit when it’s determined to transfer is required. They download it back to the patient’s phone or cloud solution, whatever it is. They keep the information as required. I understand they have to do billing. They have to have legal review capabilities, maybe an archive of some kind and they have to be able to do some training and stuff off it. 

We can grant them the rights to use those things but nothing else. There’s no other way they can use the data except what is dictated by the patient. Then my wife presents it the Cerner shop. She pulls out her phone, makes the same selections, presents the barcode. Even though it’s a Cerner shop, they inherit all the information, including the chest X-ray which can automatically go into the workflow from the previous location.

My father in law gets the sleep that he needs because the questions have already been asked, they just need to verify them. He gets discharged, the entire record comes down to his phone. We move to Florida in two weeks which we are and the next health system picks up where the last one left off. Are there holes with this? Sure.  But let’s choose to solve the right problems, right? 

The problems we’re trying to solve now are kind of silly. We should be trying to solve the problems like, “Okay, we give every patient has access on their phone. H ow do we ensure that we protect them from nefarious actors? How do we ensure that those kinds of issues don’t come up?” You know, so many, invariably somebody says to me, “What if the person’s incapacitated and I’m like, we’ve already solved that problem, it’s called break the glass.”  We know how to solve that problem?

Let’s solve the problems that we need to solve. With this type of solution, we end up with a better experience for the patient, we cut down on duplicate tests, we reduce cost, we reduce burnout, we improve quality by having the complete record at the point of care.

[0:13:09.6] BR: Seems like all the things we’re trying to strive for. I say, let’s get to this solution and then we can solve the problems around this specific solution. And I’m not saying that there aren’t some challenges to it. I’m just saying, it’s a better place to start.

All right, I want to get to LinkedIn and some of the observations that came from that. The comments fall into a really handful of categories. There’s the, “I’ve been there.” There’s the call to arms, there’s the what we should do or what we can do, there’s sort of this problem opportunity category and of course, there’s the category of who is to blame?

Let’s start with the, “I’ve been there,” category. Mitch Parker, CISO, Indiana University health is responding to, Ed Marks who also relayed the story where he has similar problem. He said, “Ed, I feel pain. We had the same issue moving between Pennsylvania and New Jersey and Indiana.”

“This is a major issue, especially for parents of children with special needs. Every parent of them has to have the binder with all the relevant info.” He goes on, “You know, we can do better and we should do better with exchanging info. New tech doesn’t work if orgs don’t transform to use it.”

Let me talk about the binder a little bit. You know, my journey in this back in 2012, actually started with the binder. I was on a panel for at the Health Evolution summit with Aaron Levie with Box, Lee Shapiro, 7Wire Ventures and formerly Allscripts, and Aneesh Chopra, first CTO of the federal government and interoperability champion.

[0:14:36.5] BR: A woman implored us to do something about this. She told us of her story of taking her child around the country, complex case and she was carrying multiple binders with her and she was terrified that you know, transporting the information that way and people were just flipping through pages like this. She’s like you know, there’s something important on page 110 that she’s afraid they’re going to overlook. 

I left there with, “This is a problem I want to solve. We built the case, we got the funding, invested in several startups, see what we could do. We invested in Clearsense and [inaudible 0:15:05]. You’ve heard me about them before. Both were – I own no interest in them, whatsoever. Both were designed to be an aggregation layer for all healthcare data with a set of APIs on top of it, security layer. Not just the EHR data but all the health data. 

We design the clinical viewer that would aggregate the data and present the record from across various EHR’s, we created a patient app that allowed them to share a onetime use record with any health system. sound familiar? Many years ago, by the way. We could aggregate MEDITECH, Allscripts, Cerner, Practice Fusion, a ton of Epic. Other EHR’s. We did this through connectors, we did some reverse engineering of the data stores to make sure that the fields were going into the right place and you know, we overlayed machine learning to make the ingestion process quicker, better.

What happens? Bill, where are these solutions? Well, what happened is, there is a merger, I left the CIO, both companies are still around, doing really well, but they lost that vision, that original vision because they lost their benefactor. And the health system that took over the health system innovation group didn’t see the value of it. Didn’t see the value of a health system platform. 

And quite frankly, I’m a huge proponent of platforms being the mechanism for change within industries and not point solutions. This health system innovation group seems to be focusing on point solutions and it’s really kind of sad.

[0:16:27.4] BR: They really did nothing with these two companies, both companies were really forced to pursue clients through things that health systems are paying for. Application rationalization, EHR consolidation, archiving legacy systems. They both are doing pretty well today but focusing on the basic blocking and tackling and plumbing of healthcare.

You know, I say this to say, this topic isn’t new to us, it’s been around for a while, there are solutions that are designed to address this. 

