By Pooja Babbrah, Melissa Bundy, Tony Schueth
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The podcast currently has 43 episodes available.
Welcome to "The Dish on Health IT," a podcast brought to you by Point-of-Care Partners, a leading health IT consultancy. Each episode features a rotating panel of senior consultants and guests who discuss trends and innovations in health IT, providing insights and recommendations to help organizations leverage advances to solve their business problems.
In this episode, POCP hosts Tony Schueth, CEO of Point-of-Care Partners, and Pooja Babbrah, PBM and Pharmacy Lead, are joined by Shivani Patel, Executive Vice President of Patient Access Operations and Technology Solutions at Asembia. Together, they delve into key topics including specialty prescribing, pharmacy interoperability, TEFCA, and consent management, highlighting how technology, policy, and process improvements can drive positive changes in healthcare.
The conversation kicks off with an introduction to specialty prescribing. Shivani explains that specialty prescribing involves treatments that are typically more complex than standard prescriptions due to factors like high cost, special storage requirements, and adherence challenges. She points out the logistical gaps and barriers in the specialty space, such as prior authorizations and communication challenges between stakeholders. Pooja adds that the lack of a standardized definition for specialty medications further complicates the process, leading to delays and confusion.
Moving on to pharmacy interoperability, Pooja describes it as the ability to share clinical data between pharmacists, providers, and other stakeholders. She emphasizes the importance of providing pharmacists with the right information they need, instead of overwhelming them with excessive data. For instance, pharmacists should not have to sift through 500 pages of patient records to find relevant information. Instead, they need targeted, pertinent data to improve patient care and streamline processes.
The discussion then shifts to TEFCA (Trusted Exchange Framework and Common Agreement), which aims to fill information gaps in the healthcare system by setting standards for data exchange. Shivani and Pooja discuss how TEFCA can enhance transparency and interoperability, helping pharmacists and other stakeholders' access and share necessary patient information more efficiently. Shivani notes the potential of TEFCA to establish a universal patient identifier, which could significantly improve data sharing and patient care coordination.
Consent management is another crucial topic covered in this episode. Effective consent management is essential for pharmacy interoperability and ensuring patients' privacy and data security. Shivani and Pooja explore how consent management can be improved to make the sharing of patient information more seamless and secure. They emphasize the need for standardized consent processes that allow patients to control their data while ensuring that relevant information is accessible to healthcare providers.
Throughout the episode, the panel highlights the role of technology in improving the prescription journey. Shivani discusses how Asembia uses technology to support the industry by connecting stakeholders and providing tools to manage patient care better. This includes everything from prior authorizations to benefit checks and copay cards. Pooja underscores the importance of industry collaboration and transparency to create standardized solutions that benefit all stakeholders.
Towards the end of the episode, Shivani shares insights about the Asembia Summit, an annual event that gathers industry stakeholders to discuss trends and innovations in specialty pharmacy. She invites listeners to attend AXS25, the next Asembia Summit, which will take place from April 27th to May 1st, 2025, at the Wynn Las Vegas. The event offers a premier forum for learning, networking, and exploring the latest advancements in the industry.
Tune in to this episode to gain a deeper understanding of the complexities of specialty prescribing, the importance of pharmacy interoperability, and how collaborative efforts in technology, policy, and process can enhance healthcare delivery. Don’t miss the insights shared by industry stakeholders on why they attend the Asembia Summit each year. For more information and to suggest future topics, email us at [email protected] or tweet us at @POCPHIT.
The special episode of The Dish on Health IT episode provides insights and coverage from the recent HIMSS24 conference. Hosts Pooja Babbrah, the PBM and Pharmacy Lead and Jocelyn Keegan, Payer/Practice Lead with Point-of-Care Partners dig into their observation from HIMSS24 before reacting to stakeholder interviews from the floor of the Interoperability Showcase on topics ranging from the impact of the final CMS interoperability & prior authorization, benefits of API adoption and pharmacy interoperability opens with a montage of HIMSS24 attendees.
--NOTE: The sound quality of the kiosk interviews is not ideal. If you prefer, you can watch this episode on video for close captioning of the kiosk interviews--
The episode opens with a montage of HIMSS24 attendees sharing what they find valuable about attending HIMSS. Pooja Babbrah then opens the episode explaining that she and co-host Jocelyn Keegan share their key takeaways and insights from the biggest health technology conference in the industry.
Jocelyn started the conversation off by sharing her observation that the work over the last 15 years to forge scalable connections to improve data fluidity has been fruitful and reached a tipping point. Importantly, the conversations we heard at HIMSS24 showed an acknowledgment as important as data fluidity is the content of what we are exchanging, and that data quality is just as important.
Jocelyn then shared her second observation which is that we need to build a skillset and pool of resources who can do the next phase of work that is needed. She shared that when she worked in the financial industry which was at the time transitioning to interoperability and automation, they had to hire and develop the critical thinkers needed to think through how to best leverage technology, approach change management and do the abstractions needed to be successful. Health IT is at a similar place; we probably need more clinical informaticists because how we use technology in clinical workflows is extremely important, but we also need operational experts to help pull through how shifts in one workflow should get pulled through in others. She went on to say that we need people understand data mapping and why clean data is so important.
Pooja thanked Jocelyn for her insights before sharing her own. She mentioned that she heard talk about whether ViVE and HIMSS could both survive because they occur so close together, and are big investments for companies to make to attend or exhibit. She shared that her view is that they are different enough in programmatic and attendance mix that she believes they both have value and will survive.
Adding to Jocelyn’s point about data quality, Pooja added that data governance and sending the right data to the right people at the right time versus just sending a data tsunami. Pooja continued by adding that it’s also important to meet people where they are. This was clear at the post-acute care listening session. Some care facilities are not yet FHIR-enabled, some can send data via FHIR but perhaps are not yet API-enabled, how can we meet those facilities where they are even if they aren’t using cutting-edge technology? Most stakeholders are going to be somewhere on a spectrum of tech adoption. We need to be flexible in how we do things.
Pooja went on to say that another observation is that the importance of consent management will continue to grow, and that real work is starting to be done to figure out what patient-centered consent management might look like. We need to be able to exchange the right data at the right time with the right people, but we need to ensure we have the right consent to go along with it.
Pooja mentioned some industry initiatives on consent including the HL7 FHIR at Scale Taskforce Accelerator, which has launched a new consent project. Public meetings for the FAST Consent project have launched and will be held regularly.
A consent learning lab was held at HIMSS24 for the second year in a row. Pooja expressed that she attended both last year's and this year’s events and she could feel a shift including the presence of regulators who were in the room. She explained that the conversation focused on actual work and progress being made in California and Florida as well as a huge focus on the role of consent in connecting health data and human services data.
Next Pooja and Jocelyn listened and reacted to stakeholders who stopped by the POCP Kiosk in the Interoperability showcase to give their perspectives on the final CMS prior authorization & interoperability rule, API adoption, and pharmacy interoperability.
