In this episode of The Dish on Health IT, host Tony Schueth and payer interoperability expert Kendra Obrist sit down with Rob Alger, SVP of Health Plan Technology at Kaiser Permanente, for a candid and sweeping conversation about payer interoperability, AI, FHIR, and the realities of health IT innovation at scale.

Rob kicks things off by discussing Kaiser Permanente’s unique care and coverage model, highlighting how it streamlines internal coordination and shapes investment priorities. He notes that, unlike many other health plans, Kaiser’s vertically integrated structure allows for fewer administrative hurdles, particularly in areas like prior authorization.

The conversation then turns to CMS-0057. While Rob acknowledges Kaiser must comply like everyone else, the regulation presents less of a lift for them due to their internal alignment. That said, both he and Kendra agree: the success of any interoperability initiative hinges on provider adoption, and that remains uncertain.

Looking ahead to 2025, Rob shares Kaiser’s strategic focus on simplifying healthcare experiences, especially by leveraging AI to remove friction from both clinical and administrative processes. One standout example is their ambient listening tool from Abridge, now rolled out across 40 hospitals and 600 medical offices, which is allowing clinicians to focus more on patients than keyboards. It’s one of the fastest clinical tech adoptions Rob’s ever seen.

Naturally, the discussion shifts to FHIR. Rob puts it plainly: “FHIR is non-negotiable.” Regulatory mandates have solidified its role, but he wonders whether the industry will eventually want to use FHIR or continue reacting to policy. Kendra and Tony weigh in, noting signs of growing pull once organizations recognize the potential. They agree that multi-stakeholder efforts like Da Vinci Project and FHIR at Scale Taskforce (FAST) are helping to build real-world traction by solving for shared use cases.

When asked why Kaiser stays engaged in these initiatives, Rob makes it clear it's about shaping standards early, staying ahead of the curve, and making smarter, future-proof decisions, especially when it comes to vendor selection.

The episode then revisits AI, with Rob outlining Kaiser’s guiding principles: human in the loop, bias mitigation, and responsible governance. He explains that while Kaiser isn’t trying to build every tool themselves, they aim to be excellent adopters, using AI to free up clinicians and call center reps to operate at the top of their license. It's less about chatbots and more about smarter workflows, ambient data capture, and preserving session context across modalities.

Data quality surfaces as a recurring theme. Kendra highlights increasing payer interest in tackling inconsistency and fragmentation. Rob acknowledges Kaiser has an edge due to its standardized EHR system, but insists no one is immune to the challenges, especially when AI is in the mix. As he puts it, “If your data’s not clean, you’re not going anywhere.”

As a member of the Council for Affordable Quality Healthcare (CAQH) board, Rob brings a unique perspective on industry-wide infrastructure and collaboration. He explains that CAQH, originally formed by major health plans to tackle non-competitive operational challenges, has evolved into a key player in both standards development and practical solutions like coordination of benefits and provider directories. That dual focus—advocacy and action—resonates throughout the conversation, especially as Rob underscores the importance of shared investments in foundational infrastructure that lift the entire industry.

The discussion then touches more specifically on directories and the potential of shared infrastructure for non-competitive areas of healthcare. Rob emphasizes that while payers care deeply about directory accuracy, the solution likely involves more human accountability than tech alone.

In closing, the trio shares their perspectives on under-discussed industry challenges. Rob flags cybersecurity as a growing threat, especially in light of recent ransomware attacks. Kendra and Tony shine a light on consent and pharmacy interoperability, two areas that, while not headline-grabbing, could unlock major gains in care coordination and equity.

Rob’s parting call to action? It’s time for the industry to align on clinical policy. Competing on utilization rules isn’t sustainable, and getting consensus on what’s appropriate care could help streamline prior auth and improve patient trust.

Kendra wraps by urging payers to suspend disbelief and start planning for a world where APIs and data exchange work as intended. Dream a little, and then build accordingly.

In this special HIMSS25 recap episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by co-hosts Brian Bamberger, POCP’s Life Sciences Lead, and Vanessa Candelora, Senior Consultant and Program Manager of the HL7 Gravity Project. Together, they break down the biggest themes from the conference, covering interoperability, artificial intelligence (AI), FHIR adoption, and the growing focus on improving data quality in healthcare innovation.

