Latest / Becker’s Healthcare Podcast / FHIR, Standards and the Road to Accountable Care

Transcript

FHIR, Standards and the Road to Accountable Care · Becker’s Healthcare Podcast

• 0:00
  - Hi, everyone. This is Lucas Voss with Becker's
• 0:02
  - Healthcare. Thanks so much for tuning in to
• 0:04
  - the Becker's Healthcare podcast series. It's great to
• 0:07
  - have you. I'm excited to welcome Mike O'Neil
• 0:09
  - for our episode here today on FHIR standards
• 0:12
  - and the road to accountable
• 0:14
  - care. Mike is the CEO of Medica Software.
• 0:17
  - His team partners with health care providers to
• 0:19
  - deploy advanced health IT solutions to improve the
• 0:22
  - quality and efficiency of care. An expert in
• 0:24
  - bringing new technologies into care environments, Mike joined
• 0:28
  - MedicaSoft after three years with the US Department
• 0:30
  - of Veterans Affairs where he was a senior
• 0:32
  - advisor and founding member of the VA Center
• 0:35
  - for Innovation. There, he led innovations in telehealth
• 0:38
  - and the VA's Blue Button personal health record
• 0:40
  - and also spearheaded its open source EHR EHR
• 0:44
  - initiative. Mike, it's so great to have you.
• 0:46
  - Thanks so much for being here on the
• 0:47
  - podcast.
• 0:48
  - Thanks, Lucas. It's great to be here.
• 0:50
  - Great to have you. And, again, just simply
• 0:52
  - from your experience, you've talked
• 0:55
  - for years, really, about sort of the journey
• 0:57
  - to becoming truly data driven
• 1:00
  - across health care. When you look at where
• 1:03
  - accountable care organizations or ACOs are today,
• 1:06
  - what is the gap that you still see
• 1:08
  - between the data they have and the data
• 1:10
  - they need to manage
• 1:12
  - risk and improve outcomes?
• 1:14
  - Yeah. Well, I mean, the first thing I
• 1:16
  - would say is the
• 1:18
  - the biggest gap really isn't anymore the amount
• 1:21
  - of data. Mhmm. It's more
• 1:23
  - the completeness
• 1:24
  - of that data,
• 1:26
  - the usability, which sometimes
• 1:29
  - gets into the area of the quality of
• 1:30
  - the data,
• 1:32
  - and the timeliness.
• 1:33
  - If we think about
• 1:35
  - what ACOs are trying to do, they
• 1:37
  - they increasingly
• 1:38
  - want near
• 1:40
  - real time, as near to real time as
• 1:41
  - they can get visibility
• 1:43
  - across an entire patient journey.
• 1:45
  - It turns out that all too often, organizations,
• 1:48
  - even those that are investing in data infrastructure,
• 1:51
  - are still working with data that's days weeks
• 1:54
  - old, months old, sometimes quarterly,
• 1:57
  - monthly extracts, and so forth. So I think
• 2:00
  - the ACOs that are are gaining momentum and
• 2:03
  - and seeing success, success being
• 2:06
  - both in patient outcomes and the efficiency of
• 2:09
  - of the care they deliver.
• 2:10
  - They're getting beyond retrospective reporting and saying, let's
• 2:14
  - look at how things have done in the
• 2:15
  - past and change our behavior
• 2:17
  - going forward and finding ways to use
• 2:20
  - the data really like
• 2:22
  - a a longitudinal
• 2:24
  - view of the patient journey
• 2:26
  - in real time as they make decisions.
• 2:28
  - I'm glad that you mentioned that because, again,
• 2:30
  - it is the foundation. It is incredibly foundational
• 2:33
  - to everything, and we'll touch on that here
• 2:34
  - in a little bit in in the conversation
• 2:36
  - too. I do wanna talk about, SEWP a
• 2:38
  - little bit. Not the good kind, unfortunately.
• 2:41
  - There's a lot of as we've already heard
• 2:43
  - in in the intro here, there's a lot
• 2:45
  - of acronym SEWP around interoperability.
