Experts Discuss Accessing Medical Information Data and the Infrastructure of the Health Care System

During this discussion, Matthew Michela, CEO Life Image, Joe Fisne, CIO and vice president, and Kim Chaundy, senior director of the Health Information Exchange and Interoperability, both at Geisinger, discuss how HIE’s are really significant advancements in the technology infrastructure.

Podcast Transcript:

Matthew Michela:  I'm Matthew Michela. I'm the president and the CEO of Life Image. Life Image is the world's largest global network for accessing and providing medical information and medical evidence to clinicians for care decisions and care delivery.

Joe Fisne:  My name is Joe Fisne. I'm the associate CIO and vice president for Geisinger Health System. My role is as administrator for the Keystone Health Information Exchange. I help to support Kim and her team, in terms of providing the connectivity throughout the community for the establishment of HIE.

Kim Chaundy:  Hi. My name is Kim Chaundy. I am the senior director of the Health Information Exchange and Interoperability at Geisinger. My primary role is responsible for the day-to-day operations of the health information exchange, as well as the Life Image integration with Geisinger in our community.

Matthew:  Geisinger is obviously a world-renowned academic medical center and research center at scale, with a number of facilities serving hundreds of thousands of patients in any given business quarter.

Life Image is a technology company in the healthcare space that tackles some of the more complicated healthcare issues with accessing medical information concerning interoperability, and network performance, and a number of other things concerning physicians and workflow support.

Between the two organizations, the key component of this partnership that we're talking about is really focused on increasing access to essential medical information to providers and patients so that care decisions can be made, diagnosis can be made.

The barriers that exist logistically for providers and patients to access medical information, or diagnosis and treatment, are minimized here, which ultimately provides better care for patients, increased satisfaction for patients and providers, and a lower cost of healthcare, let alone enabling innovation and all sorts of other things when you start to remove those technical barriers.

The major component that we're talking about today relating to HIE is really significant advancement in the technology infrastructure that allows access to medical imaging, which is incredibly technically complex to access and govern to patients and providers in the context of hundreds of providers throughout the state of Pennsylvania across the board. Joe, Kim, would you like to add some things to that?

Joe:  I do actually have a personal example as well too. I think it shows the value of Life Image, and how it's connecting to the HIE using tools like SMART on FHIR. Essentially, I recently was diagnosed with...actually sent out for observation to another healthcare organization, due to some symptoms I've been having personally.

Much of the imaging aspect of that, to be able to get my images and reports transferred within the HIE, really makes it somewhat simple to provide that quality patient care.

Our goal here is that as the patient community begins to grow, or as I should say, as the baby boomers start to retire in life and family members start to use the connectivity for imaging, this solution truly gives us the opportunity to really go beyond where we need to be, in the terms of patient care and making sure that we have information whenever it's needed.

Kim:  The involvement that we have with Life Image and with the health information exchange is actually taking us to the next level. It's allowing us to provide quicker, better, faster services for our patients.

It's also eliminating the duplication of radiation for the patient, or duplicate charges that maybe not necessary or unnecessary, because images can now be followed with the patient and the doctor has the information timely and more accurately.

Matthew:  Underneath the subtext for this is, we talk about medical information and being able to access medical data, lots of systems and infrastructure in place. While it's still not easy, most data that gets moved around is relatively simple data. It's data that's very discreet. It's a number and you know what it is, and you could put it in a database and understand it and move it. It's a document that gets put into a PDF form that's standardized, that somebody has to eventually read. What we're talking about here is actually unstructured data. It's imaging data itself, which is chronically hard to get, almost impossible to get in many regards. It's the lowest level of interoperability in healthcare.

Being able to find that and access it, move it around, make sure it's diagnostic quality, don't deteriorate it, get it where it needs to go...in some cases, you're moving incredibly large files here with very specific technical standards, that even really big companies, some of the bigger software companies in the world don't have networks resilient enough to move imaging around immediately.

When you talk about clinical care, there's virtually very few use cases and conditions or situations with patients now where imaging is not a part of their diagnosis and care and treatment. I can't imagine a cancer or a tumor, a mass, an accident, a bone, all sorts of issues require imaging now.

