Laurie McGraw is speaking with Inspiring Women Drs. Marjorie Rallins and Holly Miller who are experts in the space of data standards setting and the landscape of interoperability.
Both Marjorie and Holly have devoted their expertise and careers towards building the infrastructure and plumbing that fuels the clinical data information highway so that clinical data is trustworthy, useful and actionable. They share the progress made over the past few decades and the opportunity in front of us with the adoption of TEFCA (Trusted Exchange Framework and Common Agreement). They emphasize the complexities of standards and terminologies governing health information flow and highlight interoperability’s critical role in improving healthcare quality, safety, efficiency, and patient engagement.
Dr. Miller notes that while health data exchange is widespread, data often lacks reliability and usability for seamless integration into patient care. Dr. Rallins reflects on improvements since the inception of interoperability initiatives, citing advances in electronic health records (EHRs) but noting persistent challenges like semantic interoperability with standardized terminologies. She also notes that this may be technical, but is also not that hard. The “Internet of Interoperability,” prioritizing data accessibility alongside security and privacy protections is the aim.
They also discuss challenges such as data blocking and regulatory efforts to promote patient access and adherence to interoperability standards like USCDI. Overall, they express cautious optimism about interoperability’s progress amid ongoing issues of data usability, trustworthiness, and regulatory compliance, with an eye toward evolving technologies like AI for future improvements
Both Marjorie and Holly recognize that there are fewer women who, like them, have pursued a field of data standards and interoperability. Yet, they are NOT alone and with appreciation for those who work alongside them, they encourage others to choose this deeply technical path.
We close with giving both doctors a magic wand to advance the healthcare landscape. Holly officially wants to “ax the fax” and get to standardized data. Marjorie also looks to standardized terminologies but asks for national health equity as the most important path for us to pursue.
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Dr. Holly Miller
Chief Medical Officer, MedAllies
Dr. Miller is an internist who has practiced medicine using several EHR systems and has well over two decades of healthcare IT experience.
Since 2009, Dr. Miller has been the Chief Medical Officer of MedAllies a company that operates multiple networks in support of interoperability. At MedAllies, Dr. Miller provides operational, tactical, and strategic collaborative leadership.
Dr. Miller is currently a Chair, Co-Chair, or member of many Health Information Technology (HIT) Interoperability related committees and workgroups engaged in enhancing healthcare value. These include committees within the following organizations: Carequality; Sequoia; DaVinci; CMS: PACIO; ONC: 360X; IHE; NCQA; HIMSS; Moving Forward and KLAS. She continues to be a frequent speaker at national conferences.
Dr. Miller was formerly a VP and the CMIO of University Hospitals and Health Systems (UH), a community-based system with more than 150 locations, seven wholly owned and four affiliated hospitals throughout Northern Ohio. Prior to joining UH, she worked as an HIT Managing Director for the Cleveland Clinic where she also maintained a clinical practice in General Internal Medicine. She has been active in healthcare informatics research and has been a co-investigator on multiple grants.
As a member of HIMSS since 1999, Dr. Miller is a past Vice Chair of the HIMSS Board and a past inaugural member of the HIMSS World-Wide Board. Her past roles within HIMSS also included being a physician leader of the HIMSS/AMDIS Physician Community and serving as the Board Liaison to HIMSS Europe for four years. She was also active in a variety of previous S&I ONC committees and other state and government HIT committees. Dr. Miller earned her MBA at Hautes Etudes Commerciale in Paris and her Doctor of Medicine at Albert Einstein College of Medicine in New York City.
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Dr. Marjorie Rallins
Executive Director of Health Data Standards, LOINC® at Regenstrief Institute
Marjorie Rallins, DPM, MS, is a nationally recognized leader in health data standards and informatics. She began her duties with LOINC® at Regenstrief Institute January 11, 2021. She previously served as vice president and chief scientific officer of the PCPI® Foundation in Chicago as well as director of clinical informatics for the American Medical Association. Her proven experience in a unique combination of clinical research, business development and thought leadership positions Regenstrief Health Data Standards to continue facilitating healthcare interoperability at a crucial time for public health.
Dr. Rallins received her podiatric medical degree from the William M. Scholl College of Podiatric Medicine in Chicago and completed her master of science degree at Northwestern University in Chicago. She was chief resident at Southwest Detroit Hospital and practiced as a podiatrist before working as the director of clinical editors for the College of American Pathologists, where she led international clinical teams in SNOMED CT® development. Dr. Rallins received her undergraduate degree from Towson University in Towson, Maryland.
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I often mentor other people that are joining
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this field, you know, coming from
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clinical care or whatever,
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and most of them are women.
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And I gave them 3 pieces of advice,
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particularly women of color.
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I say, you know, don't let the impostor
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syndrome
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stop you from pursuing your goals because women
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are often
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considered to be impostor in this space. Right?
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So you can't adopt that. Persona for yourself.
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The other thing is to stake here and
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take risks and embrace
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new experiences because women studies show although many
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will believe that, A risk takers, right?
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By nature.
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And then the third thing, which I always
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tell women, and women of color is to
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lift as you climb.
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And and that's that's sort of my motto.
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It's a it's a driver for me.
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Because then that helps others and it helps
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the profession improve.
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So
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those are my 3 things.
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Thank you for that. Holly? So I... Marge,
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I cannot believe you brought up in impostor
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syndrome because that's what I was going to
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start.
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When when I was in medical school, I
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I don't remember what the context was, but
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there was a group of only women in
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medical school
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together. And we started talking about... Well, you
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know,
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I think that that really, they made a
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mistake when I was admitted.
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And every single woman in that group
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had... That's
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at some level have that feeling deep within
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them. Which is impostor syndrome.
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And and so I want that killed off.
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I I just given to be
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This is inspiring women, and I'm Lori Mcgraw,
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and today, I'm speaking with 2
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physicians, 2 lu
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in the space of standards and interoperability.
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I'm speaking with doctor Marjorie Rollins and doctor
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Holly Miller.