Interviewees at the kiosk included:
Themes from the interviews and host response include:
After Pooja and Jocelyn listened and reacted to the interviews, Pooja shifted to close out the episode. She took a moment to reflect on the rich dialogue and insights shared by professionals across the healthcare ecosystem. She acknowledged the collective and collaborative effort that is fundamental to advancing health IT, underscoring the critical role of technology, the growing importance of pharmacies in the healthcare delivery ecosystem, and the collective anticipation for the evolution of policies concerning specialty medications and the work toward a better way to manage consent. With a nod to the resilience and spirit of innovation that defines the HIMSS conference, Pooja expressed gratitude for the contributions of all speakers and participants, celebrating another successful year of sharing, learning, and collaborating. Looking ahead with optimism, she voiced enthusiasm for the next HIMSS, where the community will reconvene to delve deeper into healthcare's pressing issues, explore new advancements, and foster further collaborations that promise to shape the future of health IT.
In this episode of The Dish on Health IT Podcast, hosted by Tony Schueth, CEO of Point-of-Care Partners, the evolving role of pharmacists in the healthcare ecosystem is explored. Tony introduces the episode by highlighting Point-of-Care Partners as a health IT consultancy known for its deep expertise and trusted, objective perspective. He is joined by co-host Pooja Babbrah, a recognized expert in pharmacy standards and interoperability, and special guest Bob Katter, President of First Databank (FDB).
The conversation begins with an exploration of the increasing number of clinical services offered in pharmacy settings and how technology can enhance pharmacists' ability to operate at the top of their license. The importance of integrating pharmacists more significantly into the care team, especially to improve access to care in rural areas and support patient health outcomes, is emphasized.
Bob Katter shares insights into his journey in health IT and pharmacy sectors, reflecting on the significant advancements in electronic prescribing and the adoption of electronic health records (EHRs) since the early 2000s. He also acknowledges the challenges and opportunities that lie ahead.
The episode delves into the transformative role of pharmacists during the COVID-19 pandemic, highlighting their contributions to administering vaccines and treatments. Bob notes the legislative and regulatory changes at both state and federal levels that are expanding pharmacists' scope of practice, allowing them to take on more responsibilities traditionally reserved for physicians.
Bob discusses FDB's partnerships and initiatives aimed at supporting pharmacists in their expanding roles, including a project with a major pharmacy retailer focusing on drug utilization review (DUR) processes. He shares observations from his visits to pharmacies, noting how pharmacists are increasingly involved in direct patient care beyond their traditional dispensing duties.
Furthermore, the episode touches on international perspectives, mentioning Canada's "minor ailments" program that allows pharmacists to diagnose, treat, and prescribe for certain conditions. This program is highlighted as an example of leveraging pharmacists' skills to address physician shortages and improve patient access to care.
The conversation pivots towards the role of standards development organizations like the National Council for Prescription Drug Programs (NCPDP) and Health Level Seven International (HL7) in supporting the expanding clinical services provided by pharmacists. Bob Katter acknowledges the importance of these organizations while emphasizing the need for cooperation among industry players to utilize these standards effectively. Pooja Babbrah highlights innovative efforts, such as work group 20 at NCPDP, which focuses on care coordination and the potential for expanding the use of existing standards to include pharmacists in key patient care transitions, such as Admit, Discharge, Transfer (ADT) notifications.
The discussion then explores the application of artificial intelligence (AI) in healthcare, with a particular focus on FDB's initiatives. Bob Katter details how FDB leverages AI, including natural language processing (NLP) and generative AI, to enhance data curation, improve existing solutions, and collaborate with customers on developing new solutions to longstanding industry challenges. He underscores the potential of AI to streamline processes such as medication reconciliation and the authorization of specialty medications.
Pooja Babbrah expresses enthusiasm for the innovative use of AI in specialty medication automation and enrollment, emphasizing the importance of reducing the time it takes for patients to access necessary treatments. She mentions recent regulatory developments and the ongoing challenges in automating prior authorization for specialty medications due to their complexity and the dual coverage under pharmacy and medical benefits.
The podcast concludes with an invitation for any final messages or calls to action for the industry, emphasizing the collective vision and efforts towards automating and improving the delivery of healthcare services, particularly in the specialty medication domain. The dialogue throughout the episode reflects a shared commitment to leveraging technology and collaboration to enhance pharmacists' roles, improve patient care, and address the systemic challenges facing the healthcare industry.
In the final moments of the podcast, Bob Katter expresses his enthusiasm for the future of healthcare and encourages those at the beginning of their careers to consider the immense opportunities within the industry. He reflects on the significant advancements already made, such as nearly universal EHR adoption and electronic prescribing, but emphasizes that the greatest impacts for caregivers and patients are still on the horizon. Katter points to the rapid development of clinical science, including pharmacogenomics, and technological innovations like AI and cloud computing as driving forces behind these future advancements.
Pooja Babbrah shares this excitement, reminiscing about the early days of e-prescribing and looking forward to the next wave of innovation. She highlights the potential for pharmacists to practice at the top of their license, the reduction of burdens on pharmacists, and the integration of pharmacists into the care team as key areas of opportunity. Both Katter and Babbrah view the current moment as a new beginning for the industry, akin to the excitement surrounding the initial push for e-prescribing, but now with even greater potential for innovation and improvement in patient care.
The podcast concludes with a thank you to the guests and a reminder to listeners about where they can find episodes of The Dish on Health IT, signaling an optimistic outlook on the future of health IT and its capacity to enhance healthcare delivery and outcomes.
Stakeholders interested in monitoring state laws related to advance pharmacy practice can explore the POCP Regulatory Resource Center’s Pharmacist Advanced Practice Subscription as well as other subscription services.
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Point-of-Care Partners (POCP) Dish on Health IT hosts, Pooja Babbrah and Jocelyn Keegan welcome special guest Laura McCrary, President and CEO (Chief Executive Officer) of KONZA National Network.
KONZA was recently designated as one of the first five Qualified Health Information Networks, or QHINS (Qualified Health Information Networks), to participate in the Trusted Exchange Framework and Common Agreement (TEFCA)
Laura McCrary speaks with hosts about:
Before digging into the meat of the episode, Jocelyn Keegan introduced herself briefly
as the payer practice lead at POCP, program manager of HL7 Da Vinci Project and devotee to positive change building and getting stuff done in healthcare IT. She added that her focus at POCP is on interoperability, prior authorization and the convergence of where technology, strategy, product development and standards come together.
Jocelyn ended her introduction by saying that she has had the honor of seeing Laura McCrary present on several occasions and that her pragmatic approach is refreshing and that she is looking forward to hearing how KONZA will be building on their already vibrant HIE (Health Information Exchange) footprint as a QHIN.
Next Laura introduced herself sharing that she has been working on interoperability strategy in Kansas and then expanding to nationwide over the last 4 decades.
She started her career as a special education history teacher. Early in her career she realized that while these children were in her care, she should have some basic information about medications or conditions so she could be informed and able to ensure everyone was well cared for.
Of course, nobody shared medical records with teachers and parents didn’t have access to their kid’s patient records either. Making sure special education teachers or at the very least the school nurse could access necessary clinical information at the point of care became a passion of hers which led to an early success in her career which was working with the University of Kansas Medical Center setting up one of the first telemedicine programs in the public-school systems. Because of this work, since the early 2000’s, elementary kids in Kansas City, KS inner-city public-school systems have had access to basic health and telemedicine services.