• 2:47
  - Right? We talk about FHIR, USCDI,
• 2:50
  - TEFCA,
• 2:51
  - QINs, for an ACO leader, right, who's looking
• 2:54
  - at all of these different things
• 2:56
  - and who isn't necessarily living in sort of
• 2:58
  - the standards weeds and all of these acronyms
• 3:01
  - acronyms. Which developments are changing, what data they
• 3:04
  - can access today,
• 3:06
  - and where is the industry still ahead of
• 3:08
  - of practical reality?
• 3:11
  - Yeah. That's a good one because, you know,
• 3:13
  - we do love as an industry to to
• 3:14
  - get into the the alphabet and the acronym
• 3:17
  - soup.
• 3:18
  - I I I would say maybe some some
• 3:20
  - good news in that on that front is
• 3:23
  - many of these standards,
• 3:24
  - that that you mentioned
• 3:26
  - are are really getting more operational traction
• 3:29
  - rather than just being theoretical
• 3:32
  - or sometimes theoretical
• 3:34
  - will go into the area of compliance. I'm
• 3:37
  - I'm I'm dealing with this acronym because
• 3:40
  - somebody told me I have to. I'm measured
• 3:42
  - on it or something like that.
• 3:44
  - By operational, I mean, they're they're actually getting
• 3:47
  - connected with
• 3:48
  - the data that ACOs want and need because
• 3:51
  - they're trying to drive outcomes. So
• 3:54
  - I think it's helpful sometimes to to
• 3:56
  - not have to dive all the way down
• 3:58
  - into the every bit and bite and and
• 4:01
  - field of a standard, but think in terms
• 4:03
  - of
• 4:04
  - of USCDI. It's good that it's making progress
• 4:06
  - because it at least gives everybody
• 4:08
  - that I'm it's in my ecosystem
• 4:10
  - a common set of data that we all
• 4:12
  - need to be able to to, communicate about.
• 4:15
  - Fire gives us a way
• 4:17
  - to do that interoperability,
• 4:19
  - to do that data exchange, and make make
• 4:21
  - that data available. Things like
• 4:23
  - TEFCA and QHANs
• 4:25
  - establish more of a common framework for exchanging
• 4:28
  - data on a national level.
• 4:31
  - Not to throw more more
• 4:33
  - terms or acronyms into there, but,
• 4:36
  - more recently,
• 4:37
  - CMS has been doing work under the umbrella
• 4:40
  - that they call the health technology ecosystem.
• 4:43
  - One of the things that actually, I I
• 4:45
  - think I like and a number of us
• 4:46
  - like about that is it's not a mission
• 4:48
  - to create a new set of acronyms. It's
• 4:50
  - more of a mission to take the acronyms
• 4:52
  - that are already out there and operationalize
• 4:56
  - them and say, in order to improve
• 4:58
  - a patient experience, here's how you should apply
• 5:01
  - those
• 5:02
  - standards, those acronyms,
• 5:04
  - in order to better make,
• 5:07
  - health care data truly usable. Here's how we
• 5:10
  - think you should apply those. That operational aspect,
• 5:13
  - that's what I I mentioned at the at
• 5:15
  - the start of this this answer. That's good
• 5:17
  - to see from from folks like myself and
• 5:20
  - here at Medica Software.
• 5:21
  - We're trying to help folks make real world
• 5:24
  - use of their data, so the operational aspect
• 5:26
  - is a good one. And I I think
• 5:28
  - I don't wanna ignore that you mentioned specifically
• 5:31
  - maybe fire in here. Yes.
• 5:34
  - FHIR is something that, you know, that we
• 5:36
  - look at, and I think the industry is
• 5:38
  - increasingly looking at is not just
• 5:40
  - an interoperability
• 5:42
  - checkbox.
• 5:43
  - I I was told I have to
• 5:44
  - make my data available via FHIR API.