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Doctor Rollins is the executive
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of long she has
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many years as a nationally recognized expert in
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the field of both standards data setting and
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health care as well as
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interoperability,
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and doctor Holly Miller
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is At met allies, and she also has
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2 decades as next expert. I don't know
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how many different committees she is on in
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terms of standard setting and interoperability, but it
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is a lot. She's also has been a
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practicing
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positioned. So she really appreciates the wide interoperability
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is so important in the air of health
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care. Doctors Rollins and Miller, thank you so
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much for being on inspiring women.
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Thank you for inviting us laura.
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Great. Well...
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Sure. Mark so so Marjorie, why don't we
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just, like, a little bit more on your
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background? I'm no way doing a justice in
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terms of just all of the accolades and
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things that you've worked on over the years.
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Could you just give us a little bit
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more of your background?
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Yes so I am a clinician and a
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a diet pediatric
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physician by training,
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but most of my,
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professional career
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has been spent
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in,
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informatics and terminology standards as you know, Laurie.
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I also that also microbiology.
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Stand, I don't know if you know that.
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And
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began my career by working doctor Anthony Fauci
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at the Washington Hospital Center in Washington Dc.
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My national treasure, Can we just gauge that
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here?
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It it was a wonderful experience. I was
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right out of college.
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Had no idea of who I was working
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with, but it was a a wonderful experience.
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But,
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you know, I'm been I'm a terminology and
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in
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invitation,
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and terminology standards and
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making those things work so that we have
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better health care and better outcomes is my
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passion and I've done that in a number
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of ways you know Laurie at the college
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of American Pathologist, the Ama,
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and now the Rica We've been working with
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many
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organizations. And I'm certain that Of across paths
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with Holly numerous types.
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We're Holly?
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Well, I'm I'm intimidated Marquee.
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We are jerry. I... You're you're such an
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impressive background in person, but, I'm an intern
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and what that is is a primary care
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physician for adults.
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I became
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really interested it in interoperability in in, actually
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health information technology.
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In my first job, we had a homegrown
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electronic health record, which by today's standards
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was truly truly truly terrible.
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But the the fact of the matter is
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the record was available at all times and
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to everyone, and it didn't intrigued me the
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possibilities
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that could come from health information technology.
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So I particularly was interested because
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it's a way of
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thinking of thousands of people that you can
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help at once.
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And instead of just 1 on 1
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seeing patients every day.
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So
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I have been the...
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A managing director and had a very active
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practice at the Cleveland Clinic.
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I was the Chief Medical Information officer at
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University hospitals,
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And then I met on the Him board,
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doctor John Blair, who runs me at allies.
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And
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because
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the environments I've been working in had the
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ability for all of the physicians, they were
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integrated delivery network. So all the physicians could
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see the same record? And he said, well,
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why don't you come
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work with us, because we have an open
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community where we need to figure out interoperability
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because no 1 has information
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from other physicians in an open community of
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small physicians. So I was intrigued and I
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went to work at Med Allies. And since
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then, we've evolved greatly
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Yeah, Well, listen, let's dive of into sort
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of like, you know, where we are with
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interoperability.
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I mean, first of all,
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standards, terminology,
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datasets,
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and how these things sorta, like, flow through
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the electronic,
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air waves is complex, kinda geek stuff. Let's
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be let's be honest. So when we take
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2 positions,
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and we sort of, you know, take your
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clinical knowledge and apply it towards this very
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deep technical
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book, critical
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applications for how data moves around the system.
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I think it's you have a unique perspective
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to actually not just
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how to make it work, but why it
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is so very, very important. If we think
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about what interoperability
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tends to do of the definition, I believe,
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is that tends to
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improve quality,
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safety
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and
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efficiency by engaging
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patients, families, it intends to improve care
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coordination,
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improve public and population health. So this is
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actually written
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into the Aca,
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and I would love to start with... So
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How are we doing? How are we doing
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with the state of interoperability
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today? And maybe Holly, you could kick us
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off of that?
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Sure. Thank you, Laurie. Well,
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first of all, let me say that there
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is massive
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exchange going on. So millions of records are
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being exchanged as we speak today.
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That being said,
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the constituents that are receiving those records, so
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clinicians
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consumers,
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payers, etcetera,
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don't
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necessarily find the data useful.
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And if it's not trustworthy
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useful and actionable.
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Unfortunately, it it won't be acted upon and
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and integrate it into the king.
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Integrated into the care.
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So I think
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there was a study that just came out
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that Mickey T Head of o c commented
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on that
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that in fact, people that are using the
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data,
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find interoperability
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very useful
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But I think the other thing that's really
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important to consider in our state of interoperability
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right now is that there are exchange networks.
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And if they're not on the same framework,
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they can't exchange with each other.
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Which is why I'm so excited about the
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Trusted exchange framework and common agreement or T,
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Okay? Alright. So I wanna talk about T
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gov before we get to that, and I
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wanna talk about some of those, you know,
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aspects of trustworthiness.
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Action ability
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and utility.
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Marjorie, what are your thoughts? I mean, it's
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been 14 years since the Aca was put
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in place. So,
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while, there is tremendous progress, and there's millions
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of records being exchanged every day. Where would
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you so to put it on the scale
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of whether those 3 factors
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action ability, trustworthy nest utility?
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Or do you have about... Do you look
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at it in additional ways or different ways?
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Yeah. That's that's a great question. I would
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say that
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I think interoperability
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goes all the way back to 19 96.
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With the
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you know, when the paper was released to
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Heir human
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because that's when we first connected
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medical errors,
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with our fragmented healthcare care system. So that's
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when we really launched a focus on interoperability.
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And Aca was downstream stream from that. We've
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made a lot of
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significant progress since then. Right?
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Ehr are much more improved because of
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policy and technology working together,
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there's better access to data patients have better
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access. We all know that, and now we
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have T.
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I would say,
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while we've made these great strides, there significant
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work in progress that still needs to go
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on,
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today, 70 percent of providers still fax results,
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and Holly, I'm sure you know that.
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And then
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all the parts of interoperability
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because it has various perspectives
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are in different stages. Right? And so
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the semantic term,
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terminology or semantic interrupt ability that uses a
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Cpt,
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lying and sn med
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still has a lot of work to do
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the long way to go.