The telemedicine project helped Laura realize that technology really could bridge access gaps if we built and employed a robust technology infrastructure.
When asked about KONZA’s mission and reasons for becoming a QHIN, Laura shared that the name “KONZA” is named after a Kansas prairie that is one of the most beautiful prairies in the nation.
The way KONZA originated in Kansas around 2010 is a bit different than how other HIEs started. Most states at that time received federal funding through the American Recovery and Reinvestment Act to establish health information exchanges.
Kansas was different in that instead of standing up a state-sponsored exchange, they actually encouraged a private-public partnership and opened the floor for any organization who wanted to do business as a health information exchange in Kansas could so as long as they meet a set of very rigorous accreditation requirements, which included some pretty innovative ideas for that time.
For example, one of the things that was required was that the health information exchange needed to share all information with patients. As early as 2012, Kansas HIEs were required to have a personal health record for patients where they could access any data that was in the health information exchange. QHINS must also do this by offering “individual access services” and KONZA has already been doing this for over a decade.
In addition to sharing data with patients, Kansas also required data sharing of HIPAA (Health Insurance Portability and Accountability) approved treatment, payment, and healthcare operations data with payers as it relates to their members.
Laura continued by sharing that today, 4 exchanges do business in Kansas, and they all work together as well as connect to other exchanges. KONZA also expanded to be able to serve patients across state lines as Kansas residents cross over into Missouri quite often to consume healthcare.
Because of this history and background, Laura shared that becoming a QHIN was a natural progression and a way to support their mission to make sure all participants have access to their own or their patient’s data.
Pooja asked Laura about the process of becoming a QHIN. Pooja acknowledged the stringent requirements for QHINs and mentioned challenges discussed at the ONC Annual meeting in December.
Laura shared KONZA's experience, saying they initially thought it would be like Kansas certification requirements. However, the application process involved demonstrating sustainability, financial viability, high trust certification for security, and proper information sharing using IHE protocols. KONZA became a candidate QHIN in February of the previous year, requiring the development of a project plan addressing technology conformance testing and demonstrating business viability.
Laura emphasized the challenge of meeting high-level requirements, including safety, security, project management, and board governance. Notably, QHINs must have 51% of their Board of Directors as members, ensuring those participating in the network make decisions about the business model. KONZA reached 49% and welcomed a new member from a public health organization in January. The ongoing process involves meeting the remaining requirements to become a fully certified QHIN.
Laura said the process of becoming a QHIN is a continuous work in progress. While they successfully crossed the finish line and are in production, she emphasized the need for ongoing changes to advance interoperability and data sharing. Laura highlighted the importance of QHINs working together as colleagues and federal leadership setting expectations for the national network. After four decades of working on the project, she expressed great satisfaction with the current state of progress.
Pooja inquired about the impact of the diverse functional areas of the first group of QHIN designees on their operations. She expressed curiosity on behalf of Point of Care Partners, highlighting KONZA's background as a health information exchange in Kansas and seeking insights into how this background influenced KONZA's role as a QHIN.
Laura responded by emphasizing the significance of diversity among QHINs as a valuable asset. She expressed excitement about the potential for innovative solutions to emerge from the diverse backgrounds of QHINs, enabling a departure from a one-size-fits-all approach. Laura expected the development of exciting and innovative solutions unique to each QHIN's diverse background.
Pooja then invited Jocelyn to share her thoughts. Jocelyn expressed appreciation for Laura's insights, noting that knowing more about Laura's background made sense. She highlighted the importance of Laura's background in approaching long-term transformation. Jocelyn commended the incremental progress and permanent change advocated in the industry, aligning with Laura's pragmatic approach.
Jocelyn acknowledged the mix of QHINs as fascinating and emphasized the importance of meeting people where they are. She recognized the relay race nature of the journey, with December marking the start of a new phase. Jocelyn predicted the challenge of creating compelling business cases and exploring the evolving business model for QHINs. She expressed interest in seeing the progress reports as end users transition from the HIE world to the TEFCA world.
Laura emphasized the importance of KONZA serving as the QHIN for Health Information Exchanges (HIEs) and growing out of the HIE space. She expressed the belief that onboarding HIEs to their QHIN is crucial for expanding access to a broader set of data, benefiting patient care. Laura highlighted the critical role HIEs play in meeting the healthcare needs of communities, states, and regions.
To ease this onboarding process, KONZA actively reached out to HIEs. Laura shared her personal commitment by mentioning that she had personally spoken with every HIE in the last six months. Additionally, KONZA planned to initiate HIE office hours to engage with HIEs and discuss the onboarding process to the QHIN. Laura conveyed a strong sense of responsibility, stating that if HIEs were not successfully onboarded to QHINs, she would personally feel like they had failed. She recognized the significant value and commitment HIEs have provided to their communities and stressed the importance of building upon their established connections and capabilities.
Jocelyn initiated a discussion on expanding endpoints and the role of payers in TEFCA. She acknowledged Laura's insight into the base requirement in Kansas that involved having payers at the table, filling gaps in understanding about payer participation in national programs. Jocelyn expressed interest in understanding the implications of active payer participation, especially with recent rules requiring payers to provide data to providers.
Laura provided a comprehensive response, highlighting the common inclusion of payers in HIE networks and the evolving landscape outlined in TEFCA requirements. She emphasized that recent rules, including prior authorization, point towards increased payer participation in the QHIN model. Laura praised ONC's efforts and leadership, acknowledging the challenge of absorbing the vast amount of information released.
Laura discussed the significance of two specific SOPs (Standard Operating Procedure) dropped on Friday related to delegation of authority and healthcare operations. She encouraged stakeholders to focus on these documents, emphasizing the critical role they play in bringing clinical and claims data together. Laura outlined the historical challenge of integrating clinical and claims data, noting that TEFCA offers an opportunity to bridge this gap.
Notably, Laura highlighted the requirement for payers participating in the QHIN model to provide adjudicated claims. She acknowledged that while this transformation may take time, conversations with payers indicated openness to sharing crucial data that providers might not have. Laura expressed excitement about the groundwork laid in the SOPs, anticipating an amazing transformation in healthcare. She encouraged innovative companies to explore the delegation of authority, foreseeing its profound impact on healthcare transformation.
Pooja highlighted the collaboration between CMS and ONC in recent rule drops and mentioned the inclusion of FHIR (Fast Healthcare Interoperability Resource) in the latest regulations. Jocelyn asked for comments on this, pointing out varying levels of maturity in QHINs' FHIR programs. She emphasized the shift towards API (Application Programming Interface) and codified data over documents, aiming for automation and reducing human involvement. Jocelyn expressed interest in Laura's perspective, considering the existing collaborations and partnerships.
Laura explained the importance of EHRs (Electronic Health Records) being FHIR-enabled for effective data sharing with QHINs. She clarified that while QHINs can be FHIR-enabled, the critical factor is whether EHR vendors support FHIR. Laura highlighted the necessity for EHR systems to have FHIR endpoints and publish them in the RCE (Recognized Coordinating Entity) directory for effective data retrieval. She stressed that both FHIR endpoints and resources are crucial for successful data exchange.
