Health 3.0 promises improved access to health related information, facilitate patient self-management and preventive care as well as enhanced health professional expertise. If implemented well, it can have a significant impact on healthcare delivery, patient decision making, and reimbursements to the healthcare providers. How are healthcare systems and other related partners getting ready for Health 3.0?

Contributor

• • Paul Wilder, Chief Information Officer, New York eHealth Collaborative

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Transcript

Sanjog Aul [00:00:27]:

Hello, and welcome to CIO Talk Radio. To learn more about the show, please visit www.ciotalkradio.com, and then join the conversation with us today, using #health care, and, also CTR live. That is #CTR live. Our topic for today’s show is Getting Ready For Health 3.0, and our guest for today’s show is Paul Wilder, who’s the chief information officer with New York eHealth Collaborative. How are you, Paul? I’m doing great. Thank you very much. So, business, the way it is running out there in health care, as we all understand, is looking for ways to connect all the different providers and, physicians and everybody else and that plumbing, if you will, is being created. However, it seems like we have not done enough yet. At the same time, now we are saying, let’s make this customer centric, which is patient centric, and try to create value by having them use this data in such a way so that they are becoming more informed and knowledgeable about what’s happening to them and become proactive with taking care of their health, and even when they’re coming to the health care facility, the organization that whole health care organization can align themselves to a better, health for them. Now all of this that I just mentioned is my interpretation. So Paul, coming to you when you know that Health 2.0 is the new thing out there where we are also saying, okay, what happened to Health 2.0? Are we done? What’s your thought here?

Paul Wilder [00:02:12]:

Yes. It’s a great point. I was asking around some of my staff saying, hey, I need opinions on how 3.0, I’m going to be having a little chat on it, and my first statement to them was, of course, I thought we’re still building 2.0. So what do you think of 3.0? And, actually, so let me just step back and say, what does 3.0 kind of mean to me? And I think it can mean multiple things, and, people can go on the web right now and try and find out and Google it and find out how to 3.0 or Bing it, whatever you want to use, and you’ll get different definitions, and I actually subscribe to two of them that collide together. One is, and you said patient centric, I think, 3.0 is contemplating a patient driven health care environment, which I think is different than patient centric. I think we’re trying to build patient centric right now, where you have the gatekeeper, primary care provider or a hospital system or an ACO, whatever it is that’s trying to coordinate care, and they’re trying to put the patient at the center to say, let’s make sure the data about that unit when we’re looking at that unit is properly utilized and that we’re coordinating their care, and I think that’s great, but 3.0, I believe, takes that a step further and says, how do you get the patient to drive their health care, not be the thing that is being managed by other people? And I think that’s a fundamental difference in the way we think of a person, and I think there’s many analogies in other industries you could think about. The second part of 3.0, goes along with Web 3.0 and the idea of a semantic web and, really, for lack of jargon, a web that has a lot of things tagged so we can search and integrate data across disparate data sources, and I think they’re both viable components and very important components of 3.0, but at times, you have to think about which one you’re actually trying to solve because you mentioned getting data to patients. Well, getting patients engaged in their health care and driving it doesn’t necessarily have to be highly data specific. A classic example is, patients like, patients like me, a great website, we would argue is a 3.0 type of website. It’s people with disease states that are similar coming together to try and socially manage each other better, and that doesn’t require a lot of data. That requires good people who collaborate, share ideas, thoughts, quality scores, everything between themselves without it being truly data centric. They’re not passing clinical records to each other. They’re asking questions and asking for advice and support.

Sanjog Aul [00:04:51]:

Now with all of this, when you mentioned patient driven, do you think if we ourselves who are say in the healthcare industry and working on these patients and helping them get better, we ourselves are struggling to see what would really, move the needle, and then we are saying these patients who who are essentially the recipient of the service, if they start saying I want this and I want that and one is the practicality of all the things that they would like to get, another is to expect them to come up with ideas to solve as if like we are ourselves giving up or are helpless. Is that, the challenge we’re going to face?

