Mark Scrimshire – Chief Interoperability Officer, Onyx

In the HealthBizTalk podcast, Tony Trenkle interviews Mark Scrimshire, Chief Interoperability Officer at Onyx, to discuss the future of healthcare data interoperability. Mark shares insights into enabling seamless data exchange through innovative solutions and the role of FHIR standards in empowering patients.

Transcript Of the Podcast

Welcome to Health Biz Talk, the industry’s leading podcast that brings you today’s top innovators and leading voices in healthcare technology, business and policy.

00:00:09
And here’s your host, Tony Trenkle, former CMS CIO and health IT industry leader.

00:00:16
Good afternoon.

00:00:17
This is Tony Trenkle on Health Biz Talk, and I’m happy to have as my guest today Mark Scrimshire, who’s the Chief Interoperability Officer at Onyx Health.

00:00:30
Mark, welcome.

00:00:32
Hi, Tony.

00:00:33
Great, great to be here.

00:00:34
Thanks for inviting me.

00:00:36
Well, thank you for joining us.

00:00:38
So, Mark, why don’t we jump right into it?

00:00:41
I know you’re a busy man, so we don’t want to take up too much of your time.

00:00:45
So I took a look at LinkedIn and you’ve got a very diverse background and maybe you can tell us a little bit of how you got here today.

00:00:55
How did you become the Chief Interoperability Officer, from your background to getting here in, in the Cliff Notes version, of course.

00:01:06
Okay, the Cliff Notes version.

00:01:08
So.

00:01:08
Well, I mean, I’ve been involved in it since I was a kid.

00:01:13
My parents ran a data prep company in the uk, So I sort of born to it, but really, I suppose the journey into health really started when I came over to the US 25 or so years ago, worked for a startup there, but ended up basically running the IT function for Iridium, the satellite phone company.

00:01:36
When we, we launched that.

00:01:39
And after that I, I got drawn into people wanting me to go work for them and I, there was so many people asking, I decided to set up my own company.

00:01:48
So we did that for, for a good few years and I ended up actually having to write a daily blog for AOL to explain what was happening with what was then web 2.0.

00:02:01
So this was back in like 2008, 7 and 8, right?

00:02:05
Oh yeah.

00:02:06
And I went to one of the, the Web 2.0 conferences.

00:02:09
So I was writing this daily blog for O’Reilly and went to one of these web conferences and there was a, these unconferences going on which were, you know, unscripted.

00:02:20
And there was when you had a bunch of health geeks getting together on a Friday night in San Francisco to talk about tech, IT and technology and healthcare.

00:02:31
You realize there’s something there.

00:02:33
So I ended up starting a health camp as an unconference and bringing all sorts of people together.

00:02:40
And that ultimately led to me, because of the various connections I got whilst I was working for a payer, I, I left the, the particular payer and was really focusing a lot on, on Health Camp and just meeting lots and lots of people and it, we ended up, you know, doing things like supporting the original version of Blue Button, which goes back to, as you know, about 2009, 10.

00:03:09
Right.

00:03:10
And developing some open source stuff around that and healthcamp.

00:03:15
We were always promoting patient access and I had a, you know, a few diversions through working with 3M health information systems, taking their systems to the cloud and ending up where I was invited.

00:03:31
I was more or less told to go and apply to CMS or to the, the Idea Lab at HHS and went through that process and got the opportunity to go and work on Blue Button at cms.

00:03:50
So that really took, you know, five years.

00:03:53
We, you know, building out for like three years and then launching and promoting and so on.

00:04:00
And that was, really got me involved in a lot of different things.

00:04:04
And the, the thing that drove me there was saying, you know, if we can get the largest payer in the world to do something cool around patient access, the industry might, might well follow.

00:04:18
And you know, from there I’m now retained by da Vinci or the HL7 or to write some of the implementation guides that CMS then points to in regulation.

00:04:31
And we built our ONIX platform to basically help payers comply with those regulations.

00:04:38
So it’s really enabling patient access, but doing it from the payer side is sort of where I’ve ended up.

00:04:46
But it’s really about solutions and trying to find a way through to get to a result.

00:04:55
And I’m always coming at it from that perspective.

00:04:58
How can we do something practical to really make a difference?

00:05:04
So that’s, that’s the Cliff Notes version.

00:05:06
All right, thank you, Mark.

00:05:08
You know, I’m amazed at some of the improvements we have made.

00:05:12
I, I got an echocardiogram today and within an hour after I left the doctor’s office, I had the results in the portal and I knew exactly how I’m, how it turned out.

00:05:27
But on the other hand, I run into problems if I’m going with different providers who work for different health systems.

00:05:36
And that was the thing we were trying to solve many years ago.