Regarding facilitated FHIR, Laura expressed excitement about its implementation by the end of Q1. She mentioned the role of facilitated FHIR in responding to payers and highlighted the importance of the healthcare operations SOP. Laura also discussed the bulk FHIR initiative by NCQA, expressing enthusiasm for participation. She emphasized the significance of FHIR in sharing minimum necessary data, addressing the challenges posed by lengthy patient care documents. Laura underscored FHIR's role in providing relevant information to physicians and caregivers based on their specific needs.
Pooja, the host, moves to the closing segment, asking cohost Jocelyn and guest Laura for final messages or calls to action. Jocelyn commends Laura on FHIR progress and highlights the importance of maturity and bulk FHIR for automation. She mentions an upcoming Da Vinci Community Roundtable discussion on the clinical data exchange FHIR guide and encourages engagement with Laura for early participation in payer use cases.
Laura emphasized the profound opportunities with QHINs, including potential in public health and COVID response. Laura invites those interested in discussing the future of healthcare data and transforming patient care to reach out via LinkedIn, email, or to call her.
Pooja expressed gratitude to guest, Laura McCrary for joining The Dish on Health IT and to listeners for tuning in.
Thank you for tuning into The Dish on Health IT’s 2023 end-of-year recap. Point-of-Care Partners' (POCP) subject matter experts, including, Pooja Babbrah, Pharmacy and PBM Practice Lead; Jocelyn Keegan, Payer Provider Practice Lead; and Kim Boyd, Regulatory Resource Center Lead, gathered to discuss their top 3 health IT milestones for 2023 and their expectations for 2024. They also delved into the highly anticipated final version of the Interop 3, focused on advancing interoperability and improving prior authorization rules. Offering insights and advice, they guided listeners on approaching the initial review of this significant final rule. Point-of-Care Partners extends warm holiday wishes and a Happy New Year to all.
Host, Pooja Babbrah kicked off the episode informing listeners that this episode will be a special format. POCP has subject matter experts galore so this episode will bring together a small group of POCPers to look back at 2023, discuss what 2024 will have in store and talk a bit about the anticipated final Interop 3 rule.
Cohosts Jocelyn Keegan, recently honored as the DirectTrust Interoperability Hero, and Kim Boyd, a contributor steeped in policy knowledge and serving as POCP’s Regulatory Resource Center Lead, introduced themselves before the trio transitioned to the main discussion.
They contemplated a format for the day, aiming to dedicate the first half of the conversation to a round-robin, where each would share their personal top three events or trends from 2023. Pooja referenced the HIT Perspectives 2023 trends article, outlining POCP's collective trends. However, today's discussion allowed each participant to present their individual lists before delving into the much-anticipated final rule.Top of Form
Kim initiated the round robin by expressing that her top priority is healthcare interoperability, acknowledging its vast scope emerging from the 21st Century Cures Act and beyond. Within this expansive interoperability landscape, she highlighted the advancements within the FHIR community, predicting a swifter adoption of FHIR than previously witnessed. Her second ranking milestone revolves around artificial intelligence and machine learning, particularly their rapid uptake and integration into policy. Kim anticipated a more robust policy oversight of AI in the future. Her third notable milestone encompasses telehealth and telepharmacy, noting that the COVID-19 pandemic significantly increased patient reliance on remote visits for healthcare.
Jocelyn followed, emphasizing that her list complemented Kim’s perspective, offering a different angle. Her primary inclusion highlighted the industry's transition into implementation mode in 2023, witnessing real-world progress and widespread adoption of FHIR at scale.
Jocelyn provided examples supporting these observations. The first involves the reaction to the proposed attachments rule, released alongside the prior authorization proposed rule. While many organizations expressed their belief that attachments might not be crucial for future progress, the responses to the Interop 3 proposed rule were predominantly positive.
Her second HIT milestone relates to AI but primarily focuses on acknowledging and addressing the baked-in bias potentially inherent in AI and other advanced technologies. She highlighted the steps included in the HTI-1 proposed rule, aiming to mitigate bias and initiate discussions on ensuring the unintentional disruption of the path towards equity.
Jocelyn's third milestone centers on TEFCA, highlighting the progress made and the anticipated clarification expected in 2024 regarding its scope and limitations.
She connected TEFCA back to the first topic, emphasizing the necessity for alignment between the TEFCA infrastructure, rule framework, and the emerging API world. There have been ongoing discussions and industry feedback stressing the need for better alignment between the FHIR roadmap and the TEFCA roadmap as the industry shifts towards more real-time interactions.
Finally, Pooja presented her list, with pharmacy interoperability holding the top spot as her absolute milestone. She expressed her honor in participating in the HITAC Pharmacy Interoperability Task Force, emphasizing POCP's long-standing advocacy for integrating pharmacists into continuity of care discussions. She highlighted the importance of this focus in bridging access gaps, facilitating genomics testing, and building momentum for sharing data with pharmacists. This includes ensuring their access to patient records and their ability to share data with the broader care team, a significant development.
Her second and third priorities revolved around emerging trends in pharmacy with broader implications. Second on her list was Pharmacogenomics, involving genetic testing to discern the effectiveness or ineffectiveness of certain medications for specific patients. Pooja's third priority was digital therapeutics, an area where POCP has already made strides. She noted the growing emphasis, not only for pharmacies in understanding how to administer these therapeutics but also for payers in determining coverage policies.
The discussion then pivoted to sharing reactions and perspectives on each other’s lists. Kim expressed her delight in hearing pharmacy interoperability as Pooja’s top priority. She highlighted the dichotomy within the healthcare ecosystem, emphasizing the divide between pharmacy services and NCPDP standards on one side, and clinical services with HL7 standards, including FHIR, on the other. Kim noted the increasing convergence between these realms, particularly with enhanced collaboration between NCPDP and HL7. She anticipated continued advancements in NCPDP concerning pharmacogenomics, digital therapeutics, social determinants, and the flow of relevant health data.
When questioned, Jocelyn emphasized the criticality of integrating pharmacy into data flow and recognizing pharmacists as integral members of the care team. She stressed the impact of provider shortages in recent engagements with the US healthcare system.
Jocelyn echoed Kim’s perspective on the alignment of pharmacy and clinical standards, emphasizing their collaborative synergy rather than competition. She emphasized the need to ensure the right patient data reaches the appropriate care team members, including pharmacists, at the opportune moment, asserting that this alignment significantly enhances patient care.
Jocelyn highlighted that technology is designed to facilitate transitioning from one standard to another. She emphasized the increasing significance of robust data exchange, particularly the exchange of quality data, between payers and pharmacies as the industry transitions towards value-based care.
Agreeing with Jocelyn, Pooja explained the challenges in integrating pharmacists into value-based care contracts consistently. However, she noted that as data exchange between pharmacies, other healthcare settings, and payers improves, barriers diminish. Pooja underscored the broader benefits of enhancing pharmacy interoperability, emphasizing advantages not only for pharmacists but also for providers and payers.