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To get where we think we need to
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be. And 1 reason for that is what
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relates to a hell, it's buying in and
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adoption and what's in it for me. I
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think that's, you know, that's the main
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place of where we are. We don't have
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regulation to push us that far. Do you
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mind do you mind defining semantic
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interoperability in more layman's terms? Yes. I I
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should do that. So semantic inter interoperability is
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ensuring that
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data
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or information means that the same thing
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regardless of how it was
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captured. So,
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you know, things like
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myocardial infarction and heart attack mean the same
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thing,
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even if they recorded differently,
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in standards like like snow mad and even
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Cpt and I I know people Lori like
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to say Cpt is not a standard, but
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it is. If it's its own type of
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standard
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and it helps
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imprint sort of normalize
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information so that we all know that we're
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comparing and talking about the same thing, apples
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to apples.
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And even red delicious apples to to yellow
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delicious apples. But, you know, when it's record,
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but those things are both apples and we
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need to know that. So Yeah.
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That's what's semantic interoperability.
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There's also structural and
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functional and other types. But I... I think
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that's a part of interoperability
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that still
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isn't in development.
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Okay. So let's maybe to go through sort
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of some of those qualitative aspects of interoperability
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today. So the the usability,
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the trustworthiness
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and the action ability of data, and then
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maybe we can move to T and what
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that will further do, like, what
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is and what it will further do. But,
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so usability,
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just like, like, what what
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what what do you mean by that? Holly
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in terms of, like, how useful or not
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useful data is even when it's being exchanged
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or maybe you can talk about all 3
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of those aspects, usability, trustworthiness
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and action ability when data's is flowing around,
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when is it substandard?
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So let me start with trustworthy they've because
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for many people, that is really 1 of
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the the most important things and it and
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if you consider
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what could happen,
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having the wrong
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information on your patient come in, thinking it's
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your patient's information.
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Obviously, that becomes very clear that without being
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able to trust the data,
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there's no way you either just you even
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wanna go near it. So there's no standard
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right now for the way that a patient
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demographics are recorded.
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So 1 each Ehr might do it 1
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way and another Ehr might do it another
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way. And,
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therefore,
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as that information flows from 1 system to
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another, it may be misinterpreted,
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and,
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you may end up
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getting data on than an incorrect patient. So
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I think that's work that's actively being done
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that that ensuring that
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when you get the information, it is on
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the correct patient that you're looking for or
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individual
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or the individuals getting their own data, But
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as a
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physician, when you are seeing data, you know,
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about the patient that's in front of you
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or you're going into the room, and that
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data has come from,
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from systems whether your patient was seen in
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your particular clinic, a hospital
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or somewhere else, You know, III
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broke my foot,
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you know, on on vacation or something like
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that. How how would have physician recognize
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that the data might not be correct? How
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does that present itself? And how do you
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determine or are there ways to determine that?
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Well, I think I think the most important
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in the first step is to validate
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with the person in front of you. So
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they can clearly let you know know. I
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never didn't break my foot. I don't know
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what you're talking about
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so that...
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Or, you know, if you start... And I'm
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I'm particularly talking about a new patient. Yes.
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So
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validation is key, and and I...
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My
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1 of 1 of the things I hope
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for, but I think this is still in
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some ways controversial. Is that
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consumers of health can look at their data
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and correct things.
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So if I'm looking for a consumer of
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health care is looking at their medication list,
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and it's correct. But they stopped taking a
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education because it gave them stomach upset to
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be able to put that in their record
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and for their clinician to see it.
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Mh.
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So
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so that's
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a aside, But...
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That's if you were gonna go your trustworthiness.
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I... I yeah. So that's trustworthiness.
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If we go to maybe
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maybe action ability and utility,
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Marjorie, what are your thoughts perhaps about those
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those aspects of the data as it's being
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moved around the big systems of, you know,
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the air waves across on different health systems?
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How are we doing in those 2 areas?
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I think we're
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I think we're doing
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better.
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So we have standards in place.
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So that data means the same thing,
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you know, when when we send it from
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1 place to another, you move from 1
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hospital to another...
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That your results are your results or your
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data
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are connected to you in the way that
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they should be.
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And, you know, there's there's all kinds of
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processes and protocols
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to help that.
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The challenges I mentioned earlier
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is
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ensuring that
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the providers and the institutions
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adopt
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the protocols
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and and
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you know,
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recommendations
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that are put forth. Sometimes it comes from
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the federal government. Right? And the federal government
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is very
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sort of thoughtful
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in how they regulate and mandate things.
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And so here in the Us,
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there are recommendations that you should do. They're
00:16:53
getting closer
00:16:55
to
00:16:55
recommendations that you must do.
00:16:58
Because a lot a lot of this is
00:17:00
not
00:17:01
technologically hard, it's cultural
00:17:03
and its people that have to adopt these
00:17:06
processes and protocols in order for them
00:17:09
to to work and get adopted.
00:17:12
Mh. Mh. And I'd like the I like
00:17:15
the concept of also trust but verify. So
00:17:19
physicians
00:17:20
sort of, you know, looking, but also verifying
00:17:22
with the patient. And I also like, you
00:17:24
know, holly your recommendation from a patient perspective,
00:17:28
of having the data, but also verifying it,
00:17:31
you know, taking proactive
00:17:32
action
00:17:34
as a patient to verify the data that's
00:17:36
in front of you as a step. So
00:17:38
let's talk about some of those, sort of,
00:17:40
you know, advances in terms of but beyond
00:17:43
desired
00:17:44
to required
00:17:46
in terms of what can happen with regulation.
00:17:49
Holly, you mentioned T.
00:17:51
Maybe you could explain what it is, what's
00:17:54
coming and what we should expect from that.
00:17:58
Well, t
00:18:00
is the acronym for the trusted exchange framework
00:18:03
and common agreement.
00:18:05
And that was really created as part of
00:18:07
the 20 16 20 first Century Cures Act,
00:18:10
which gave us all kinds of wonderful things
00:18:12
fully. I I love that act.
00:18:16
And T is meant to be the Internet
00:18:20
interoperability.
00:18:21
So really the on ramp for interoperability.