HIMSS25 once again proved to be a crucial gathering of healthcare leaders, vendors, and policymakers, drawing nearly 28,000 attendees. Vanessa notes the continued focus on interoperability and trust, with a clear divide between experienced stakeholders refining their strategies and newcomers trying to grasp the fundamentals of FHIR. Brian, a HIMSS veteran, points out that first-time attendees often struggle with the complexity of both the conference itself and the discussions around health IT’s latest advancements, particularly AI and its real-world applications.

To add perspectives from the conference floor, Tony introduces a series of interviews with HIMSS25 attendees and industry leaders, including Anna Taylor, Associate Vice President, Population Health and Value-Based Care of MultiCare, Erin Weber, Chief Policy & Research Officer, CAQH, Mariann Yeager, CEO, The Sequoia Project, Matthew Holt, Founder/Writer of The Health Care Blog, and Lynne Nowak, Chief Data and Analytics Officer. Each interview provides insights into the real-world implementation of interoperability and FHIR, the evolving use of AI, and how data privacy and governance are shaping health IT strategy.

FHIR adoption was one of the topics covered in the interviews. Some, like Mariann Yeager and Erin Weber, expressed optimism about FHIR’s expanding role in clinical data exchange, while others, such as Anna Taylor, highlighted persistent scalability challenges and limited adoption for administrative functions like prior authorization. Matthew Holt offered a broader view on data exchange, arguing that while data mobility has improved, the real challenge is how organizations actually use and integrate that information. Vanessa underscores that while FHIR is gaining traction globally, large-scale implementation remains a work in progress. The panel agrees that translating theoretical frameworks into real-world adoption is the next crucial step.

AI was another dominant topic, with a mix of enthusiasm and skepticism surrounding its potential. The HIMSS interviewees discuss AI’s growing role in streamlining administrative workflows, summarizing patient records, and enabling ambient listening for clinical documentation. However, as Brian bluntly puts it, the “magic” of AI is still far from reality—many tools promise seamless EHR integration but lack the ability to write back into clinical systems, requiring manual intervention. Lynne Nowak and others emphasized that AI’s effectiveness is directly tied to data quality—bad inputs will only lead to bad outputs. The consensus? AI has real potential to enhance workflows but cannot replace clinicians, and health IT leaders must focus on governance, usability, and ensuring AI supports, rather than replaces, human decision-making.

As the conversation wraps up, Vanessa highlights the critical role of policy and strategic innovation in shaping the next wave of health IT progress. With new regulatory shifts and uncertainty around TEFCA, organizations must stay agile while ensuring that patient privacy, data integrity, and consent management remain top priorities. Brian brings the discussion back to life sciences, stressing the importance of leveraging patient insights and real-world data to drive treatment adherence and improve outcomes.

HIMSS25 reinforced that while FHIR, AI, and interoperability remain hot topics, the industry is now at a critical inflection point—shifting from theory to execution. Organizations must filter out hype, focus on data quality, and build scalable solutions that improve both clinical and administrative functions.

For those who couldn’t attend HIMSS25 or want a deeper dive into what’s next for health IT, this episode provides a comprehensive breakdown of the major takeaways. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or your preferred platform. The podcast is also available on HealthcareNOW Radio. Full video versions are also available on POCP’s YouTube channel. As always, health IT is a dish best served hot.

In this episode of The Dish on Health IT, host Tony Schueth leads an engaging discussion on pharmacy interoperability, a topic at the center of a recently published POCP white paper funded by the NCPDP Foundation and supported by Surescripts. Joining Tony as guests are, John Hill, Executive Director of the NCPDP Foundation, and Larry King, Director of Intelligent Prescribing at Surescripts, to unpack the white paper’s findings and explore the future of pharmacy’s role in patient care.