Let’s get to a couple of more, I’ve been there stories. Scott Win, Healthcare Life Sciences enterprise sales leader. “God bless Bill, I had the same experience in Hawaii with an emergency situation I was in. They had no access to my Epic records from Hope and came out immediately saying they needed to do surgery when in fact there was a flare up of Diverticulitis. It scared my whole family. The surgeon even said we may have to stay in the island for two more weeks before transporting back from the main land.” 

Another been there, it is still spotty, I was surprised at NW. This is Fred Dempster, executive recruiter, I was surprised at NW immediate care when their Epic had a record for my wife’s EKG from another hospital system. The thing that I said to Fred about this is it is a shame that we’re surprised when it works. It is a shame that we are surprised that the records actually came across. 

Here is an example of sort of the call to arms. Neil Stein, Senior Vice-president of Technology services OrthoCarolina, “The data belongs to the patient. Open access is key to seamless healthcare.” And I agree with Neil and I sort of made the case that the patient doesn’t own the record. They only own the record explicitly in one state and that is the state of New Hampshire.

And then I ended up with a back and forth with somebody who’s in HIM, saying, “You’re wrong, the patient knows the record.” I happen to know that the patient only owns the record in one state. There are 27 states where it’s ambiguous who owns the record.

It doesn’t clearly state the patient. It doesn’t clearly state that the originator or the creator of the record and in the other states it clearly says that whoever creates the record, owns the record. This is actually a tricky situation when you think about it. Because what we are saying is if I take note about you, I am sitting here with the client and I take not about that client because I wrote about that client, they should own the record, right? 

[0:18:29.6] I don’t own the record even though it is my book, my pen, my paper, I am writing. I don’t own the record because I wrote about somebody else, they own the record. This is a tricky legal construct if you will, who does own the record? And it has far reaching implications. So it is not as simple as saying all 50 states the patient owns the record, away we go. Because now we get into an interesting place. 

You know another of example, this is Lisa Connelly, the vice-president. “So many great minds in health care across organizations, how do we make sharing happen? We have been talking about it for over 20 years. When we became patients and realize the impact, we personally start to dig in. Let’s make it happen.” 

Absolutely, a call to action. There is a whole category of how did we get here. Jukka Valkonen, award-winning digital products and solution producer companies cut off so I can’t tell you who it is. 

He said, “Sorry to hear about your frustration and yes, lived it too. It’s unfortunate that many of the excellent RIO’s and HIE’s I help stand up in California eventually withered away.” It is an example of we stood up these RIO’s, we didn’t fund them very well. My experience as a CIO was being a RIO that went out of just ceased to exists on a Friday afternoon and we had to scramble to come up with a sharing solution in one of our markets. 

Ryan Yost, experienced chief financial officer, federally qualified health clinic at rural hospital, talks about training possibilities overwhelm the hospital personnel. The move towards national data exchange is what’s supposed to alleviate this problem but several of the systems don’t talk to each other, which the government did not mandate when they invented. This didn’t need to be this hard or waste so much money. So, we got here through the federal government mandating the use of medical records without really understanding overall the implications of it. 

[0:20:10.6] So that is one of the ways we got here and you know.

Somebody Subro Chatterjee, PHD, digital transformation technology operations executive, goes on to talk more about that. This is after 24 years of HIPAA and 10 years of ACA, there is still an unbelievable distance to cover. No wonder cost quality curve is still and will continue to rise. So that is what people are saying. They are saying how do we get here and they are talking about the government mandate. They talk about the lack of standards. They talk about a lot of different things. Okay, what can we do? Let’s get constructive, what can we do? 

Dan Brown, CSP, senior account executive for Magenic. I am going to assume that G is a J, Magenic. He says, “Is this a potential block chain opportunity?” The answer is sure. It’s not necessary, I don’t think. The immutable record makes it better but sure, it could be. Craig Evans, Precision Healthcare Consulting said, “The sad part of the story is…” 

He essentially goes on to say, “Hey, we have this mechanisms, CCR’s, CCD’s, we have this mechanism to be able to send this across but health systems don’t use it.” To which I say I’ve sat behind physicians who are using their CCD’s or whatever and to be honest with you, I don’t wish this on anybody. I have seen records with hundreds of PDF’s of CCD’s in PDF type form for people who are trying to string through this. Now some of that we could use NLP. 

We could make it into discreet data elements but until we are using the raw record, until we are using discreet data almost and we are moving those into an unverified state but still moving them into the EHR, I think we are going to continue to have this problem more than what we can do. Bill, my vision is one platform that allows the patient to have full control over their data. This is [inaudible 0:21:52], healthcare technology business leader. 

[0:21:55.4] And you know, my only thing back to back to him is who owns the platform? If it a single vendor, you are going to end up with a monopolistic type problem. If it is the EHR company, you are going to end up with innovations slowing way down and if it is the government, I have privacy concerns. That is why I still think that it is going to be multiple companies, common plumbing instead of policies and that is the direction I think we are heading and I think it is the right direction. 

