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EPISODE 11 | Interoperability in Healthcare

July 9, 2021 | 27 min 38 sec

Podcast Host – Madhura Gaikwad, Excellarate

Podcast Guests – Punkaj Jain, SVP Healthtech at Excellarate | Arun Mirchandani, Executive Advisor and Technology Leader | Srinivasan Venkataraman, AVP – Operations at Excellarate

Brief Summary

The COVID-19 pandemic has brought the importance of healthcare data interoperability under the spotlight. Not only does interoperability enable better productivity and enhanced patient experience, but reports suggest that healthcare data interoperability can reduce costs of over $30 billion for the U.S. health system.

In this episode, we talk to a panel of seasoned HealthTech professionals to discuss the challenges in healthcare data interoperability, and the solutions offered by modern technology. Our guests cover topics such as:

  • What is interoperability in healthcare?
  • Building healthcare data interoperability solutions
  • Compliance and security in managing healthcare data
  • Standardization of healthcare data
  • Covid-19 impact on healthcare ecosystem and interoperability

Transcript

Madhura Gaikwad (00:08):

Hello, and welcome to yet another episode of zip radio podcasts powered by Excellarate. I’m your host Madhura and the topic for today’s episode is interoperability in healthcare. I’m joined today by Punkaj Jain Senior, Vice President Health Tech at Excellarate. And he will be my co-host as we chat with our guests on interoperability in the healthcare industry. Our guest speaker for today is Arun Mirchandani Executive Advisor and Technology leader with more than 20 years of expertise in the healthcare domain. We also have Srinivasan Venkataraman a AVP operations at Excellarate who brings in healthcare domain expertise with his work in the health tech space. So welcome onboard Arun, Srini and Punkaj.

Punkaj Jain (00:52):

Thanks, Madhura for the introduction. Coming from the enterprise tech, I understand the importance of interoperability and it is kind of given in FinTech industry due to standards and interoperability, I can see my bank credit card’s information, and send, receive money on my phone. However, in the health tech, interoperability is not quite there yet. My complete health information is not accessible to me on my phone. So, Arun, let me turn to you, provide your perspective on what interoperability means in the healthcare world.

Punkaj Jain (01:27):

Yeah. Thanks, Punkaj. That’s a loaded question, you know, it’s not just a financial world. I mean, you look around, you can see all sorts of in travel industry, in retail, the things that you can do with just a smartphone were all possible cause of the way the different systems interact. And it was all made possible cause of standards being set on storage of data, communication of data, security and those things. In healthcare where, you know, we’ve all been involved for a couple of decades, interoperability, almost like a co-letter word. It’s an anathema because it’s the most important of all industries in that sense that it takes care of people’s lives. And yet the industry as a whole has been stuck in, you know, prehistoric times when it comes to interoperability, it’s been talked about and talked about for at least 10 years, if not longer, maybe even longer.

Arun Mirchandani (02:25):

But I know I’ve been personally involved in this at least for 10 years of interoperability and you can still not have the basic access to your own medical record as an individual. I mean, think about that. Right. I can find out on my mobile app, where is the pizza that is being delivered, that I ordered 15 minutes ago, whether it is out of the oven, whether it is with one of the delivery vehicles, but I cannot find out about my lab results, I cannot find out about my, you know, next appointment. So, interoperability is a really big problem in healthcare and it’s something that we all need to focus and address very quickly. And, actually what happened with the covid really highlighted the fact. The day was the vaccine center, and they were handing out physical handwritten notes on people who been vaccinated, you know, I just came from India where, you know, all of that is done on a mobile app called aarogya setu and you know, your, your, the digital certificate is available on a mobile app, you know, which when you can get vaccinated, where you can get, get vaccinated. And yet here in US, it was being written on a piece of paper and there was computer site for meters, right? So that symptomatic of the problem of interoperability and lack of interoperability in healthcare.

Punkaj Jain (03:43):

That’s a good experience you shared. So, Srini, let me ask you, given what just Arun mentioned, can you talk about Excellearate experience in building interoperable solution and specifically in the health tech industry, this different health data formats? I am sure that is one of the fundamental issues why we are not there yet.