The conversation begins with Tony laying the foundation for the discussion by defining pharmacy interoperability as the seamless, bi-directional exchange of health information between pharmacy care settings and the broader healthcare ecosystem. This connectivity ensures that data flows effortlessly without adding complexity to the workflows of pharmacists or other providers. Tony highlights the POCP white paper, which outlines critical opportunities and challenges in achieving this vision. The document calls for leveraging standards and technology to integrate pharmacists as key contributors to care teams, addressing  medication management and broader clinical services.

John Hill and Larry King bring their unique perspectives to the conversation. John shares insights into how the NCPDP Foundation is focused on grants that expand the pharmacist's role, improve patient safety, and enhance access to care. He emphasizes that the white paper marks a pivotal step toward identifying gaps in interoperability and opportunities to engage pharmacists more fully in patient care. Larry draws from his experiences as a pharmacist and industry leader, highlighting the complexity of patient needs and the roadblocks that prevent pharmacists from working to the highest and best purpose of their license. Both guests underscore the need for workflow-friendly solutions to reduce administrative burdens and allow pharmacists to spend more time on meaningful, patient-centered work.

The discussion delves into the growing role of pharmacists, who are increasingly stepping beyond dispensing medications to provide direct patient care services, including immunizations, chronic disease management, and comprehensive medication reviews. Tony and his guests agree that pharmacies are uniquely positioned to fill gaps in care, especially in underserved areas, and to offload basic services from overburdened primary care practices. However, for pharmacies to step into this larger role, significant progress is needed in interoperability, reimbursement models, and technology adoption.

A key focus of the conversation is the critical role of standards in enabling interoperability. John elaborates on how NCPDP works to ensure data can be exchanged seamlessly, highlighting their collaboration with HL7 on standards like the eCare Plan. He explains that standards not only ensure data consistency across systems but also reduce the burden on users by integrating into existing workflows. Larry adds that Surescripts’ efforts to implement interoperable solutions, such as Qualified Health Information Networks (QHINs) under TEFCA, demonstrate the potential of standards to create a nationwide framework for secure data exchange.

The guests also discussed the importance of using sustainable financial models to incentivize investment in interoperability. Larry points out that while there are some reimbursement programs for clinical services, inconsistencies remain a significant barrier. Both guests stress that the industry must develop scalable payment models that align with pharmacists’ expanded roles and address the technology investments required to connect pharmacy systems with the broader care continuum.

Emerging technologies like AI are also prominently featured in the discussion. Larry shares how Surescripts is leveraging AI for tasks like parsing patient instructions and monitoring network activity for compliance issues. John highlights NCPDP’s efforts to explore how AI can support standards adoption and governance. Both agree that while AI offers enormous potential to optimize pharmacy workflows and enhance clinical insights, it must be implemented cautiously, with safety and security as top priorities.

As the episode nears its conclusion, the guests reflect on the ideal future state of pharmacy interoperability. Larry envisions a world where patients experience seamless care, with providers and pharmacists having immediate access to comprehensive, accurate health information. This would eliminate redundant data collection, reduce errors, and enable faster, more informed decision-making. John echoes this vision, emphasizing that interoperability can empower pharmacists to operate at the top of their licenses, improving patient outcomes and addressing provider shortages.

Tony closes the discussion by encouraging listeners to take actionable steps, such as engaging with workgroups like NCPDP’s Work Group 20, reviewing the POCP white paper, and participating in industry initiatives that drive interoperability forward. John and Larry emphasize the urgency of acting now, describing this as a once-in-a-generation opportunity to create lasting change in healthcare delivery.

For more insights and resources, including links to the white paper and details on key industry initiatives, check the episode summary. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or Healthcare Now Radio to stay informed. Let’s continue the journey toward a more connected and efficient healthcare system—because health IT is a dish best served hot!

