Episode#2: Interview with Lynda Rowe

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  • Guest Bio
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Lynda RoweSenior Advisor, Value-Based Markets, InterSystems

Ms. Lynda Rowe is Senior Advisor for Value-Based Markets at InterSystems, and has for two decades held senior-level positions in health information technology. She was most recently an executive in the health market at Booz Allen Hamilton, where she led a number of consulting projects for the Centers for Medicare and Medicaid and the Office of the National Coordinator within HHS. She provided leadership for quality measurement, health information technology use and adoption, health information exchange, interoperability and standards, and meaningful use engagements. She spent a number of years running the analytics department for Managed Medicaid plans in Massachusetts. She is currently vice chairman of the board of directors at Family Health Center in Worcester. Ms. Rowe continues to focus on the advancement of interoperability, technology use and adoption and government policy through various workgroups and task forces.

Highlights from this episode

  • HIPAA and our national consent model
  • How to know progress on interoperability when we see it
  • The challenge of Health IT standards not really being standards
  • Disruption in the technology vendor space as it relates to interoperability
  • The potential of richer data in the hands of providers and patients
  • Proprietary data in an interoperable system
  • FIHR and open standards
  • Fax machines as the enemy of interoperability
  • NOTE: The transcript below is a rough approximation of the dialog and has not been cleaned up from the automated transcription service. It is meant to help listeners search/find for key topics. 


    Hi everyone. I’m clay Ferris to practice lead for Client Solutions and mostly Medicaid.com. You’re listening to our special series on interoperability and the healthcare industry. This is part of our ongoing project called critical conversations in Medicaid.


    We interviewed experts from a wide range of roles to get a key perspectives on this topic while there are new regulations and rules by both CMS and onc our discussions deal more with the broader issues and challenges related to interoperability. I hope you enjoyed learning from these experts as much as I did and don’t forget to check out the related issue brief. We did on this topic at mostly Medicaid.com.


    A quick bit of housekeeping first, we would like to thank our sponsor for this series intersystems graciously made this project possible. If you’re not familiar with the intersystems, they provide a wide range of solutions to government agencies and Managed Care organizations to improve Healthcare outcomes and control cost. Please make sure to check out their work and learn more about what they do at inter systems.com slash Medicaid second. Here’s the disclaimer.


    We intentionally interviewed experts with different perspectives and These they speak for themselves only and their inclusion in this series in no way constitutes an endorsement of mostly Medicaid or our sponsor. It’s also important to note that their opinions are their own and do not reflect the opinions of our sponsor now sit back grab a cup of coffee some headphones and listen to some of the most important insights. You will hear related to interoperability and Health Care Systems.


    This episode features Linda row Linda and I covered a lot of ground which makes sense. She’s one of the most extensive and broad sweeping backgrounds on this topic from all the experts we talked with I learned a lot in this discussion and Linda brings a passion and death to the topic that really Bridges the gap between technical details and the patient experience. I let her give her bio and the discussion but the highlights are Linda is a senior advisor for value-based Market Center systems. She has led the health it.


    It’s for two decades and various senior level positions prior to her work at intersystems. Linda was also an executive in the Health Market at Booz Allen Hamilton there. She led a number of projects for CMS and the office of the national coordinator within HHS and Linda’s also has been a number of years running the analytics departments for manage Medicaid plans in Massachusetts. So we cover a lot of ground I’ll give you some of the highlights just to kind of see where we’re going. We talked about HIPAA and our national consent model. Linda has some good thoughts.


    Jean how to no progress on interoperability when we see it. She also points out the challenges of Health. It standards that we have not really being standards. That’s pretty important. So I encourage you to listen to that part of the discussion particularly. She talks about disruption and Technology vendor space as it relates to interoperability. She also talks about the potential of getting Richard data in the hands of providers and patients the challenges of proprietary data and interoperable systems. She gets into some of the technical details.


    The fire and Open Standards and finally, she makes some really good points that I think are that are helpful around fax machines being the enemy of interoperability. So sit back grab a cup of coffee and listen to it on this conversation that we had with Linda row. Hi everyone. Thanks again for joining us for another episode in our podcast Series where we’re talking about interoperability and with us today. We have one of the top experts on this topic in the space.