And then somebody says, “If it is Epic to Epic the records should definitely be available.” And I do want to point out, I did call the CIO, CMIO the next day. They looked up my father in law’s record at the other health systems in Pennsylvania and they found them and they determined that, “Hey, this is a training issue.” We are going to go down to our ED and really help them figure out how to use care everywhere. Great, fantastic. 

My only problem with is are we suggesting that every health system should just get the Epic? When people give me this like, “Hey, this works. This is great and it works for 40% of the population in the country or this many records because it works in care everywhere, is that enough for us? Should we be okay with that?” I almost looked at some of this Epic shops when they say that to me and I am like, “So you’re done, you’re not working on this problem anymore?” 

This is Epic’s problem. If they choose to work with other EHR’s, you’re okay with that? If they don’t choose to, you’re okay with that too? I think that is really abdicating our responsibility to our communities that we serve, which is a higher call than our loyalty to our EHR provider be it whoever it is, quite frankly. I think if there is multiple EHR’s in our community, that has to be a call to action for us. We either need to do that through the technologies that are available or be searching out new ones. 

[0:23:36.9] You know this goes on a little bit further. Kyle Johnston, VP of client and services said, “If all EMR’s could talk that would be awesome as you look into hospitals on Epic should be able to work together but I don’t believe the same is true for Cerner and Epic and others.” Actually, it can work, we choose not to make it work is sort of my point in this and then he referenced somebody else who said, “Hey this is really hard.” 

Again, which I say, no it’s not. It really isn’t. I mean it is complex from a data quality standpoint from a semantic inoperability standpoint. From a technology standpoint, it is not that hard quite frankly to write a set of API’s is not that hard. To aggregate that data not that hard. To aggregate it into all format not that hard, okay? Now clearly there is nuance to it and not everybody in the world can do this. But there are definitely companies out there who have been working on this for close to a decade.  And in other industries for multiple decades we can do this. 

In fact, you can see this in the Google health medical record that they are doing for Ascension. You can see that they are pulling multiple EHR’s together that they are harmonizing the data. That they are making a medical record across multiple EHR’s for those patients and they are not the only ones. There is others that can do this. You know we are doing it in 2014 and I know it is possible. 

So, we have to talk about data quality and inoperability. Claire [inaudible 0:24:55], experienced servant leader who excels at building engaged teams to get results. Sounds like a great person to hire. She says, “Two thumbs up for freeing the data however the value and accuracy of that data concerns me because of the documentation burdened on a lot of EMR’s are just copy and paste and every point has a respiratory rate. Every patient has a respiratory rate of 18.” 

[0:25:17.7] And I agree with her on the data quality problem. Here’s what I found on data quality. Transparency is a powerful data quality tool. Patients are the best data stewards and when you shine the light on data, it really starts to move very quickly. Doctors see other doctor’s information, patients see the doctor’s information, they start to ask questions and that whole thing accelerates into which Clara again came back and said, "I couldn’t agree more, health care is ripe for disruption especially the EMR.” 

And she goes on to talk about how data quality can help. All right, who’s to blame? I know you are waiting for this category because everyone wants to know, who’s to blame on this? And I will just tell you what some people have said and I am going to tell you my take on this in a minute. 

So, Ashley Altman, nursing leader in psychiatric mental health care agreed. “The EHR companies claim they keep data from being shared due to HIPAA laws, which is just an excuse for putting profit before patients. It can be done and still protect patient privacy. In the words of the six-million-dollar man, we have technology so let’s use it.” And we do and I agree we can make this happen but that also gives you an idea of the sentiment on this. Also, who’s to blame? I like this one because it is going to make an interesting point. 

Helen Waters, EVP MEDITECH board member, somebody I greatly respect. “I hope your father in law is doing well. Bill, great point on freeing the data, overdue progress and commitment to true interoperability across EHR is what we all need to be committed to, to fully execute on. Doable today, it drives better outcomes and inform clinical decision making.” So MEDITECH supports inner operability for Helen Waters who is extremely high up in the organization. 

[0:26:58.5] Cerner has come out in support of the ONC rule. Who is missing? Okay, Greg Desrosiers, PNP, senior IT project manager, couldn’t help himself. “I could not agree more and you can thank Judy Faulkner, CEO of Epic directly for this problem. She has been stomping her foot in protesting inner operability when it is exactly what is needed at this point. Shameful.” you knew somebody was going to jump on this right? 

So here is my response to Greg. Greg, Judy Faulkner is not the villain. It is a complex issue. Yes, there are monopolistic tendencies of markets at work. But health systems talk the talk and don’t walk the walk here either. If health systems wanted to share records effectively, there are a hundred ways outside of the EHR to make it happen. 

