Transcript

Dr. Peter Shook (Chief Health Officer):

Welcome everybody to another uh episode of our partner engage webinar series. Today we’re going to be talking about the inevitable necessity of national healthcare exchange or interoperability. Um before we get started today, I want to introduce Maline Crawford, our senior manager of marketing, uh for a few housekeeping items uh related to today’s webinar. Meline.

Maline Crawford (Host):

Thanks, Dr. Shek. And thank you everybody for joining us our live webinar today. Before we jump in, I’d like to review a few housekeeping items and this webinar will be recorded and we will share it at the end of the call and the slides with you. Uh, please make sure to use the chat for any comments as all webinar attendees will be muted. Um, and please don’t forget about the Q&A feature at the top of the webinar. We will review those questions at the end of the call. And without further ado, let me turn it back over to Dr. Shuck to get us started.

Dr. Peter Shook:

Thank you, Meline. We’ve got a format today where we’re going to open the conversation with about a 10-minute presentation just discussing the inevitable necessity of interoperability in healthcare and then we’ll open it up to a distinguished panel today. And joining me today um are uh Terresa Bell, the president and founder of uh NOTU and Matt Becker the VP of interoperability. So we look forward to them being part of the panel. uh at the end I have some questions for them that I think will be uh uh stim generate stimulating conversation and then we’ll invite your questions as we close out today’s webinar.

So without further ado I want to talk a little bit about why uh interoperability is essential in healthcare and why there is this uh inevitability of national exchange uh no matter what we’re uh what part of healthcare we’re in. If you think about the market forces that are driving health care now, whether it be healthc care’s uh the cost of healthare uh for uh the purchasers of healthcare and there are only really two purchasers of healthcare in the country. Uh they’re taxpayers through taxpayer dollars that fund CMS um uh and the department of defense uh veterans administration etc. um that also help to subsidize some of the ACA programs. Um then there are individuals who pay uh part of same taxpayers pay part of their own health care through uh cost sharing uh in their insurance plans and the portion of the deductible they pay uh through their employer. And then there are employers who pay the other part of health care uh costs in the country uh through the deduct uh through the uh uh premiums that they uh provide uh to their employees as benefits. So really only two people who purchase healthcare in the country. And whether when you’re a purchaser of healthcare, you’re looking for value. you’re looking to control the cost of health care. So if I think about the other key stakeholders outside of those who purchase healthare, we think about a payer who basically moves money from a purchaser of health care uh to a provider of health care and does so based upon standards um whether consensus based or evidence-based uh around what is acceptable care or what is acceptable and necessary treatment. We think about providers who are looking for um value out of health care. They’re looking for value in a number of different ways. providers um run businesses in healthcare uh and provide um uh uh services through businesses. Those businesses need to maintain a margin to have a mission. So they’re looking to reduce expenses and administrative burden that uh drive up uh costs uh to deliver care. They’re looking to improve decision making and clinical outcomes uh so that they can provide the best care for their patients. They’re looking to provide the best consumer most uh consumer experience and the most integrated consumer experience across the continuum. So they’re looking for value in a number of different ways. Patients are also looking for value in care, whether it be by cost, whether it be by outcomes, or whether it be by experience. So no matter how you slice it, all of the key stakeholders in health care are looking for value in some way. And the value they’re looking for is independent of whether in the valuebased relationship, valuebased uh contracting relationship or fee for service relationship. Matt, if you’ll advance to the next slide, we’ll talk through this a little bit.

I think it’s important for us to understand what I mean by value in healthcare. Um, and as I think about value in healthcare, we talked a little bit about this to the providers, payers, and purchasers and how they’re seeing value. If you go one more slide, Betty, we’ll talk about the value equation in healthcare. And the value equation in healthcare really is quality over cost. If I break that down a little bit further, it’s outcomes plus experience is what it equates to quality. And unit cost times utilization is what equates to cost in healthcare. Now we can improve value in health care by moving these levers all in sync or or in different ways individually. We can move more than one at a time or we can move one at a time. If I improve outcomes, experience, cost and utilization remain the same, I’ve still driven value in healthcare. If I decrease unnecessary utilization and waste in health care and everything else stays the same, I’ve still improved the value to those key stakeholders in healthcare. So the question is how does interoperability, how does the exchange of clinical information at the point of care for the purpose of treatment and other purposes of use actually improve these aspects of the value equation and deliver value to health care professionals to healthcare businesses and indeed the entire health care system. Matt, if you’d advance the slide one further, we can get into a little bit of that detail.

When I think about uh clinical outcomes as one of the measures of quality and I say okay how can interoperability improve clinical outcomes? Well, having the right information to the right person at the right time at the point of care improves the safe care environment. Simple example, an accurate allergy list and an accurate medication list. A complete allergy list, a complete medication list are incredibly foundational for a safe care environment. Matter of fact, I would say as a provider, it’s hard to say you have a safe care environment or that’s as safe as it should be without that information. That can be provided through interoperability, through exchange across a national framework. Optimal clinical decisions. If I don’t have the right information, I don’t necessarily have the right clinical decision. We providers worry all the time about AI and the fear of AI replacing us. AI as well as a provider, we’re only as good as the information we have. If I don’t have information, there are blind spots in in that information. I’m making assumptions to fill in those blind spots and those assumptions may or may not be correct. So, it’s important to have um information at the point of care for optimal clinical decision-making and improving outcomes. Other areas as well, but let’s talk about patient experience. I don’t know how a patient can have a good experience of care in a health system that is fragmented and that will by nature get more fragmented as we become more specialized and we drive care into the home. I can’t think of a more fragmented healthare system than every patient receiving specialized care in the home. It’s where we should go. It’s where healthcare is headed because it’s cheaper there. That’s what patients want. But it increases fragmentation and puts a premium on the net need for communication across different venues of care. So in order to knit together a fragmented healthcare ecosystem, information must flow across that ecosystem to create seamless coordination of care. Additionally, from a consumer experience, I used to work for a health system that had uh went through a branding change. And one of the important things um about that branding change was it said, “I get to know you better as a PA uh as a person so I can treat you better as a patient.” Think about the impact of knowing a patient from one venue of care to the next venue of care from one time period to another time period. the patient’s not reintroducing themselves to every health care provider who is a part of their health care continuum in uh an incredible enhancement to patient experience and then more timely access to care because I know them. I’m able to spend more time actually caring for that patient, making quicker decisions and getting them care more timely.