    We’re very excited to have her we’ve got Linda row with us and she’s going to have a conversation with her thoughts on interoperability similar to what you’ve heard in the other episodes or what you will hear in the other episodes been what you’ve listened to so far. But but from her unique perspective with all the work she’s done in this space. So Linda if you don’t mind just kind of give the listeners a few minutes on who you are and what you do and your background.


    Door. Hey clay, so this is when the row I currently work for intersystems, but I want to give you some background in perspective. So I’ve been doing this work and interoperability for a long time now, you know, I’ve done it inside the walls of Health Systems, but back in around 2005.


    I had the opportunity to work for an organization called the mass ehealth collaborative in Massachusetts, and we were given Some funding to actually say, you know a few sort of implement electronic health records you create an information exchange it connect to community together what good things could you do and I led a community through that process for three years. I got to work on the New York state project to create a Statewide interoperability backbone and platform. I then went on and worked through a government contract with Booz Allen.


    I worked for the office of the national coordinator where I worked in this great program clay called The Beacon communities where 17 communities Across the Nation got funded through the office of the national coordinator to actually say, you know, if money isn’t an object or you know, if you’re sort of not in a constrained budget, what can you do with health it and interoperability to actually improve the outcomes of an entire community and there were multiple interventions that were happening in each of those 17 communities, but my role is really as As the interoperability and at the time meaningful use subject matter expert to set up help guide these communities and help them think through some of the tactics and strategies to do that. I worked for o&c on program for Meaningful use stage 2 did some training there. I spent some time looking at and sitting on him as interoperability panels. I have spent a lot of time in the industry.


    Just trying Look at this topic and understand it and have been passionate about how do we make things work better for both our Health Care system if that’s what you want to call it, but also for our patients for people like me and my mom and other people who I think are unfortunately said of at the you know, the mercy almost of the health care.


    Air system and not having access to really the information that they need and so that’s been my my journey and my passion and a lot of the regulations instead of funding we can talk about later but those certainly helped push and Propel us forward in this journey. Right? Right. Thank you. And I know we’ll get it we’ll get this will get to cover sort of some members specific perspectives as well as providers as well as technology kind of as we progress through the conversation.


    But one thing I’ve found that’s kind of important in each of these conversations is let’s set the stage with you know, a definition like a lay persons simple definition of interoperability. I keep it in mind. Our audience is going to have very technical folks for a non-technical folks. But how do you define interop sort of a working definition of interoperability?


    So for me it’s about getting the right information, you know clinical and Illustrative information to the right person or the right setting of care in a way that’s actually useful and impactful.


    So if you think about historically some of the definitions that are more tactical it had to do with you know, the standards and what standards were using, but if I can’t get no the right information to that referring physician that then actually helps Have better insight into their patients and help that patient, you know make their journey to Better Health than I think I’ve failed at being interoperable. Right? It’s very similar to another conversation which we said, you know, there’s the standards and there’s the technical specifications but really does it help impact that patient.


    That’s the real the real standard you’ve obviously Really been involved at this kind of from multiple different perspectives, you know, how as an industry as a group as an industry. How long do you think we’ve been trying to achieve interoperability, you know related to that what’s different now? What would have been the sort of things we’ve been stuck on but like from a historical perspective. Where are we in the story? I guess how long we’ve been doing it.


    What’s been the Holdups, yeah, so it depends on where you want to start the story because it back in the really really early days, you know, if you think about Hospital systems and their best of breed, you know, they were buying all these different it systems that didn’t talk to each other and they were actually using internal interoperability right to share information. So I worked on a radiology information system. I had a share that radiology data back to the main hospital information system so that the Physicians on the floor is could actually see the results, right?


    that was sort of for me and that was I hate to say this but you know the 80’s 90’s that that was happening and we’re trying to figure that out then but I think that the real inflection point right for me came probably in the early to mid-2000s when a bunch of folks started to do these Pilots, right the schnoz and other things like that where there is a little bit of funding and a little bit of interest and saying, you know, we’re really not as So are we shouldn’t be as insular and really now that we are thinking about digitizing our data and this was actually for me before meaningful use that we were thinking about getting folks on to electronic health records and digitizing their health information and being able to share that because if you think about interoperability the way we think about it today, right it has to do with digitized information and for decades we did not have that digitized information. Everything was locked up in a paper chart, you know sitting in a file cabinet or in somebody.