Paul Wilder [00:05:34]:

Well, I think it’s one of the challenges for sure. Let me say there’s analogies in other industries and I think there’s an important one to think about. We think about banking a lot because banking has a lot of transactions that go back and forth and there happened to be a large advantage, sorry, against healthcare in that the transaction sets that go across are very, very simple. It’s a very defined set of fields. It’s a CUSIP, an amount, an account, an error code, very simple amount of data. Lots of things happen with it after that, but the transaction in between is very simple, and in healthcare, unfortunately, the data transaction, when we move to digital between one system to another, is very complex, but I think there’s an important lesson that we can get from the banking side that is not that has nothing to do with data. It has to do with where do you meet your customer, and, if you think about the introduction of the ATM, the first ATM machines, the feedback from the consumer base was pretty negative, right? It was, they’re getting rid of the bank teller and this is horrible. Why are they making me do their job? This is now a teller machine. I have to interact with it. I don’t see a human, and now, most people that interact with an ATM machine would say, thank goodness it exists. I have this thing that’s reliable. It’s there. The line is short. I don’t have a 50 person common feeder line, and what’s done is it made the common feeder line that’s at the bank today much, much more efficient, much more efficient. When I go to the bank and I want to, say, get a mortgage or I want to open a new account, there’s two or three people in front of me and the service I get is very specialized. I’m seeing the right type of person in the bank, not a teller that does generalist stuff that I then have to go see a specialist, and so if we think about it in health care, if you can shift some of the administrative stuff towards the user of the service, they might use it better and surprise you. And even in this case, when we talk about the ATM, the consumer was the one that was up in arms. Saying, Lord. This is I’m not gonna get the right service. Now you’re like, can you put more stuff in that device? Can I get my mortgage loan in there and press a button? Some give you stamps. They’re looking for more service at ATM, not less, because people wanna get their service where they are, not where we want them to be, and health care, digitizing and allowing web based access, mobile access, all the different points that a patient wants to use, puts at least the administrative level of health care closer to where the patient is. It doesn’t require a disruptive relationship. It’s disruptive to go to health care. I use my kids as an example because you really don’t, in my opinion, start choosing health care until you start choosing it for someone that can’t choose it for themselves. I find that when I pick a primary care provider, I start out by looking for who’s the closest to my house or who’s closest to my office, and then when you pick for your child, you pick very different attributes. You start looking at how’s the paint? Is it peeling off the wall? How is their communication skills? Do they separate well in sick rooms? All these workflow things you never cared about as a 25 year old well person, and now you’re thinking, okay, I have this other being I have to take care of and make sure it’s doing really well, and you ask all the questions. When we get data to patients, they will ask a lot of questions, and we should be prepared to answer them, not hiding the data because we’re afraid that they’re going to ask questions. It’s the wrong approach to hide from the releasing and freeing the data to the patient.

Sanjog Aul [00:09:12]:

So what all you just mentioned, is that the scope of what 3.0 is gonna bring? Because it’s a small incremental shift, which essentially says that just be more transparent with the patient throughout the curing life cycle, if you will, if there was a phrase like that.

Paul Wilder [00:09:33]:

Yeah. So, you know, again, 3.0 could mean many things to it depends almost how geeky you are, and if you’re really down the weeds at a geek level, you want to talk about the tagging, the RDF, the semantic web, all these, what the outside world thinks are acronyms that make no sense, which are very important for the sharing of data and the coordination of data, but at a fundamental level, the 3.0 that are experienced with a patient, may not look earth shattering, right? In fact, when we get the data to them, I think as health care side of the world, we want to see what they do with it because we don’t really know, but we know that data is very powerful and that data in the right hands and, in this case, the patient has the right to their data, so it must be the right hands. It’s better than it going to people they don’t know are looking at their stuff. They will probably do amazing things with it. Now what amazing things? They don’t know yet either, and they’re looking for apps to help them, and that makes sense. They’re gonna go to their app store, whether whatever phone or mobile device they have, and look for ways to look at this data and siphon off pieces of it. If you’re a chronic care for diabetes, there are only certain measures you need to know about to make sure you’re in control and to communicate back to your provider, and I think that’s, to me, one of the most significant parts of 3.0 is if the lexicon, the digital lexicon in ontology and the tagging is more consistent, we can actually take patient generated data and give it back to providers. Because that’s a treasure trove of daily life data that people want to share if it’s shareable. Now, on the flip side, the providers need better tools to sift through that, otherwise it’s data overload. My Fitbit spits out a lot of data that my doctor can now know that I’m jogging 5 miles, walking 3 miles a day, and he says, so what? What do I do with that? But for certain chronic care and certain conditions, it is good to get that feedback back. So you see in Web 3.0, at the very, very edge, at the bottom of a lot of diagrams, a lot of reports, you’ll see mHealth. mHealth becomes a significant portion of it and the collection of data at the point of care, and the point of care for a patient is wherever they are.