Talk about unit cost for a second. Now, we’re on the denominator of that value equation. We’re talking about unit cost. Unit cost is a very complex thing, but think about it as the price of a CT scan, the price of an office visit to a provider, the price of a hospital admission. There are a number of things that go into that and some of those are baked in in inefficiencies and lack of productivity of the providers because of the manual workflows that were locked in because we don’t have the information to us in a timely manner in a digital manner that we can easily process, easily digest and make quick uh quick decisions and changes in workflow. So creating efficiency allows us to potentially offer services at a lower cost um and be more competitive in ter terms of unit price. Utilization is critical here and this is a big one both for uh patients for providers and also for the purchasers of healthcare in terms of cost of care. I often have never asked for interoperability. I say often I’ve never asked for interoperability. I’ve never said hey uh uh Teresa not to give me interoperability off the shelf. I’ve asked for information. I’ve said, “I need to see the CT scan result from the emergency room done on Sunday when that patient presents to me on Tuesday with abdominal pain that’s unchanged and I need to figure out what the next step is.” If I don’t have that CT scan from the emergency room, I’m going to repeat the CT scan because now I have to make the decision for that patient and I need information in order to make that decision. So, it’s incredibly important because I would have cost the health care system another $800 for a CT scan that I didn’t need to do if I had access to the CT scan that was done over the weekend. Incredibly important in terms of decreasing waste and and making informed decisions. So really when you think about it, every component of the value equation for every stakeholder in healthcare can be positively impacted by the exchange of clinical information at the point of care for the purposes of treatment and additional purposes of use which are done through the national exchange frameworks. They’re the only thing that provides that comprehensive national total health care landscape u me mechanism of of of uh clinical information exchange. So if every stakeholder needs it, if every stakeholder derives value from it, there is a necessity that health care needs this national exchange clinical information at the point of care. So Matt, if you’ll move to the next uh next uh slide here as we kind of begin to wrap this up and get into some uh good dialogue with uh my colleagues here.

If I think about again the role that interoperability or the exchange of clinical information at the point of care plays in bringing value to health care. It’s eliminating waste and reducing unnecessary costs, reducing unnecessary administrative burden to providers, increasing productivity, lowering sprints, improving margins in healthcare businesses, improving clinical outcomes, and uh improving coordination of care and consumer experience for patients uh and providers. Next slide, Mandy.

So, where do we get our national uh uh health information exchange today? Um, we’ve got a couple of legacy national uh exchange frameworks in care, quality and commonwealth and direct trust. Um, and then we’ve got TEFA, which is the most recent iteration and we’ll talk a little bit about more uh more of that today. I’m sure there’s a lot of interest in where we are with TEFLA and uh I hope that uh we will get to that and share with you where we are and where we believe TEFA should go, where we think it is going um and where we hope to drive it. um uh as advocates um and participants uh in that framework. But you can think about this as kind of a natural evolution. There are a number of things that need to happen. You have to have a trust framework, rules of the road of how you share information that need to be compliant with uh law. Um and also recognize um uh the the evolution that healthcare has taken over the last number of years. Um uh and then you iterate on that once you have the framework in place. You have a technical framework that sits underneath it and then you iterate on it with learnings over time. And TEKA has been the most recent iteration of natural exchange national exchange frameworks. Um, and one that uh is unique in a couple different areas. Um, and we’ll talk about that in our panel discussion, but I’ll highlight them here. One in that it’s ubiquitous in its purposes of use. It’s stems all the way from treatment through individual access to payment and operations and public health. uh the first national exchange framework to robustly uh have that undertaking across the same exchange framework. Uh it’s unique in its public private partnership presently which is a critical uh of critical importance in terms of gaining momentum and understanding um of national uh information exchange as well as addressing some of the historical challenges that we’ve seen uh across uh the uh prior uh prior networks. There are other uh uniquenesses in TEFLA that we’ll get into in more detail in our discussion and I think the value of TEFA versus care quality all those things we can talk about a little bit our discussion uh but that’s currently where we get our national exchange uh uh frameworks uh the landscape now u Maddie last slide here as we talk about kind of the call to action what’s important for you guys to do um uh uh through our Q&A uh uh process.

So, I’m going to now inter introduce Teresa and Matt again into the conversation. Invite them into the conversation. And I have some questions that I kind of want to just go over with them a little bit. Um uh and ask them and ask them to kind of weigh in on um as we go uh as we go through here.

Matt and Tracer, can you hear me? Just to do a sound check really quick.

Matt Becker (VP of Interoperability):

Yes, we can hear you.

Dr. Peter Shook:

Perfect. Perfect. Hey, so Matt, I’m going to address this one to you just right off the gate here. We we’ve heard uh the crucial and I think we’ve established the necessity for clinical information exchange um and the national uh networks uh through the presentation here. Um I hope that we’ve gotten uh all agreed to the the need for that. The question I guess is uh from my perspective, how crucial sharing clinical information at the point of care um and what mindset shifts are necessary for policy makers around the landscape for national uh information exchange. Tracy, I’ve got the same question coming to you from a technology perspective. Um so I’ll just prep you in uh in advance for that.