    The trunk of somebody’s car and until that information actually got to a place where you could share it electronically interoperability sort of didn’t jump to the Forefront. So I would say that once sort of meaningful use and the use of ehrs, you know, and with their benefits and flaws the data started to become available, right? And so where are we at in that Journey?


    The good thing is we’ve moved through meaningful use we’re now at promoting interoperability the federal government did intervene because the Horses weren’t really driving it fast enough to get us to that digitized. So once you get there, then you start to say alright, so, how are we doing and getting the information and I think you know there have been efforts. There are good National efforts that happen through you know Common well in Sequoia that have helped build some of the you know framework or the the backbone, but then there are these nodes and I think the problem now is that we still aren’t connected right?


    There are still all these Pockets of very strong interoperability that might live in a particular region or particular Health Service area, but that it’s that there’s still that sort of Disconnect. So I think we still have a ways to go in this journey, but I’m very hopeful given set of what I’ve seen of the the course of my history working in this area.


    So this next topic is sort of a if you had a magic wand kind of topic and let’s A let’s say it is in an area and a market in which is kind of Leading Edge and has had had a good bit of success. What what two systems would you pick to be fully interoperable first if you had a magic wand like what are the most critical ones?


    That’s interesting if I had a magic wand. Well, I guess there are a couple of things that structurally you’d have to figure out. The first is sort of HIPAA and our national consent model. Right and I’ve told a lot of people this that that HIPAA was built around a paper world or around the claims transactions at right it really didn’t Envision all this data sharing and so sometimes it actually precludes or creates sort of a barrier for us to think.


    More openly about interoperability. But right now I think just ubiquitous. You know, I always put the I’m a patient hat. Gee wouldn’t it be really nice if when I walked into my primary care is office that I didn’t have to fill out this paper chart thing, you know fill out the paper, you know, the clipboard right? No more clipboards because somehow somebody had at least sent me a link that said here.


    Can you fill this information or it make sure it’s up to date because I understand that they need that and then when I walk And knowing that the primary care physician of the specialist emceeing actually can get to the other information about me. I mean, I would say that sort of that in my you know, wildest dreams if that really happened and it happened consistently and it happened for every patient irrespective of where they thought care. That would be my magic wand that doesn’t start to address what I would call the other aspects of our health systems or Health Care delivery.


    No, which is the Post Acute Care and getting it into social services. But like let’s just get this care coordination foundational, you know, I walk in for my visit and you know, the fact that I had a mammogram done but it wasn’t at this Hospital actually sits in my primary care is inbox is be fabulous, right? Yeah.


    I’ve even from personal experience family members having long episodes of you know, very scary severe things happening it is It is a breath of fresh air when you walk into a provider, you’ve never been in before and magically they have all your Imaging or they have I your lab and it has to do with are you still within a certain system and how that systems doing that kind of stuff but it really is nice and I think it’s so nice because it’s not necessarily common, you know at least heretofore. So what have been like looking back, you know.


    All the different things you’ve done in this what are have been some of the successes in the end in your mind and the effort and it can be even simple things and maybe even the simpler the better particularly thinking for the non-technical listeners what it what have been some of the real some of the real progress made or maybe like an example of success and interoperability.


    So I would say that the first one in you know, for those who aren’t technical they probably still know what meaningful use is I would say digitizing electronic, you know, our electronic health records and digitizing a lot of the information that’s about patient a person a member has been foundational right? Because like I said you there is no interoperability without data to share it turns a vignette.


    and successes, you know there have been some really good communities right that have set up some amazing programs where they’ve really and again, maybe it’s within a system or its across systems when I was working in the beacons, you know, they figured out how like I was working up with the Mayo Clinic and they had figured out how to get information to school systems, right so that you’d actually know about an asthmatic student and if they had an asthma attack, School would have that information and actually be able to act on it and say yes, we know this. This child has asthma here are the things we know about them. Right? It’s like those things where that information is where you want it when you want it and a boundless, you know, it doesn’t have to sit within the walls of a particular organization. It is more about the journey that a patient is taking through time.