Sanjog Aul [00:11:57]:

So this is interesting where we want that data and that would actually help these patients themselves and, that’s why you want them to adopt it and they want you want them to come on board. Do you think it is a little premature for our Health 3.0 to kick in? Number 1, it’s not pervasive. So you do not have literally all types of data that you would need from for a patient to actually start giving you. Do we have policies which actually will allow the already you know, we are already concerned about privacy. Yep, and then you are talking about literally every every breath you take is to be recorded and sent back, and that could have another level of issues that could crop up or lawsuits could come up for whatever reason, and the third is, as you mentioned, are we truly ready to take all guzzle all this data in, but still not if we are not able to do anything meaningful, then all the plumbing and every every other effort that you’re gonna put in, it’s gonna be money spent, but not as much value created.

Paul Wilder [00:13:12]:

Well, that’s a very good point, and I actually do think that the concept of 3.0 on the especially on the geeky side is a little ahead of itself. The idea that more tagging integration of where data is coming from and we’re not talking necessarily about specific data about a person. In some respects, it’s also data about a drug that links to collateral, which links to the source. In many ways, it’s organizing the web for health care, and then giving those tools to patients so they can better research the data they’re getting from their provider. Health 2.0 was making sure that we digitize ourselves and start the education material process, right, that it was more passive. It was post stuff, expect people to read it, and now we want to know that they’re studying it, that they understand it and that they’re using it, and I do agree that your point is very valid that we are I’m not sure if you’re putting the cart before the horse, but in some respects, we are ahead of ourselves in designing 3.0. Now that doesn’t mean we shouldn’t do it though. Every was it every journey begins with a step, and one thing you learn from database technologies, which a lot of your listeners are probably well aware of, is if you don’t structure something upfront and at least collect the data, you will not have it to analyze later, and this type of data, while it seems voluminous, can be pared down and isn’t that much. It fits on your phone, and you don’t have to release it all. It fits on your smartphone. You don’t have to release it all every time, but you want to start collecting it. Healthcare has a bias towards large studies. If you want to test a clinical delivery or a clinical pathway decision, you have to do a study for it, and some of these things are longitudinal for decades. There’s a heart study in the Midwest that they started with kids at 5 years old and said, let’s track them for the next 30 years and see if children that are more obese than they’re 5 are likely to have cardiac problems when they’re 35, and that seems like an obvious conclusion. You see, of course, if an earlier obese person is likely to be a later obese person and we do know these are linked to cardiac problems. So yes, but to prove that, we had to do a large study. If we have data that we’re collecting that we can then look at through a lens retrospectively, we can do that study real time and say, hey, I have a question and let’s see what the data gives me as an answer. It’s not necessarily all have to be Watson like where I say, tell me something I don’t know. There’s a lot of questions that if we don’t start collecting data, we won’t be able to ask it, and that’s going to be a shame.

Sanjog Aul [00:15:59]:

Let’s take a quick break, listeners. We’ll be right back, and so we spoke about the reason why it exists and the way it can be utilized effectively. Now as you very rightly mentioned, every journey begins with the step. So let’s talk about the first steps towards health 3.0. What steps are we taking? What was our, thought process before we take or have taken the first step? Where is this journey beginning? What’s the foundation are we are we building in order for us to be eventually successful with this? Please take your listeners. We’ll be

Paul Wilder [00:16:40]:

right

Speaker 0 [00:16:41]:

back. HP is proud to sponsor this program. Find out how the HP as a service solution for SAP HANA can help you gain instant impactful business results without capital investment by logging on to hp.com. Transform information into intelligence and a competitive advantage with a full spectrum of SAP HANA products and services from HP, a global SAP hosting partner.

Speaker 0 [00:17:12]:

Bosch Software Innovations is proud to sponsor this program. Visit www.bosch-si.com/connectedmanufacturing to find out how Bosch can help you improve your operational performance and become a manufacturing industry leader in a connected world. Change the way you predict, manage, and produce outcomes. Bosch connected manufacturing.

Speaker 0 [00:17:41]:

HP is proud to sponsor this program. Tap into our expertise, innovation, and services to bring your most important workloads to the cloud. You are listening to CIO Talk Radio with Sanjog Al. To learn more about the show, please visit www.ciotalkradio.com. If you have a question or comment, call toll free at +1 (866) 472-5790. That number again is +1 (866) 472-5790. Now back to the show. Here’s Sanjog Al.

Sanjog Aul [00:18:26]:

Welcome back. So what are the first steps, Paul, that you feel are to be taken in order for it to be a good foundation and compare that or contrast that to the ones that we are indeed taking?