Matt Becker:

Yeah, from a policy perspective and thank you Dr. From a policy perspective, I think it’s just making sure that we include everybody that is taking care and treating that patient in their entire life cycle as part of that discussion in terms of policy and making sure that all those folks have access. It’s inevitable that we need uh that care throughout the patient’s journey, whether that’s in the hospital, whether that’s an outpatient, whether that’s specialty, whether that’s long-term or home care. And one of the things that NOTU has fought for for uh over a decade now is its ability to make sure that across the continuum of care, every provider has access to that patient’s data when they need access to that data. And it’s it’s both the access and the timing that are critically important to making sure that uh patients are well taken care of no matter where they show up. these visits uh in the home, these visits at therapy uh typically have three to five minutes of prep time uh where folks need that information and need to know their patient immediately and that uh the from the policy perspective. We need to make sure that we continue to push in terms of making sure everybody’s included in that. Um we have gotten uh we’ve as an industry we have moved the needle forward a lot in there and making sure that emergency medical services providers uh therapy providers, home care providers, long-term care providers all have access to that information. And we’re going to continue to push in that direction so that every single treating uh person is able to access the full continuum of care of that patient’s record and be able to act on that appropriately at the right time.

Dr. Peter Shook:

Matt, thanks for that. I And guys, I’m going to shift in and Matt and Trac, this is probably no uh uh it’s not foreign to you guys. I’m going to shift into podcast mode here for a second and just get informal about some of these questions and have uh kind of additional dialogue with you. Matt, you rais a couple of good question, a couple of really good points that I want to make sure we summarize uh for folks uh to get the key takeaways. Number one, it’s really understanding that in order for national healthc care information exchange to have the impact that we think it should, the entire continuum has to be included in that exchange process. Meaning they have to be able to query networks and receive information, but they also have to participate in giving information back to the rest of the healthcare continuum. It’s a birectional uh uh process there.

Matt Becker:

Yeah. And it doesn’t work without that because it when we’re talking about uh especially long-term care therapy in the in the areas that we serve, um being able to deliver that information in a succinct way back to the hospital when the patient gets readmitted, back to the emergency department, back to a specialty care clinic is critical. that information across um long-term care and home care really informs those clinicians when the patient is in an emergency to make sure that they understand the full gamut of what the patient is going through and making sure that they can provide the right care at the right time. And without that, this just doesn’t work. uh you’re only getting pieces of that information if you are relying on the outpatient and hospital side of things and you don’t really understand how to give the patient the the full care that they need in an in a critical moment.

Dr. Peter Shook:

And I I I’m going to bring Trace into the conversation here in just a second. But I the the other piece as a correlary to that is therefore advocacy to mainstream health care and to policy makers about there is a continuum outside the hospital that is equally important to what has historically happened in the hospital both from a treatment perspective and a information perspective. um and that they all need to be committed and that the other side outside the hospital has not necessarily had the same robust support through federal programs, funding, etc. in order to get the technology where it needs to be to do it. Um and we need to continue to be a voice for those spaces so that national interoperability works for everybody and not just a few.

Matt Becker:

Yeah. Right. to dig into that a little bit further. The American Recovery Reinvestment Act that uh was under the Obama administration signed for electronic health records and uh eventually interoperability for major hospital systems and amulatory systems. Um long-term care, post-accute care, therapy, etc. got left out of that in terms of getting funding to actually produce this technology. And these are the folks that have some of the thinnest margins anyway. And so being able to deliver that type of data exchange to them uh in a birectional way at an efficient cost and method is critically important to making sure that we bridge that gap that Vara kind of produced unintentionally produced as part of meaningful use.

Dr. Peter Shook:

Wonderful. And Trace, I’m going to I’m going to bring in the conversation from a technology perspective. what mindset shifts need to be um made uh by technology vendors, by EHR vendors uh and partners as we seek to promugate national healthcare information exchange um through these frameworks.

Teresa Bell (President & Founder):

Yeah, I had um I was thinking about that as as you and Matt were working through some of the policy discussions. the the impact to especially I’ll say electronic health record vendors which um have always been in a tough position whether they’re certified or not um for different reasons have so much coming at them at any given moment. First of all, I’ll express the awareness of that uh because the the implication of interoperability as it sits today is is putting even more pressure on it. So um I will say the biggest mindset shift is going to go from a check the box mentality that hey you know we are now in TEFA or we are now doing this to really focus to adoption of interoperability in your product. And it sounds cliche but it it it is the most important thing. People will hear me publicly say this all the time. The two biggest issues to the adoption of interoperability nationwide have far less to do with technology have far meaning the technical framework itself or policy have to do with awareness and experience and it’s completely within the control starting with the major EHR vendors that sit out there. It is completely in the control of these EHR vendors to determine if interoperability will be adopted within their product. And I always say take the thought out of it. If a user or a provider has to make a decision to instantiate interoperability or they have to make a decision to go do something, they won’t go make that decision. It is a far bigger shift and change then build it into the workflow. That’s the constant conversation I’m having with our technology vendors, especially our EHR vendors, is it make it just make it just be an outcome. So, when I get a referral that comes in, why why are you asking me to go push the button to see if there’s more data? Why are you making me do that? Why not why not deliver it to me in a workflow that’s frictionless? Take the choice out of it for me. And I don’t mean that in a negative way. Just take the friction out and make interoperability come to life within my experience. And that is where we will see the biggest adoption and and and shift just a complete ground shift here where interoperability will just feel natural to people because it just becomes part of the experience that they have and we will start getting into the real tangibility. It’s it’s just been fascinating to watch over the last I’ll just put it to a decade even though I’ve been in it far longer than that. In the last decade, what we’ve continued to kind of swirl around as an industry is policy, no offense, Matt, technology and the technical framework. And the real rubber will meet the road when from the largest EHR vendors in what I’ll call traditional healthcare to everything that sits around the hospital start to absorb the mentality of what can I do to make this frictionless, not make it a choice. It just shows up in the product and it’s just part of core workflows. That will be the gamecher in healthcare for us healthcare will be that shift and it’s been a check the box and understandably so it’s been a check the box mentality before is like we did it yep we met you know MIP’s criteria we did this we did that but it’s not created behavior change and we really need to ponder why it’s not created behavior change and it’s for that very specific reason.