    So those are the kinds of things when I say Aha, this is you know, this is great progress that we’re seeing, you know, and even seeing some of the work happening between payers and providers now right where they’re breaking down some of the walls and starting to share information back and forth for the benefit of their Mutual, you know patient / member and I’m starting to see more of that which I find incredibly exciting. So some of the things that are being done through the DaVinci project, which is about sharing information between payers and provider.


    Nations using some more, you know modern versions of Standards like fire.


    So let’s kind of flip the question what have been some things that have not been successful that you thought maybe you should have that were that were kind of disappointing that it took so long or has been so intractable any examples come to mind their now again, you know, and I think this was something that you’ve probably heard before is sort of you know, our standards aren’t really standards from their sort of Frameworks and Often when you think you’re getting the information you need it’s actually missing, you know the information that you thought you’re going to get. So I think that that’s been always a great disappointment. Right? You’ve got this digitized information.


    But because Healthcare is such a cottage industry instead of everybody practices differently and every HR is a little different you just don’t get that Harmony that you’d like to see in the information that we’re trying to move and share, you know, and I can just just remember when we were first doing some of this, you know, and even now where you’ll get data and you’ll look at and you’ll say wow. This is woefully inadequate, you know, we’re missing information or information the wrong kind of information for what we expected.


    I think that’s sort of one of the barriers and I talked about this before so if you know, if you want to really see a patient’s whole information we have to think about how do we move information and give patients control and And right and allow them to share that information in a way that’s controllable yet allow it to flow to where it needs to go. Once they’ve done that. Right? Right that is that is frustrating around the standards for folks that have listened to the other episodes in this series. I mentioned that you know, 20 years ago. I was on a data standards group at Hopkins and it was just chaos.


    You had all these really really smart folks trying to figure out how do we even really set a standard? That’s that’s helpful and will deliver what we expect right? Like you’re talking about not getting what you expected even when we’re using this things. So let’s let’s put on kind of a different perspective hat and think from a provider perspective. Do you think you know based based on the interaction of the providers your knowledge of the market? Do you think that providers as a group?


    Believes it interoperability is key to improving outcomes or is there is there resistance has that changed in recent years? What is the provider take on interoperability?


    You know, I think it’s there’s a spectrum right of sort of you know adoption and sort of I don’t know. It’s skepticism or you know, maybe it’s you know fear doubt and uncertainty but when I was doing a lot of my implementation work with providers around not just implementing electronic health records, but also information sharing some of them were concerned, you know, sort of who would get to see the information. Is there a liability I would say on the other end of these in vet and and Bell can’t say the word.


    Those who vandalize sharing the information and really want to see happen and it’s like are just pushing and pushing to make it happen. And and you think about the burden right? So unfortunately, we have not made this easy for a lot of our providers to do what they need to do to get the information to where they need to it’s not built into their workflow. It’s not ubiquitous.


    It’s sort of not like I walk into the room and turn on a light switch and the light bulb comes on and everything’s happy. It’s like it’s almost a lot of work that they never ever anticipated that would happen for those who really Champion it though.


    They have started to see benefit like when I log, you know, when I’ve heard provider say when I actually pull information on a patient from you know, an Information Network and hir and I actually get a hit and I get rich – And it’s the right information. I actually can do really good things for that patient because I now know way more and have much more context. But again, I think our other problem Clay is that we just overload them with so much information. So now that we have all this digitized data, we’re almost in the opposite problem, right? There’s a lot of data there’s a lot of information but how do I make it specific and targeted for what a cardiologist would need?


    What a rheumatologist would need rather than just blasting them with all this information that may not be relevant or impactful for what they’re trying to accomplish, right? Yeah. It made me think some really good points in there. It made me think about I want to say a few years ago. We would start to see, you know, General news items that say providers now have to hire an FTE just to deal with their EHR, you know, the whole new staff load or whatever.