Highlighting the pivotal role of pharmacists, Pooja stressed their potential as invaluable resources for gathering social determinants of health data. She emphasized their significance in care delivery, identifying patient needs, and facilitating connections with community services. Given the frequency of pharmacist-patient interactions, she emphasized the criticality of collecting and sharing this information with the broader provider team.
The conversation then shifted to the Interop 3 – Advancing Interoperability and Improving Prior Authorization rule, expected to be released by the end of 2023 or early 2024. Kim initiated the discussion, focusing primarily on the prior authorization aspect of the rule, acknowledging its broader scope.
Kim emphasized the crucial need to establish transparency and automation to address the delays in treatment caused by prior authorization or impeding patients' understanding of their coverage when a PA is not approved. The rule encompasses various APIs facilitating exchanges among payers, providers, and patients, utilizing the Da Vinci implementation guides.
Regarding industry feedback on the proposed Interop 3 rules, Kim highlighted the notably high volume of comments, predominantly expressing overwhelming positivity. Approximately 68% of the comments agreed with the rule's intent. Although some HIPAA-related concerns were expressed, very few disagreed with the rule overall, which was intriguing given its extensive scope. Providers consistently voiced their desire for a more efficient prior authorization process, advocating for faster turnaround times and increased transparency regarding reasons for denial.
Kim underscored the significance of the inclusion of the patient access API, stressing its value for all individuals as patients. She emphasized the importance of augmented access and transparency, not only concerning clinical information like test results but also regarding payer information related to coverage and reasons for prior authorization denial.
Jocelyn aligned with Kim’s overall assessment and expressed disappointment over the proposed rules' omission of automation for specialty medications or treatments covered under the medical benefit. She highlighted this overlooked area, expressing disappointment at its continued exclusion.
One thing that brought Jocelyn immense satisfaction was the inclusion and acknowledgment of the Da Vinci Guides' role, which significantly boosted morale. There has been noticeable maturity and widespread adoption of Da Vinci guides this year.
Jocelyn expressed surprise at the absence of staggered deadlines in the proposed Interop 3 rule. From the Da Vinci community perspective, strong opinions have been consistently voiced to all HHS colleagues—ONC and CMS—over the past couple of years, emphasizing the importance of promoting gradual progress rather than imposing substantial leaps. Hence, the alignment of everything with the 2026 deadline was quite unexpected.
Pooja expressed her appreciation for Jocelyn's mention of the absence of specialty medication. She highlighted the stakeholders' growing interest in addressing specialty automation. Notably, many specialty medications require prior authorization, making it surprising that a proposed rule focused on prior authorization didn’t include items covered under the medical benefit, such as specialty medications.
The discussion shifted towards offering advice to listeners on how to approach their initial review of the final rule when it's released. Pooja inquired if there were any specific strategies to consider. Jocelyn openly admitted that she would start her review by performing a search using control + F for the words "Da Vinci" before delving into noting the specific IGs named and understanding the timeline. Additionally, she highly recommended reviewers commence with the rule's introduction, as it sets the expected scope for the details.
Kim humorously mentioned her plan to break out the eggnog before diving into the review, expressing eagerness due to its overdue nature. She echoed Jocelyn's emphasis on paying special attention to standards requirements, specifications, and particularly the timelines. She's curious if any staggering will be introduced.
Kim highlighted her interest in uncovering any mentions of TEFCA and seeking details regarding prior authorization. Anticipating stakeholders' keenness for the timeline, she pondered how organizations less proactive in their approach might adjust their interoperability roadmaps.
The trio acknowledged the waiting game as they anticipated the final rule, expecting it to drop within a week or a few weeks. In closing the episode, they shifted focus to their expectations for progress in 2024, sharing their final thoughts.
Expressing gratitude, Jocelyn thanked Pooja, Kim, and all the dedicated Da Vinci members committed to transforming healthcare. She emphasized the privilege of their work and the influential role they play in driving industry progress forward.
Continuing, Jocelyn emphasized the importance of stakeholders having a plan in place, having selected partners, and scoped out project requirements, considering the multiple requirements in proposed rules like HTI-1 or disincentives related to information blocking. With policy activity accumulating, starting work becomes increasingly challenging if stakeholders haven't initiated their projects.
She highlighted that interoperability and emerging policies transcend mere technology, impacting fundamental business transformation. It's about establishing collaborative frameworks with partners, providers, suppliers, pharmacies, and community members.
Recognizing the learning curve, Jocelyn stressed the need to leverage collective experience, emphasizing the necessity of investing in building skilled professionals for this transformative journey.
Additionally, Jocelyn pointed out the considerable activity at the state level, highlighting states like Washington, California, and Utah potentially setting more aggressive deadlines than anticipated by CMS.
Kim contributed by mentioning the Office of the National Coordinator's rule-making efforts around certification. Specifically, she referenced the FY2025 rule encompassing real-time prescription benefit and the new SCRIPT standard, particularly pertinent to pharmacy interoperability.
Agreeing with Jocelyn's state-level observation, Kim highlighted a Wisconsin Bill allocating $500,000 annually to drive the adoption of real-time prescription benefit tools. States like Wisconsin actively support moving patient empowerment solutions forward where progress has been slower.
In 2024, increased AI-related policy activity is expected, not only at the federal level but also within certain states as they unveil details regarding the integration of artificial intelligence in healthcare. Privacy and security will be pivotal aspects of these developments. TEFCA's prominence, especially in the initial six months of 2024, cannot be overstated.
POCP houses experts deeply entrenched in these areas, dedicating their days to aiding organizations in navigating the landscape, aligning strategies with competitive trends and policy shifts, as they are intrinsically intertwined. Further industry consolidations are anticipated, influencing healthcare interoperability and patient care delivery.
Looking ahead, there's a breadth of promising developments on the horizon, but staying abreast of these changes requires daily vigilance—a facet in which we aim to empower and assist. Pooja echoed these sentiments about 2024, emphasizing the significance of pharmacy interoperability.
She highlighted the recent recommendations from high-tech quarters, advocating for pharmacy inclusion at the table. Pooja referenced the Sequoia annual conference, where the importance of not overlooking pharmacists was underscored. She hinted at discussions swirling around the potential formation of a pharmacy workgroup under the Sequoia project.
The recommendations stemming from the HITAC pharmacy interoperability task force aimed to unite stakeholders and emphasize various focal points in the field.
Reflecting on 2024, Pooja's closing thoughts emphasized the importance of collaboration. Encouraging individuals with substantial pharmacy knowledge and hands-on experience in operability to step up and contribute, she urged for their active involvement to ensure the comprehensive inclusion of this expertise.
Closing the episode, Pooja extended her gratitude to her esteemed colleagues, Jocelyn Keegan and Kim Boyd, and expressed sincere appreciation to the audience for their unwavering support of The Dish on Health IT, underscoring its immense value to everyone involved.
The podcast "The Dish on Health IT" is brought to you by Point-of-Care Partners, a distinguished health IT consultancy. In the opening minutes of the episode, the hosts, Pooja Babbrah and Jocelyn Keegan, set the stage for a dynamic conversation focused on the HL7 Da Vinci Project and its real-world implementation results.