00:18:25
And it's designed to be comprehensive
00:18:27
of so that we can increase secure an
00:18:30
appropriate access to data,
00:18:32
and,
00:18:34
marjorie, you'll love this, ensure a core set
00:18:36
of data is available among networks connected through
00:18:39
that common agreement.
00:18:41
And and I would
00:18:43
emphasize that data On c takes such a
00:18:46
huge part in this,
00:18:48
what are is the required data to to
00:18:52
to exchange.
00:18:53
And as you reference, Laurie, it's decreased the
00:18:56
cost, improve efficiency,
00:18:58
provide health information networks and health It developers
00:19:02
with the common set of privacy and security
00:19:04
requirements.
00:19:05
So really, if you think about T
00:19:08
and and what
00:19:09
it's meant to do is
00:19:14
bring the...
00:19:15
And Use the analogy of of,
00:19:18
transportation.
00:19:20
T
00:19:22
through the
00:19:24
recognized coordinating
00:19:25
entity, which is Sequoia
00:19:27
drew together industry constituents
00:19:30
to develop
00:19:31
the, trusted exchange and common agreement.
00:19:34
And these were
00:19:36
a common set of principles terms and conditions
00:19:40
to enable the exchange of electronic health information
00:19:42
nationally.
00:19:44
And and so
00:19:45
what
00:19:46
T could does is have a
00:19:50
in has created requirements for an
00:19:53
infrastructure technically
00:19:55
as well as the rules of the road
00:19:58
that everyone who signs and participate in in
00:20:01
T has agreed
00:20:03
to
00:20:04
this set of principles
00:20:06
and the conditions. And for example, that
00:20:11
that
00:20:12
if I'm querying for a patient
00:20:16
for treatment reasons, that that that is truly
00:20:19
why I'm praying for that patient because I'm
00:20:21
treating the patient.
00:20:24
There's... And so the common agreement is really
00:20:26
what
00:20:27
everyone rating has agreed to.
00:20:30
And I think that where we're going
00:20:34
is
00:20:36
to build this super highway
00:20:38
where
00:20:39
everyone ultimately will will participate
00:20:42
all health constituents.
00:20:43
Marjorie, when does T go into place and
00:20:46
and, who who has to comply with it?
00:20:49
I think anyone who
00:20:52
signs that agreement,
00:20:54
has to comply with that. So I think
00:20:57
the agreement was signed
00:20:59
in on December fifteenth
00:21:01
or 12/14/2023,
00:21:04
and the big announcement happened in Washington, Dc
00:21:07
at the O c,
00:21:09
conference and holly I'm sure you you were
00:21:11
there. Were you there?
00:21:13
My my boss was. Is there okay. Med
00:21:16
Allies was 1 of the first rare designated
00:21:19
cue. So Right. So
00:21:21
Right. So that's kind of how you...
00:21:24
If you agree... You have to sign in
00:21:26
and agree,
00:21:27
And it... I think it starts with the
00:21:29
cue hands correct? Am That I correct, Holly.
00:21:32
Right. Yes. Absolutely. And Q is the acronym
00:21:35
for qualified health information networks. It. So again,
00:21:39
the Rn c rs... I saw I'm sorry.
00:21:42
The recognized coordinated
00:21:44
entity or Sequoia was was
00:21:47
assigned to test
00:21:49
and designate
00:21:52
qualified health information networks
00:21:54
that then would have their customers
00:21:58
and their customers in t speak, our participants.
00:22:03
And if a participant is wants some of
00:22:07
their
00:22:08
linked
00:22:10
organizations also to participate, they would be called
00:22:13
sub participants.
00:22:15
So you can see the real that we're
00:22:17
getting it to the bowel of
00:22:21
is great. And we and listen, at health
00:22:23
care. We love our acronyms
00:22:25
in health care, and I know this because,
00:22:27
like, in my family, 1 of the fun.
00:22:30
Thanksgiving games is for my kids just, like,
00:22:33
play little acronyms and just like, you know,
00:22:36
speaking health care. And they have no idea
00:22:38
what they're talking about, which is kind of
00:22:39
fun around the, the festive table. But if
00:22:43
we look at sort of, like this advancement,
00:22:45
and it sort of you have to sign
00:22:46
into it. The, you know, we know in
00:22:49
healthcare there there is,
00:22:51
talking about, you know, data blocking. People, you
00:22:54
know, organizations that don't necessarily want to share
00:22:59
their data. And I think
00:23:01
for most people,
00:23:03
it is easy to comprehend
00:23:06
that they would want their
00:23:08
physician, their clinical team to know everything that
00:23:12
there is about them to receive the best
00:23:15
care. Yet. We hear in health that there's
00:23:18
data blocking, and that's still a thing. And
00:23:21
so, Margaret, I'd love your perspective on just
00:23:24
you know, so the where does that exist.
00:23:26
Why does that still exist, And do we
00:23:28
expect that to
00:23:31
go away
00:23:32
anytime soon?
00:23:33
Well,
00:23:34
I I mean, it exists because people biz
00:23:36
build businesses around
00:23:38
selling data. Right? It's it's that simple.
00:23:42
III
00:23:43
don't
00:23:44
I I can't say that people have
00:23:48
Nefarious
00:23:49
intentions
00:23:50
about blocking data. It just
00:23:52
serves their best in interest. But
00:23:55
that's why the 20 first century cures act
00:23:58
has provisions that prevent that. Right? That's why
00:24:03
patients have to have full access to their
00:24:06
data. And if you're accepting
00:24:08
government money. You can't block that. Right? I
00:24:11
don't know this... I can't articulate the specific
00:24:15
provisions that state that. But you can't do
00:24:18
that. The same is true for
00:24:21
organizations,
00:24:22
you know,
00:24:23
they can't
00:24:25
if if that information is
00:24:27
requested under certain criteria,
00:24:29
you have to make that information available. That's
00:24:32
also been built into T.
00:24:34
Right?
00:24:35
Right? So if you're gonna,
00:24:38
participate in T, then you have to follow
00:24:40
the the the rules and god at been
00:24:43
outlined that draw from other pieces of regulation
00:24:46
as well.
00:24:49
Holly, what would you add to that?