    I have a lot of providers have scribes. That’s it there, you know do the work of putting it into the EHR. My ophthalmologist has described it sits there and does tap tap tap, you know while she’s talking. Right? Right. And and that’s what we intended. Right? Well, I was in with a family member the other day in a very Specialist of visit with a specialist and incredible provider also could type really fast and the provider was sitting there.


    Are typed in the whole time and I you know, it’s almost like words per minute should be a new hatest metric or something but it is interesting. It’s not necessarily what certainly I’m sure some of this will see change over time.


    Like that’s probably expected by doctors that are you know, finishing, you know, Med students today probably expect that versus folks that finished up everything, you know, 20 years ago or whatever so Okay, let’s kind of move into the the vendor world of this and I I believe and I’ve kind of given my disclosure of my cynicism on some of this but you know, I believe interoperability edits and at its core involves very very large technology vendors and very very small technology vendors, you know, they need to be able to to be interoperable their systems and everything in between.


    Between and the example that I give you know, if we were to talk to some of the giant systems, you know, I think it’s only now that they are incentivized to change and maybe open up some of this more but how does that how does that work in all of this? You know, what is changing now that makes it make more business sense for you know an ethical Cerner and I have all the big ones.


    I mean though, you know we We all know kind of the giant groups there. So how does this what’s different now that makes this make more sense financially for the larger vendors. It makes total sense for a patient perspective for providers in which it’s not a burden for members, you know to have that Fuller picture, but how does it make more sense now than it has before for the larger vendors. I think that’s a tricky question. Right?


    Because what I think is that many of of the larger vendors have got to figure out how to morph their their business models right and make sort of figure out how do you continue to be successful while opening the doors and making sure that you’re interoperable, you know, and this goes this is true of any of them and I don’t think I think some of the new o&c rolls around sort of information blocking will help open those doors up, but you know, Every business has got to sort of reinvent themselves or rethink who they are and their when there are these big inflection points in time. So, you know, these new rules that are coming out I think will be a new inflection point for others for for vendors big and small to rethink. You know, what is our ecosystem. How do we all play? And how do we reinvent ourselves in this in this new market?


    And I think we’re all going to figure that out and and are trying to have our strategies but I would I’d say that open systems are ones that are interoperable and can do this in a good way or the ones that and and can make it ubiquitous right that that it’s actually it helps me do my job better if I’m a provider or even if I’m a patient or a patient advocate right? I can do my job better. Those are the ones that are going to win right, you know, the ones that continue to make it more and more difficult at some point it will preclude.


    Them from being a player in the market, right? I mean to some extent you know, this is the story we’re seeing in all Industries not just Healthcare. So I mean, this is the disruption story, right? All right, it is all about this disruption and there are a lot of big disruptors that are walking into arm into Healthcare now and saying we don’t know a lot about health care, but man we know a lot about disruption right?


    I think that when you’ve got the, you know, the Amazons and the Googles and the Microsoft stepping into this market and Saying you know, we’re going to figure this out. If you long time players can’t write and that’s something especially when you know, you look back at what happened in other Industries, right? I always think about you know you I used to go first rent, you know get you know, the plug-ins for my VCR and then I got remedies and you know now I just stream it. Well gee whatever happened a blockbuster they are gone. No, I think a lot of them are starting to look in Psych.


    I don’t want to be you know, Not part of this ecosystem. So I do I then adapt and change to be a partner in the ecosystem. Right?


    I think you’re I mean, I think we have hit as you say this inflection point and I think you know the new the new regs are probably riding a wave of other things to write their kind of probably responding as well as will create new things to respond to, you know, we’ve seen to I’m extent for the folks in the audience have been involved in my de and all the Mis stuff. This is part and parcel of all that as well, correct? Yeah, so one question in this get somewhat somewhat specific to today. It’s this idea of proprietary data. I’m interested to get different guest perspectives on this not be interested to get yours.


    There is some data that is actually the data itself is proprietary the example I give is petticoats, you know that’s owned by the AMA and that’s pretty important reference information for any, you know, Care Management or anything in the healthcare space and then another you know, some of the drug therapeutic classes are proprietary assets of I think Mark or somebody else and they’ll be other examples and those are just kind of the most discreet examples, but what will be in your view the impact of increased interoperability ability on retaining ownership of certain proprietary data. How will that work? How should we navigate that?