Introducing their guests, they warmly welcome Anna Taylor, Associate Vice President of Population Health and Value-Based Care at MultiCare, and Heidi Kriz, Director of Medical Policy and Medical Management at Regence. Both guests are not only accomplished professionals but also members of the HL7 Da Vinci Project, where they play pivotal roles as early implementers of the Da Vinci Fast Healthcare Interoperability Resource (FHIR) Implementation Guides.
The hosts underscore the key themes of the episode, which revolve around sharing insights from early implementation projects, understanding the tangible benefits and returns on investment, and exploring how their experiences in the Pacific Northwest can serve as a model for nationwide FHIR adoption.
As the hosts and guests delve into the discussion, they shed light on the core issues they are working to address. Heidi Kriz highlights the existing silos in healthcare, where payers and providers often work independently, using different data standards and requiring access to multiple portals. They recognize the need to promote a common language and reduce the administrative burden of healthcare processes. A major area of concern is prior authorization, which often leads to delays in care. Their aim is to make the process more transparent and incorporate it into the provider's workflow, thereby automating several steps that currently require manual intervention.
Anna Taylor supplements this perspective, emphasizing that their goal is to find a many-to-many solution that involves multiple stakeholders. With thousands of members to care for and thousands of providers to collaborate with in the MultiCare Connected Care ACO. To navigate the complexities of these relationships, they aim to streamline data administration, allowing more resources to be devoted to direct patient care. Open standard APIs, like FHIR, play a pivotal role in this quest for a comprehensive, interoperable solution.
Jocelyn Keegan highlights the significance of implementation guides within the Da Vinci Project. She underscores the importance of repeatability and the need to get information to where it's needed, thus improving overall efficiency and user experience.
The hosts and guests underline the role of collaboration as the linchpin of their endeavors. They emphasize the necessity of involving diverse stakeholders, including providers, patients, community organizations, and other contributors to the healthcare ecosystem. The objective is to create a harmonious and collaborative environment that benefits all parties involved.
Heidi Kriz shares the story of how Regence, from a business perspective, became engaged in the Da Vinci Project. The organization's CEO and leadership recognized the need to enhance the member's experience, particularly regarding the prior authorization process. This realization prompted a series of discussions and plans to implement collaborative, interoperable solutions.
In the early moments of this podcast, the stage is set for a conversation that promises to explore healthcare's complexities, emphasize the role of collaboration, and advocate for interoperability. The guests, Anna Taylor and Heidi Kriz, offer valuable insights from both the provider and payer perspectives. They highlight the need for automation, standardized processes, and the creation of a seamless healthcare ecosystem, ultimately aiming to enhance the patient experience and streamline administrative tasks.
When asked about key insights or any “aha!” moments. Heidi shares that it was realizing the power of collaboration between a payer and a provider. The ability to come together to solve complex healthcare transactions and streamline processes marked a profound shift in their approach. The synergy between MultiCare and Regence in tackling a common goal was a testament to the potential of collaboration in the healthcare ecosystem.
Heidi's second aha moment came when they went live in October 2022. After years of hard work and dedication, seeing their vision become a reality was truly amazing. The initial results were already impressive, but Heidi recognized that they were just scratching the surface of what could be achieved in terms of process automation and instant information delivery.
She also highlighted the importance of involving patients in the process. The ability to provide timely information to both providers and members, enabling them to make the best decisions for their care, was a transformative idea.
Another valuable lesson for Heidi was the necessity of embracing failure as part of the innovation journey. Adapting and making changes based on feedback and evolving needs was crucial, even if it meant not getting everything right the first time.
As for Anna, her aha moment was realizing that the combination of a business-centered approach and the right technology expertise was key to success. It wasn't a matter of choosing between one or the other; both were essential. This perspective underscored the importance of collaboration between these two aspects of healthcare organizations.
Anna also shared the concept of the "magic button," where providers found immense value in a simplified, streamlined process. The idea of having a single point of access to manage transactions and receive instant responses became a game-changer, simplifying the lives of providers and driving home the importance of automation.
Both Anna and Heidi spoke about the remarkable return on investment they experienced. Anna cited the Data Exchange for Quality Measures (DEQM) implementation, where they saw immediate returns by closing quality gaps and receiving financial incentives. The investment in developing these open standard APIs proved to be worthwhile, not only in terms of financial gains but also in making providers' lives easier.
The discussion revealed that the journey to healthcare transformation through initiatives like the Da Vinci Project is challenging but entirely feasible. Success hinges on a combination of collaboration, transparency, and a willingness to embrace change. The ability to iterate and adapt is essential, and organizations that strategically invest in these initiatives will position themselves for long-term success in the evolving healthcare landscape.
In this podcast segment, Anna Taylor and Heidi Kriz discuss their experiences and insights regarding healthcare interoperability and the impact of open standards and APIs in the healthcare industry.
Anna emphasizes the importance of embracing open standards and APIs, highlighting their potential to transform the healthcare landscape. She encourages organizations to take a close look at their current processes, especially if they are spending a significant amount of time and money on old-fashioned ETL (Extract, Transform, Load) packages. By adopting open standards and APIs, they can free up their employees' capacity, transform their culture, and ultimately improve healthcare.
Heidi adds that the risk of not adopting these technologies is greater than taking the leap. She cites the staggering amount of money wasted due to the lack of open standards in healthcare and emphasizes the potential for financial savings and enhanced patient care through interoperability. She also stresses that putting patients and people at the core of healthcare is vital.
Both Anna and Heidi underscore the importance of community collaboration, particularly through organizations like Da Vinci, which provide resources and support for implementing open standards and APIs. They encourage organizations to start small, focus on foundational changes, and build a culture of transparency and collaboration.
As they conclude, they invite more providers and partners to share their success stories and experiences, urging the community to come forward and tell their stories to inspire and educate others.
In summary, Anna and Heidi emphasize the transformative power of open standards and APIs in healthcare, the necessity of community collaboration, and the need to embrace change to improve healthcare for all. The discussion also highlights the significant impact these technologies can have on productivity, transparency, and patient care in the healthcare industry.
Learn more about this and other Da Vinci Project Implementations:
In the latest episode of "The Dish on Health IT," brought to you by Point-of-Care Partners, a riveting conversation unfolds as the hosts, Pooja Babbrah and Jocelyn Keegan, welcome a distinguished panel of guests from the National Council for Prescription Drug Programs (NCPDP). The episode begins with warm introductions, setting the stage for an in-depth exploration of the cutting-edge developments and innovations in the realm of Health IT.
They kicked off the episode by introducing themselves, shedding light on their roles and professional backgrounds. Jocelyn Keegan shared her primary focus on payer-provider collaboration and prior authorization, setting the context for the exciting discussions to come.
The spotlight then shifted to their esteemed guests from NCPDP, including Lee Ann Stember, President and CEO, John Hill, COO and Foundation Executive Director, and Christian Tadrus, Vice Chair of the NCPDP Board of Trustees. Each guest provided a brief glimpse into their professional activities, highlighting their significant contributions to the healthcare landscape.