Dr. Peter Shook:

Wow. So much there. Uh so much rich content there. And I think from my perspective as a provider, if I’m thinking about a provider’s perspective and mindset change that needs to occur or healthcare entities mindset that needs to occur, uh we’ve got to get out of our learned helplessness. Um I let me add a couple things to the to the technology piece because I think one of the things you said I’m was translating into a provider perspective. some of our partners that are on the call that may have uh end users that they’re getting ready to roll things out to understanding what you’re saying about the technology mind uh mindset shift and how that translates to a provider. We in technology and I really didn’t realize this until I got into technology and stepped out of healthcare. We tend to think because it’s digital it’s better but my experience as a provider with electronic health record wasn’t that it was better. it was that more work was put on me, that I had to do more. That stuff that used to be done by other folks now fell to me. Um, and the promises of an electronic health record were better documentation led to better reimbursement, which led to better margins um and uh uh better access to information. Well, what happened is the better documentation led to a cluttered record with a bunch of information that I didn’t need um uh to make clinical decisions uh and made it harder to find. the reimbursement went up, but the margin went down because I had it to support all of the uh the investments related to the EHR and the upgrades and I was still left actually doing just as much administrative work but now it was digital. So if we’re going to have a a mind shift techn technology when you’re talking about friction, it’s not friction between technologies that needs to be removed. It actually means that if we’re going to have a technology solution like interoperability for providers to use that it’s got to be something that is less work and generates less noise. If you have something that’s equal work but creates additional noise, you have something that eliminates noise but creates more work, then you’ve really got to talk about the value proposition. So it it and and I think that’s one thing that that it we have to empower technology vendors with the information around workflows and clinical workflows to be able to have the conversations with those clinicians to be able to have conversations that they need to have uh with the people that are using a tool. From a provider perspective, we need to get out of our learned helplessness. Um we believe that everything is is put upon us to increase administrative burden and we need to get active and we need to say what information we need. We need to understand where we need it and we need to actually get engaged in the conversation by connecting and beginning to use it. If you want a voice, come to the table. You know, if you want if you want to eat something, come to the table. That’s where the service is. And and I think when we when we’re not using uh interoperability and we as providers are complaining about it and telling us all the things we need to fix uh and and so forth, uh we’re not actually um uh progressing. The other thing is we need to stop looking for perfection. We’ve been dealing for with imperfection as providers our whole careers. Whether you’re a healthcare entity, whether you’re an individual provider, and when I say provider, I don’t mean just doctors. I mean anybody in healthcare. Whether it’s a patient can’t remember their medications and we do our best to write it down. Whether it’s um I fat finger something when I entered into EHR and now the blood pressure is 160 over uh 80 as opposed to 130 over 80. um whatever it is, we’ve been dealing with inaccurate, incorrect data for years and doing pretty well with it. We can always do better, but if we can at least take the data we have and put it in the workflow for providers where they need it, that’s progress. Perfection will come and we can work on it in parallel. So providers need to get engaged. They need to get over their learned helplessness and they need to be active proponents of telling us how does this actually make it better for you? Um and how can we actually make the experience better for you? Anyway, okay, next question. Oh, go ahead, Trac. If you got

Teresa Bell:

I was going to say there’s I love the fact that you you and I y and yang on this one where you put the pressure on the providers and I put the pressure on the the technology vendors. It’s it’s appropriate. The the interesting time that we’re in right now um unlike even I’ll say 18 months ago is that we have we have all this data now accessible to technology vendors. The pressure on the technology vendors historically has been you have to figure out what to do, what data to pull, what’s important, where’s the workflow, and that equates to time and a lot of money and a lot of resource. the benefit now that AI is bringing in, you know, week over week, the changes in what we’re seeing in AI to drive a lot of that value to the edge and take a lot of burden on having to build it needs to absolutely be factored into the equation as we have made this huge amount of data available. Getting to the right data at the right time in the right workflow to take it from your slides. There are resources and technology that allow that to be done easier than it’s ever been done before. And we don’t want to lose sight of that. The two coming together, interoperability plus AI built into a built into a workflow and then whatever whatever the process may be is you’ve never had a time like this in healthcare to be able to make change and really create change. So I just want to I wanted you to have the last word on that subject.

Dr. Peter Shook:

No, no, no. I absolutely love it. I we we’ve often said it’s the most transformative thing that will happen to healthcare, at least in my lifetime. You may live longer than I, so there may be something else that comes along uh 10 years after I’m dead. But um but I I really do believe that for those reasons. Next question to both of you guys just real quickly. I know that we’ve talked a lot about and heard a lot. Hey guys, we we’ve already solved treatment. I mean treat treatment people are exchanging for treatment. It’s working. We’ve solved it. No problem at all. I think we touched on where I think you all’s perspective is uh uh on this, but let’s be clear about it. Have we solved it? and if so, what’s next? If not, why? Um, and what should we be focused on? I think you guys each touched on it a little bit. So, Matt, we’ll maybe first come to you and then and then uh Trace, come back to you as well.

Matt Becker:

Yeah, I think from the policy standpoint, we’ve definitely made huge huge strides in making sure it’s available to everyone. It’s not completely solved yet, for sure. um there are still areas that have an accessibility and it really not only comes down to the policy side but it just becomes the accessibility side. I think just what I was talking about earlier in terms of what was funded uh what folks have have had available to them in the past. Um it’s making sure to Teresa and Dr. Shik’s point that we not only give the these folks the access but give them that access in the right way and as simply as possible to make sure that they can incorporate that into their into their workflows. And I don’t think that has been 100% solved yet as kind of brought forward by the the issues that we’ve already kind of discussed. Um I think the next step there is not only making sure that every treatment provider has access to the right information at the right time, which is that point I will hammer home until I die probably. Um but at the same time making sure that those folks um have have the affordability and the access to in order to do that. um the ability of somebody a rural provider, a rural sniff or a rural uh rural uh uh telealth provider not being able to have access to these folks to take care of every patient in the United States and only take care of the patients who can afford the good technology is is not sustainable and it’s not going to be sustainable especially as we move forward um into making sure that these different points are just going to be more and more critical to patient care as our uh folks age into long-term and and skilled nursing facilities and things like that, it’s happening more and more with every passing year.