00:05:41
As long as I’ve been involved in it, which is over 20 years, but yet it seems to me like I still have to deal with this issue of multiple portals and in some cases I’ve even had to bring, physically bring, and this is within the last two years, physically bring information from one provider to another.

00:06:03
And it just seems to me like we’ve made a lot of progress in some ways, but, but what about your personal experience.

00:06:10
I mean you’ve been, you’ve been jumping on this at the national level.

00:06:13
Has your personal experience been like mine, are you, are you doing.

00:06:17
But maybe.

00:06:17
Yeah, I think every, everybody has that issue.

00:06:22
You know, if you’re, typically when you’re dealing across multiple providers that can be, you know, one can be on Oracle’s health platform, others can be on Epic and they don’t really want to talk to each other.

00:06:38
But increasingly now with these, the, the APIs and this, this is really, it’s great what the combination of CMS and astpl, the ONC is doing in really driving the industry forward, that we can connect our apps to those, at least a standard set of APIs and get certain level of data, which means that we can pull that together.

00:07:04
And it’s great to see the way that, you know, some patients are really pushing the envelope.

00:07:10
You know, I was talking to a month or two ago to one guy and he’s dealing with issues with, with his kid and he’s got a massive amount of data that he’s managed to pull together and he’s, he’s, he’s actually throwing it at things like chat GPT to actually make sense of the data.

00:07:32
Oh, really?

00:07:33
That’s interesting.

00:07:35
It’s really, you know, what is becoming possible.

00:07:39
You know, yes, we’ve still got some major things that we’ve got to improve on, but if you are really incentivized, you can get a long way.

00:07:51
Today it’s much easier to get access to the data than it was five, seven years ago.

00:07:58
And we always forget how much effort it’s going to take to move things.

00:08:06
I think the latest interoperability rule from CMS is a really potentially transformational.

00:08:14
You know, I describe part of what I do in actually helping to write these standards is I’m creating the next generation of problems to solve because, you know, we’re all starting to get frustrated with the fact that I have so many different logins to so many different patient portals.

00:08:35
You know, why can’t I use the same account, right.

00:08:39
And be able to at least use the same user ID and password, right.

00:08:43
When I’m connecting to these different things.

00:08:45
And I think it’s going to come because we’re creating this, this next generation of problems, right?

00:08:52
The fact that we’ve got to connect to so many things and if you think about what’s going to have to happen with providers being able to query, you know, 20, the 20 or 30 different payers that they’re dealing with.

00:09:04
Right, right.

00:09:05
We’ve got to solve this problem, right?

00:09:08
And so everything that’s ONC or ASTP and CMS are doing around TEFCA and so on is really, I think going to try this forward.

00:09:19
I think, you know, there’s a couple of levels really talk about.

00:09:24
I mean I look@login.gov that the government has and that that’s still a work in progress but it’s allowing me to go on to multiple portals and get government information, whether it’s from Homeland Security or Social Security Administration or others.

00:09:42
You know, why can’t they do something like that in the, in the, in the healthcare world, at least from an authentication standpoint rather than to have me go into multiple portals, even if I couldn’t get all the information together, I could at least have a single access that allowed me to.

00:09:59
I think it’s going to come.

00:10:01
There’s been a lot of work going on in the Karen alliance to really try and drive that forward.

00:10:05
Some of that in terms of as I say, tiered AW is going to sort of filter into Tefka.

00:10:13
So potentially people can, can access in a, through sort of one channel.

00:10:18
But you know, I, I, I think going back now 15 years and having arguments with the security folks at one of the big payers that I worked for, you know, and saying why do we want to be forcing, you know, our members to have a user ID and password for a service they don’t want to use so that when they come in they’ve forgotten what the password is so the first thing they do is reset it.

00:10:46
Why can’t we use a user ID and password that they use every day?

00:10:51
And now with the, the advent of, you know, technologies like Fido and so forth and basically biometrics on your phone, it’s becoming much simpler to get to that point where I’ve got one password, right, and being able to use that over and over because I’m now tying it in with biometrics to make sure it is me that’s making the access.

00:11:13
You know, you talked about login.gov but with Onix, when we’ve serviced the Medicaid space, we have actually worked with ID me very similar sort of solution to login.gov and that’s been really good from the Medicaid’s perspective because the way ID me works is that they’re not really relying on things like credit reports to try and verify that you are who you say you are.

00:11:43
So it really fits.

00:11:44
But then you’ve got the advantage that yes, I can use that same user ID to go and deal with my taxes, go and deal with my employment or unemployment if I’m in certain states and access my health data if I’m on Medicaid.

00:11:59
So it’s, it’s starting to come and I think that will accelerate over the next couple of years as we really try and drive forward with tefca.