    Well, so ownership in terms of the you know coding systems or the licensing is one thing and again, I think as a system where probably as long as they’re they own those sort of legal rights, but the information they convey needs to be interoperable. Right? So your example of a CPT code. I still have to be able to share that for all kinds of different reasons right regardless of whether I need to sort of pay to own that.


    Library and update that library on a regular basis and maybe over time that will become obsolete too because we’ll come up with some yet new set of open standard for doing this because you know, look our standards continue to evolve and maybe as an industry as there is some convergence will see new standards emerge that are more open and not proprietary. But in the meantime sort of you still should be able to share it right?


    I mean nobody owns social determinants data, and we’re still trying to even You’re out. How do you share that? Right but to some extent that needs to be shareable and we need to figure out how to do that and create a maybe even a standard for that. Now will somebody owned that standard and make it proprietary? I hope not but let’s hope that sort of there’s some openness in how we as we evolve we think about it and create new systems and new paradigms that are more sort of accessible.


    That makes a lot of sense and I try it now now my mind is turning on and open standard for procedures and diagnose. It just seems so far it seems wonderful but it seems so far off, but it would be nice. So let’s move kind of a little bit to Patient perspective and talk about this idea.


    I’m highly oversimplifying but you know, one of the things is about information blocking and in some of the new rules and or proposed rules and you know at its core I believe the idea is Clay the patient ought to be able to go to almost any touch Point within the health care delivery system his PCP certainly his health plan the hospital maybe even Pharmacy that type of thing and say I would like to access, you know, my My full record my full health care record. I guess that’s the logical conclusion and and use case of interoperability from Member perspective. And I think we talked about this a little bit. You know, we’ve both seen kind of nice but uncommon examples of that where we see things are easily at least the providers have it but I think we’re talking about us being able to get it. How long do you think that’s before that’s a reality in you know, the majority of patient experiences.


    So I want to think about this in a segmented way to right.


    So let’s think about sort of the evolution of cell phones and cell phone use and adoption and then all of a sudden we went to, you know iPhones and Androids and apps right so that Evolution took time, but not Buddy wants to use it in that way. And if you think about our population, there are some use cases where consumer mediated exchange makes a lot of sense to me as a consumer having access how many consumers will actually take advantage of that because there are some as you know in some of our special populations that will never do that. Right? Should they be able to have access to it? Absolutely. Will they access it? That’s a different question. I think some of them would rather say, you know, hey provider, it’s really your your purview to make sure.


    Information gets to my next point of care because that’s sort of part of that care Continuum and I really shouldn’t have to I call it the data Sherpa I shouldn’t have to be your data Sherpa in this in this whole thing. But what you might find very funny and this is I’m dating myself but like 15 years ago. I was in a meeting up in Vermont and this heated fight broke out in this conference in this room.


    I was in between those that believed the huh hospitals and Health Systems believe that they owned the data it was their data and that they could decide and consumer Advocates who said wait a minute, you know, I’m the patient. This is about me and I mean they were shouting at each other and I was thinking wow, this is like a really hot topic and this was you know a while back but I think you know the way I’ve always thought about it is sort of, you know, the provider or whoever the caregiver is is creating with their sort of knowledge and expertise that have an assessment.


    That is part of their intellectual sort of property and we are creating that but they are then the stewards of that information but that information should be available to the patient. Right? My bank is my Steward, but it’s still my money. Right? Right, right.


    So so I think of it that way, but I think that for every Sort of patient consumer they have to decide. You know, how do I want my information share do I want my provider to mediate that and I’ll give consent or permission in a way. Maybe that’s what my app does right? My apps is yep.


    You can share that but I don’t need to have it all on my my phone or whatever my mobile app to see it because that’s not what I’m interested in because of who I am or my circumstances and there are people like me that you know log into six different portals just because I do want to See what the information is and I want to see if it’s accurate and I actually want to may be updated if I don’t think it’s accurate or ask questions about it. So, you know, we’re all different and it’s the question is should we the answer my mind is yes, but should we make everybody a data Sherpa? Maybe not right, right. Yeah, that’s you know, what I have said on this is for the most part.