• 5:47
  - But it's
• 5:48
  - allowing organizations
• 5:50
  - to better determine what is exactly the granular
• 5:53
  - data that they need
• 5:55
  - to to access it,
• 5:57
  - either to retrieve it or to share it
• 5:59
  - in a more real time way,
• 6:01
  - and and move past,
• 6:04
  - the, you know, batch kind of interfaces,
• 6:07
  - custom integration,
• 6:08
  - exchanging large flat files, and do something that
• 6:11
  - helps them be more flexible, more granular,
• 6:15
  - and more real time. So, again, it's the
• 6:18
  - there's the standards element of FHIR that's been
• 6:20
  - worked on for years, but that operational aspect
• 6:23
  - of really putting it to use for real
• 6:25
  - world data that I think is starting to
• 6:27
  - show some results.
• 6:29
  - Do you think just as a follow-up to
• 6:30
  - that too, do you think that that's a
• 6:32
  - true enabler specifically for ACOs right now when
• 6:35
  - we're looking at fire?
• 6:37
  - I do. I there's a couple of efforts
• 6:39
  - that I think ACOs
• 6:41
  - can benefit from. And in some cases, some
• 6:43
  - of the forward looking ones are leading it.
• 6:46
  - For example, for computing quality measures, which often
• 6:50
  - is
• 6:51
  - used to measure provider performance,
• 6:54
  - there's growing efforts including,
• 6:57
  - not to, again, throw in another acronym, but
• 6:59
  - NCQA,
• 7:00
  - the organization
• 7:01
  - that defines
• 7:02
  - HEDIS measures, one of the most common
• 7:05
  - measurement metrics.
• 7:07
  - They are defining how to do that, how
• 7:09
  - to compute those measures specifically using FHIR data.
• 7:13
  - EHR vendors from
• 7:15
  - the large players like Epic and Oracle Health
• 7:19
  - on down to,
• 7:21
  - down down the whole list are starting to
• 7:23
  - make data available via Fire API,
• 7:25
  - and ACOs are starting to realize they can
• 7:28
  - they can use that. They can reach out
• 7:30
  - and retrieve
• 7:31
  - the data that they they need for
• 7:34
  - the use case they have,
• 7:36
  - and follow policy,
• 7:38
  - so that they don't get into data use
• 7:40
  - issues.
• 7:42
  - And FHIR,
• 7:44
  - having operational
• 7:46
  - FHIR data and operational
• 7:48
  - FHIR APIs
• 7:49
  - is making it possible
• 7:51
  - for ACOs to do this.
• 7:54
  - I wanna talk a little bit more about
• 7:56
  - something that you started our conversation with, what
• 7:58
  - you said. Again, the problem is that isn't
• 8:01
  - necessarily there is no data. We have so
• 8:03
  - much data. The data is available. It's
• 8:06
  - there. How should organizations, ACOs specifically, right, think
• 8:10
  - about turning all of that, you know, aggregated
• 8:12
  - multisource data then into
• 8:15
  - timely and usable insights
• 8:17
  - for the organization, for care managers, for clinicians,
• 8:20
  - and network leaders specifically as well. And, again,
• 8:23
  - what separates those organizations that then in turn
• 8:26
  - generate real value from that data
• 8:29
  - versus those that are just collecting it and
• 8:31
  - saying, hey. We have all the data available.
• 8:34
  - Yeah. Actually, even in the way you you
• 8:37
  - formed your your question, it's, I think, pretty
• 8:39
  - insightful.
• 8:40
  - Just adding
• 8:41
  - more feeds or or just building,
• 8:44
  - a yet larger data warehouse
• 8:46
  - Mhmm. In and of itself, it that that
• 8:48
  - doesn't create the value.
• 8:50
  - It's a little bit of a cliche, but
• 8:53
  - if you think in terms of the value
• 8:55
  - comes from using that data so that you
• 8:58
  - can deliver the right information to the right
• 9:00
  - person at the right time, so forth, in
• 9:02
  - the way that drives the actions or the
• 9:04
  - behavior they are looking for, that's the goal.
• 9:06
  - So, you know, if we bring that down
• 9:09
  - from
• 9:10
  - 30,000 feet for for ACOs, they're thinking about
• 9:14
  - things like
• 9:16
  - what patients need out outreach today.
• 9:19
  - Mhmm.
• 9:20
  - In my provider set, which ones have
• 9:23
  - some emerging
• 9:24
  - gaps? Let's let's just call it quality gaps
• 9:26
  - or care gaps. Yeah.