Dr. Peter Shook:

Yeah, absolutely. Terry, so your thoughts on that? Uh I know I I know you don’t have many strong thoughts about this just from very don’t have strong opinions.

Teresa Bell:

Uh absolutely not. We’re not even close. Um, and the reason I say that is just I have one litmus test and hopefully this is not offensive to anybody, but our fax volume went up in 2024 in US healthcare. So, we have not solved the problem because the majority of facts that happens happens between providers. And if I no offense to my fax friends, obviously we support fax within our within our ecosystem, but our fax volume went up. So clearly we have a gap in a problem statement and there’s multiple problem statements in in the treatment definition. To Matt’s point, do I think largely the policy for treatment and you know being has been defined? Yeah, I do. There’s some you know we have some rough edges there left to left to say. Uh but as we push into it, we have adoption. We have to get adoption across the ecosystem. Once we get adoption and we go back to the previous question that was asked, then we’re going to get into what does actual adoption look like? So there’s adoption and signing up for it, right? And then there’s usage. What does the usage look like? We’re going to find more and more friction points as we bring more and more of health care on. And we have kind of a ying and yang in healthcare. We have the referring party or we have the rendering parties in healthcare. And we have not solved those workflows. And so when those workflows aren’t solved, I don’t care if we have a a treatment definition out there. I don’t care if we have a great policy until we solve the actual problem we set out to. And we’re going to find a lot of things as we push into it. But what it takes is usage. We have to we have to get to usage to know what problems we need to continue to solve. And it’s going to be in workflows. It’s going to be in content. And that all comes back to let’s just get it going. To your point on not progress, not perfection, we have to get it going. We’ve got to get off the starting block in many parts of healthcare for providers to solve the treatment problem holistically. Some of the I I can guarantee you there’s issues we haven’t uncovered yet as it relates to broad treatment based exchange. So no, it’s not solved. And our lipmus test is the the amount of fax line that goes in healthcare today that’s not going between systems.

Dr. Peter Shook:

Yeah, I I boy I really agree with that. Yeah, go ahead, Matt, please. Sorry.

Matt Becker:

One point I I want to nail home there is th this idea of perfection being the enemy of great. And I think we’ve experienced this with many many issues both from a technical and policy perspective over time. And we can give examples until we’re blue in the face. But this idea that we’re preventing exchange because we’re being I wouldn’t say too careful but too uh narrow-minded in terms of what we share and when. uh for a particular treatment workflow when a provider is sitting there at the other end waiting for the data really needs to be one of those points we focus on and make sure that we remove the barriers to rather than trying to make everything perfect and each exchange be perfect in terms of uh all the notes are signed off on by three people and complete for example and things like that people just need the data and they need to act on the patients well

Teresa Bell:

to that Matt sorry Dr. that when we talk about treatment, we’re we’ve been narrowing our conversation to quer to query and TEA has two sides to the equation and we’re forgetting the other side of the equation. But treatment and push-based exchange are part of the technical framework for Tesca and those can’t that can’t get lost as we solve for query which is certainly the the more difficult of the two from the policy and privacy protections but pushbased exchange will also be solved in this equation because you need both you need both for treatment you have event driven workflows that initiate queries and in the reverse right and we have to solve for both so I want to make sure that the the framework is also called to light that we haven’t completed it. We haven’t completed the technical framework yet. Sorry, Dr. Sh.

Dr. Peter Shook:

No, no, no, no. There’s no no no. There’s no this is fantastic. I think we’re letting people in the living room um as we have these discussions internally a lot and I think it’s important. Um I think it’s good for them to be part of the discussion. The the the I I think I’m to in total agreement that I think there are two levels of adoption. There’s the policy and technical adoption which is not easy, but it’s easier than the usage adoption or end user adoption, right? getting it actually inculcated into the workflows. It’s it’s it’s one thing to have a an EHR vendor connected. It’s another to have an enduser actively using information exchange in their daily workflows. To the points we were talking about earlier and to me that’s the that’s the era we’re in now. And I think if when I think about treatment being solved in that statement, I think we have largely solved it from a policy and a technical connectivity issue, right? It can always be iterated on and always better. we we can do both sides from the query piece and from the push piece but we haven’t solved is the enduser adoption um of uh interoperability and that’s where the impact of interoperability is felt and that’s why we’ve talked for a long period of time and you hear me talk about this all the time internally and externally is moving from a technical conversation anymore about interoperability which was incredibly necessary not demonizing it was incredibly necessary to get to standards to get to frameworks um all that kind of stuff but because we have gotten to a certain point, we’ve got to now morph the conversation into an impact conversation, a value conversation so that actual providers can understand, hey, this isn’t something I need to buy off the shelf. This is something I should be demanding is integrated into every aspect of what I do. And I should be looking at ways to make that information make me better, uh, make my business better, make my uh, care delivery better and so forth. Because again, no doctor that I know has ever asked for interoperability. They said, “Can I see the CT scan? I need the PTI and R result. I need whatever it is um in order to care for that patient moving forward.” And that’s all present through exchange, but they don’t necessarily see it that way. And we’ve got to get to get to that point.