00:12:08
Yeah I think from the log inside I think we’re, we are making progress because we have a lot more methods and certainly two factors help with that and a lot more of this using biometrics at certain ways and pass keys and other things.

00:12:24
So getting back to tefco, what do you, what are your thoughts about that?

00:12:29
Do you think it’s going to bring us to the holy grail?

00:12:33
Or maybe I ought to step back and say well what do you define as the holy grail of interoperability and how close we come to that definition?

00:12:43
I I still think we’ve got a long way to go.

00:12:47
Yeah, there are a lot of roadblocks.

00:12:50
We but this, this next two, really two, three years is, is potentially going to be transformational because we, we’ve done a lot in terms of point to point connectivity.

00:13:04
If you look at the original CMS interoperability rules, it at least allows in theory for consumer applications and developers to connect in a more or less standardized way.

00:13:17
There’s still a lot of rough patches to sort out but it’s so much better than it was 10 years ago.

00:13:25
Right.

00:13:27
And now we’ve really got to take this the thought of you know, literally millions of providers wanted to connect with a couple of thousand payers and being able to exchange information.

00:13:42
The way that we’ve gone through registering consumer apps to these APIs and doing it effectively manually.

00:13:50
Right, right.

00:13:51
Is just not going to scale.

00:13:53
So it, this is going to force us to find out methods that will allow this exchange to basically registration and authorization to happen at scale.

00:14:08
And you know I, I just to put the latest payer data exchange implementation guide to into ballot and in that you know I’m saying you do not want to be going and developing against this these implementation guides in isolation.

00:14:26
Right.

00:14:27
You need to stay plugged into these user groups like DaVinci, like the HL7 work groups and projects like Trebuchet and you know, Onc’s 10 by 10 to really understand what’s evolving because I think there is going to be a lot of recipes that are going to get developed for how we can deliver this stuff at scale and that’s going to evolve.

00:14:52
I think pretty Rapidly over the next two years as we gear up to try and meet that 27 deadline.

00:14:59
Right.

00:15:00
Well, I think looking back on my experience in the government and what I’m seeing today, the government has tried to play a bunch of different roles.

00:15:08
They’ve tried to be, you know, throw money at the community to make it happen.

00:15:14
They’ve tried the STIC approach where they’ve put deadlines and then taken actions against those who don’t meet the deadlines.

00:15:24
They’ve tried something in between where they set up the standards and then have the private sector do the work for the most part.

00:15:34
What do you think is the best way to.

00:15:36
You talked about the prior author, which obviously is a good example of CMS as the regulator.

00:15:42
ONC has done a lot with the regulator and also with.

00:15:45
As kind of the con.

00:15:46
The grand conveners.

00:15:48
Do you.

00:15:49
Where do you see the government’s role going forward?

00:15:53
Do you see it more in that mode?

00:15:54
Or do you think we need something again like a high tech to put additional funding out there to make people hit the next step?

00:16:06
There are probably some core components that we may need government funding around to really get things moving.

00:16:16
When you look at the problem that we have today, the first step is really where do I go?

00:16:23
How do I find out where I go and get connected?

00:16:27
Right.

00:16:27
We don’t have, you know, a discovery or directory service.

00:16:31
Right.

00:16:32
That everybody can go to.

00:16:34
Correct.

00:16:34
So that could be something that federal funding could enable.

00:16:39
Maybe it should be something like a public utility.

00:16:42
Right.

00:16:43
Then once you’ve got that, you’ve got to have the ability to basically declare who you are and be identified that you are able to do that particular interaction, whether it’s request a prior authorization or to retrieve data about members from a payer as a provider or a payer to exchange data with another payer.

00:17:08
There are going to be these different use cases and the biggest challenge we’ve had in the last couple of years has been getting to the point of who do you trust to say these parties can actually play together.

00:17:20
Right.

00:17:21
It’s not been a technology problem.

00:17:24
We have the technology we just hadn’t had the, the will to agree to about somebody convening.

00:17:34
And I think we’ll start to see that again.

00:17:37
TEFCA is going to be part of forcing function, I think.

00:17:41
But to your point, okay, what, what’s the role that government’s playing?

00:17:46
The thing with this prior auth rule is that really makes it different, I think, is that you look back at the, the original interoperability rule and There’s a lot of payers, you know, rightfully saying, look, I made all of this investment but I’ve got a dozen people using it.

00:18:04
Well, firstly you’ve got to actually tell people that they can and that encourage that there are applications.

00:18:10
And I think the biggest problem there was that there’s really been no real vehicle for consumer apps to have a viable business model other than using you as the patient, as the product.

00:18:29
Right.

00:18:29
And selling data, et cetera.

00:18:32
You know, I, I’ve advocated for a long time saying, wouldn’t it be great if in my health plan I had the ability to basically say take 10 bucks a month and decide what digital app I want to invest in because then I become the customer.