Enabling the HIE, enabling institutions like Geisinger that are focused on patient care with getting that type of information in conjunction with other data really, really is a significant leap forward to be able to do it in an efficient way. That's why this thing is so important and so crucial.

Again, not to minimize the effect of getting a drug list and what my antibiotics were from one place to another. That's incredibly important, but you start to layer on for things that are really expensive or really troublesome for patients, take a lot of expense and a lot of care and treatment.

Having that imaging available in the same way and the same time is just a leap forward, as Kim had suggested, in what most of the industry is able to do.

Joe:  If I could add one more thing, as well, is that you can't underestimate the value of having the image plus the information, the reports that go along with that, as well, too. If you think about it, a physician may receive the image or a specialist may receive the image.

At the same token to have the report right there, and to be able to speak with the patient, that's a point in time that really gives you a truly inclusive and integrated medical record that really helps to expedite the care process.

I think that this truly is that next step. It's that next place to go where we...In the world of interoperability, it truly gives us a leg up in terms of coordinating care.

Matthew:  Joe, I think that's a really good point. A lot of our customers, and we work with 90 percent of all the academic medical centers in the country, I think people would be utterly shocked to really understand how many of even those leading institutions may do a digital transfer of a medical image as you described, but then they fax the report over. It's unbelievable.

Joe:  That's more common than we think.

Matthew:  That's right. This solution that we've built together here using our smart apps and FHIR really standardizes that at high speed, performance, and durability in a way that allows the transfer of all types of data, including the reports, which really makes a difference for clinicians and patients.

Kim:  I think, just to mention, when collaborating and putting forth this effort, we focused on the physician's point of view. We wanted to make sure that it works well with their workflow and that it's not labor intensive.

This work is being done within the natural workflow of the physician, and there's very minimal delay in pulling down those images, even though they're so large. That is critical because time is of the essence sometimes in the emergency room.

The physicians no longer have to wait for the image to come up or the report to be faxed. It's all there at their fingertip.

Matthew:  I think one other piece of it, too...I tend to focus on the patient side of the fence, as well. If you think about...I mentioned earlier about the baby boomers. How many people that are octogenarians really don't really understand how the healthcare system works?

When they have to go for a test or a procedure and they've got to bring that DVD along with them. It's got to get uploaded in the system and from there...This way here, it really connects it in a nice flow so that that physician can have that data there, right in front of them, and speak to the patient about their condition, and get the true essence of what the diagnosis should be or what that patient's feeling like.

You take the stress away from those elderly folks that can't and don't understand what the technology is or how to navigate the health care system. It really benefits you from a satisfaction standpoint, I would say, based on the provider as well as the patient.

Joe:  I would agree. When you think about the healthcare system, and I think people who don't work in it don't necessarily understand it, although people unfortunately that have to use healthcare services do. It's so typical to show up at the physician's office when you have a referral and you come in, and they don't have the information you need.

They're sending you somewhere else for imaging, you're running around, they give you incomplete information. You have to come the next week because the data's not in the EHR, they don't have the report.

All of those things affect satisfaction of both parties, increase costs because you're doing multiple visits – increase as Kim had mentioned – imaging that has to have it because it's duplicated here.

Underpinning this is whatever the workflow the physician is, and that workflow may be slightly different in how an office, a cardiologist that one of the Geisinger facilities operates, his workflow slightly differently than a radiologist might, or an oncologist, let alone across the whole health system.

They've designed their practice every day to be as efficient as possible. What this solution helps enable is that whatever they do, they can keep doing. It's just getting them that essential information combined right at when they need it.

This is about the acceleration of the provision of healthcare data. Once you do that, many, many other problems go away and people are generally happier, right? It helps live within the complexity of healthcare that is required.

Your doctors, you do want them to operate as efficiently as possible, without putting additional technical burden on them, or making them have to be computer science experts. It happens behind the scenes for them.

Joe:  Exactly. The other piece too that we can really add on to that is if you look at the telemedicine aspect of things, where folks may be living in a rural area, or your physician may be in a rural area, this allows those providers to really have a communication where they may need to go to a higher level of care, and at the same time allow them to not have to travel back and forth.