Next question, if I can. I know we’re uh getting close on time here. And Mattie, I hope you’ll keep us honest on time. we tend to uh uh go pretty uh pretty long but um okay we’ve had national exchange for a number of years as I alluded to with the historic uh national exchange frameworks care quality direct trust and so forth what’s different about TEFA why is it important I alluded to a couple things u but but uh maybe Tracer we’ll start with you on this one and Matt um uh come to you to to to round us out and keep us honest

Teresa Bell:

Well, I think it’s um there’s a number of of differences depending on the perspective you’re coming coming at it. But obviously a key one is the the public private participation uh that we’ve seen in in TEFLA which creates a different um engagement u from all parties involved and including the QENS the federal government being involved uh regulation coming behind it um all the way to participation I I and I also think there’s just in the industry for all the conversation we’ve been having there’s a lot of visibility to TECA unlike there’s been with some of the other national networks that we’ve seen. So visibility, participation, support uh for TUKA um because I think there’s just the kind of the inevitable feeling that everybody has that this is going to happen. So public private participation makes a significant difference in in how we’re pushing forward. Um and seeing regulation behind it has also I think been a one of many, you know, changes that we see with chapter that have been positive. Matt, love to get your perspective on the same question.

Matt Becker:

Yeah. And I’d like to touch on the regulation a little bit too because um this was part of the 21st century secures act. This was legislated by Congress to say you all are going to do something to create a national framework for data exchange. Ducket is that answer. One of the pieces that was pushed then and is pushed now by both parties is incredibly bipartisan issue is that patients have the right to own their own data and be able to do with it what they see fit. And one of the things that TUKA has in production today is this ability uh which what we call individual access services, but it really is this idea of patient control of their record to say, “Okay, I’m I’m Matt Becker. I know I’ve been seen at these six places. let me take control of my own record through an application of my choice to say, okay, I need to not only take care of my own record for my own sake, but be able to push that to the right folks as needed in the in the workflow to make sure that I am in control of my own healthcare journey. And that has been a big step for TESA. And what that step leads to, I think, um, and what, uh, both Congress and, um, the ONCASTP has pushed for is this idea of ubiquitous exchange and this idea that TUTA has the floor and they’re going to set that floor pretty high for how they’re going to make data exchange possible in the future. And it’s not going to be just a hospital transaction. It is going to be a more ubiquitous sharing of healthcare data across all folks in the sector that need that data to actually make health care in this country uh improve uh on an incremental basis rather than kind of keeping us in our own little silos which the other frameworks have tried to uh punch through but haven’t been able to. TEA already has in some regards uh especially with individual access but is promising to push through in the future as well.

Dr. Peter Shook:

Yeah, I’m going just take a minute to plug a couple things that we will have an upcoming webinar devoted to individual access that you guys will both be a part of that I think um would be very educational for folks. Um we think it’s far more transformative on its front and we’ve taken a lead position in in in solving for individual access for consumers. It’s interesting just and that that’s coming up uh uh in uh uh midappril and then uh we’ll also have a podcast out around individual access that y’all can listen to as well. I think um one one of the things that just on a kind of a funny note is I think about other parallel industries when I think about healthcare we changed the word we started using consumer uh uh to refer to a patient a number of years ago and it was an intentional change um in in in healthcare and it was an intentional change for a couple of reasons. One was to orient providers to something that you think and providers again ubiquitous entities, individuals to this concept of consumer experience or patient experience which we were you it sounds bizarre as a provider that I have to say we need to be focused on the consumer experience when that’s what we do is we deliver experiences to people every day through relationship um and through the care we deliver. But so that was one thing to get us focused on that and the other one was very important. When you think about the word patient, when you’re a patient, you go to a health care provider or healthcare entity and things are done to you. Decisions are made for you. Um, and you don’t know the cost of those uh uh uh decisions and procedures. Many times you don’t have the expertise or understanding. It’s very difficult to know uh what’s happening and you move from one place to another. You’re there’s no agency that you have as a patient um uh in that term and it invokes kind of those negative things. Consumer a consumer has agency. A consumer shopping for a TV can shop around transparently, see prices, go and touch it, um, uh, look at it, um, etc. before they buy and then they can choose to buy it from wherever they want, um, and choose to have it delivered however they want, uh, installed however they want, etc. They have agency and so there was a real intention in that regard. When I look at what the pharmaceutical companies did when they started to bypass their channels and go to um uh directly to consumer with their marketing and I as a provider was now squeezed between the pharmaceutical companies coming into my office to represent new drugs uh and new services and the consumers who had read about that information and coming and asking me about it. individual access has that potential for us um to really upset how we look at privacy, ownership of uh uh clinical data and so forth because now it’s I have a right to my information and now it’s much easier for me to get that um through this technological framework. So now I have empowered and given a consumer agency that will help improve their outcomes but will also drive a lot of other changes innovation in healthcare, how we share data and so forth. So so looking forward to that discussion.

Okay, another question here. About five more minutes and then we’ll open it up to the audience uh to to invite them in for questions um uh as as we go through it. So, if you got questions or have had comments, please be putting those in the chat. Maddie I uh uh I know is scrubbing the chat and we’ll uh bring those questions forward as we come here. Um last question from my perspective. Um when we say national exchange, we know that means sharing clinical information at the point of care, but what information is actually being exchanged? Can we talk about that a little bit? We hear that question a lot. Um, and maybe uh maybe Teresa, we can start with you on this one.