00:18:52
Right.

00:18:53
And I can choose what works for me.

00:18:56
Right.

00:18:56
And that provides a, then a business model that a lot of consumer apps could potentially get, get behind because they’ve now got a source of revenue.

00:19:06
Right.

00:19:08
So that was one of the problems with the original rule.

00:19:11
But this prior auth rule I think is going to start off as a compliance solution that payers will not want to be on the bad side of cms.

00:19:23
Right.

00:19:23
So they’re going to get compliant.

00:19:27
But I think what they will see is the efficiencies on both the provider and the payer side that come from implementing these standardized APIs are going to be such that it becomes a business transformation initiative.

00:19:42
And so they’ll want to apply this across the rest of their business.

00:19:47
I mean, think of it from the provider side.

00:19:49
I’ve got a Medicare Advantage plan that I’m dealing with members in and I’m reaching out to one of the big payers because they run that plan and I can do an automated prior auth and get the answer in five seconds that I don’t need a prior auth.

00:20:04
And then, you know, a patient comes in that’s on an employer plan with that same payer and they have to go and get the facts out.

00:20:12
Right, Right.

00:20:13
How long is that going to last when you’ve got those APIs.

00:20:17
Right.

00:20:17
And some of the forward thinking payers are already saying what’s it going to take to do this across my entire line of business?

00:20:25
And that’s really what we want, right.

00:20:28
Is that will start to really drive because then we’ll start to see some real ROI coming from the investment in interoperability.

00:20:38
That will then evolve, I think around the work NCQA is doing around digital quality and being able to take that same data and use it to really measure yourself in terms of the quality of the service you’re delivering, which has an impact ultimately on how much you get paid by cms.

00:20:58
It’s going to start to come together.

00:21:01
Yeah, I think that’s exactly right.

00:21:04
And what I found in the past is part of what we tried to do and what CMS continues to do is a lot of times you put the compliance out there, but you’re basically pointing towards the North Star.

00:21:17
So the first point or data point is to get the compliance and then you start helping the community to see the business value of it and the advantage as it becomes more mainstream.

00:21:32
Then they start saying, well, I don’t want it to just be my government business line or my Medicare business line, but I can apply it across every business line and then, then it starts becoming more of a business value as opposed to a compliance thing.

00:21:48
But I think bringing the consumers in.

00:21:51
My biggest issue I found with the technology community is the technology community is obviously focused on technology.

00:22:02
We don’t deny that.

00:22:03
But I think the other thing the technology community misses in the healthcare is the people who spend the most time in the healthcare space are people over the age of, let’s say 60 or so.

00:22:17
I mean, so a lot of the technology has been aimed at sometimes a 35 year old who doesn’t even use the healthcare system unless they, you know, break their leg playing basketball or something.

00:22:29
You know, they rarely use it.

00:22:30
I mean, I rarely used it when I was that age.

00:22:33
But you know, as we know in Medicare, that most of the funding around Medicare goes to chronic disease management.

00:22:43
It goes to, you know, 25% goes to last year of life.

00:22:47
And it just seems to me that if you want to get consumers involved, look at where the consumers are and develop applications that are, you know, convenient and easy to use for, for people, it could be convenient and easy to use for the 30 year old who’s helping their parents or the 65 year old who’s, who’s trying to do it themselves or, you know, anybody in this stream.

00:23:11
But the focus, I think has been wrong and I think that’s been a lot of the challenge that I see because a lot of people are not technology savvy and unless it’s something that really helps them in terms of better care or getting their information faster and easier or, or saving them money, they’re not gonna, they’re not gonna spend the time to do it.

00:23:35
Yeah, I, I mean, I agree with you that we have to think not only there’s two things we probably need to change.

00:23:42
One is this idea that, you know, those folks that are over 60, are basically technology illiterate.

00:23:49
Right.

00:23:50
It’s not really the case exactly.

00:23:52
There’s a lot of people that are quite happy to work with stuff on their phone or on an iPad.

00:23:59
They may not have a laptop or a desktop, but they can do a lot with the technology that they have in their hand every day.

00:24:07
And then the other thing that we really need to work on is thinking about the caregiver, as you say, and particularly where you’ve got these families that are, you know, spread out across the country and being able to coordinate across.

00:24:24
It’s not just one caregiver, but it’s potentially a family of caregivers that working together to, to help somebody achieve the best they can.

00:24:34
Right.

00:24:35
So we, we’ve got to also think about how we can allow that data to flow to the people that need to help, you know, particular patient or beneficial.

00:24:47
Which I think is another challenge with interoperability.