    There’s going to be a small group of people that want to just out of the gate and as people like me data nerds. I want I want as much data as I can and certain I’m very interested in myself. And I want as much information I can have from a healthcare perspective, but that’s not going to be common and I think most people want push that button that says give me all that information until they need it right until they have a very sick child or they themselves are very sick and they are not successful.


    Not getting what they need from the healthcare system so it and they’re saying, you know things like they’re dealing with oh well have your doctor fax this over to that doctor or you know pay $12 for copies of your or whatever it is all that stuff. That’s kind of been the Legacy model and I think that’s when at some point in most people’s lives. They will want to have that easy button to push to get all that information because they will then I think a lot of it will be because maybe the system has failed them.


    So maybe if Operability is as successful as we think it will be a hope. It will be it will be less need for that button to be pushed on the member side. But you know, it’s funny because what I keep saying is if we really want to enable interoperability. We have to Everyday shut down to fax machines until they’re all and then all of a sudden people will magically figure out how to share information in a different way. That is so true. That is so true.


    That you know, that could be that could be a that could be the way we fix all this that could be knowing right practical. But if you think about you know, we’re so dependent still and think about a medical school student today who like don’t even have like, what is this fax? That’s right. What are the favorite East Side training me on how to send a fax right? That’s so true. Then that you know that maybe the simplest answer of all we need we need to push for that.


    So so still thinking about you know, I guess leavers around information, you know, the rules themselves. They it has some things around information blocking him at a high level. There’s Financial penalties and there’s what I call the shame list or a blacklist where organizations that are kind of found to be blocking information be put on this theoretical list.


    Do you think that will have a big impact either the financial penalties or this Blacklist thing or is that something you Is not not a big enforcement mechanism.


    So I think that depending on what the penalties are and how significant they are and the fact that not only their penalties but it actually would be published I think about HIPAA HIPAA the penalties for HIPAA breach used to be so marginal that like it wasn’t a big deal. But now they’re so significant that a HIPAA breach is actually a big Financial hit. I mean people, you know, there are organizations. There are cleaning up messes that are costing them, you know their organizations.


    Ian’s of dollars right over over a breach and that’s a hit to a bottom line that know, you know, CEO CFO wants to see so so my guess is depending on what those penalties look like that could be a deterrent because people certainly short up their privacy and their security their security systems. Right when the reach is the cost of a breach the shame thing.


    I’m not so sure of, you know, I know that when you show a group of providers that have how they are performing against one another Sure that that in a competitive way instead of makes them realize. Oh, I didn’t realize that that’s how I was how I was performing against my peers, but I don’t know if the large-scale shaming or you know, if your name is out maybe if your names out in the you know, Wall Street Journal New York Times maybe that will influence sort of buyer Behavior purchasing Behavior, but that takes a long time to change right if you’re highly invested in in a technology a platform.


    Turning that around and change making that changes. It’s not going to happen. You’d rather see your vendor remediate right then to leave them and maybe that’s under pressure that it’s going to create play is more pressure to remediate as opposed to I’m going to bail you out but the mean time and we talked about this previously, we’ve got some of these disruptors who say, you know, we’re not going to do that.


    We’re just going to come in and try to you know, do it a different way and that it might shake it up enough, right? Yeah, I think so. That’s some good. That’s some good some good insight there, right? So it may put buyers in a better negotiating position. And if I was one of these to your point about the disruptors, I would come in and say, you know what, we’re never going to show up on that list.


    And if we do I’ll give you back 80% of your contract that or something like that, you know, they’ll start to put things at risk so it could be It could be it could have a positive effect, but maybe not necessarily just in the direct punitive path, I guess so kind of last question on this and this is your brought up. If and this is kind of to me the letters like this obvious. I don’t know if the word is tension, but you know, an interoperability is all about making the data more available and although some you know, some friends of mine.