You can keep that individual in the community within their practice, so as you start to diagnose them and keep the patient comfortable within their own community, and at the same time, that provider can have access to those higher levels of technologies and care providers that can really help those patients.

Matthew:  One of the things to that was really key to this, because I think we described really the benefits of this from the patient point of view, the provider point of view, and the system point of view, was really the relationship.

The team is working with Geisinger, here from my perspective at Life Image, we're talking about one of the world's leading institutions with some of the world's leading people on staff, and having the teams tackle these really innovative problems that no one else has tackled in such a collaborative way, and coming out successfully on the back end was really a joy for us to do.

Really, I think a testament to Geisinger and their team and how innovative they really want to be in their environment to help lead healthcare, which shouldn't be a surprise given the leadership position of Geisinger. Technology is hard, and this was really a wonderful successful collaboration to get here.

Kim:  I want to add just from the collaboration perspective, working with Life Image and our physicians, it was a collaborative effort understanding how technically to make things happen, but operationalizing it so that it's more efficient.

Life Image really took a hard stance and look at we need to make sure that we optimize the operational perspective so that it's meaningful, it's very easy to use, and there's great value out of it. Working with a partner like that, who understands technology is great, but sometimes you have to make sure the technology is working with the workflow or the operational part of taking care of the patients.

Matthew:  That's really excellent. I think as we looked at this from a Life Image point of view, number one, we want the technology to work. Number two, it's got to work at scale. Number three, because Geisinger has a big footprint, number three it's got to work within the Geisinger workflow and technology environment, so there's a degree of local customization and making sure that meets. Then on the back end what we were doing collaboratively is also making sure that when we put this in place, and implemented, and built it, it was something that the rest of the industry could look at, and then could use.

Whether they work with us to do it or they create it themselves, we really are establishing some standards here nationally about how to do this kind of work, which we think in the long run will have, could have, the promise of a lot of very significant impact across thousands of hospitals here and the entire country.

It starts from a place of really a great collaboration, making sure we looked at all of those aspects. This wasn't just get it done so it only works in this one place, which is what unfortunately a lot of healthcare IT does, this really was how do we innovate and build a basis and foundation for something for the industry here?

Joe:  If I can add on top of that as well too, Life Image really was a, if you look at it, they were a partner with us. We recognized that we had something within the HIE, but Life Image has that technological experience and the patient experience through time that can show us those workflows, how do we integrate it together, how do our clinicians and providers tie in to this?

Their guidance through this process was really phenomenal, and the commitment they have to help getting here, and use their, take their technological expertise and bring it to fruition in this project, really makes things work well.

It's the understanding and their openness to look at our workflows to see we do, or their guidance in terms of how we deploy something like this in a way that's meaningful has been truly a great collaboration. The benefits it gives just don't stop here. They'll continue to go forward as we move further.

Matthew:  I absolutely, and thank you Joe, I absolutely agree. I think what happens sometimes, we're having a conversation around a pretty innovative new technology capability, and we talked a bit already about what benefit it provides.

It's easy for us in the industry, for Life Image which is primarily a technology company, and Geisinger that has to deal with the technology challenges among many, many kinds of vendors to focus on, "Hey, we solved a great technology challenge, isn't that fantastic." We actually did, and yes, it's fantastic.

Really what this is about is about patient care. These kinds of solutions save lives. These kinds of solutions help people diagnose things more accurately and faster. These are things that allow people to get care that’s more appropriate than it would have been otherwise.

This kind of technology solution reduces medical errors. This kind of solution lowers costs and avoid costs, right? It is about patients and about lives. I think overall, that I think between all of us collaborating on this, I think that's always been our focus here between us to make sure that it's not just a technology solution, but the technology is a means to an end, and the end is really about people, here.

Kim:  Matt, that was well said. I cannot agree more with you, especially from the Geisinger perspective of all of us making sure that the patient is the center of attention and it's all one Geisinger treating the patient.

With this collaboration together, we all are one Geisinger. That includes our vendors. Our vendors are not just vendors. They're a part of our team.