00:24:50
You know, I’ve been, I get involved in with, I’m on the board of an assisted living organization and the technology in a lot of these nursing homes and you know, assisted care facilities leaves a lot to be desired as, as does the ability of people to utilize them.

00:25:07
And you know, it seems to me if that’s where a lot of the care is occurring and a lot of the expenditures in healthcare, it seems like we have to develop solutions and getting some of that community involved.

00:25:21
And I know we’ve been trying to do that for years, but it still seems like they lag.

00:25:26
Yeah, we actually thought about that when we built our blue button because there were two things that we did.

00:25:34
One was working with NIH on basically personalized medicine.

00:25:40
And so we designed the API so that you could actually have effectively technical a long lived token.

00:25:50
Right.

00:25:51
So one of the use cases I was basically building towards was the fact that I could, for example, as a beneficiary want to be, become part of a research program.

00:26:02
Right.

00:26:03
Could just as easily be, I want, I’m going into long term care.

00:26:08
You could have an onboarding app that could take that beneficiary through giving permission for that app to collect data using these standard APIs.

00:26:21
Right, right.

00:26:21
And then once that’s in place where it’s got this token that can be refreshed, which is, is all part of the standards.

00:26:29
Right.

00:26:30
Then the actual beneficiary doesn’t need to be involved.

00:26:36
The problem we have with a lot of, for example, the EMR implementations is you’ll get a token that lasts an hour.

00:26:43
So if you want to come back You’ve got to now go and log in and get your password and do all that stuff again.

00:26:50
But if you have this ability for a long lived token, then effectively the app can just be going and getting data whenever it needs to, every day, every week, whatever, without the beneficiary having to lift a finger.

00:27:08
That sort of step actually makes it possible for things like long term care to have apps that could be collecting data about the people they’re taking care of without it being a high overhead.

00:27:26
So there are things that we can do with the technology we’ve got today to really make a difference.

00:27:33
Yeah, and I think, you know, talking about that, it’s even interoperability of things as well because one of the things I saw recently I was doing something with ARP and somebody had developed smart toilet seats.

00:27:48
And you know, it sounds kind of humorous, but the idea behind that is it was really, it’s really a good way to gather a lot of information about people and habits and things of that sort that can really be applied to the health space.

00:28:05
Obviously there’s privacy issues but, but, but all of this stuff is going to involve some privacy issues and privacy trade offs.

00:28:12
That’s something we’ve dealt with for a long time now.

00:28:16
And I think part of what we need to be thinking about is what are the touch points that we can provide in addition to the phone and some of the normal ways people communicate that can even provide us additional for longitudinal data.

00:28:31
I mean part of the challenge we have, we go to the doctor’s office, our blood pressure reading is high, we go home, it’s, it’s regular.

00:28:38
A doctor can put a monitor on you, but that doesn’t necessarily because you’re still thinking of the monitor.

00:28:44
But if you put it in a more benign way that the person could be then looked at for, you know, blood pressure, glucose levels, other things, I mean it could really be a game changer.

00:28:57
But of course that requires interoperability as well as, you know.

00:29:01
Yeah, I mean I’ve gone through this, I have a blood pressure monitor at home.

00:29:06
Right.

00:29:06
And actually ended up taking it into the doctors because we getting relatively high readings and actually got them to compare so that we could at least understand.

00:29:16
Okay, so this may be, you know, eight points higher than an actual reading taken by an assistant by or by the doctor.

00:29:25
And for years I’ve argued this that you know, you’ve got white coat syndrome and we arguably waste billions of dollars a year because of white coat syndrome.

00:29:36
Your blood pressure rises because you’re in the doctor’s office.

00:29:41
And I’ve argued for years that we, we could have a blood pressure monitor at home and we can take that.

00:29:48
And you can argue that a physician will do a much better job of getting an accurate reading.

00:29:53
But my argument is that if I take that reading, you know, every week or every, you know, two times a week, I’m going to be consistently bad.

00:30:03
And that’s.

00:30:04
But so the trend is more important than the accuracy of an actual reading.

00:30:08
Right.

00:30:09
And it’s that trend that, that’s worth it, that provides potentially a lot more data.

00:30:15
And then you can start to have systems that can look at those trends and pull that information.

00:30:21
We can easily, you know, I, I get my blood pressure readings on my, on my phone from that device.

00:30:27
Right.

00:30:28
And I could, I could choose to share that with, with my doctor.

00:30:32
Right, right.

00:30:33
There’s a lot we can do and with, with smart homes, you know, think about not only pressure pads on the, on the toilet seat, but maybe, you know, when you, to check that you actually got out of bed.

00:30:45
Right.

00:30:46
And the things that you can do with, if you allow, for example, your airport, your own pods or whatever to actually monitor what’s going on, they can actually detect stuff that’s happening.