    Who who are all about HIPAA regs would disagree I think HIPAA is all about making the day less fat. I know it’s about protecting it and all that kind of stuff. But to me, it seems like interoperability and what most of us think of as the core mission of HIPAA are at odds with each other. And then how do you think about that? What is it? What’s your take on that?


    yeah, you know it’s interesting because you know, if you read into the o&c rule around information blocking instead of what some people sort of I hate to say it maybe hide behind HIPAA in order to not share information yet on the other hand HIPAA never said that explicitly hip is actually always said that if you have treatment payment operations if you’ve got a business associate agreement if for certain types of information your Your patient can sense you can share that information. So yeah, they’re at attention, but I think it’s an important tension. And again, I think other Industries have figured this out in tackled it banking, you know tackles this all the time, right? How do I make sure that if I am in you know South America I can get cash out of a cash machine now that doesn’t mean that it won’t get hijacked because that certainly has happened but there are protections that you can put in place.


    then that your stewards put in place on your behalf, and you actually have some control over that control those levers on how tight or loose you want those as an individual right don’t ever let me, you know use a credit card out of the country unless I physically phone call you versus the user machine learning and figure out when I’m going to travel out of the country and automatically, you know know that I can use it out of the country even though I don’t give you affirmative consent and so again, I think we have to be open about how do We think about these sort of the permission in a way that is more ubiquitous in the workflow of how a patient functions in a healthcare system not how a provider or other actor functions in the Healthcare System. Right? Right. So me signing a form at the beginning of a visit. Sometimes. It’s just not a helpful thing.


    Whereas if you had something, you know, simply you handed me a tablet and while I’m waiting it you said of tap through and you understand In a language and simplicity that makes sense to you how to do this and it perpetrates through the system, you know, the or you do it on your mobile app or whatever you did make it. It’s sort of easy for the patient to feel they have control but then make sure that the stewards of that information actually enact that control in a way that you’ve expressed it. Right, right. Yeah. I think you’re I think you’re right, isn’t it?


    An important tension it still comes back to what are we really doing in terms of helping out patient outcomes. I also think your point about you know, the way hit the has been sort of implemented certainly on in the workplace. Like I at least on the private sector is not necessarily how it’s written let alone intended. I can remember working years ago in large data Hub organizations.


    And you know, we used to call legal or the CSO the anti sales department. Okay. Anyway, this has been a really really good discussion a lot of insights.


    Is there anything before one of the thing I want to talk about because we didn’t really get to it and it is Is in the rules and that’s about fire and Open Standards. And again, I know that our standards aren’t perfect. But one of the things I actually find exciting and sort of where we at today that’s different is that we’re now using some of the sort of Open Standards and some of the technology of the internet right to try to conduct and transact Healthcare business.


    So the use of Fire and Fire resources and profiles The Argonaut project things that have actually started to Think about how do we open up and share data in a way that’s not stuck in the old mode of I have to have a sort of a physical. You know, I have to create a connection point to point right?


    I can now open it up and and firing apis are not going to solve all our problems at all use cases, but the fact that we are now moving to a place where we can actually think about, you know web services and Open Access and exposing only the information that That sort of is needed at the time. It’s needed to I think that that again it’s going to take time but I think that that’s also an important Game Changer and we see fire not just here in the US.


    We see it internationally that it’s really starting to take hold around the world in terms of a way to start thinking about, you know, creating the healthcare version of the, you know, internet economy right of that data sharing and so I didn’t mention that I think that’s an important component that sits in that role is being able to expose all kinds of different information using Fire and Fire resources, right? And I know it’s something that’s come up in a few few different the conversation. So I think probably what we’re going to want to do for the folks that are listening. We’re going to want to pull together a couple of good the most Medicaid example together a couple of good resources that we make sure we kind of link out to on each of this for everybody to kind of get smart real quick on on fire.


    Fire and the API pieces of this Linda. Thank you so much. I really appreciate you taking the time and thank you for being with us today. Yeah, thank you. Totally enjoyed a clay. Take care, and I look forward to listening to all these different podcasts that you’re recording. Excellent. Thank you. That’s it for this episode in our series on interoperability in healthcare. Thank you for listening. Don’t forget to check out more of our great content at mostly Medicaid.com including the issue.


    Reef and other interviews in our critical Medicaid conversation series and don’t forget to visit enter systems.com to learn more about our sponsor until next time. I’m clay Ferris.