Srinivasan Venkataraman (04:03):

Absolutely. Thanks, Punkaj. And that was a fantastic and Introduction, Arun. And I think you both have kindled the thought, even though we are working with latest technologies experienced in domain with all the gadgets, are we still primitive in sharing the health data to our audience? I think looks like it, but as you rightly said, this pandemic, and also even before that the energy was driven towards servicing the customers. So, to your point, Punkaj just want to set the stage and table of what Excellarate does in the health tech industry. So, we have dealt with various areas within healthcare, you name it like a PBM – Pharmacy Benefit Management, Pharmacy Software Solutions, Enterprise Pharmacy Solutions, Fee for DB in that space contract pharmacies, Speed/Split Billing audit tool, Disease Management Wellness. Why I, I named all these areas is each one was catering to specific client needs and how the data has to be massaged and broadly classified you can say the clinical data is into electronic health. That’s the primary, you know, goal.

Srinivasan Venkataraman (05:13):

We need to deliver electronic medical health for our clients and administrative data, claims data, patient disease registry, health survey, and clinical trials. So, this is the classification categories. And in that specifically what the major challenge we have dealt with in our experiences, dealing with claims file and orders. By the end of the day, these two are kind of, uh, central nervous system, which is converted to money. And also it’s important for our clients, the patients and members to know about their profile. So what the challenge, biggest challenge we have faced is each pharmacy chain or independent pharmacy or a health center, we deal with, they have a specific format in place, how to make it, you know, you massage it, bring it into a common stage and then process it and to name some drug formal, claims files, drug price files, order files, receiving us acknowledgement, invoice notification, advance ship notice we are almost halfway through. And in the coming conversation we can about our roadmap and how we are going to make it much more organized and centralized for our, and this is our health ecosystem Punkaj and, our journey in the health tech.

Punkaj Jain (06:35):

Great. Arun, do you have any questions for Srinivasan?

Arun Mirchandani (06:37):

Well, one of the things that I wanted to highlight here was that we have been talking and there are in fact existing so-called standards for storing of data, patient health data in the form of a electronic records, sharing of that data between health system or health IT systems using things like HL7 and fire. And very recently Apple basically put their entire weight behind what, they call Smart with is built on top of fire, it’s a protocol or it’s an API framework that allows any mobile application to use fire interfaces, or in this case, smart interfaces to extract data of the electronic new medical record. And in the most recent iOS, announcement, they did couple of weeks ago, they’ve actually now been able to not only read data out of the, the EMR systems that patient might want to carry with their mobile phone, but also develop a mechanism for uploading longitudinal data from their smart watches, from there you know their worn medical devices up in to the EHRs.

Arun Mirchandani (07:59):

Now that apple has thrown their weight and CMS has thrown their weight. I think there is a lot of opportunity that might be coming up in the coming, you know, months to sort of accelerate this vision of really, truly creating an exchangeable format where multiple applications, you know, where you basically write an application once, and it doesn’t matter which interface or which EHR you’re interfacing with in the background. So, any thoughts on that previous to how Execellarate or you know, that the technologies that you have could help some of the ISDs in that domain?

Srinivasan Venkataraman (08:32):

Definitely, I think, you name some big players like Apple. Yes definitely. I think we are watching the health tech, the space and the government support. And Arun, ask you rightly pointed out, one of the good news that we got in the month of April this year is from the National Coordinator of Health IT ONC, and they said you, I mean, as a provider, as a healthcare solution provider technology and domain, along with our prospects and customers, we have to make the data, healthcare, data, EHR, Electronic Health Record available for our members and you name it all types of eight clinical node that is defined by United States core data for interoperability. So having said that a decade before, it was a big challenge, you named it correctly, HL7 standards and underlying factors, HIPAA, the health insurance portability and accountability act the complaints. So, what happens is like how software industry comes up with new version, even HIPAA, HL7, has their own standard.

Srinivasan Venkataraman (09:35):

We have a responsibility to make our software meet the standards, and that should not pose a security challenge. So yes, we do have our information security infrastructure, governance, and our architectural team, work in parallel to make the security compliance, multifactor authentication, so on so forth available as to address the QSack and to expose the data in a very user-friendly format at the same time, not being lenient to have the data leak for other customers. And, I think to name, to quote some, and I think we have exchanged that in a manner in the past is, is fire. I mean, FHIR, that is the future. The roadmap is, it’s already in the market, but it took some time for everyone to adapt. It’s nothing but fast healthcare interoperability resources, but is that end of all, no, nowadays, like you said, smartwatch, you name any gadget it should make the data available for them in a quick and easy manner, without much of a trouble, always the industry, they say three click formats.