Lee Ann Stember, serving as the President and CEO of NCPDP for the last 43 years, is recognized as a leading figure in the healthcare standards development landscape. Her dedication and unwavering commitment to enhancing patient care and healthcare efficiency through enhanced pharmacy standards and workflows.
John Hill, the Chief Operating Officer of NCPDP and Foundation Executive Director brings a wealth of experience and insight to the table. John's multifaceted role in managing NCPDP's operations and spearheading the Foundation's efforts demonstrates his commitment to driving positive change in healthcare. His role as a pivotal liaison between NCPDP and various stakeholders underscores his dedication to fostering collaboration for the betterment of healthcare systems.
Christian Tadrus, the Vice Chair of the NCPDP Board of Trustees, is an instrumental leader in the organization's strategic initiatives. As a key player in the coordination of care and innovation workgroup, Christian is at the forefront of efforts to bridge the gap between pharmacists and other healthcare stakeholders. His deep understanding of the evolving role of pharmacists in healthcare positions him as a thought leader in driving healthcare interoperability and innovation.
The conversation shifted to the topics of the day and the guest were asked to elucidate NCPDP's mission and its remarkable milestone accomplishments. Lee Ann eloquently explained NCPDP's role as an accredited standards development organization, driving healthcare interoperability and ushering in a new era of efficient healthcare solutions.
One of the key highlights of the episode was the discussion surrounding the National Facilitator Model pilot. This groundbreaking initiative is designed to provide real-time prescription testing and immunization data, revolutionizing public health and care coordination. The hosts and guests underscored how this model could streamline healthcare processes, enhance patient outcomes, and elevate overall efficiency. Read the research findings from Phase 1 of NCPDP’s National Facilitator Model Pilot: https://ncpdpfoundation.org/pdf/NationalFacilitatorModel_Phase1_Report.pdf
A significant theme that permeated the conversation was the evolving role of pharmacists in healthcare, especially during the pandemic. Pharmacists have taken on an expanded role in clinical services, including administering tests, treatments, and immunizations. This paradigm shift underscores the critical need for healthcare interoperability.
The episode also unveiled a new workgroup, the Coordination of Care and Innovation (CoCI), which aims to bridge the gap between pharmacists and other healthcare stakeholders. The objective is to ensure that standards are aligned to support the evolving role of pharmacists in patient care. Watch this video for an overview of NCPDP’s new CoCI, Work Group 20. https://rebrand.ly/NCPDP-WG20-mem00
In conclusion, this captivating episode of "The Dish on Health IT" offered a comprehensive overview of NCPDP's mission, milestones, and innovative endeavors. The National Facilitator Model pilot emerged as a beacon of promise for healthcare efficiency, while the evolving role of pharmacists highlighted the need for robust healthcare interoperability. The introduction of the Coordination of Care and Innovation workgroup symbolizes a pivotal step in unifying healthcare stakeholders. The key takeaways and calls to action include supporting NCPDP's three-year plan, emphasizing interoperability, health equity, and public health, and encouraging collaboration to drive positive changes in healthcare delivery.
Learn more about NCPDP’s Work:
On this episode of "The Dish on Health IT," hosted by Ken Kleinberg and Jocelyn Keegan from Point-of-Care Partners (POCP), healthcare technology enthusiasts were treated to an engaging discussion with a special guest, Alice O'Carroll, Interoperability Product Manager at Florida Blue.
Ken Kleinberg, the senior consultant and innovation lead at POCP, kickstarted the episode by extending a warm welcome to listeners, emphasizing POCP’s pivotal role as trusted and independent health IT consultants. He expressed their unwavering dedication to uncovering the latest healthcare technology news and milestones.
The episode promised an illuminating exploration of some of healthcare's most significant challenges and opportunities from a payer perspective including:
• CMS MANDATES IN HEALTH IT: Ken introduced the episode by shedding light on the far-reaching impact of CMS mandates and other policy initiatives within the healthcare technology space. The hosts emphasized that merely adhering to regulations falls short; healthcare stakeholders must aspire to achieve more.
• ARTIFICIAL INTELLIGENCE (AI) IN HEALTHCARE IT: The episode delved into the transformative potential of AI in healthcare but perhaps used in a more mundane way than expected.
• ENHANCING DATA QUALITY IN HEALTHCARE: The hosts underlined the paramount importance of elevating data quality standards within healthcare. They highlighted how this mission not only benefits healthcare providers and payers but also empowers patients and enhances overall healthcare outcomes.
• PATIENT CONSENT MANAGEMENT IN DIGITAL HEALTH: Among the critical issues discussed was the management of patient consent not only across the ecosystem but also the need for the patient to be able to grant access to pieces of information and not their full record. Most importantly, patients need a way to revoke consent at any time. Consent is a challenge demanding immediate attention within healthcare technology.
Alice O'Carroll's introduction was met with enthusiasm as she joined the podcast as a distinguished guest. She donned multiple hats, including her role as the Interoperability Product Manager at Florida Blue and her status as one of the champions of the HL7 Da Vinci Project—a remarkable collaborative initiative.
Alice passionately shared her personal dedication to healthcare interoperability, tracing her journey into the realm of interoperability mandates and their profound impact. She underscored the unique role of these mandates in reshaping the entire business model of health IT. She explained that she had a deep belief that interoperability can usher in meaningful change, benefiting not only patients but also all stakeholders in the healthcare ecosystem.
At Florida Blue, Alice and her team stood at the forefront of CMS mandate compliance, actively participating in industry workgroups like Da Vinci to ensure alignment with industry standards and drive positive transformation.
The discussion swiftly transitioned to the impact of policy developments, particularly CMS mandates, on payers in the healthcare technology landscape. Alice offered her perspective, tracing the lineage of mandates back to CMS's Meaningful Use initiative. She painted a vivid picture of a rapidly evolving regulatory landscape, touching upon mandates such as the transparency and coverage mandate and the no-surprises act. Alice emphasized the vital role of industry involvement in effectively influencing and navigating these transformative regulations.
Ken questioned the philosophy of merely checking the regulatory box and explored why organizations, including Florida Blue, should invest additional time and resources in healthcare technology. Alice passionately responded, underlining that the healthcare technology industry's business model is undergoing a profound shift. She explained that compliance with mandates like USCDI creates opportunities, such as payer-to-payer data exchange, but real value emerges from leveraging data to benefit members, lower costs, and enhance quality.
The trio ventured into the thrilling domain of artificial intelligence (AI) in healthcare technology. Ken and Jocelyn recognized the potential and challenges AI presents. Alice joined in, envisioning AI's role in transforming unstructured data into structured data, thus enhancing data quality and interoperability in healthcare technology.
Alice and Jocelyn delved deeper into the pivotal topic of data quality, acknowledging the healthcare technology industry's historical shortcomings. Alice stressed the need for a universal standard and the challenges posed by unstructured data. She discussed how regulations accelerated data exchange but also emphasized the significance of data stewardship and accountability in healthcare technology.
This dynamic conversation encapsulated these crucial healthcare technology themes, painting a vivid picture of an industry undergoing unprecedented transformation. As Ken, Jocelyn, and Alice shared their insights, they collectively illuminated a path forward—one where interoperability, data quality, AI and consent management converge to progress healthcare towards a more patient-centered approach.