00:31:00
I was actually, somebody’s car alarm went off yesterday just around the corner and my home pods chirped up on my, on my watch and said, there seems to be an alarm.

00:31:12
Should we report it?

00:31:15
No, it’s outside.

00:31:17
Right, Right.

00:31:17
There’s all sorts of things possible.

00:31:19
Right?

00:31:20
Yeah.

00:31:20
And I think, I think part of the challenge is, like you said, make it technology agnostic so people don’t even think.

00:31:31
Just like I think Apple has done a really good job, I think in the health space.

00:31:35
Focus on things like blood pressure or other things that people do have real concerns about and not as much on just something that is allowing them to look at stuff that they don’t understand.

00:31:49
I mean, I got a lot of information through these portals, but I don’t even understand.

00:31:53
Sometimes it sounds alarming, sometimes it’s not.

00:31:56
You know, and I think part of the challenge needs to be get it down to the layperson’s level.

00:32:02
Maybe AI is a, is a way to do that, but that, that kind of thing is, is what’s going to, I think, drive the consumers.

00:32:09
Yeah.

00:32:10
The reality is that for, for the vast majority of us, we don’t care about all this data.

00:32:18
Exactly.

00:32:18
Until we do.

00:32:19
Until we do.

00:32:20
Right.

00:32:21
And then we want, so what you want is systems that will gather all this data and then they’re usually Pretty good at actually filtering through it.

00:32:32
Right.

00:32:33
And AI just makes that that much more powerful.

00:32:36
Right, right.

00:32:37
So we want to actually, I remember going to a, a, an event on the Hill a number of years ago now and one of the secretaries from one of the, the health committees in, in Congress basically said, you know, my Nintendo Wii knows more about my health than my doctor.

00:33:02
And we forget that.

00:33:04
And I think our job as, as technologists is as these things are particularly on the interoperability side.

00:33:12
As these things start to come into play, we’ve got to make it so that it’s easy to get that into standardized forms because again, if you’re going to do this at scale, you can’t be dealing with every implementation is a custom implementation.

00:33:29
It’s literally got to be plug and work.

00:33:32
Right.

00:33:33
And that’s where we’ve got to get to.

00:33:36
And that again, is our big challenge in interoperability is at the moment, it’s a lot of plug and play and we’re trying to get things working.

00:33:46
If you look at Flexper’s recent report, is the core of the data is there.

00:33:52
It’s the.

00:33:53
It took me three months to actually get permission to access the data.

00:33:57
Right.

00:33:57
And there were certain things that that particular API does in a strange way in getting connected.

00:34:05
Once I connected and got my credentials, I’m good to go.

00:34:10
And that’s what we got to get.

00:34:11
Sort of.

00:34:11
That is what is going to kill this next phase of interoperability.

00:34:15
Every implementation is a custom implementation.

00:34:18
Right, Right.

00:34:19
We will not get anywhere.

00:34:21
Yes, yes.

00:34:22
And that’s an issue.

00:34:24
Let me circle back a minute to trust.

00:34:26
You talked about trust.

00:34:27
I think one of the issues around trust is also business advantage.

00:34:33
I think a lot of, you know, we saw that with.

00:34:36
Won’t mention their name, but it begins with an E.

00:34:39
But we saw that for many years with them.

00:34:43
There was some concern about you give out the data, you get the end.

00:34:47
We saw that.

00:34:48
We’ve seen that with the health plans and even, even in some of the provider communities as well.

00:34:53
So, so to me, trust is one facet of it.

00:34:57
But it’s also this concern that, you know, it’s like the, you know, who builds, who pays the tolls to build the bridge?

00:35:04
You know, it’s.

00:35:05
And, and I think that’s a lot of the issue here too is that people don’t want to give up a business advantage by controlling the data they think they have.

00:35:16
And I think they’re getting.

00:35:17
That’s marginally better at that.

00:35:19
Maybe.

00:35:21
Yeah.

00:35:22
I think about that as we at some point will reach a stage where there is basically, I’ll call it a data inversion.

00:35:32
Right.

00:35:33
And what I mean by that is, if you look around, there’s not that many organizations out there that can afford to be another Google in terms of amassing massive amounts of data.

00:35:45
Right.

00:35:46
And where we’ve been up to now in healthcare has been, you think back to originally the providers.

00:35:52
You know, it’s my data.

00:35:54
No, you wouldn’t have any of that if I hadn’t gone to visit you.

00:35:57
Right, correct.

00:35:59
Now with.

00:35:59
With all of this stuff now on our phones as well.

00:36:02
So we’re generating far more data about our health individually than any health system is gathering, right?

00:36:11
Absolutely.

00:36:11
So you will reach a point where it’s actually a disadvantage to try and gather all of the data.