Reference Links: 

POCP Pharmacy Interoperability Whitepaper: https://info.pocp.com/pharmacy-interoperability-whitepaper 

NCPDP Foundation abridged results report: https://ncpdpfoundation.org/pdf/PharmacyInteroperability_AbridgedResults.pdf  

NCPDP Foundation website (for grant proposals in connection with the CTA of future opportunities for grants): https://ncpdpfoundation.org/home.aspx  

NCPDP Standards website (for encouraging involvement/collaboration in WGs in connection with the CTA of getting involved/supporting the mission): https://standards.ncpdp.org/  

Surescripts Blog, "Ready for Action: Advancing Pharmacy Interoperability": Preparing Pharmacy with Technology to Participate in Healthcare Interoperability | Surescripts 

In this episode of The Dish on Health IT, Host Tony Schueth, CEO of Point-of-Care Partners (POCP) and Co-host, Kendra Obrist, Payer Strategy Senior Consultant with POCP, welcome Anthony Murray, Chief Information Officer of MRO, to tackle one of health IT’s most pressing topics: payer-provider data exchange and interoperability.

The discussion begins with introductions and a light-hearted acknowledgment of the traditional friction between payers and providers. Anthony shares his journey from pharmaceutical work to leading MRO’s efforts in clinical data exchange. He emphasizes the enduring challenges in interoperability, including siloed systems and the complexities of real-time data sharing.

The conversation then shifts to the evolving patient-centric approach. Anthony and Kendra explore how technology like patient portals has improved engagement but highlight gaps in bidirectional data exchange. They dive into the payer-provider dichotomy, with Kendra explaining how payers are shifting their mindset to view data holistically as patient data rather than isolated categories like claims or provider information.

Later, the trio examines successful payer-provider collaborations, such as Anthony’s example of a client achieving a 63% improvement in quality scores through seamless digital connectivity. They also spotlight the Da Vinci Project and other initiatives driving innovation in the space.

The regulatory landscape takes center stage with a discussion of the CMS-0057 rule, which aims to streamline prior authorization and bolster interoperability. Both Anthony and Kendra share candid views on the challenges of implementing these changes and the opportunities they present for strategic advantage.

Closing on a forward-looking note, Anthony calls for active industry participation in shaping health IT’s future, urging stakeholders to engage in accelerators and public comment opportunities. Kendra envisions a healthcare system that embraces real-time digital experiences, aligning with the expectations of younger generations.

Tune in for actionable insights and spirited dialogue about the future of health IT and interoperability!

Key Themes:

• Challenges in payer-provider data exchange
• Opportunities in patient-centric interoperability
• Regulatory impacts, including CMS 0057
• Examples of successful collaborations driving innovation
• Strategic shifts in viewing data holistically

Listen now to explore how collaboration, technology, and regulation are reshaping health IT! Find us on Apple Podcasts, Spotify, and Healthcare Now Radio, or watch on the POCP YouTube channel. Don’t forget, health IT is a dish best served hot!

In this lively recap of the HLTH 2024 conference in Las Vegas, The Dish on Health IT dives deep into the event’s biggest topics with host Tony Schueth, CEO of Point-of-Care Partners, and guest co-host Seth Joseph, Managing Director of Summit Health and contributor to Forbes.com. Known for its forward-looking focus on healthcare innovation, HLTH 2024 was packed with discussions on artificial intelligence, data interoperability, data security, and the emerging technologies shaping the industry.

Tony and Seth kick off the episode by reflecting on HLTH’s unique vibe, contrasting it with other industry events like HIMSS. They offer honest reactions to the glitzy atmosphere and networking opportunities that HLTH provides and discuss how its “futuristic” focus is a magnet for healthcare investors, entrepreneurs, and thought leaders. Seth provides a candid look at the range of perspectives on AI in healthcare. While excitement around generative AI applications remains high, he notes a growing willingness to challenge its real-world impact and value, marking a shift from last year's unbridled enthusiasm to more cautious optimism. Tony echoes this sentiment, observing that AI and other tech innovations will only prove their worth when they meaningfully improve patient care and operational efficiency.