Paul Wilder [00:18:40]:

Well, I think the first step is internal. It’s a human step, which is deciding to move forward. Healthcare has momentum towards not moving. A classic example of technology disruption was the stethoscope, which was in the 1800s, and it took over 70 years for it to get adopted, because doctors believe that, putting their ear to someone’s chest was just as effective, and they could hear the thoracic sound. So why should I adopt this other newfangled technology called the stethoscope? And now we’re seeing the stethoscope potentially upended by very cheap portable ultrasounds, which give even more data with the same care event. So for health care, it starts with the willingness to move, the desire to move and desire to change. Now, in this case, what’s a little bit different is we actually don’t quite know what the destination is. There’s a promise out there right now about if we digitize health care, we will be able to solve some of health care’s problems, and unfortunately, that’s about the level of detail that we stated it to the general consumer. In this case, when I’m talking to the consumer, I’m talking to the doctor, not the patient, which is the next consumer after that. The purchaser of the electronic health record, you know, has been told that if I get this thing, my life will be better, and unfortunately, their first experience is it’s not. There is a learning curve, and then we have to move. So the first step is to move. Now, the good news is, through many policy and funding mechanisms, particularly from CMS, Medicare and Medicaid, they incented providers to get EHRs and to start the digitization process, and that’s very, very significant because we finally got past the hurdle of why would I want to digitize, I already have this thing called paper and it’s perfectly sufficient for what I do as a practice to it’s an inevitability that you will digitize. No practice starting today, brand new practice, will start with a paper record. It doesn’t make any sense. They’re going to start with an electronic record, and to me, this is very much the equivalent to the way we think about email. If you’re a CIO back in the late 90s, you were having to justify to your board or to management why to adopt email because it actually cost money and it seemed disruptive. You had paper and you had couriers and you had fax machines, and now it’s not a question of email, it’s a question of cloud, local, Gmail, Outlook, Exchange. You’re making questions about the technology and direct implementation, not about should I. So we’ve taken the first good step, which is let’s get ourselves off the mindset that paper is the way to start. Digital is definitely the way to start and to get things moving, and that’s Web 2.0 is let’s move from a paper to a digital world. 3.0 builds on 2.0 and says, okay, now that you’ve started to structure this data or at least collect it. I guess that’s the better term. You’ve collected the data. Now we need to structure it better. Now because the reality is a lot of this digital data is in text blobs. There’s still a fair amount of dictation and transcription that’s not codified, and for safety reasons, we need to get that coded so that you can see the complex, the contraindications and share better.

Sanjog Aul [00:22:13]:

Now with all the different flavors that you mentioned, the

Paul Wilder [00:22:16]:

kind of data that we are collecting or we have

Sanjog Aul [00:22:16]:

collected so far, even when you have collected so far, even when you speak about the blobs of data, etcetera, that had already started before health 3.0 actually was even spoken about. So are we trying to say that, okay, data collection, we started in the beginning, but we did not know what should we do with it or what could we do with it, and now health 3.0 is more of an initiative to say, to encourage the end users or the patients to even share more, and then while we on our side come up with an engine which will make sense of all of that, which is is the semantic web you mentioned?

Paul Wilder [00:22:51]:

Yeah. So I what I believe is we’re moving from a b to b conversation to a b to b to c conversation. So, we were talking in terms of the convincing to move to digital was to convince the providers to move. Interestingly enough, we didn’t need to convince the consumers. They thought health care was already further along. If you went to a consumer, a patient, and said, can my doctor share data with another provider, and asked them this question three or four years ago, they kind of assumed that was already working, right? So when you talk about policy blocks and what do we need to do to protect the data and make sure it’s shared appropriately, a fair amount of consumers thought it already was, because their interaction with the business side of health care, was more electronic, and that’d be the insurance and payer side. You get your EOB, you get your explanation of benefits. It looks like there’s some structure in health care for a while because that’s the part you got. We didn’t quite realize as consumers that when you left the office, you left your primary care visit, and your instructions of what to do next were things you wrote down on a notepad or had to memorize, that the reason why you were carrying that out verbally was because they didn’t have a printout to give you. They didn’t have an electronic system. They were transcribing things, but that was just putting to a text based report plopped into a paper chart record, which then got filed. So these systems, even when they were electronic, were often integrating at a paper level, and so we moved to that’s not good enough. I said, okay, that’s not good enough. We have to integrate at a better level than that. It’s not just financials, it’s clinical data that needs to share across clinical systems and then across clinical competitors and people that cooperate with each other, and that’s a relatively monumental shift. This is 5 years of work that changed from a very low adoption rate, single digits ambulatory, to 60%, 70% of doctors on digital formats versus paper. That’s a big difference. Now, the consumer was probably ready before the provider was ready, but we need the provider as the data generators. If you think of this in a factory system or a process, they’re the ones that are really generating the data. We needed them to be ready to structure a little bit to get the tools so that we can start getting that data to consumer. So it’s almost like Health 3.0, the idea of now moving data to the patient to the consumer, is an obvious conclusion from the first step of getting into providers. We’re actually just going further down the value chain and closer to the actual consumer. We regulate on the vendor side in health care, which I was in my former life, more of an integration policy side today, but back then, our customer was the provider network. It was the hospital system. It was the IPA. We weren’t quite on the consumer side, with rare exception, and the rare exception you saw was in pharma in particular, where you saw direct to consumer marketing that was to pull through their provider so they would prescribe that stuff more, but the rest of the digital stuff, no, there still isn’t much that’s marketing from the big guys down to the consumer. What we’re seeing now is more entrepreneurial companies, smaller companies wanting to use that data. They’re the ones marketing to consumers. You’re not seeing the big, tried and true health care IT names doing much of it yet, but I believe that they’re going to emerge and figure out that value pitch to help the providers communicate with patients better. So I think it’s an obvious conclusion to the first step, and in fact, I think it actually is the first step, and we just mixed up the order because we had to.