Srinivasan Venkataraman (10:42):

You all might have heard three clicks. If I’m allowed to do more clicks, right. I will lose the interest. And also, I may lose where I’m heading to the direction. So, we are trying to use the roadmap is smart, which is nothing but Substantial Middle Applications usable technology with fire. And we have a framework in place called file ambassador. That’s called nothing but electronic data it changes framework and tool, which we have incorporated with many of our customers to do this exchange in a very secure, friendly manner, to, to answer your question.

Arun Mirchandani (11:16):

I am glad you brought ups Theors because one of things that the ONC chair talks to party has been doing pace is to create this mechanism along with cures of careten stick, where the stick is the part where they actually have liability or a penalty for not health system providers, but mostly health IT software providers and health information exchange that if they block access to health information to be used by a third party, then they’ll be penalized up to $2M. And for health system providers, the penalties in the form of reduced reimbursement from CMS. So that’s the stick where it’s called Information Blocking Pan. So, that has been very made explicit in the cures act. The carrot part is where the doctor Tripathi and his ONC are using their bully puppet to basically create a set of standards or promote a set of standards like the smart and the fire, and coke the industry in that direction to say, this is how you’re going to be able to share information.

Arun Mirchandani (12:22):

This is, you know, this is available, it’s a standard format and there should be no reason for exchange of information to be happening. So, I think they’re finally moving in the, a direction because as, as we started this conversation, it’s been a known problem for a long time. And what happened with the pandemic and what’s happening even now where, you know, simple things like vaccine, what they’re trying to call vaccine passports, or, you know, whatever the name would be, ultimately all that information about individuals’ vaccination status and whether they can travel or not is all, has to be done electronically. And right now, we are finding ourselves, you know, behind the eight ball of that. So, I think I I’m, I’m very hopeful in the direction of the industry in coming months and, and years.

Punkaj Jain (13:04):

Arun, I have a question for you, like in terms of this data format exchange, I’m glad to hear the standards and ONC and they are moving towards that. Are there any limitations? We are certain health data records they say like, okay, like physicians’ notes, physician’s notes on my file, my health record, when I visit a doctor not to be go out of their EMR or EHS systems, are there any restriction around the data piece itself?

Arun Mirchandani (13:33):

Very good question. Yeah. Yes. The current thinking has been that at least from a consumer standpoint, from patient standpoint, the patient will have to give permission to the health systems or what data the health system or whoever is the carrier of the data, the store of the are allowed to share with the providers. Right? So as a user, I can say, I want to share, you know, my glucose measurements, such and such lab results, blah, blah, blah, with my PCP, or, you know, with particular provider. And then that information, the burden is now on the health system or the, the store of the data systems to say, can we make that available? Now, there are a lot of details to be worked out as you’re trying to hint here, which is, it’s not obvious that, you know, a health system will be able to just openly provide that information. It may be in the wrong format. It may have other security and privacy concerns that have to be dealt with. So some of those details still have to be worked out, but the direction that has it laid out by ONC is very clear that you, as a user, as a consumer, have access to your own data, that you can carry with you wherever you want and share it with whoever you want, but you have to give fire authorization to the appropriate Systems to, to allow them to do that.

Punkaj Jain (14:53):

That is great. So, Srini, that is what you were referring earlier in your, when you mentioned file ambassador, like our Excellarate solution or an architecture framework we have built, which helps enable actually ease the data understanding and the story and the transmission. Can you little bit elaborate on those part? Like what Arun just mentioned, like there are some restrictions, how does file ambassador handle all these things?

Srinivasan Venkataraman (15:16):

Fantastic. I think you connected the dots well Punkaj and I think it was interesting what Arun said about the QSack rules and the government support. And to answer your question, file ambassador framework and tool that we have built, what it does is the primary mode of is electronic data interchange in a very short span of time. Meaning, what happens is the health data volume is huge. Sometimes it takes hours, multiple days. So, we are built the engine in such a way it uses the core assembly it, it uses the CLR. I mean, I’m going little technical there, there, what it does is transfer of data will be quick and at the same time, not losing any parameters. And what that means is we use the security and the encryption standards, and that follows the guidelines defined by HL7 and HIPPA. And what it means is like you said, you are traveling and suddenly, you know, somebody’s calling and why don’t you share your profile?