00:24:52
Oh, a lot.
00:24:54
I think marjorie, you did a great job,
00:24:55
but I think
00:24:57
when we think about the obstacles
00:24:58
to interoperability,
00:25:02
dis determination of standards and technology
00:25:04
is really a slow process
00:25:06
because the development
00:25:08
by
00:25:10
Hiv
00:25:14
companies
00:25:15
has to happen,
00:25:16
then training has to happen, roll
00:25:19
and finally adoption.
00:25:21
And and this is an area where sometimes
00:25:24
a bad job of training and identify roll
00:25:27
role based workflows
00:25:29
in the
00:25:30
organization doesn't happen. So adoption is extremely slow.
00:25:35
It doesn't happen overnight. And And that leads
00:25:38
to a lack of,
00:25:40
patients or frustration. And and then
00:25:44
the hype cycle starts for the next shiny
00:25:46
new technical object,
00:25:48
So so I think that's 1 of the
00:25:50
things, but
00:25:51
back to
00:25:53
information blocking, It's it's not only
00:25:56
They won't get government money. They will be
00:25:58
fined
00:25:59
very very significant fines.
00:26:01
And
00:26:02
that's in the H html 1 rule if
00:26:04
anyone is interested.
00:26:06
And then,
00:26:08
I did wanna go back, Lori to what
00:26:11
you were saying about...
00:26:13
You know, implying that there might be a
00:26:15
render that is they... Is a blocker.
00:26:18
Mh. And there are rumors flying, but
00:26:21
we have worked very, very closely with that
00:26:25
vendor.
00:26:27
And I will say that
00:26:29
1 of our customers is Vera,
00:26:31
and Vera or Onesie Twos practice,
00:26:34
and this vendor has very large
00:26:38
organizations.
00:26:39
So
00:26:40
that kind of
00:26:43
communication between small practices and large organizations is
00:26:46
critical. If the patient goes into the hospital,
00:26:49
they the
00:26:51
small practice has to know what happened to
00:26:53
the patient and vice versa. So it's really
00:26:55
very important flow of information, and we really
00:26:58
got down into the weeds, of the workflows
00:27:01
to make sure that this would work.
00:27:03
So, I mean, just to just to put
00:27:05
a name on things. So, like, you know,
00:27:06
some of the reputation,
00:27:08
things in health care are that, you know,
00:27:11
hospitals can be typically
00:27:14
pinned as blockers of
00:27:17
information,
00:27:18
and, you know, Epic as a vendor has
00:27:21
has
00:27:22
reputation of being,
00:27:24
not
00:27:25
fully on board with interoperability.
00:27:28
Are you saying Holly that that is less
00:27:31
true today than the rumors
00:27:33
would state? Are you saying that the rumors
00:27:35
are evolving? I mean,
00:27:37
I'm saying I'm saying actually, that that is
00:27:40
absolutely not the case. And the ben owns
00:27:42
are referring to is epic
00:27:44
we did learn that Epics customers have concerns
00:27:47
about trust and security using
00:27:50
this new test up. And we know
00:27:54
because we've worked with them very, very closely
00:27:56
that Epic is completely committed to He.
00:27:59
But if you do imagine 1
00:28:01
serious wrong step that gets publicized nationally,
00:28:06
it might kill
00:28:08
what we're trying to achieve or really slow
00:28:11
it down. So they want to be cautious,
00:28:13
and they want to be sure that everything
00:28:15
is right
00:28:17
in order for tech to be completely successful.
00:28:20
And part of that is to make sure
00:28:22
that trust and security,
00:28:24
is present and that all players are following
00:28:26
the common agreement.
00:28:28
That's a you... That sounds like an optimistic
00:28:30
view for progress
00:28:32
and working through what have been historically
00:28:36
discussed as bit large barriers just to sort
00:28:39
of like, you know, put words to it.
00:28:41
Marjorie, you know, do you share that view?
00:28:43
And I'd love to also get your perspective
00:28:46
from,
00:28:47
you know, being responsible for like, 1 of
00:28:49
the standards that, you know, are really important
00:28:52
in the sending of data, you know, back
00:28:54
and forth just, you know, the role of
00:28:56
the actual term technologies
00:28:58
within the interoperability space.
00:29:01
Yeah. Well,
00:29:03
I've never really... When it comes to, you
00:29:05
know, what's which
00:29:07
vendors are
00:29:09
intentionally blocking. I I can't really speak to
00:29:11
that. And I don't know if it's
00:29:14
intentional. I just know it's about
00:29:16
what's in their best interest. Right? As a
00:29:18
business, we all know.
00:29:21
In terms of,
00:29:22
you know, we are you know, where the
00:29:24
terminology fits in and into sort of this
00:29:27
larger,
00:29:28
maybe T discussion,
00:29:31
you know,
00:29:32
and we... You also have to agree to
00:29:34
follow
00:29:36
other
00:29:36
recommendations like
00:29:38
the Us Cdi, that's another...
00:29:40
The United States Core data,
00:29:43
interoperability,
00:29:44
which is essentially
00:29:46
the minimum datasets
00:29:48
of e data elements that should be
00:29:51
exchanged
00:29:52
electronically.
00:29:53
And if you use you Us Cdi, that
00:29:57
means that you have to use terminology
00:29:59
recommendations
00:30:00
to do that. So like
00:30:03
for sharing
00:30:04
observations and laboratory results, no Med ct,
00:30:08
for
00:30:09
you know, clinical findings, etcetera, Cpt,
00:30:13
and Icd are also named
00:30:16
and you have to agree to use those
00:30:18
in accordance with those
00:30:20
recommendations,
00:30:21
because that's how
00:30:24
you know, larger
00:30:26
policy initiatives like T,
00:30:30
exceed or sexy succeed because people have agreed
00:30:33
to do that.
00:30:35
The challenges is sometimes,
00:30:36
I think with
00:30:38
Us regulation is how far do they
00:30:42
mandate. Right?
00:30:44
And I I think that's holly I'd love
00:30:46
to hear what you think about that. If
00:30:48
that's okay, Lori. Yeah. Absolutely. And you already
00:30:51
know that Holly all, the Holly put out,
00:30:54
like, big fines coming. So
00:30:57
What I mean, you know, and other in
00:30:59
others sort of single payer countries, there is
00:31:02
a lot of choice.