Matthew:  That's a great point, Kim. If you think about it, we don't go into a relationship in an adversarial type of an approach. It's more of Life Image is part of our time. They understand us. We understand them. It's how you come together and look at each other to say, "Hey, how do we take these great innovations and bring them to fruition?"

The only way you can do that is if you both get at the table and sit and talk with each other and define that working relationship. That's been something that's been very satisfying through this process.

The first thing that I would say healthcare executives need to understand and be focused on is that nobody should ever be moving medical information around on physical media. CDs should be wiped out. There's no reason for it. It's not a technology challenge.

Attaching information like reports and other data that goes along with your medical information and your imaging is not a technology challenge. It's all doable. Across this industry, unfortunately, clinicians at many institutions aren't technology experts and don't understand what's available.

The basic underpinning of making sure that medical information is available when you need to is frankly not a technology challenge. It's an understanding, an awareness, an education, a business kind of problem.

Before Joe talks specifically about how you think about partners and vendors here, that would be, overall, my call for the industry, is let's get rid of the disc, guys. It's unnecessary and unfriendly to patients and doctors. It's something we've been solving as an industry for a decade. Let's get on with it and make that happen.

I think that awareness is important.

Joe:  You were actually going right where I was headed. I think that when you sit down...You said we cannot do things through physical media anymore. It should be done electronically, for lack of a better word.

It's really understanding that mission. What is it we're trying to accomplish? Define what those use cases are, those things that we need to improve on. Here, it may seem very simple. It is really. We're improving communication between providers.

When you take a look at these types of things healthcare executives should understand, what is it we're trying to accomplish? Then, how do we take that and suit up or match up with your vendor partner to say, "Can you achieve the goal we're trying to achieve here in this case?"

In this case it's the transportation of images with the technological or the textual information together at the same time improving workflows.

That's a big thing for healthcare executives to understand, is there is opportunity here. How do we define that is so appropriate. I think that's where, when you select your vendor, are they your partner? Do they have the technical capability? Do they understand the problem that you're trying to solve?

Then, you define a concise message. That's how you begin to sell it to the executives because there is an opportunity here to improve care. I think it's very tangible all the way through. You just need to define that and help to select who would help you achieve your goal.

Kim:  From my point of view, I think, also, when you're looking to choose a vendor you want to look at someone who is following the standards and using the advanced technology that is out there today to capitalize on the FHIR and the ability to move images or anything else quicker and faster.

When reviewing a vendor, I’d love to open up and see that they're following the standards and they're able to adapt to other processes or other vendors and it's not a solo or just a one-to-one connection. I think that's critical, as well.

Matthew:  As the technology partner or vendor, so to speak, the things I would counsel the industry to do is that I think, building on what Kim has said, is, number one, if they use proprietary standards, run. Run as far as you can.

While those solutions can provide a lot of benefit and a lot of ROI, and, in some regards, can be really sexy short-term, they trap health systems and providers into places that are far more expensive in the long run.

Our healthcare industry has far too long allowed the vendors to insert non-standard and proprietary things inside their technology stack as a means of resisting competition or creating barriers to switching costs. Interoperability, open public standards, are key.

I would add, make sure folks are innovating and applying the most common standards. We're experts in the imaging space, among other things. People say, "Well, moving images? That's just DICOM. DICOM's been a standard for more than two decades. What's the big deal with it?"

What they don't really understand is that every manufacturer messes around with DICOM in some minor, small way. If all you can do is DICOM, you actually can't transfer most of the imaging that occurs, that's been developed in the industry in the last handful of years. It changes all the time.

Those are folks that don't comply with standards. You have to make sure that people understand, and innovate, and are flexible across the board.

Then the thing I would then also counsel a lot of [organizations] and folks to be aware of is make sure that the folks that you're thinking about and working with have a diversity of experience. I run into organizations all the time that may have a rich technology product or platform, but it's only used in one place or in 25 places and is highly customized.

It makes a really, really big difference when you have a lot of broad experience. Part of the reason that Life Image was able to help solve these technology problems in conjunction with Geisinger is because, again, we work with 90 percent of the academic medical centers around the country.