Srinivasan Venkataraman (16:18):

We’re trying to book an appointment. You don’t have to wait, go to a health center, get the permission from the doctor. So, what file ambassador does is overnight, it transfers all the data from the respective health partners and stores it in a centralized database system, in a hierarchical format or non-hierarchical format, normalized denormalized. So, it makes it available for our customers. It could be a third-party gateway, third party administrator, or a pharmacy or a hospital. And from there on they can massage the data and make it available responsive format. Responsive is the future of the user interface. In, when I say responsive, they can see it in any type of gadget, any type of resolution, screen size. So that is the web interface. And, uh, right now we are setting our footprint into the cloud as well. So that means anywhere, anytime data is available, that’s the format we are heading to. And that’s file ambassador, Punkaj.

Srinivasan Venkataraman (17:15):

I would like to add one more and I think you’ll be interested to hear this, this as well from Excellarate standpoint, apart from our domain technology experience, the future is artificial intelligence, machine learning, you know, newer language processing. We have that, and the research department is working on the health tech data as well, but it is in the baby steps because the whole industry is trying to understand and adopt like Alexa and Google. How about we all, you know, hey, can I have my data, Alexa, I’m just saying, or Excellarate, can I have my data, it be readily available for them. I mean, that will be a, a golden day, I think. And we’re marching towards that. You know what I’m saying?

Arun Mirchandani  (17:58):

Yeah. Yeah. The word that comes to the, that comes to mind is crawl, walk, run. So, wow. Yeah. Once we are able to actually do the basics, I think there’s, yeah, there’s a lot of innovation that is in the sidelines that is waiting to basically explode on the scene. So yeah, we all look forward to that day in our lifetime.

Punkaj Jain (18:18):

Great. So one of the questions I have for both of you, like when I talk to our clients and prospects, one of the thing, this, like we can manage all the staff data from all that stuff, but they always bring the security issue, the rules and regulations about the data, leaving the country, for example, USA, if you are a US patient and US, there are some rules, some organizations, right? So, what is Arun, in your opinion, how does the healthcare industry in your, coping with that stuff, and then Srini, if you can follow up with like how you are handling that kind of sensitive information, healthcare data is obviously the most sensitive information there is. I’ll let you go Arun, drive first.

Arun Mirchandani (19:01):

Yeah. That’s a follow-on question. The fact is that, you know, all of these health agencies are know nationally oriented. All of them have very strict rules and restrictions based on the country’s laws. So, it’s true that it’ll be a long time before I, as a user can, you know, live for two months in one country and then travel to yet another country and then able to, you know, seamlessly have access to that data that I can share with the provider in the local country. I think that that’s long ways to go, but within country, there are very regulations on how the data is stored and when you, how its secured and how it is transmitted and those are you know, available technologies we all have been using for last several years. So, there is no technological barrier per say, but there’ll be policy issues to be dissolved. For example, the GDPR has come up right there. They’re way strict stricter on what information it’s not even health information, it’s any personal information that cannot be shared with any third party outside, the boundaries. So yeah, that’s, I don’t have an answer to, I just think that, you know, once we are able to solve these problems within the nation or within the region, then they’ll be, you know, market forces that’ll dictate how fast, you know, this data can be exchanged across international boundaries. But again, like I said, you know, crawl, walk, run.

Punkaj Jain (20:28):

Yes, yes. Srini, I heard, you initially mentioned security and HIPAA compliance and everything. So can you little bit touch about, I understand that across the nations it’s we are not there yet. Let’s crawl first. So can you talk about like within the country we have Excellarate has clients all over the world. So how do you deal with within the country data issues?

Srinivasan Venkataraman (20:47):

Sure. I think, I don’t know whether any department thought about you. You’ve already created a backlog for us, Punkaj. No, no, trust me. It’s a wonderful question because we talk about availability of data anytime, anywhere, but what about outside the country? But now it is global. You know, morning you are in one country and next day you are in another country. So, but the thing is, I don’t mention a good point. The act and the regulation in each country is different. Even though health data is made available from Excellarate point of view, nowadays we host, or we make a solution available in the cloud. That means, you know, CDN Content Delivery Network. It, it is available everywhere throughout the world, as long as you have a gadget and internet connection. But what it does is our customers restrict them based on their geolocation, geographical location and IP address.