00:31:03
Here, it's third party payer. I didn't it
00:31:06
make that it it impacts how
00:31:10
regulation
00:31:11
develops and is adopting. So
00:31:15
Mar, I think that's a great question. And
00:31:18
part of the
00:31:21
slowness that we're all frustrated with is
00:31:24
that we have and and Us usc is
00:31:26
a great example.
00:31:27
We have that evolving
00:31:29
over time and getting better and better and
00:31:32
more and more
00:31:34
going deeper and deeper into
00:31:36
the information that that really has to be
00:31:39
communicated back and forth when you're taking care
00:31:40
of patients.
00:31:42
And yet,
00:31:44
we're on
00:31:45
a a much earlier
00:31:47
version than what's been working on now because
00:31:51
see developers in
00:31:54
Ehr and health information technology
00:31:56
have to
00:31:57
continually be working on these things.
00:32:00
So it's
00:32:01
it's...
00:32:02
They have so much mandated
00:32:05
right now in order to get certified
00:32:08
that it's hard to go even faster.
00:32:11
And and that's frustrating for everyone.
00:32:14
Right. We just released a version 5 of
00:32:17
I would make comments on that. We should
00:32:19
be hearing about that today. I think On
00:32:21
c is gonna release
00:32:23
what Usc version 5 is. But most people
00:32:26
are on version 2. Correct? That's what's that's
00:32:29
what's mandated.
00:32:30
Right. To be certified.
00:32:32
So inter. Of that. And and Laura, I
00:32:35
just wanna add 1 other thing because I'm
00:32:36
sure this drive marjorie absolutely crazy.
00:32:40
Not only
00:32:42
there are electronic health records that aren't certified
00:32:46
and that they have their own
00:32:49
developed codes that have nothing to do with
00:32:52
our standard codes. They're just kind of... They
00:32:55
just said, oh, we'll code this is this
00:32:57
And so those have to then be
00:32:59
translated
00:33:01
into the standard codes. So that's still going
00:33:04
on. It's it's a really
00:33:06
It's a... It's a tangled web.
00:33:09
Semantic interoperability.
00:33:10
Right? That's what we just learned at the
00:33:12
beginning of night. Get facility. There's our problem.
00:33:15
Right. So like the slowness of this, let's
00:33:18
talk about, you know, the onset of Ai.
00:33:21
That is moving at... Lightning pace and Ai,
00:33:25
you know, in terms of all the systems
00:33:26
that are out there that are using
00:33:28
Ai, generative and other, that's just only creating,
00:33:32
you know, enormous amounts of new data and
00:33:36
information to be
00:33:38
exchanged.
00:33:39
Can that help in the, the speed of
00:33:42
the, you know, details of the data exchanges
00:33:45
and how those need to line up? Do
00:33:47
you see any
00:33:49
potential for progress there or or not.
00:33:53
Those faces say no.
00:33:56
Well,
00:33:56
I I do. I I think yes. Go
00:33:59
ahead.
00:34:01
In terms of Ai,
00:34:02
some of the things that I'm excited about
00:34:05
are
00:34:05
if I want to
00:34:09
look for
00:34:10
everything that's related to diagnose... This diagnosis.
00:34:15
And I could find all the records that
00:34:17
that are related to that diagnosis that reference
00:34:20
either that diagnosis or treatment for that diagnosis
00:34:23
or Medicaid, etcetera.
00:34:25
Because we do have to
00:34:27
explain why we're ordering something, and so it
00:34:30
it could... It's... They'd become linked. So
00:34:33
if I wanted to treat someone, and I
00:34:35
wasn't quite sure what the path had been
00:34:37
in the past,
00:34:38
that would be terrific to be able to
00:34:41
have Ai go out and just finished.
00:34:44
Or or in everything that has come in,
00:34:46
search through it and just present to me
00:34:49
in my Ehr,
00:34:51
what I that that example.
00:34:54
So great opportunities for usability. What else do
00:34:56
you see, Marjorie?
00:34:58
Well, I actually see
00:35:00
Ai helping with those
00:35:02
Ehr that don't use the standard. So they've
00:35:04
got their own
00:35:05
local
00:35:06
technologies. They're not mapped to the new ones
00:35:09
there.
00:35:11
You know, they need to move to the
00:35:14
latest version of Us Cdi,
00:35:17
But they need to at least be using
00:35:19
the standards in the Ai can help with
00:35:21
that because mapping
00:35:23
is labor intensive. If that type of thing
00:35:25
happens,
00:35:27
and other things follow soup. And I think
00:35:30
that we can move
00:35:32
more quickly and sort of mandate more quickly
00:35:37
later versions of important standards like Us Cdi
00:35:41
that help us get to the interoperability
00:35:44
that we're looking for. Does that does that
00:35:45
make sense?
00:35:47
It does to make Hell listen. I know
00:35:49
that we could go, like, for a long
00:35:51
long time on the details of the standards
00:35:54
and I'm sure there's more acronyms we haven't
00:35:56
even begun That's that's done. But I wanted
00:35:59
to go back a little bit.
00:36:01
It is, you clearly are both lu,
00:36:05
x spurt and leaders
00:36:08
in this really important space. And I'm hearing
00:36:10
a bit of optimism
00:36:12
and hopeful nest that even though it's been
00:36:15
since 19 96
00:36:16
that we've been really trying to advance in
00:36:19
the space of interoperability.
00:36:21
I just love to get a perspective. It's
00:36:24
this is... You know, it's kind of a
00:36:25
little bit of a nerdy space, and I
00:36:27
would say it's more, is less of a
00:36:30
women led space
00:36:33
than than other spaces of technology.
00:36:36
So I'd love to get a perspective as
00:36:38
clinicians as women as leaders,
00:36:41
what drew you into
00:36:43
being the experts that you are in this
00:36:46
particular space? Marjorie, do you wanna start first?