The podcast culminated with a valuable reminder from Alice and Jocelyn for healthcare technology professionals to actively engage in industry workgroups and partake in the ongoing transformation of healthcare data sharing and interoperability. They championed a collaborative approach, where both business and IT partners collaborate effectively to navigate the evolving healthcare technology landscape.
In closing, Ken expressed his gratitude to his guests, Jocelyn Keegan and Alice O'Carroll, for their passionate insights and engagement in the healthcare technology discussion. He also extended his thanks to the audience for tuning in and invited them to stay updated with future podcast episodes across various platforms as the dynamic field of health IT and healthcare technology continues to evolve.
In this episode of The Dish on Health IT, hosts Pooja Babbrah and Jocelyn Keegan both leads at Point-of-Care Partners welcome Dr. Su Chen, program manager and clinical director of CodeX, and Michelle Galioto, deputy program manager of CodeX, to discuss the mission and scope of the CodeX community. CodeX is an HL7 FHIR Accelerator that advances clinical specialty terminology data standards to improve healthcare outcomes.
Dr. Su Chen provided an overview of the CodeX community, highlighting that CodeX is a not-for-profit, member-driven community that aims to advance clinical specialty terminology data standards. CodeX began its work focused on cancer but has since expanded to genomics and cardiology. The idea behind CodeX is that if we can capture the right level of granular clinical data to support complex disease states, we can treat the patient in a more informed way as well as use the data to better understand what is working.
Dr. Su Chen and Michele Galioto both have a clinical background which is somewhat uncommon for guests of this podcast. Both guests shared that their clinical experience and the understanding of the negative impact not having the right data at the point of care can have drove them both to get involved on the health IT standards and technology side of things. The perspective is that if clinical data can be collected and disseminated, real change and positive outcomes can be influenced.
CodeX member population span across, provider organization, specialty societies, patient advocacy, regulators, life sciences, etc. They all came together to make strides in data collection and fluidity. The CodeX community brings together all these different perspectives, to really understand real-world pain points, requirements and what needs to be done to move the needle and really impact patient outcomes in a positive way. While CodeX is focused on standards development, it’s more than that because we must pull it through to adoption.
Host, Jocelyn Keegan, weighed in to echo the idea of FHIR Accelerator members generally, not just CodeX, coming together to make sure the real-world problems are accurately represented and that solutions are pulled through in testing and pilots before being adopted out in the wild is really what makes the FHIR Accelerators so special and that she sees the same passion being brought to bear in the HL7 Da Vinci Accelerator, even though it has a different focus.
Dr. Su Chen recapped some of CodeX success stories sharing has had growing real-world traction and adoption in the last six to nine months and has started to have outcomes of real success in its pilots and use cases. She shared that CodeX has approximately ten use cases that span patient care, patient care coordination, public health research, payer processes, and more.
Some of CodeX's more mature work can now be found live at real-world clinical care sites and the data being gathered is being leveraged in trials. There is also a trial matching pilot that is attempting to improve enrollment for clinical trials using standards to expand the pool of possible trial candidates outside of the trial site or the close network of physicians related to the trial. This expansion of the trial recruitment pool could help improve trial enrollment rates from 3-8-fold.
One of the use cases to highlight is prior authorization in oncology work. This use case brings together a collection of interested parties, EHR, vendor health, IT groups, and payers to reduce the burden of prior authorization across the healthcare team to benefit the patient. CodeX is addressing real-world problems that can be solved, and the investment in MCODE by MITRE and the community to create the right pool of cancer and cancer terminology within the FHIR community is making things better than they are today. CodeX is also starting to see traction in the international community including Germany and Brazil.
CodeX is being creative and learning from each other, cross accelerator, cross HL7, and time pieces together so that we can get to end goals faster. In doing so, CodeX is starting to see greater voices added to the table, starting to look at prior authorization, not just in cancer, but now in cardiovascular health or genomics.
The episode closed out by our guests encouraging listeners to get engaged with FHIR if you haven’t already. There are many policy requirements and there will be more to come so if get engaged with the FHIR community now. If listeners are interested in the work of CodeX in particular, they can engage with the work that CodeX is doing by joining as a member, attending public calls, and checking out the CodeX website. Clinicians are especially encouraged to get involved and offer their perspectives, but all are welcome. CodeX is a generous community that promotes its members' needs and collaborates with other accelerators, working groups, and standards organizations.
This episode of The Dish on Health IT features guest Kyle Kiser, CEO of Arrive Health, joined Point-of-Care Partners (POCP), hosts and health IT leaders Pooja Babbrah and Jocelyn Keegan to discuss price transparency and real-time pharmacy benefit (RTPB) check. They also discussed user centric design, optimizing adoption, and related policy and standards.
To kick off the episode, Pooja Babbrah introduced herself as the host and Pharmacy PBM Lead with Point-of-Care Partners. Jocelyn Keegan then introduced herself as the POCP Payer Practice Lead. Pooja then asked Kyle Kiser to introduce himself where he explained he is the CEO of Arrive Health and has been with the company for almost 9 years.
They then talked about the benefits of tools that allow for more visibility for providers and patients into coverage and price, as well as the key considerations when designing and rolling out new tools to optimize adoption and consistent use. They also discussed the role of policy and standards related to price transparency and RTPB.
Kyle explained that Arrive Health is a company inspired by Dr. Kevin O'Brien's experience with his mother Lucy. When she came to Dr. O’Brien with an issue of out-of-pocket spending, using his expertise, he sought out ways to reduce her spend. This led to the creation of Arrive Health and the mantra “Lucy Up” which is a reminder of their mission to make sure patients can afford their medication. They focus on the patient-provider relationship, and their customers and partners are those looking to save money on their medications.
The conversation shifted to focus on the vision and mission of a company that has been around since 2013. The focus from the beginning was to improve healthcare value by connecting patients and providers with the right information at the right time to drive the right decision. This conversation then shifted to price transparency and the policies that have been put in place to make it easier for patients to understand what they are paying for and how the industry can help to smooth out some of the pain points they face when it comes to affordability. The company is committed to its mission and is continuing to focus on the patient-provider relationship as the most leveraged opportunity in the value chain.
The conversation then focused on the current state of making price more transparent in the healthcare industry. The group agreed that real-time benefit check has been a successful addition, offering a strong value proposition for providers, payers, and patients. They also acknowledged that there is still much work to be done on the medical benefit side.
The group discussed the ever-increasing complexity of benefit carve outs and the ongoing challenge of validating patient identity and connecting with their benefit details at the granular level needed to really understand coverage and out of pocket costs. They then discussed the role of policy in raising the floor for the industry without boxing out innovation by making requirements too narrow or prescriptive.
The conversation shifted to prior authorization and the work of Da Vinci Project on price cost transparency. The participants recognize the need to get pricing information to the payer and patient at the right time so that they can make decisions about their care that they can afford. Da Vinci's four guides allow for similar workflows to that of RTBC today due to the separation of activities on the medical side compared to a dispense event.
The podcast currently has 43 episodes available.