Teresa Bell:

Well, um, and and Matt’s going to be uh equally supportive of this conversation, but what the framework calls out TEFA in particular is the USCDI, right? And the USCDI um the complete data set being available and depending on your purpose of use, so let’s stick to treatment here. depending on and individual access quite quite honestly um the USCDI is is the complete record within that is generated within that electronic health record so that’s what’s being exchanged now how it’s being exchanged is primarily through um CCDA so continuing what we’ve seen in other national frameworks through the CCDA uh it’s a consumable understood format that can be exchanged between organizations and between systems um but we’ve also I think as a side note here because we represent an audience of EHR vendors in particular that have not been certified um and thus have not had the financial impetus or the financial compulsion or the ability to really get to structured data. We’ve encouraged those uh vendors to start their participation in the spirit of progress not perfection by making available PDFs in an unstructured CDA. And the reason we do that and people I get kind of the hairy eyeball every time what you know we need to get to structured data if we completely agree we need to take people down that path but isn’t the exchange of of unstructured data better than the facts machine better than seeing it come across a copper wire being able to exchange it electronically and do that through the framework. So we do encourage participation with the USCDI which can be represented both in an unstructured and a structured way um on these frameworks ultimately working towards getting to the US CDI in a structured codified format uh that’s available.

Matt Becker:

Yeah. And let me go a level deeper here. And I I just want to say that this the structured format, what it allows for is the the machine interpretable piece of what medication is a patient on, what allergy does the patient actually have to incorporate into clinical decision support and other things in the chart. What it doesn’t do um is take away from the actual information that the clinician sees. And whether that’s a PDF or whether that’s a CCDA, all you’re seeing in the CCDA is essentially the PDF version of the US of the that chart through uh the CCDA format which is called the narrative. And so whether you’re talking about the narrative or the PDF, you’re basically seeing a snapshot of the patient’s information in time, allergies, medications, problems, immunizations, everything you see on that CDI list in one snapshot, whether that happens to be in one technical format or another. And so when we talk about uh perfect being the the enemy of great, I think great means making sure that a clinician at a hospital can see the full patient summary in one glance, which is either that summer or that uh narrative or PDF. And then moving that step deeper, yes, we want to get to the point where that is machine interpretable for all those other aspects that we have there, but not getting to that first point is is critically harmful to patients. I think the other piece of that that I want to add on to Teresa is that this idea of of USDI again um the USDI version one that you’ll see that’s in effect today is much more geared towards uh an outpatient somewhat long-term care um and and hospital experience. Um right right now uh CMS is taking feedback on USCDI version 6 through April 14th. We will be commenting. Others on this call should take a look and be commenting what data elements are going to be critical for you in making sure that your patients receive care. And that is a constantly evolving standard that we we keep very close attention to. And we encourage you to do the same because that is the future of how we uh narrow down literally thousands of data elements that are on every patient’s chart to what is most needed and most interpretable by clinicians at the point of care when that data is exchanged. And certainly for current partners, we would encourage you to uh uh contact us if you have particular concerns or um uh have uh things that you want to make us aware of that we can double advocate for you as well. Well, if you’re not a current partner and want some uh uh understanding of that, please reach out to us and we’re happy to do that.

Dr. Peter Shook:

I I I’m going to I’m going to I’m the dumb doc on the call and you guys took it, you know, deep and deeper. I’m going to come back out I’m going to come back out from a 100 foot drone perspective and say, “Okay, I’m a homeare agency. I’m an internist. I’m a hospitalist. Can I get the labs um uh through uh National Health Exchange Frameworks? Can I get the imaging studies? Can I get the uh progress notes? Those types of things. What kind of information is exchanged there? Um I think I know the answer, but I want to just I want to just clear the air there for those who might be end users um or uh providers on the call. Mr. Becker,

Matt Becker:

I I don’t know that I have a a better response other than what I’ve already given to that. I think it’s Yes.

Dr. Peter Shook:

So, so, so let me let me Yes, you Yeah, you do. I want you to have a better response. I’m a provider. I want you to have a better response. I In other words, I you can get the lab data um uh through a CCDA if it’s in if it’s if it’s recorded and resulted into the system of record which you’re querying. You can get that lab data. I can’t get an imaging study, but I can get the narrative of that imaging study um through the the CTD uh framework and so forth. So I I I what I’m trying to get at is for people to understand that the general information that you would want you can get through a CCDA. There are some specialized circumstances that may need to be uh a different resources and different exchange methodologies, but there’s a a ton of valuable information that moves providers forward today through that CDA. Um, and then how the system of record that receives it chooses to ingest that information or present it to the provider is another uh wonderful opportunity as well. So that’s what I was kind of trying to get at from a provider.

Matt Becker:

I think I get what you’re saying and thank you for that. That’s that’s helpful.

Dr. Peter Shook:

I think again sometimes I talk in riddles. Sometimes I talk in riddles. Hey comment for as we wrap up our formal presentation and panel and open it up to the team. I do want a little call to action here because I I think we went through the presentation. There were four main personas in healthcare. Um, and everybody on this call is one of those personas for sure. You’re a purchaser of healthcare and you’re a patient. If you’re a technology vendor, you’re serving providers uh of healthcare. Um, and you may be a provider yourself if you’re an enduser. The reality of it is what do you need to do hearing all of this? What do you need to do differently tomorrow? What can you do differently tomorrow? What should you do differently tomorrow hearing this information? Um, and let’s say you’re moved by the information and believe that it’s inevitable, you believe there’s value there, etc. If you’re a patient, you ask every provider, are you able to see my old records? Are you able to get my records and see what other providers have provided for me? You should want to understand that because it’s tantamount to a safe and foundational to a safe care environment. So, you want to know that and be empowered to ask that question. If they’re not, don’t be alarmed. Many might be, but they don’t know that they are. Uh, and you may have actually unlocked an opportunity for them to learn how to use their own system differently. If you’re a provider, you should be asking your technology vendor, “What are my capabilities in relationship to National Health Information Exchange? Do I have the ability to query records? How does it work? How can you make it as simple for me as possible to Trace’s point about removing friction? Why do I have to go through a thought process that when I’m seeing a new patient, I have to click a button to get their new records, why aren’t new records query at the point of registration u when we’ve created a record for that patient and it’s automatically there for the provider to review before they go in to the office and now it’s part of my normal workflow to take a look at a couple of the key documents etc. So providers need to ask your um technology uh vendors for that. If you’re a purchaser of healthcare, an employer on the call, which all of us work for employers, and many of us um uh are employers, um you should be working with your payers to build networks of providers that are connected because connected networks of providers sharing clinical information at the point of care deliver better care, more cost-effective care, and generally run a more efficient, effective business. So it’s incredibly incredibly important um uh from those perspectives. So no matter what persona you identify with or what role you play in healthcare, you can take action today to begin the process of getting connected, which as we’ve all talked about is really important in terms of adoption um and aiding the progress to perfection uh journey as we move through it. So let’s open it up for questions from the the group. U Maddie, I’m going to let you kind of MC the questions as they come through.