• 9:28
  - Where in my network is utilization going in
• 9:31
  - the right direction? Where is it going in
• 9:32
  - the wrong direction? So these are the things
• 9:35
  - that you want to have guiding
• 9:37
  - your technology investment. So if you say, look.
• 9:40
  - I'm I'm gonna have an effort to add
• 9:42
  - more
• 9:43
  - feeds. I I would say,
• 9:46
  - one of the things that rural health transformation
• 9:49
  - program, which is a a big focus in
• 9:51
  - in many states these days,
• 9:52
  - is to get more,
• 9:55
  - clinics, especially, obviously, rural smaller clinics, you know,
• 9:59
  - connected, which can can can amount to, well,
• 10:02
  - I just I'm gonna get more feeds.
• 10:04
  - But the way to steer that to be
• 10:06
  - productive is to say, look, how does that
• 10:08
  - access to data
• 10:10
  - for me as an an ACO help me
• 10:13
  - identify patients for outreach, identify quality gaps? And
• 10:16
  - then how does that help me go back
• 10:18
  - to those
• 10:20
  - caregivers, those providers
• 10:21
  - with something useful so that they can improve
• 10:24
  - the care they're delivering to to those patients?
• 10:27
  - So
• 10:29
  - maybe I'm I feel I'm I'm almost Lucas
• 10:31
  - restating your question, but a successful ACO is
• 10:34
  - able
• 10:36
  - doesn't ignore the fact that you do need
• 10:38
  - feeds if you need more data, and and
• 10:40
  - an efficient data infrastructure is very important.
• 10:43
  - But they're looking at it in terms of,
• 10:46
  - how am I generating insights
• 10:49
  - that that are plugged into the right workflows.
• 10:51
  - Actually, I think that is a concise way
• 10:53
  - to say it, to use that data investment
• 10:56
  - to sharpen those insights, which directly
• 10:59
  - helps them with, efficiency and and care delivery.
• 11:03
  - In that process in and of itself and
• 11:05
  - you've touched on it, just now too. I
• 11:07
  - I do wanna spend a little bit more
• 11:09
  - time on the rule access piece of this
• 11:12
  - and how this works. Again, as you've said,
• 11:14
  - there's a lot more attention on this now,
• 11:17
  - both from the policy side, but also in
• 11:19
  - general,
• 11:20
  - especially for ACO growth,
• 11:23
  - on in rural areas and underserved populations.
• 11:27
  - Again, we know that infrastructure
• 11:29
  - realities are different there. It looks different. The
• 11:32
  - funding is different.
• 11:33
  - It's simply not as readily available as in
• 11:36
  - more urban areas.
• 11:38
  - What does that interoperability
• 11:40
  - done right look like then for rural focused
• 11:42
  - ACOs? And, again, where do you see those
• 11:44
  - biggest opportunities
• 11:46
  - for them
• 11:47
  - to close care and data gaps in those
• 11:50
  - communities?
• 11:51
  - Yeah. This is this is a very timely
• 11:54
  - topic.
• 11:56
  - I think, first of all, for for rural
• 11:58
  - ACOs, so the the the rural participants in
• 12:01
  - ACOs,
• 12:03
  - interoperability, that it has to be, you know,
• 12:06
  - the ultimate in in terms of being practical
• 12:09
  - and
• 12:10
  - and being scalable. I said practical because there
• 12:12
  - are generally limited resources. There's no no resource,
• 12:17
  - to waste.
• 12:18
  - And scalable, often, we think in terms of
• 12:20
  - scalability for
• 12:22
  - larger and larger datasets and larger and larger
• 12:25
  - workloads and how do we scale up. But
• 12:26
  - scalability works in the other direction as well.
• 12:29
  - So,
• 12:30
  - you what you wanna make sure is that
• 12:32
  - you have systems,
• 12:34
  - including interoperability,
• 12:35
  - data exchange, data usability
• 12:38
  - that
• 12:38
  - are efficient and work well for small footprints,
• 12:41
  - for small practices down to the single single
• 12:44
  - doctor level,
• 12:45
  - and and sparse populations and so forth. They
• 12:48
  - shouldn't be penalized with the the technology they
• 12:51
  - can access because they're smaller in scale.