So federal government messed up with MU and high tech and funded these EHR monopolies without the proper controls.  Now they are playing catch up. Judy’s actions make her the poster child for a much larger problem, which is really true.

And so here is my word to Epic on this, I highly respect Judy and what she had done for the industry. You have to remember where the EMR was when Epic really started to come into its own. Systems were making the move, making huge mistakes and they were headlines in major newspapers and EHR implementations were going wrong. 

And Epic stepped into that void and they stepped in with a highly prescriptive model to ensure that implementations went well. They really should be applauded for this and not villainized. Now what does Epic do next is important. I personally and I don’t think anyone cares if Epic has a 1005 market share of every health system in the country. I don’t care what transactional system of record my health system uses. I do care if Epic uses my health record as a part of a bargaining chip to solidify that 100% market share. 

[0:28:52.1] As a patient, I didn’t choose Epic. I chose the insurance carrier. I chose my doctor. And now what I am doing is I am not asking Epic. I am asking my health system. I am asking my doctor, my insurance carrier, my health system to give me my record, all of it, raw format on my phone. I want to be able to present at the physician practice of the health system and provide them my entire medical record like these poor families have to do with their binders. 

I want to sell my data to people who are willing to buy it. That is my prerogative and I want to be able to share it with research if I chose to do that. When I am told that my health system can’t because of their HER, I really get angry. You know this should be an election year issue. It probably won’t be because Epic is situated in a swing state and no one wants to upset the people in the great state of Wisconsin. 

Here is my note to Judy. You know the health systems that use your system revere you warts and all. Now it is time to focus on winning the patient’s confidence. I would say partner on this. This is really the most important topic of the decade and I think it’s really – Epic has the chance to be the hero in this by stepping up and taking the mantel of making health care data exchange across all EHRs work. And in order to do that, you have to lay aside of the natural competitive instincts and say, “What is in the best interest of all patients?” 

All right, so what’s next? Patient-centric interoperability requires a mechanism and mandate a champion and a means, okay? The mechanism is fire. The mandate is a 21st Century Cure’s Act and public pressure. The champion right now is ONC and that bipartisan legislation. And really the team at the ONC and the means is going to be the free market economy, not a federal solution. Apple, Google, Amazon, Microsoft, Health Catalyst and others offer platforms that can pull this off today. 

[0:30:49.9] And that’s what’s going to happen if you put this data in the hands of the patient, there will be this ecosystem that emerges and it will be those players and it will be other players that emerges to say, “Hey, we will handle your data for you and we will provide value on top of that. We will provide care navigation. We will provide second consults. We will provide–.”

You know in some cases, this is going to be health systems who are smart enough to take advantage of this. This is going to be the Mayo’s of the world who say, “Look, you want a second consult from Mayo and we are going to stand up this mechanism for looking at the medical records of everyone in the country to identify ways to do this.” ‘

This is platform thinking, this is what John [inaudible 0:31:27] is working on. So, there is an opportunity here. Smaller players like MphRx, Heart, Clearsense are ripe for investment or even purchase for the players who can’t figure out the technology. 

When I hear of EHR players not being able to figure out how to write API’s, first of all I sort of scratch my head because this is not hard. The second thing that I scratch my head and I say,” Just buy somebody. You got billions of dollars, you could buy these guys for a rounding error on your financials.”

Here is the situation, this is all falling into place. This is not going to move at the glacial pace it’s move over the last decade. This is going to move at an increased speed. And there will be renewed urgency to do this for the good of the patient. So that is the journey. That is where I get to in my head. That is the area where I think this could get a lot better across health systems and to deliver on the promise of great care for everyone in our country. 

I’m sure this went a little long. I may just stop saying 23 minutes at the beginning of the show because I keep missing that mark. 

[END OF EPISODE] 

[0:32:30.0] BR: That is all for this week. Special thanks to our sponsors, VMware, StarBridge Advisers, Galen Healthcare and Health Lyrics and Pro-Talent Advisers for choosing to invest in developing the next generation of health leaders. The show is a production of This Week in Health IT. For more great content, you can check out the website at thisweekhealth.com or the YouTube channel as well. If you want to support the show, the best way to do that is to share with a peer. 

Send an email to someone and just say, “Hey, I listen to this show. I am getting a lot out of it. I’d love to talk to you about it” that is the best way that you can support it. We’ll be back again every Friday with an interview and every Tuesday, we are going to take a look at the news. And I promise, next week I will look at 10 news stories and in two weeks on that Tuesday, we are going to have a special episode, [inaudible 0:33:10] and myself are just going to talk news on that Tuesday episode before hymns and hope that you guys will tune in for that. 

Thanks for listening. That is all for now.

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