00:36:49
Yeah. I mean, you know, I've always wanted
00:36:53
I'm a clinician. Right? And I've, you know,
00:36:55
I... Went the medical school and
00:36:58
residency,
00:36:59
practice for a while,
00:37:01
but really wanted to
00:37:05
figure out how we could get better data.
00:37:08
To to help
00:37:10
us get better outcomes. It's really that simple.
00:37:13
Right?
00:37:14
And so
00:37:16
that's what led me to to get a
00:37:19
master's degree interoperability, and that's what brought me
00:37:21
here.
00:37:23
I think 1 of your other questions, I'm
00:37:24
curious is, it is definitely
00:37:26
a male
00:37:29
dominant space. It's generally not a place for
00:37:32
women,
00:37:33
but the numbers are growing. Right?
00:37:35
And and women have made significant
00:37:38
contributions to informatics.
00:37:40
Quite frankly,
00:37:41
Lori peoples
00:37:42
still talk about Lauren G at the Ama.
00:37:45
Oh,
00:37:46
they do. You know. And I think of
00:37:48
people like Suzanne Bak and who's a professor
00:37:50
of,
00:37:51
research chat and, you know, at
00:37:54
Columbia school of nursing and Karen Des, who
00:37:58
was the O c director
00:38:01
and it's now chief health officer at Google
00:38:03
Health.
00:38:04
All of those people, you know, women are
00:38:06
are making,
00:38:07
great strides. So I've got a bit off
00:38:09
topic, but
00:38:11
I just myself wanted to...
00:38:14
I just have an interest in figuring out
00:38:16
how we get better data to get better
00:38:17
outcomes. Well, you've committed your entire career to
00:38:20
it and you continue to advance it. Holly,
00:38:23
how did you catch? Catch bug.
00:38:26
First, I wanna mention that we have another
00:38:29
icon, Marjorie Rollins.
00:38:31
And yourself, I'll miller it.
00:38:34
And
00:38:35
it's it's what you've done is film in
00:38:38
your career. But
00:38:40
I think I already referenced the first
00:38:43
I realized the potential for electronic health records.
00:38:46
And
00:38:50
it it just struck me. And at at
00:38:52
that time, I was so naive to how
00:38:54
complex this is.
00:38:57
So
00:38:58
So I really started,
00:39:01
getting more and more involved in health information
00:39:03
technology as I was practicing.
00:39:06
Because I recognize
00:39:08
my passion really is trying to make an
00:39:10
impact to improve
00:39:13
the state of people's lives. And
00:39:17
I believe that
00:39:19
getting health information technology into interoperability ability. Right?
00:39:23
Is the is a is a strong path
00:39:25
to being able to impact many
00:39:29
people.
00:39:33
If we think about the future, and just
00:39:36
having spent, you know, what has been decades
00:39:40
professionally for both of you towards,
00:39:42
making advancement and whether it's been, you know,
00:39:45
significant advancement in just the past 10 years
00:39:48
or going back 25 years,
00:39:51
if you could both waive your magic wands.
00:39:55
And think about what you want to have
00:39:58
done in this space in the next 5
00:40:01
to 10 years, you know, giving it more
00:40:03
than tomorrow, but giving a, you know, not
00:40:06
so far
00:40:07
out in the future. What does that look
00:40:10
like And what does is it going to
00:40:13
take to get to your vision of where
00:40:16
you want us to be in the space
00:40:18
of standards data exchange use usable data, Holly
00:40:22
why don't you start.
00:40:25
Well, you did mention that we had a
00:40:26
magic wand. Right? Yes.
00:40:30
I I think
00:40:31
with my magic wand, I really would want
00:40:35
every
00:40:35
applicable health.
00:40:38
Inter interrupt on Tesco.
00:40:40
And obeying the common agreement or following it.
00:40:45
We already talked about that that
00:40:48
it will be a slow process. So... But
00:40:50
I am optimistic
00:40:51
for the time frame that you referenced.
00:40:54
And the other thing that we kind of
00:40:57
touched on is I want to eliminate
00:41:00
the facts.
00:41:01
And I've a I've have a good friend
00:41:03
Jack Hathaway
00:41:04
who would say, I wanna axe the facts.
00:41:10
I can't believe... I can't believe the 70
00:41:12
percent number of, you know, physician offices out
00:41:15
fax
00:41:16
results. IIIII
00:41:18
wouldn't can't on of a bankruptcy machine anymore.
00:41:21
Right Useless of facts is because you you...
00:41:25
You if you have no data in your
00:41:27
system, you just are reading.
00:41:30
And then to eliminate the use of non
00:41:32
standardized codes really to have
00:41:35
the standard, you know, that that
00:41:39
everything
00:41:40
mapped perfectly, like
00:41:42
positions document in Icd 10.
00:41:45
But
00:41:47
and and Marjorie will speak to this, but
00:41:49
what is
00:41:50
most used is Sn med. So there has
00:41:54
to be a standard
00:41:56
mapping across those 2 or
00:41:59
that we require using only 1. So
00:42:03
standardized codes to me is essential. And then
00:42:06
bringing Lt pack into the picture. So having
00:42:09
the Lt pack electronic health records
00:42:12
require
00:42:13
certification.
00:42:14
And
00:42:15
and
00:42:16
and also to include Lt pack in Medicare
00:42:18
quality based payment adjustment... What is Lt pack.
00:42:21
With a Lt? I'm sorry. I... You promise
00:42:23
more in the acronyms.
00:42:26
I'm happy to applaud. Blood room post acute
00:42:30
care.
00:42:32
Hospice,
00:42:34
skilled nursing facilities, meet rehabilitation facilities,
00:42:37
that whole
00:42:39
full
00:42:40
of full ecosystem of, systems that support all
00:42:44
angles... The health space. That's great. That's a
00:42:47
that's a big ask of your magic wand.
00:42:49
Don't we can get there.
00:42:51
III
00:42:53
think
00:42:54
your time frame is probably not inaccurate,
00:42:58
but I do think we'll get there.
00:43:00
Awesome. Awesome. Mar, you the 1 now?
00:43:03
Well, yeah. I have 2 wishes with my
00:43:06
magic wand. 1 is it's very practical.