They are really, really complicated places. If there's a technology challenge out there, we’ve probably run into it. We probably made a mistake with it in the past. There are certainly others out there that have similar experiences, but it's that diversity.

It's not getting tricked into this is the latest web app that looks exciting. Have you been in the trenches and dealt with all this custom integration around non-standard stuff? Those are the war wounds that help providers avoid the problem two years and three years from now that they can't anticipate.

Kim:  Matt, that was dead on. I also want to actually say, when looking for a vendor like Life Image, Life Image jumped on the wagon and worked with our other vendor, Orion, from our HIE perspective.

The collaboration between the two vendors to make this work was purely beautiful to see, the cohesive and the mission of both systems, both vendors working together for a common cause. The ability for a vendor to be able to be open to other vendors is critical, as well.

Joe:  The other piece I can add, too, Kim and Matt, is that where Life Image comes into play is that they have that experience in the industry. You've got a lot of new rules that are coming out, new interoperability rules that are coming forward.

By looking at things like SMART on FHIR and assuring that we're taking advantage of what is out there, but yet aligning yourself three, four, five, 10 years down the road to make sure that we can continue to provide the care in a very expeditious way.

Life Image brings that to the table and says, "Hey, here's what our experience is. Here's where we think you need to be." It's that experience and that advice to the executives and the team that helps us position ourselves to be much further along as those rules get deployed.

Matthew:  Thank you, Joe. I appreciate that. We spent a lot of time doing policy work and working with the ONC and with Sequoia, and Carequality, and CommonWell, and the rest. If it's a group talking standards, odds are we're either paying attention or at the table because it really is that kind of standard setting, that next generation of innovation that you want to make sure you understand.

I think as Joe had described, if you're not [paying attention], it just means you're going to a lot of back end reworking. On the technology side, we would call that reworking technical debt that you've created today because you didn't know what has happening tomorrow.

We do spend a lot of energy trying to understand, and anticipate, and make sure that everything we're doing is aligned with those emerging technologies and standards so that our customers on the back end have less to worry about, less rework, less TCO, less cost because we weren't aligned.

Again, just reinforces this issue of not using proprietary data standards because they all have to be adjusted all the time. That's where your cost and time comes in and kills you later.

Joe:  Based on the experience that I articulated earlier about my own personal medical issues is the ability to have this information without having to worry about who to go to. Where do I go to get my records released? What do I have to do?

To have this all done seamlessly without the intervention of folks in different departments, divisions, wherever it may be. To have it done automatically so that it can help expedite the care for our patients, to me that's exciting because I look to those...There's going to be a huge demand in the next 10 to 15 years on the health care system, as there is already.

The point is that we're going to be able to help providers practice efficiently without frustration of lost information and letting them have all the information they need when the care is delivered. For the patient, it's the satisfaction of not having to deal with the bureaucracies of many healthcare institutions to get the records released.

Matthew:  Building on that, Joe, from my point of view being able to implement a solution like this, again, through the technology collaboration, a patient care collaboration with Geisinger, this is a solution that's deployed. It's hundreds of institutions, more than 350 now, here, through the HIE have this kind of capability.

Being able to deploy this in a way that leverages its scale, the ability to do what Joe had described and affect patient care. That's really exciting.

Kim:  I can even echo even more. I think we're finally trying to focus on the patient, making sure that the patient is being taken care of, no matter where they go and not having to duplicate the engine and put the patient through unnecessary worrying about trying to get their data so that they could go see another physician.

It's making the ease of healthcare for our patients and allowing them to feel good about it.

Joe:  I have to echo as well, too, is that the other benefit you get is...We talked about the patient-specific and the provider-specific, but the provider to provider...If my physician consults with another provider and they have to talk to each other, that information flow happens in-between the provider continuum.

You have your episodes where maybe a patient is sitting in front of a physician, but at the same time my care team can all communicate, sharing that same information without having to go through the hassle of faxing and disk recovery or whatever it may be. Having all that together in a very complex environment, streamlined, truly gives an added value that goes beyond where we are today and tenfold. It gives us great success.