Sanjog Aul [00:26:38]:

When you look at the challenges which may come up because the way now we are defining earlier, it was looking like another, you know, rather complex initiative. Now it looks like it what you’ve kinda where maybe if I if you’ve simplified it in a form where it looks like more of a data dissemination, data collection, data semantics, and figuring out what’s what’s going on within all the plumbing that we have already placed as part of Health 2.0. So it looks like an incremental improvement over it, but not something earth shattering or shatteringly different, and if that’s not the case, how are we creating, the business case for something like this? Because if we look at what it’s gonna fetch us, perhaps better, relationship with the patient and customer, and, yes, an incremental difference in the way, a patient would get treated or feel that they’re getting treated. Is that, is that enough for us to go ahead with such an initiative and put in the amount of investment it will really need for it to start creating value? But let’s explore this when we come back from the break, so let’s just please stay tuned.

Speaker 0 [00:28:04]:

HP is proud to sponsor this program. Tap into our expertise, innovation, and services to bring your most important workloads to the cloud.

Speaker 0 [00:28:16]:

Bosch Software Innovations is proud to sponsor this program. Visit www.bosch-si.com/connectedmanufacturing to find out how Bosch can help you improve your operational performance and become a manufacturing industry leader in a connected world. Change the way you predict, manage, and produce outcomes. Bosch connected manufacturing.

Speaker 0 [00:28:45]:

HP is proud to sponsor this program. Find out how the HP as a service solution for SAP HANA can help you gain instant impactful business results without capital investment by logging on to hp.com. Transform information into intelligence and a competitive advantage with a full spectrum of SAP HANA products and services from HP, a global SAP hosting partner. You are listening to CIO Talk Radio with Sanjog Al. To learn more about the show, please visit www.ciotalkradio.com. If you have a question or comment, call toll free at +1 (866) 472-5790. That number again is +1 (866) 472-5790. Now back to the show. Here’s Sanjog Al.

Sanjog Aul [00:29:48]:

Welcome back. So we do want to move ahead, provide better experience to customers, patients. That’s that’s part of continuous improvement journey, and and since data is there, might as well make sense of it. Is that good enough, business case for someone to start putting in any dollars? Yes. You will need some significant changes in the way, the data is interpreted by the providers and then some specific device related changes so that you can collect enough from the patients. Who’s funding this, and why would they do it?

Paul Wilder [00:30:26]:

Yeah. Fortunately, I believe that the funding is gonna come from desire and will. The steps that an institution could take to start moving towards a 3.0 world aren’t very expensive. The big steps might be, but we don’t know yet. The first step is, now that you have digital, can you apply both technology and policy, internal policy and institution, to share that data, let the patient have it? The patient is going to do a couple of things with that data. One, they’re going to look at it and decipher that it’s very difficult, and for a while, they might ignore it, but some of them, when they start to see emerging applications come out that translate that data and to be honest, a lot of health care is about translation. It’s not about talking differently to a patient. It’s about just using slightly different words. You don’t use a Latin term for the medication and a cream. You mentioned that you had a rash, and I gave you a cream, and you got better. You don’t describe it in terms of a disease state. You say you had a rash, and you simplify stuff. Well, tools can do that simplification. Computers can actually do a fair amount of it if we have it semantically organized and we have the tags appropriately so that we can translate in a way that the medical community thinks is the right way to translate, and, I believe that the institutions that are more integrated and more integrated, not necessarily inpatient to outpatient to various service lines, but that are integrated at a payer level, where they’re at financial risk, where they’re acting like a provider network that also does insurance, they’re starting to see this already. The more the patient can keep themselves in control, the less financially burdensome they are to their own system. So, the greatest tool, I believe, that’s going to come out of 3.0 is the very tight social network that it’s going to enable and foster, and that tight social network is your family and friends. Right now, you have trouble as a patient getting your data. It’s even more difficult to get the data for your children or your mother or father. So as we have an aging population and that aging population looks to the younger children to help care for them, without necessarily having to do really expensive health care solutions, we’re going to need that efficiency. We’re going to need things that help translate disease states, and perfectly honest, giving me data is one thing. I’m a relatively well person. I have some, you know, I’ve had some procedures for things that aren’t chronic, that aren’t going to kill me, but as my parents age, they’re likely going to need some form of care that I don’t understand yet, that I do not experience yet, and I’m gonna seek out data for that, and, when I can get the data from my mother, who is likely going to need some form of care that I don’t understand yet, I will need that tag so I can go pull it together and help her providers provide better care to her when she’s asking, is confused, and is not sure what to do. I think that’s very important, is to be able to engage more people, and that’s the social part of 3.0. It’s not me posting my clinical record on Facebook. It’s finding my support network, utilizing them, leveraging them, and making it in a community effort. It does take a village to provide better care to everybody.

Sanjog Aul [00:33:55]:

Who all do you think when you mention about, the village, who all would you say will form this village? To what degree would you be inclusive when it comes to even including the patients? Because they are the ones who are the center of this whole thing.

Paul Wilder [00:34:12]:

Well, you know, I believe that, the patient’s gonna start creating their village once they have the data and see some tools where they can start to create it. The challenging part is creating the healthcare provider side of that

Paul Wilder [00:34:27]:

village. Our policies right now, for very good reasons, are restrictive in the ability to share data between providers. We have health care law, both federal and state, that in many cases requires explicit consent of patients to move data around. So Provider A can’t send to Provider B unless they have a direct one to one relationship or the patient says, Please send that data, and if we can get the social tools in the hands of the patient, I believe those connections can be established faster. So you can imagine, think of Facebook and Friending that I might want to create my own health care circles and say, these are the providers I see. I’m going to invite you into my record, which I have collected by connecting to all of you. So you as my providers, you 10 providers, I’ve done a connection. I’ve sucked down data. It’s on my phone. It’s on the web. It’s on in the cloud, wherever I decide to put it, and I’m gonna invite the other nine of you collectively to see it and share. I don’t need you each to coordinate with each other because I know who you are, and now you’ve built that village around yourself with around the policies. I can do whatever I want with my data. You as a provider are actually restricted unless I give you permission, and the way that permission is collected today is often very manual and not explained very well. You check-in at a doctor’s office. They hand you a consent form, and they actually hand you multiple variations of that. They hand you one for, providing treatment services, and then they hand you another one that says, here’s how we’re gonna share your data, and one’s a HIPAA form, and that HIPAA form describes what they are not gonna do for health care operations and the like. Often there’s a third one that says, There’s this thing that we can connect to that has data about you. Would you like to give you permission to look at it? And it’s an onerous form. It’s an onerous process, and it’s scary when you’re at a doctor’s office and you present another form that you’re not sure what it does, and by releasing that data and giving people a chance to do that on their couch when they’re comfortable, when they can see what this data is we’re talking about, they’ll be more comfortable with their other providers looking at it. To create that trust, you have to share the data, and I think that’s a fundamental restriction we put in health care is that trust is established by protecting things, and no, trust is established by opening it up and allowing the data to flow in a secure and private way.

Sanjog Aul [00:36:59]:

Now we feel that, yes, there is hope and, of course, there’s effort being put in there. What would you think needs to come together in terms of policies, procedures, standards, and best practices so that we are not using a shotgun approach to this because it’s just going to create a lot more leakage than actually a forward movement?