Srinivasan Venkataraman (21:43):

Okay, you are coming from this country. So there, the regulation is we are not supposed share the data outside, even though our application and our solution may work, but we leave it to the client’s judgment and client policies and procedures to restrict the access. But as, and when, once they relax it, what that means is, is more work, more security testing for us to make sure across, see nowadays what happens is we are testing browser compatibility. You all might have heard, we tested an internet Explorer, Google Chrome, Mozzarella, you name it safari. Now what we’ll do, we’ll do a security testing for geo locations. And that’ll be a fantastic thing to do. I think you made my thought in horizon grow. Its fantastic idea provided the government, all the regulations, shake hands, you know, and they agreed to it like a golden handshake.

Punkaj Jain (22:37):

Okay. Okay. So, thanks Arun and Srini, I mean, it’s been a great discussion. I definitely learned a lot from both of your experiences. I think we are almost running out of time, so I will let Arun, you go first, and Srini go second and kind of summarize the interoperability and data issues you’re your perspective as you see it.

Arun Mirchandani (22:59):

Punkaj, I will need the audience with some optimism that I am looking forward too. You know there if you would have asked me this about this anecdote two years ago, I would have probably been, you know, locked you out of the room.  If you’ve thanks to COVID, you know, it has allowed several agencies, health agencies and organizations on the, in the ecosystem to organize and collaborate in ways that we’ve never seen before. There is an organization called the COVID-19 health care correlation, that included 1200 different health systems, public agencies, individual providers, payers, and so on. And they organized themselves just to tackle with basic things like, you know, how do we, you know, logistically coordinate, the PPE when, you know, when this whole thing broke up, broke in front of us all the way, from there to sharing information about what is the best formularies for treating COVID patients, what are the best practices for, you know, isolation, this, that, and that happening all in real time because we were facing calamity of proportions that we’d never seen before, that type of organization, there’s another one that comes to mind that’s, the vaccine credentials initiative. And, you know, we talked about the fact that the vaccine, information is bifurcated, and it’s not, centralized in one location.

Arun Mirchandani (24:17):

So, the health industry did realize that we have to come together and there is an vaccine credentials coalition right now that is moving fast. I get work speed to try and get all this, stuff digitized. So that gives me a lot of hope and optimism for the future. We just don’t want another pandemic or another, these, you know, God acts to move the industry forward. But I think everybody has learned a lot from what just happened and the importance of getting all this, that health data centralized and flowing freely has become paramount. So, with that, I will let stream your mind.

Srinivasan Venkataraman (24:52):

Thanks Arun. And first of all, I would like to thank both Punkaj and Arun, for this invite, for this thought pro working conversation, that’s I would point it. And, I mean, I’m taking a lot from the experience point of view from Arun, and Punkaj you kindle a lot of interesting thoughts so that take away, and what we are going come up with from Excellarate is, as the name says, we are going accelerate some of the availability and interoperability of data in our solutions.  As soon as possible, following all the guidelines, policies, and procedures based on queues and USDAI. And what that means is one is it’ll be gadget friendly, and it’ll be eco-friendly in terms of you don’t have to worry about your, infrastructure. You can access it via iPhone or Android or iPad. As a matter of fact, we are going to make it much more responsive and available for you. And that’s the goal, our technology, our domain, our solution is driven towards and also cloud our footprint will be on the cloud. And we do have our experience on AWS at one of the partnerships that we have recently got and Azure and Google cloud. So that means our customers do not worry about technology agnostic nature, and also the features of our software and solution. And that’s the promise. And also, I’ve taken a lot from this conversation. Thank you both.

Punkaj Jain (26:24):

Thanks Srini, to summarize the key takeaway for, from today’s discussion from my perspective is that healthcare data is a different format, getting to it, understanding it, and then transmitting it has been a technical challenge on top of all the compliance and security aspects. However, unfortunate it is, but the COVID pandemic has brought the healthcare industry and government together in terms of defining the standards. We saw the boom in telehealth and telemedicine. Our healthcare ecosystem came together and came together fast. Let’s continue to work on interoperability in the health industry together. Thanks again, Arun and Srini for an open discussion and providing your insights. Thanks, Madura, for organizing the event.

Madhura Gaikwad (27:15):

Thank you Punkaj and thank you, Arun and Srini for taking the time to join us today. This was a fantastic discussion, and we will keep it going in an upcoming episode where we continue to explore challenges in the healthcare domain. Thank you everyone for tuning in. If you are looking to accelerate your product engineering, digital transformation and business agility, visit our website, www.excellarate.com for more information. Thank you.

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