• 12:54
  - So that that's actually an an important aspect.
• 12:59
  - Interoperability
• 13:00
  - done right
• 13:02
  - for for
• 13:03
  - a rural focus, I think, is,
• 13:06
  - finding a way to
• 13:07
  - make sure that,
• 13:09
  - that geography,
• 13:11
  - resource, infrastructure limitations
• 13:13
  - don't become that barrier, the thing that's preventing
• 13:16
  - you from improving the quality of of care.
• 13:19
  - So what we look to do is to
• 13:21
  - to be able to to make
• 13:23
  - make sure that interoperability
• 13:25
  - is actually creating a connected ecosystem.
• 13:28
  - And so now rural participants
• 13:30
  - can connect to that ecosystem efficiently,
• 13:33
  - And then there's a, you know, bidirectional benefit.
• 13:37
  - They can provide
• 13:39
  - data into,
• 13:40
  - let's say, the the centralized system so that
• 13:43
  - as an ACO, you have a more complete
• 13:47
  - view of the the
• 13:49
  - full care journey of the patient, as I
• 13:51
  - I mentioned earlier.
• 13:52
  - That's important. It's not it's not enough. You
• 13:55
  - don't get a complete picture
• 13:57
  - of the patient journey if you only have
• 14:00
  - data from large acute care hospitals, for example.
• 14:04
  - When when we talk about EHR data, you
• 14:06
  - really need
• 14:07
  - the data from every place that a patient
• 14:09
  - is receiving care. And then in the other
• 14:11
  - direction, interoperability
• 14:13
  - should make it easy for
• 14:15
  - the small practices,
• 14:16
  - the small facilities
• 14:18
  - to gain the benefit
• 14:20
  - of the the larger system. It should not
• 14:22
  - be that you're you're not able to
• 14:26
  - identify the patients for follow-up unless you are,
• 14:29
  - participating in a in a large hospital. You
• 14:32
  - should be able to do the same kind
• 14:33
  - of thing for rural patient pop populations and
• 14:36
  - smaller facility.
• 14:38
  - Interoperability
• 14:39
  - done right allows you to do those things.
• 14:43
  - It's goes both ways, and I think that
• 14:45
  - that's really, really crucial. It should
• 14:47
  - the word in and of itself, I'm always
• 14:49
  - fascinated. Interoperability,
• 14:50
  - like,
• 14:51
  - again, it should be the same. Right? No
• 14:53
  - matter where you are. I I think that's
• 14:56
  - a that's a very pertinent point. Mike, it's
• 14:57
  - so great to have you on. I do
• 14:59
  - wanna leave our audience with,
• 15:01
  - something actionable too that they can leave with
• 15:04
  - here.
• 15:05
  - Looking at your own work, right, if you're
• 15:08
  - advising an ACO
• 15:10
  - executive today, setting a data and interoperability
• 15:12
  - strategy, right, for the for the future, they're
• 15:14
  - trying to set this up,
• 15:16
  - What would you prioritize today, and what are
• 15:19
  - the common mistakes
• 15:20
  - that you talk to them about and say,
• 15:22
  - hey. This is not what we want to
• 15:24
  - do.
• 15:26
  - Yeah. So we we focus an awful lot
• 15:29
  - on technology and how it's used to,
• 15:33
  - improve care and and efficiency as we've mentioned
• 15:36
  - here throughout our discussion.
• 15:38
  - I I would say first, though, that the
• 15:40
  - biggest mistake, the thing to avoid is treating
• 15:43
  - interoperability and and your data infrastructure
• 15:46
  - as a purely technology project.
• 15:49
  - And that that happens maybe more often than
• 15:52
  - than you would think. I would include in
• 15:54
  - that, by the way, to the don't so
• 15:56
  - don't just launch a technology project for the
• 15:58
  - sake of saying I've I've launched technology or
• 16:01
  - I've spent some technology budget
• 16:03
  - or even for
• 16:05
  - compliance sometimes. I mean, we compliance is important,
• 16:07
  - but,
• 16:09
  - on its own, just tech projects or compliance
• 16:12
  - can end up where you as you go
• 16:15
  - down that path, you start to wonder, am
• 16:16
  - I really getting an ROI?