Paul Wilder [00:37:21]:

Yes. I think these standards are a big one, a big barrier right now. If you had asked me a couple of what’s restricting our ability to get to a 3.0 world, standard is one of them. Healthcare documents have thousands of elements in them, and they’re actually pretty well organized today. There’s a procedure, diagnosis, It has a there’s a code set, ICD-10, SNOMED CT. There’s various acronyms I could throw at you that describe how to describe data. The problem is any individual record has all of them in there, and, it’s difficult as a developer to be an expert at all this stuff. We don’t teach people health IT standards in college. We teach them, you know, Java, XML, general computer theory, how to, you know, databases are structured, what are relational versus hierarchical databases, the differences, why I choose one or the other, but we don’t talk about health care standards. So health care, keeps developing all this stuff on its own, and it’s building them in a very complex way. So when I hire a brand new, out of college computer science person, I have, like, six months to train them, and then when I’m done, they’re very marketable, right? It’s a very strong market, and it’s difficult to retain them afterwards. So, we need to simplify things, and one of the ways to simplify it is a unified standard, and, from what I’m seeing from the vendor side in the marketplace, this is a unique market that is looking for some level of regulation. There’s a first mover disadvantage that if you’re first to the standard, and everybody else isn’t, they’re making a fair amount of margin on professional services to do custom integration while you’re not, and so, yes, your service tail of monitoring and configuring and servicing the connection you’ve already made will be a lot cheaper to do if everybody is in the same standard, but until they are, there’s no incentive to be there. You need people to go there together, and, you know, I point back to banking. Again, banking is very simple, but, on the credit card side, you may think that the move to the chip version of your credit card is taking longer than you’d like it to take versus the magnetic strip, but the whole credit card industry moves at the same time because they have a standard that is very tight. It is pervasive and it’s controlled through industry association pretty well in check. Health care can’t do that right now because there’s too many entities. The interests are misaligned in many cases, and the standards are too voluminous. So, there is a pretty strong desire if you start asking people to say, yes, we’d actually rather them force a standard so we can all move to it and we’ll still make the same margin long term. We’ll lose professional services upfront, but our ability to service the customer will be cheaper. So we’re okay with that. We just need everybody to go at the same time. I don’t want to be first.

Sanjog Aul [00:40:22]:

It looks like more of a movement or it needs to be a movement versus an initiative, which is a defined or a finite start and end because it looks like an ongoing improvement to what we have already achieved. Who should lead the movement? Who should be the protagonists in this whole act, if you will? And what are they expected to do so that it sparks interest of all the appropriate stakeholders or who should be the stakeholders in this in order for this to move forward? Let’s explore that. Please stay tuned, listeners. We’ll be right back.

Speaker 0 [00:41:01]:

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Speaker 0 [00:41:30]:

HP is proud to sponsor this program. Tap into our expertise, innovation, and services to bring your most important workloads to the cloud. HP is proud to sponsor this program. Find out how the HP as a service solution for SAP HANA can help you gain instant impactful business results without capital investment by logging on to hp.com. Transform information into intelligence and a competitive advantage with a full spectrum of SAP HANA products and services from HP, a global SAP hosting partner. You are listening to CIO Talk Radio with Sanjog Al. To learn more about the show, please visit www.ciotalkradio.com. If you have a question or comment, call toll free at +1 (866) 472-5790. That number again is +1 (866) 472-5790. Now back to the show. Here’s Sanjog Al.

Sanjog Aul [00:42:46]:

Welcome back. So this being a moment at least looks like you need some leadership, someone who will be like the Pied Piper or a set of people or set of entities who would take the leading role or protagonist and, if this was an act. Who do you think they are and or should be?

Paul Wilder [00:43:07]:

Yeah. So you’ve probably heard this in a variant before is that health care has a bit of an advantage over some industries in that it’s very personal. We all experience it. So, you ask people why they go into health IT or health care in general, it’s because they want to do something directly services people. It’s also not a bad place to make a living, too. There’s very specialized people here, so it’s there are jobs, and it’s a fun place to be, and, I think the movement idea is correct, and the reason why it’s a movement is because we don’t know exactly what to do, but we know we need to generally, collectively move in a certain direction, and so it requires multiple parties to be involved or it requires a very strong heavy hand. Now our history and likely future of The United States is we’re not going to have a heavy hand saying by policy, you must do X, Y, or Z, partially because they know and we know that they’re very likely to pick the wrong technical framework for it, that it needs to grow some in some way organically to get where we want to go. So I think part of the champion group here is people like myself. It’s people very interested in health care, that have that bring a story to the table. Every one of us needs to have a story. Every one of us needs to be a salesperson in some respect. You don’t become the CIO of a hospital just because you’re smarter than everybody else. You’ve also proven that you can lead, you can organize, you have some vision, and you understand where you want to go, not necessarily where you are right now. So IT is very important right now, and that means that we have an opportunity to do little projects on the side that dabble in this and see marginal change at institutions that are quasi coordinated and potentially really large change at very large institutions that are very, very, very integrated. So, a classic example of the very, very integrated is a Kaiser Permanente style. They have a very large cohort of patients that they have full risk and delivery responsibility for, and you see greater patient engagement out there. They’ve made an effort towards how they engage data in their patient portal and interaction. Many providers are saying that the patient portal or sharing of data isn’t a high value to their customers, and I would strongly argue that part of the reason why they don’t see the high value from their customers is because they don’t know how to sell it to their customers yet. The provider doesn’t know what to say. So, CIOs, CTOs of large institutions and small need to help their providers understand it so that they embrace it and turn around to their patient and say, this is why there’s a benefit. Now, that sounds easy, but it’s difficult when you’re in medicine these days. You went to four years of med school, a bunch of residency, you had to be in accountant, finance, and now you’ve got no technology too. So you are seeing more and more movement towards cloud based IT services for the small providers and larger systems of providers coming together for more complicated products in terms of IPAs or being bought out by hospital systems. I think that’s necessary. I think we’re seeing a lot of change, and my only concern, I have many concerns, but my key concern right now is so many things are changing that even if we’re right, even if we bend the cost and quality curve that we have better quality without increased costs or costs go down at the same time, either one would be good, that we won’t know which variable actually made the change because we aren’t able to experiment one variable at a time, and I’m not suggesting we should. I do believe we do need to have multiple projects and multiple attempts at different disease states and different conditions and different areas of the country and different demographics, but in the end, we’re probably going to overdo it. We’re going to overprepare, because we don’t know which specific thing moved the needle, but we are seeing change, and we are seeing that when we integrate, particularly payment reform and clinical delivery reform, some very interesting things happen, and when I say clinical delivery, I’m not necessarily talking about drugs and devices. It’s the organization, the way we set up health care, how much we vertically integrate between home care, long term care, acute care, inpatient, outpatient, the like. That integration, so most consumers don’t know, has been relatively lax until now, but there are a fair amount of government and local programs that are, I wouldn’t say, forcing but are very much encouraging that integration to occur, and it is showing benefits around the country.

Sanjog Aul [00:47:47]:

With all that we have happening in front of us with with respect to health care changes and then this health 3.0 coming, what do you think your message should be or is going to be for these business and technology leaders who are, number 1, trying to understand this better and number 2, embark on this journey in order to make this a reality?

Paul Wilder [00:48:12]:

Yeah. My number one thing I say, almost any presentation I get has a lot of providers in the room, and surprisingly, this actually works, is the last part of almost every presentation I give talks about the patient portal, and I always tell them, be a patient first, and at some point, you will integrate, you will interface with health care even though you have your MD, and something’s not going to feel right. It’s because you flipped to being a patient, and, I implore them to, while they’re in the waiting room for their doctor visit, when they’re going to someplace else, that they pay attention to the process around them, not necessarily to improve their own practice, but to experience what the other side’s experience. I think we often go heads down saying, We’re doing it right. We’re doing the best we can, is what we hear about as well a lot, and the reality is when we interface with health care on the other side, we go, Wait a second. This isn’t how even I would have set it up. Something’s wrong here, and then if you went and you’re a patient at your own facility, you find out that even your own facility doesn’t deliver it the way you expect it to, because things change when they start to deliver out the edge. So be a patient first. Put yourself in the real consumer’s shoes, and then start trickling up. It does require a little bit of a network effect of I get on board, someone else gets on board, and then we start sharing more data. I think that the holding of data, as the gold that you have as a practice is breaking down. The data is extremely valuable. It is very, very valuable, but it doesn’t mean you should hold on to it. It’s more valuable when it’s coordinated, integrated, and shared with others and we can collaborate together.

Sanjog Aul [00:49:56]:

On behalf of the show and our listeners, I’d really like to thank you, Paul, for taking the time and sharing your thoughts on how the patients themselves and the health organizations can actually collaborate and work well together in order to harness the full value of the semantic web and other form of, health information that may be available, which will come a turnaround and basically help both parties. Thank you so much again.

Paul Wilder [00:50:20]:

Thank you very much. Appreciate it.

Sanjog Aul [00:50:23]:

And listeners, please like us on Facebook, follow us on Twitter, and do not forget to sign up for our monthly newsletter. Thank you again once again for listening to CIO Talk Radio. This is Sanjog Al, your host till next week. Take care, and God bless.