00:36:19
And it’s more about being able to access the data and be able to do something with it than it is to have it and let it out in bits and bytes.

00:36:30
And that’s the data inversion I see, is that it’ll be more important that we have the ability through interoperability to reach out to where we need to go and get the data at the level of granularity we need.

00:36:44
You know, I remember sitting in a meeting a number of years ago, must be 20 years ago now, where the discussion was how much data should we put into a CDA document.

00:36:56
Yeah, right, right, I remember that.

00:36:58
It’s a crazy question, right?

00:37:02
You want to be able to get at the data you need.

00:37:05
Right.

00:37:06
And I think that this will come round where, you know, ultimately I think we will have some sort of consent platform for us as individuals we may choose.

00:37:16
Who are we going to trust to manage that for us?

00:37:20
But shouldn’t I be able to do things like say, you know, if I’m concerned about cancer research, shouldn’t I be able to set up a rule that says if somebody comes in and proves they’re a cancer researcher, and I would be happy to let them have access to my data for purposes of cancer research.

00:37:43
Equally, I might want to set up a rule that if I turn up unconscious in the er, any doctor that is in that ER should be able to access my data to be able to diagnose the problem.

00:37:57
That is the way we’ve solved that up to now is every interaction I’ve got to go through, you know, a 50 questions.

00:38:05
I’m exaggerating.

00:38:06
No, but it is to choose what.

00:38:07
I want to do.

00:38:08
It’s a point solution.

00:38:10
You know, everything’s a point solution.

00:38:12
Instead, there’s certain Things I ought to be able to say, yeah, I’m, I’m comfortable with that and let’s set that up as a rule.

00:38:20
And now when somebody is accessing data, they ought to be able to consult those rules to determine what they’re allowed to, to get at.

00:38:30
Right.

00:38:31
That’s ultimately where I think we’re going to end up.

00:38:34
Yeah, I think you’re right.

00:38:36
I think it’s, it’s the same as your settings on your iPhone.

00:38:39
You set up your settings on your iPhone and it controls everything from, you know, your audio to your brightness to your various apps when they can be, be accessed and everything else.

00:38:51
And we do that, you know, and that’s.

00:38:55
You go back to thinking about payers.

00:38:59
You know, when I was working for Payer, you would, you’d be thinking about what can I implement that sort of 90% of the members can use.

00:39:09
But to your point about the iPhone, I bet you if we compared front screens on our phones, they’d be totally different.

00:39:16
Right.

00:39:16
Where we’re heading to is a world where we’ve got a whole bunch of 5, 10, 15% solutions that make up what I need, right, to keep me healthy.

00:39:29
And so we have to get away from this, of what can we do for everyone?

00:39:34
To what can we, how can we create an environment, an ecosystem where you can have a whole series of these apps, services that really meet the requirements that we need because everybody is different.

00:39:49
And so I’ll have a different, you know, 20 different apps than you would have.

00:39:54
Right.

00:39:54
And that’s okay.

00:39:57
And I think that’s where we’re heading towards.

00:39:59
I remember years ago when Microsoft was pushing their Office products, I always said that you should have a series of questions.

00:40:08
You ask about what type of user you’re going to be because they would always give you everything plus the kitchen sink.

00:40:14
And it was like you only use probably 5 to 10% of the capabilities of it.

00:40:18
And, and we’re moving towards that.

00:40:21
And, and really AI should be able to help us that if I just want certain questions answered or certain things, I, I want to share my data with it.

00:40:31
It should be something that you deal with up front.

00:40:34
And then whether you’re acts, doing it, using your phone or whatever, it, it then it pretty much runs itself.

00:40:41
I mean, I just feel like we’re.

00:40:42
Sometimes you make this too complicated.

00:40:44
Obviously what’s working in the background is more complicated, but yeah.

00:40:49
So.

00:40:50
All right, Mark, we’re not going to solve the world’s problems today.

00:40:54
Is there anything else you.

00:40:55
We haven’t even mentioned fire.

00:40:57
Even though we’ve been talking for about 40 minutes.

00:40:59
Is there anything you want to say about FIRE while we’re talking about interoperability?

00:41:05
I think the simplest thing for those folks that are wondering, what is this?

00:41:09
Right.

00:41:10
What is fhir?

00:41:11
Okay, it’s a specification, but a lot of people will talk about, yeah, we’re compatible with fhir.

00:41:18
It’s not about the specification, it’s about the use cases that are built on top of it.

00:41:26
So when you look at the CMS regulations, yes, they’re saying you need to support FHIR release for, okay, it’s the base space.

00:41:34
But then they go on to say, hey, provide a directory.

00:41:39
Here’s a set of APIs.

00:41:41
This implementation guide, a community has agreed this is what we want it to be able to do.