00:43:09
People say it's it's naive, but and I'd
00:43:11
like to see
00:43:13
us use
00:43:14
clinical standards like snow and law and rx
00:43:18
norm, that's the 1 for drugs
00:43:20
natively in new
00:43:22
electronic health records. But that's... And I know
00:43:25
that's a a long way off.
00:43:27
And may never happen, but that would solve
00:43:29
a lot of problems right now. Just like
00:43:31
you natively code in in Icd and Cpt,
00:43:35
you can also do that the clinical terminology
00:43:36
technologies as well.
00:43:39
The more lofty goal for me, if I
00:43:42
could
00:43:44
wave of a magic wand, it would be
00:43:46
to achieve as a nation,
00:43:48
health equity, I. E. When everyone,
00:43:51
can attain their full health potential, and there's
00:43:54
no limit from a achieving that potential because
00:43:58
of your social
00:43:59
position or other factors that affect that.
00:44:02
To me, that's what we're doing all of
00:44:04
this work. Right? When you look at the
00:44:06
the big goal
00:44:08
into hair
00:44:09
is a big piece of that. But you
00:44:12
agree, Holly? III
00:44:14
want you to have the magic wand.
00:44:17
I completely agree.
00:44:20
It solved so much. It solves so much.
00:44:23
It bends the cost curve.
00:44:25
It improves the outcomes
00:44:28
across the nation. It improves society
00:44:31
in so many ways tangible and intangible.
00:44:36
Yes. You get to keep that magic wand
00:44:39
they're all here for it. And with you
00:44:42
and support you. I think
00:44:44
so this has been really a robust,
00:44:48
conversation
00:44:48
just wanna close on 1 simple question for
00:44:51
both of you. I'm, the inspiring women is
00:44:53
here to showcase exceptional.
00:44:56
Women leaders, which you both are, but also
00:44:59
to really inspire others. The next generation of
00:45:02
women to move into
00:45:04
leadership, because of the power of that and
00:45:06
what it can be done. So just if
00:45:08
you could just share your best advice for
00:45:11
others
00:45:12
who want to be
00:45:13
like you, both of you, each of you
00:45:17
that maybe worked for you or that you
00:45:19
like to share with others just as they
00:45:21
sort of know, move their own leadership journeys.
00:45:24
Marjorie, do you wanna handle that first? Sure.
00:45:27
So
00:45:28
I often mentor, you know other people that
00:45:31
are joining this field, you know, coming from
00:45:34
clinical care, or whatever,
00:45:36
and most of them are women,
00:45:38
And I gave them 3 pieces of advice,
00:45:40
particularly women of color.
00:45:43
I say, you know, don't let the impostor
00:45:46
syndrome stop you from pursuing your goals because
00:45:48
women are often
00:45:50
considered to be impostor in this space. Right?
00:45:53
So you can't adopt that, persona for yourself,
00:45:56
your The other thing is to stake here
00:45:58
experience and take risks and embrace
00:46:01
new experiences because women studies show many will
00:46:04
believe that. Are risk takers. Right?
00:46:07
By nature.
00:46:09
And then the third thing, which I always
00:46:11
tell women, the women of color is to
00:46:13
lift as you climb.
00:46:16
And and that's that's sort of my motto.
00:46:19
It's a it's a driver for me because
00:46:21
then that helps others and it helps the
00:46:24
profession improve. And So
00:46:26
it'll only like 3 things.
00:46:28
Thank you for that. Holly.
00:46:30
So I, marge, I cannot believe you brought
00:46:32
up in impostor syndrome. Because that's where I
00:46:34
was going to start.
00:46:37
When when I was in medical school, I
00:46:39
I don't remember what the context was, but
00:46:41
there was a group of... Only women in
00:46:44
medical school
00:46:46
together. And we started talking about, well, you
00:46:49
know,
00:46:50
I think that that really, they made a
00:46:52
mistake when I was admitted. And every single
00:46:56
woman in that group,
00:46:58
had... That's
00:46:59
at some level, had that feeling deep within
00:47:02
them, which is impostor syndrome them.
00:47:05
And and so I want that killed off.
00:47:08
I I just want to be Right. And
00:47:10
men go into the world, confident, and I
00:47:13
want women to be as confident.
00:47:15
And then 1 other piece
00:47:18
of advice... I mean, follow your passions, obviously,
00:47:21
But
00:47:22
and base base your decisions on what you
00:47:24
want to do. But I have want to
00:47:26
leave 1 other thought, which is I wish
00:47:29
I had done this.
00:47:31
As you imagine
00:47:32
now, your future career.
00:47:35
Imagine yourself as an elderly person
00:47:38
and you're retiring.
00:47:40
And
00:47:42
think of
00:47:44
the things that at that stage in your
00:47:47
life,
00:47:48
that you reflect on as being most important
00:47:52
and then ensure that you include them in
00:47:54
your plans.
00:47:56
I think a lot of women
00:47:59
don't want to be mommy tracked,
00:48:02
and they actually end up
00:48:04
spending less time with their children and families
00:48:06
than they would have wanted to. Mh.
00:48:10
This is such
00:48:11
great closing advice and also magic wand comments,
00:48:16
and I really appreciate both of
00:48:19
your perspectives on this. I really wanna close
00:48:22
out this inspiring women, the conversation with a
00:48:25
sincere. Thank you both for the leadership and
00:48:28
the work that you do to make the
00:48:30
entire higher
00:48:31
ecosystem of health care better for all people.
00:48:34
I think that's just incredibly important and it
00:48:36
may be slow, but the continued work that
00:48:39
you both due in lead is imperative to
00:48:41
making it happen. This has been a great
00:48:44
inspiring women conversation. I've been speaking with doctor
00:48:46
as Marjorie Rollins and Holly Miller. And thank
00:48:50
you doctors both very much.
00:48:53
Thank you.
00:48:54
The pleasure. Thank you.
00:48:56
This has been an episode of inspiring women
00:48:59
with Lori Mcgraw. Please subscribe Rate and review.
00:49:02
We are produced at executive podcast solutions.
00:49:06
More episodes can be found on inspiring women
00:49:09
dot show.
00:49:10
I am Lori Mcgraw, and thank you for
00:49:12
listening.