• 16:19
  - So,
• 16:21
  - you know, obviously, we we wanna make sure
• 16:23
  - that you can drive those investments
• 16:25
  - by looking at what are my
• 16:28
  - workflows, where do I need to deliver,
• 16:31
  - I'll say insights. And and to to make
• 16:33
  - sure that's not just a buzzword, that's everything
• 16:35
  - from
• 16:36
  - identifying, let's say, high risk patients that that
• 16:40
  - need outreach immediately and
• 16:42
  - need to have
• 16:44
  - goal oriented care plans put in place and
• 16:46
  - then a way to monitor whether they're getting
• 16:49
  - that care and which in which direction is
• 16:52
  - is the patient outcome heading. All of those
• 16:54
  - things are kind of data driven insights.
• 17:00
  - I think you you in your questionnaire, kind
• 17:02
  - of leaning towards what's a what's a more
• 17:04
  - practical
• 17:05
  - guidance than just saying, hey. Spend technology wisely
• 17:09
  - and prioritize based on the things that are
• 17:11
  - important to you.
• 17:12
  - You never have perfect information when you make
• 17:15
  - interoperability
• 17:16
  - and data technology
• 17:18
  - investments.
• 17:19
  - So some common themes that we talk with
• 17:21
  - customers about is creating
• 17:24
  - really a unified
• 17:25
  - data foundation,
• 17:26
  - unified in. It should be able to handle
• 17:29
  - the data types that you're going to encounter
• 17:32
  - now and and and in the near future.
• 17:34
  - Claims data,
• 17:36
  - clinical
• 17:36
  - EHR data as we've talked about, social determinants
• 17:40
  - of health. There may be other
• 17:42
  - financial your your data architecture shouldn't have to
• 17:44
  - change every time you have a use case
• 17:47
  - that needs a a little bit different type
• 17:49
  - of data.
• 17:50
  - And then make sure that your data is
• 17:52
  - gonna be organized
• 17:54
  - for a couple of different types of workflows.
• 17:58
  - And in general, what we find is
• 18:00
  - whether it's clinical or operational, financial, from a
• 18:03
  - technology point of view, workflows can be broken
• 18:07
  - down into data needs that are either care
• 18:10
  - delivery or things that are people are doing,
• 18:12
  - looking at an EHR, looking at care gap
• 18:15
  - reports, this kind of thing. There's kind of
• 18:17
  - that operational
• 18:19
  - workflow.
• 18:20
  - Often that drives a certain type of data
• 18:22
  - architecture.
• 18:23
  - And the other, you could say, is generally
• 18:26
  - analytics, where I need to do
• 18:28
  - population health analysis, compute quality measures.
• 18:32
  - These days,
• 18:33
  - often artificial intelligence, where does that intersect your
• 18:35
  - data strategy comes into this area.
• 18:38
  - And that kind of bulk or
• 18:41
  - analytics and reporting
• 18:43
  - workload
• 18:44
  - drives can drive a little bit different technology
• 18:47
  - infrastructure.
• 18:48
  - So if you're able to say, look. I've
• 18:50
  - got a data architecture that is flexible enough
• 18:52
  - to handle
• 18:53
  - the multiple types of data
• 18:55
  - that I need and to make it operationally
• 18:58
  - useful to support
• 19:00
  - transactional kind of workloads
• 19:02
  - and bulk analytic workloads,
• 19:05
  - then we feel like you'll be in pretty
• 19:07
  - good shape
• 19:08
  - as things evolve in the the next few
• 19:10
  - years.
• 19:12
  - Mike, so great to have you on. Thanks
• 19:13
  - so much for taking some time for us.
• 19:15
  - Thank you. It's my pleasure.
• 19:17
  - Great to have you. And we also want
• 19:18
  - to thank our podcast sponsor, MedicaSoft.
• 19:20
  - You can tune into more podcasts from Becker's
• 19:22
  - Healthcare by visiting our podcast page at beckershospitalreview.com.