The Future of Health Care: Innovation and Interoperability

Joni Pidcock, director of payer services and products at Orion Health, provides an overview of takeaways from the recent HIMSS 2019 meeting and she discusses why innovation is now focused more on making something like an interoperable platform actually work.

Podcast Transcript:

Hi. My name is Joni Pidcock. I am the director of payer services and products here at Orion Health. Here to have a conversation about the follow-up to HIMSS 2019.

My particular experience coming down as a part of Orion Health, we had a great area on the floor that turned out to be 9,000 sections long, which was really overwhelming when you think about the amount of health IT services that are out in just the US.

There was some international presence there. For the most part, there is a lot of people out there in the US who are trying to accomplish the same type of interoperability, population health management, and improving overall healthcare throughout the industry. That was pretty interesting to see.

A good amount of my time was spent talking to people about that platform goal that is trying to be reached, which is combining the clinical and the payer information so that it can be utilized together as one.

There seems to be a lot of effort that is put into strategies and workflows for doing care coordination and population health management. It seemed to me that the overall feeling at HIMSS was that people are realizing that taking the time to really set up the foundation that those workflows are built on has to be a focus. Otherwise, you can't be successful down the line.

A lot of the conversations really were about data acquisition. We talked a little about this on the last podcast, that conversation that acquiring data between providers and payers is not a very simple process.

There's a lot of pre-work that has to be done. Trust has to be established. Security has to be provided. Proof that the patient's data that's coming from the provider and over to the payer is going to be protected as well as possible.

Of course, the normalization of that data to be able to ensure that your patient, coming from a provider over to the payer, is going to be the same patient, and the continuity of the medical record is going to continue.

This is not a groundbreaking innovation by any means. The people both on the private sector and in public sector who have really spent the time to sit down and really work out the problems of data acquisition, normalization, and then interoperability through things like APIs and standards such as FHIR.

Those are the companies, conversations, initiatives, and strategies that are now allowing people to really take hold of things like care coordination, workflows, and being able to affect care in the community. That was certainly an interesting takeaway that I have gotten.

Innovation really is now focused more on making something like an interoperable platform actually work. Not everything has been figured out by any means, and applying some of the newer technologies and workflows to those problems. There was a lot of focus there. That was great.

On the floor talking to different attendees and to some of the industry specialists, there's definitely a lot more focus, and thus an excitement, around the payer as a part of the interoperability initiative. Whereas before, the focus really was more on the provider themselves.

The providers and their offices, they're getting so bogged down in IT technology, changing out different applications to be able to hopefully affect the quality of care, raise the quality of care, and lessen the cost. Really what's happening is physicians have their face in the computer instead of in front of the patients.

Focusing on the payers as being responsible for helping interoperability to become successful in the industry across the board is a great step. CMS released a rule, their rule and regulation there on the floor with the hope of encouraging the payer market to become more involved in interoperability of electronic health information.

It's no longer just the providers and the payers that are going to be benefiting from the exchange of data, but the consumer themselves needs to be able to have access to this data. There's a huge burden on the patient themselves, especially someone who has a chronic issue.

Also, due to the way our healthcare market works in US, every time you change your insurance provider, it is up to the consumer themselves to ensure that their medical records are coming with them to their next set of doctors or insurance coverage.

This rule that both CMS and HHS released is putting the burden on the payers to make it easier for patient's health data to move from one insurance company to the next. Again, as an Orion employee, here at Orion, our specialty is taking that data both from the clinical and the payer perspective and marrying that together. That's an exciting prospect to me.

This is getting both the public and private sectors involved in pushing forward for interoperability, not just to meet a regulation per se, but to actually move forward with this paradigm shift of we need to be able to share data for the good of the patient, and in the process reduce the amount of money that's being spent on care.

Ordering multiple tests because one physician doesn't trust the other physician because they don't have the records and they don't understand that the tests came back, and how do you get the lab from one doctor's office to the next. All of that is huge overhead in cost.

I definitely felt the shift in HIMSS this year away from the shiny things that are available on the market for healthcare, and instead focusing on laying that foundation.