Throughout the episode, Tony shares exclusive clips from his one-on-one interviews with several key industry leaders who each offer unique insights into the conference themes and the road ahead for health IT. The interviews include:

• Bevey Miner, EVP of Consensus – Bevey shares her views on HLTH as a stage for innovation and the importance of collaboration in advancing health IT solutions.
• Frank Harvey, CEO of Surescripts – Frank discusses the critical role of data and interoperability in healthcare, and how AI could streamline data exchange and improve patient outcomes while noting the limitations of isolated “point solutions” that need a more holistic approach.
• Tim Pletcher, CEO of MiHIN – Tim emphasizes the importance of regulatory compliance, particularly with TEFCA, HTI-1 and HTI-2, as well as the need to build trust across state lines to enhance data-sharing frameworks.
• Charlie Harp, CEO of Clinical Architecture – Charlie dives into the challenges of data quality and the vital role of accurate, clean data in effective AI applications.
• Brian Anderson, MD, CEO of CHAI – Brian brings a thoughtful perspective on responsible AI use in healthcare, stressing the need for realistic expectations and industry-wide collaboration to ensure AI’s impact matches its promise.

Tony and Seth revisit the recurring theme of interoperability, an area of focus for POCP. They discuss its complex challenges and how data standards and regulatory shifts are beginning to create a more integrated system. Highlighting Blue Shield of California’s partnership with Salesforce on prior authorization as a standout announcement, Tony notes the significance of innovations that simplify administrative burdens on providers and reduce care delays for patients.

The episode wraps up with Tony and Seth’s thoughts on HLTH’s atmosphere, especially the mixed reactions from attendees about the conference’s glitzy setup. While some question the balance between style and substance, Tony appreciates the energy and enthusiasm HLTH brings to healthcare, believing it encourages important investment and public interest in health IT. Seth offers a dose of realism, pointing out that while glitz can attract attention and funding, the true test will be in the hard work and strategic planning needed to implement these innovations at scale.

For those eager to hear about the latest in healthcare innovation, this episode delivers a nuanced take on HLTH 2024, blending high-level industry insights with grounded observations on where health IT is—and isn’t—making an impact.

In this episode of The Dish on Health IT, Tony Schueth, CEO of Point-of-Care Partners, and Kim Boyd, Regulatory Resource Center Lead, are joined by Pam Schweitzer, former Assistant Surgeon General of the United States and current Chair of the NCPDP Foundation Board of Trustees. Together, they deliver an in-depth discussion on critical topics impacting the health IT landscape, including interoperability, public health data modernization, and evolving healthcare regulations.

The episode begins with introductions from Tony and Kim, highlighting Pam’s extensive career in healthcare, ranging from her leadership roles in the Indian Health Service and the Veterans Affairs (VA) system to her current position as chair of the NCPDP Foundation. Pam reflects on her experience overseeing the transition from paper to electronic health records and how this complex shift required the coordination of multiple healthcare departments, including radiology and labs.

Pam shares her insights into how policy changes, such as CMS 0057 and the HTI-2 proposed rule, are shaping the future of healthcare interoperability. The trio discusses how these regulations, aimed at improving data sharing between payers, providers, and public health systems, will ultimately drive real-time data exchange. They also emphasize the importance of infrastructure, standards, and innovation to support these efforts.

As the discussion moves forward, Pam talks about her work on public health initiatives, particularly around pharmacy interoperability, maternal health, and the broader impacts of nutrition and food supply on community health. Kim and Pam also explore the evolving role of pharmacists in public health, especially in rural areas where they often serve as the primary healthcare providers.

The conversation includes key steps for modernizing public health data systems, such as addressing the data silos between healthcare and public health systems. Pam emphasizes the need for greater collaboration and data sharing to enable a more effective public health response, especially during crises like pandemics or natural disasters.

Pam, Kim, and Tony also touch on the role of the Trusted Exchange Framework and Common Agreement (TEFCA) in promoting data fluidity and expanding the integration of pharmacists and other healthcare stakeholders into the broader healthcare ecosystem.

The episode wraps up with Pam expressing her optimism for the future of health IT and public health interoperability, while stressing the importance of ongoing collaboration between stakeholders, from policymakers to healthcare technology vendors. Kim adds that the evolution of pharmacy practice and regulatory changes are driving significant improvements in patient care and medication management.

Listeners can tune in for a deep dive into the intersections of health IT policy, pharmacy standards, and public health modernization, with practical insights from leaders in the field. This episode is a must-listen for those interested in healthcare interoperability, the impact of CMS and ONC policies, and the future of public health and pharmacy integration.