00:41:46
And the same US core is clinical data is the same thing.

00:41:51
A community is agreeing, the same interactions.

00:41:54
So from a FHIR perspective, you’re seeing a US core, you’re seeing a Canadian core, an Australian core.

00:42:02
Right, right.

00:42:02
It’s all about those communities and agreeing a way that they’re going to share data that they can understand in, in their environment.

00:42:11
And so that’s the key thing with fhir.

00:42:13
It’s not about the basic specification, it’s about the use cases and it’s really about the community.

00:42:21
Right, right.

00:42:22
That is really driving that.

00:42:24
Many specs have been, you know, taken from the ivory tower and pushed down on people.

00:42:29
But really FIRE is one of those things that’s more grassroots, that bubbles things up and makes them available and can evolve with the needs of the community.

00:42:40
And that’s really, I think, has been the real strength of fire.

00:42:44
Yeah, And I think it’s similar to what we saw with X12.

00:42:47
You set up a overall standards and then use the implementation guides to deal with the in between and the more specific stuff.

00:42:56
But the community builds a series of standards that everyone agrees we’re going to abide by, along with some implementation guides that bring you more specificity.

00:43:09
And that’s certainly what we’re looking, we’re seeing with a lot of our clients is that they’re now seeing that CMS is serious about this, about interoperability.

00:43:20
It’s becoming bidirectional, it’s.

00:43:22
It’s becoming real time.

00:43:25
There’s also the fact that these implementation guides are constantly evolving.

00:43:29
And so a lot of folks out there are looking at, is that something I want to take on or do I want to find a partner that will deal with that underlying change?

00:43:40
You know, it’s a bit like, you Know you see us recently came back from Stratford on Avon in the uk.

00:43:45
You see those beautiful white swans, right.

00:43:48
But underneath they’re paddling like crazy.

00:43:50
Right.

00:43:50
To keep.

00:43:51
And that’s sort of.

00:43:53
You want to find a partner that can paddle like crazy, but keeping everything calm for you, that everything works.

00:44:01
So, you know, that’s the evolution we’re going from, oh, let’s just buy a fi server and let’s start to put things together to.

00:44:08
No, I need a solution.

00:44:11
That’s really, the market’s very interesting in the way it’s evolving right now.

00:44:16
Absolutely.

00:44:17
Well, Mark, I think we’ve taken up a lot of your time, so I just want to close with a couple quick questions.

00:44:23
One is where can people find out more about your work and, and how they or their organization might get involved?

00:44:32
You can always hit me up on Twitter as Ekive Mark E K I V E M A R k or on LinkedIn.

00:44:41
You can find me by my name.

00:44:44
You can hit us up@onyxhealth IO we happy to talk to folks.

00:44:50
We’ve been doing a lot of outreach around this latest interoperability rule.

00:44:55
So those are, you know, three very easy ways to find me.

00:44:58
Okay.

00:44:59
And we’ll put them in the show notes when we put them together after this episode.

00:45:04
And then finally, what are the things you like to do when you’re not trying to save the world with interoperability in the healthcare space?

00:45:15
Well, funny you should say that actually.

00:45:17
I was going through my email last night and the, my schedule came.

00:45:23
I had to fill out what my schedule is for the local ski resort.

00:45:28
So during the winter, I’m actually a part time ski instructor.

00:45:32
So don’t try and get me for a meeting on Friday afternoons.

00:45:35
In the winter I, I tend to be out on the, on the slopes.

00:45:41
So that’s been really interesting because the way that you have to be able to educate guests, you’re teaching them to ski.

00:45:51
Oh yeah.

00:45:52
And you have to think about the different way people learn and absorb information.

00:45:57
And so I found, I found that over the last 15 years to be really beneficial in, in how I think about how I need to communicate.

00:46:06
Right, right.

00:46:07
You know, simple concepts like interoperability.

00:46:12
That’s a, that’s a good point.

00:46:14
Yeah.

00:46:15
If you can teach someone to ski without hurting themselves or somebody else, interoperability is a piece of cake.

00:46:23
Relatively.

00:46:24
Yes.

00:46:24
Yeah.

00:46:25
Well, yeah, relatively.

00:46:26
All right, Mark, well, thanks for your time and we will talk to you soon.

00:46:32
It’s a pleasure.

00:46:33
Thanks a lot.

00:46:34
Tony.

00:46:34
Great to.

00:46:35
Great to see you.

00:46:36
Thanks Thanks.

Disclosure: The host of this podcast is a paid Onyx Board member.

FTC Disclosure: Some guests pay to advertise on the podcast. Opinions expressed by guests on the podcast are solely their own and do not necessarily reflect the opinions of the host or HealthBiz Talk Show.