Maline Crawford (Host):

Okay, great. Um, we have one in the Q&A chat. So, TUFKA is a big step toward national exchange. How are we ensuring it actually reflects post-accute needs like home health and hospice and not just acute care workflows? What’s being done to eliminate red tape so vendors can comply and ultimately provide care on?

Dr. Peter Shook:

That’s a great question. I’m gonna uh jump it right to Matt Becker because I think he touched on that in one of the answers to the original questions. But Matt, if you want to expound on the advocacy efforts, and it might be good to revisit a little bit of the history around treatment and expanded use cases and treatment, the work that was done kind of initially uh in the TEKA frameworks.

Matt Becker:

Yeah. And I I think we’ll go back to the original form of formation of some of these points of point exchanges and care quality too of this idea that kind of hospital systems were the ones that got together and kind of decided on these rules. And we’ve been pushing um from a long-term care, postcute care, and every other sector of health care to make sure that um home health, hospice, all these other pieces are considered in not only what is defined as treatment, but in the workflows as well. Um, and so the pieces that I’ve touched on like USCDI, like um, the data availability at the time that it’s registered instead of when folks decide to release it, there are all factors that we’ve overtaken in policy to make sure that not only are home health, hospice, long-term care facilities considered, but really a strong part of that workflow. um because those kind of details are extremely important to make sure that we’re not just operating in an acute centered um acute centered field and it’s something that we’ve done for years and years and are continuing to make it process progress on and made a ton of progress in over the years.

Dr. Peter Shook:

Trace I know long enough I know your body language well enough. Go ahead.

Teresa Bell:

I’m gonna I’m gonna flip the question a bit. Um it’s not even my questions. I don’t know if I could do that.

Dr. Peter Shook:

You think you don’t have the right to do that.

Teresa Bell:

Um I would to make sure to Matt’s point there’s been a lot of advocacy done at the national level but to make sure that postacute let’s broaden it from home health hospice let’s go to therapies let’s go to everything that sits around the hospital that your needs are going to be taken care of participate get on the network show evidence of issues being existing and I’m telling you there will be issues in workflow there’ll be issues in content get active on the networks, your voices will become the loudest when you’re actually participating. We are advocating all day long as an organization. I think everybody knows that that’s on this call. But the loudest voice we can have is participation from the providers in that space and the technology vendors actually being live and active on those networks because it will give you the most influence to change anything and make sure the trajectory goes in the right way.

Dr. Peter Shook:

I really appreciate that call out. I also think that um there’s a birectional part of advocacy where we actually uh get wind of things and bring them to this community and our partners early so that they can be thinking about things that may indeed impact them and have an opportunity to weigh in. Matt was talking about the USCDI earlier. Um when treatment definition TECA was changing, we put out uh surveys related to that to try and do the best we can to inform and get information from you to take back in those advocacy efforts. Uh Maddie, next question. We’ve got about a couple minutes left. Maybe time for one more question.

Maline Crawford (Host):

Yeah. Um, any thoughts slashexperience on getting the new mindset of providers for using the available interoperability technology by having new workflows part of medical education and residencies.

Dr. Peter Shook:

Oh yeah, boy. That is a that’s a topic of conversation that probably deserves its own uh its own podcast or or uh hour conversation. But I think there is I I think this is true in a lot of aspects of healthcare. I think that the the the health care system is a result of two things. It’s a result of the business systems in which we operate, meaning the the the way we’re reimbursed and the payer systems, and it’s a result of the training of the individuals that fit into that system. Um and so whether it’s value based care um whether it’s um uh new uh care models or whether it is uh information exchange it’s something that should be taught u uh very early um the importance of it in residency. Now to that I’ll take a little counterpoint to that too. If we get to a point where interoperability is frictionless and it’s just happening because the information is there I’m not sure I want anybody to care about how they got the information. Um uh to be honest with you, I don’t I I’m not sure I want um uh residents, interns, uh uh providers thinking about, hey, I’ve got to do this and this and this. Are we connected here, here, and there? I’m dreaming over the next 5 to 10 years of a system where national exchange is happening. The information is being integrated and presented to providers in such a way that it’s almost automated and they don’t look at it um as something they have to do. Um, it’s what do I do with the information I get, not how do I get the information and where do I get it from? So, with that, Mattie, I’ll turn it back over to you. Um, I’m certain that was an unsatisfactory answer, but I I um I’ll turn it back over to you, Mattie, to close us out with any uh uh housekeeping comments, and I want to thank everybody uh first Matt and Tracer for uh your time today and being on the uh webinar, and then for everybody who attended, thank you very much. Please, as always, reach out to us if you have any questions that were unanswered and we would be more than happy to uh to answer those questions for you.

Maline Crawford (Host):

Thanks, Dr. Chuck. I would not be doing my job as a marketing manager if I didn’t plug our next two events coming up. Um so, we have as Dr. Chuck mention mentioned a webinar on April 17th um on IAS that I just dropped in the chat. So, you can all register today. Um and then we have weekly podcasts that we drop every week. So, as Dr. also mentioned um Teresa and Matt will be recording a new podcast this week on IAS. So uh be sure to follow along with us so you can get all the updates and stay in loop. Um we will share the recording and the um slides with you guys after this call. So thanks for joining us today everybody.