Catch the full episode on your preferred podcast platform, including Apple Podcasts, Spotify, and Healthcare Now Radio, or watch the video version on YouTube.

Other resources you may be interested in:

• Healthy People 2030 – Data and Information Systems
  https://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructure
• Public Health Infrastructure - Healthy People 2030 | health.gov
  https://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructure
• Strategies for Public Health Interoperability | PHDI | CDC
  https://www.cdc.gov/data-interoperability/php/public-health-strategy/index.html
• March 27, 2024 – Draft 2024-2030 Federal Health IT Strategic Plan
  https://www.healthit.gov/sites/default/files/page/2024-03/Draft_2024-2030_Federal_Health_IT_Strategic_%20Plan.pdf
• 2023 – Infrastructure for Scaling and Spreading Whole Health – Health Informatics
  https://www.nationalacademies.org/our-work/transforming-health-care-to-create-whole-health-strategies-to-assess-scale-and-spread-the-whole-person-approach-to-health

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:

• Colin Banas, Chief Medical Officer for DrFirst, shared insights on medication management and prior authorization.
• Polina Vaserman, Vice President of product Management with MHK, discussed the complexities and proposed improvements in prior authorization final rule.
• Lathe Bigler, Vice President of Clinical Network Services at First Databank provided perspectives on leveraging FHIR APIs for improving price transparency and patient care.
• Lenel James, Business Lead - Health Information Exchange & Innovation, Blue Cross Blue Shield Association, highlighted the use of FHIR APIs to enhance data accessibility for all stakeholders, including patients, payers, and providers, underscoring the importance of making healthcare data available across the care continuum to improve service delivery and care coordination.
• Melanie Marcus, Chief Marketing and Customer Experience Officer at Surescripts highlighted the role of pharmacies in expanding care access and the necessity for interoperability and policy support.
• Kathryn Ayers Wickenhauser, Sr. Director of Community Strategy at DirectTrust discusses the critical role of pharmacists in delivering care and the role of Direct Messaging can play in supporting this work. 

Themes from the interviews and host response include: 

• CMS Interoperability and Prior Authorization: There has been broad acknowledgment of the positive progress this final rule will make towards enhancing interoperability and refining the prior authorization processes is widespread, with some hoping for additional policies to go even further.
• Healthcare Ecosystem and CMS Policies: The industry acknowledges the complexities of medications requiring prior authorization. There's an expectation for CMS to broaden its research and policy scope to include specialty medications, recognizing their critical importance.
• Impact of Technology and Innovation: The importance of adopting standards like FHIR for improving healthcare interoperability is emphasized. Leveraging technology and standard adherence is highlighted as crucial for enabling effective communication among healthcare stakeholders, reducing administrative burdens, and improving patient care quality.
• Pharmacy’s Essential Role: Pharmacies are spotlighted as key to healthcare delivery, especially in underserved areas. There's strong advocacy for improved pharmacy interoperability and integration into the care team, stressing the need for policies, payment reforms, and access to health information to support their expanded role.
• Using Existing Technologies: The discussions promote the practical use of existing technologies and workflows to address healthcare delivery challenges effectively. This pragmatic approach centers on solving immediate patient care and business problems with available tools and sharing successful industry practices to foster broader adoption.
• Future Directions and Collective Engagement: A desire for ongoing engagement with health IT innovations, with a focus on interoperability, is clear in future industry events. The importance of collaborative efforts within the community and across the industry is underscored as critical for driving advancements in health IT and interoperability.

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. 

Other Reference Links: 

• https://www.fdbhealth.com/about-us/press-releases/2022-08-25-fdb-launches-fdb-navigo
• https://www.fdbhealth.com/about-us/press-releases/2022-03-15-fdb-launches-fdb-vela--a-new-eprescribing-network-to-deliver-greater-choice-and-value

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: 

• Why KONZA pursued QHIN status
• Insight into the QHIN process
• How KONZA's status as a Health Information network since 2010 forms their approach as a QHIN
• KONZA's initial Membership mix, and 
• What's new or surprising in the TEFCA Common Agreement version two

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.