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The Health Information Exchange: Dr. David Kendrick’s Story About Creating One, What It Does and What The Remarkable HIE of The Future Will Do For Healthcare


Guest: Dr. David Kendrick

Narrator (00:00):
Welcome to 360 degrees of healthcare with Dr. Stan an in depth. Look at our industry from our very own chief medical officer who will talk with other medical and industry professionals on the changing and evolving landscape of the healthcare system from the inside, and now live from zero studios, our very own infectious disease expert, Dr. Stan Schwartz.

Stan (00:30):
Thank you so much for joining us. My name is Dr. Stan Schwartz. I’m an internal medicine and infectious disease physician with a long history of practice group medical practice, medical adminis. And as you get older in life, more experience as a patient. And I wanna share my 360 degree view of healthcare with all of our listeners. I’ve got a really interesting guest today, Dr. David Kendrick, who is a professor of medical informatics and the founder of the most remarkable public utility here in Northeastern, Oklahoma, and now most of the state of Oklahoma, the my health access network. David, thank you for joining us today. Please introduce yourself. Tell us what your role at the university and tell us quickly about my health.

David (01:22):
Thank you for having me today. Uh, so I’m a physician. I practice internal medicine and pediatrics, uh, before, uh, medical school. I, I, uh, was an engineer, uh, engineering students, uh, and have trained subsequently in public health. Uh, and then of course, uh, fellowship in medical informatics, uh, returned to Oklahoma in 2008 to start the first department of medical informatics here in Oklahoma at the university of Oklahoma, uh, at its school of community medicine here in Tulsa, and as a part of that, uh, uh, uh, effort, uh, which is really, you know, the focus of our, our efforts are to improve the health of the C community, uh, and recognizing you can’t fix what you can’t measure. I began working on this, uh, project. We call my health, uh, to create the health information exchange statewide in Oklahoma to exchange healthcare records. Uh, and so I currently serve as the, uh, CEO for that organization after having found it 2000, uh, and serving since that time.

Stan (02:28):
So tell our listeners what exactly is a health information exchange and what should a health information exchange really do because, you know, you’ve taken it out of the bounds of a simple technical project and turned it in into a public utility.

David (02:47):
Well, it’s a, it’s a great question. And most people, uh, don’t really recognize that these even exist, uh, even in healthcare. Uh, it’s, it’s, uh, a not a well understood concept. And I guess the analogy I would make is, uh, when, when you walk in a room and you flip a light switch, you just expect that light to come on. Right. Uh, and, but there are a lot of things that have to happen for that light switch to come on. Obviously there has to be power. There has to be wiring and a switch leg, and all of the things happening inside the walls that, that the user of the light switch may not know about. And a health information exchange is a piece of infrastructure, kind of like that wiring and that electricity that enables the lights to come on, uh, in healthcare. And, and by that, I mean, uh, if we, if we take a fairly simple statement and I think most people would agree with, which is that every patient does a to have, uh, their complete health record health information available wherever, and whenever it’s needed for decisions about their care, whether that’s for them to have it to make choices and decisions or their doctor or any specialist, their Dr. May involve in their care.

David (03:55):
Um, that seems like a pretty simple objective, but it’s a very difficult thing to achieve you in the complexity of our healthcare delivery system today, where an individual doctors use their own electronic health record system, maybe stored locally, maybe in the cloud, but it’s separate from all other electronic health record systems that other doctors that patients may choose to involve in their care. Uh, that’s separate from their systems as well. And so we want line up in a situation where patient medical data becomes highly fragmented over time. In fact, virtually a hundred percent of people have medical records in two or more places, uh, throughout Oklahoma, we can quantify this very, uh, uh, specifically now. And so, uh, back in 2008, when we began these conversations about where to start with building a health information exchange, or how to address this problem, it became clear that we needed a, a layer, uh, or a, a connection point for all the medical records to come together, uh, such that no matter where a patient presented for care, their record would be available to them, uh, and to their provider.

David (04:59):
So they could make good decision it’s because as we know, uh, missing information like missing allergy information or missing medication lists or prior procedures or surgeries can lead a physician down the wrong pathway, or to duplicate a service or a procedure, uh, as well as incorrect information, uh, can, can lead, uh, care in the wrong direction. And the more complex care gets the less the patient can be called upon to remember from their own brains. And it’s really not fair to do that, given the complexity of what we’re dealing with. So the opportunity of health information exchange presents is to have all of the data organized so that the patient metaphorically, at least, and in the case of my health or our project in reality, can have a single centralized medical record with all of their data in it, from all of various places they go.

David (05:52):
Now, we always say that a health information exchange is more than just technology and data movement, as you can imagine, uh, there has to be a significant amount of trust in order for both organizations and the patients whose data they have, uh, and the data and the individuals they serve to be able to pool that information under one, uh, into one system, even though we know it’s better for the patient know it’s better for the care and the quality of the care we can deliver. Um, we still have to get that trust established. And so we always say at the health information exchange level, that our primary asset is not data, and it’s not the technology. It is the trust that’s built by having or organizations work together under a non-profit umbrella to of build something that, that everybody participates in the governance of. And everybody gets to jointly decide how the data will be used, obviously with the patient’s consent being the first step in that. Uh, and then that’s what leads us to be able to begin exchanging the data, uh, which can finally have its benefit of reducing errors, improving quality, reducing costs, uh, throughout the healthcare delivery system.

Stan (07:01):
I, is there any backstory to why you decided to make this your life’s work?

David (07:06):
Yeah, well, the funny thing is I didn’t decide to make my life’s work. Uh, I, uh, so I, I started, as I mentioned earlier in engineering, and so, you know, learned a lot about systems and processes and, and, you know, and, and what we can do to scale processes of high quality. And when I got to medical school, I realized that wow, here is a, an entire industry, uh, that really has lacked process thinking for generations, uh, and really was a, a, a rich, uh, area full of targets for, for improvement. And, uh, so I began developing software and health and information systems in, uh, in, uh, uh, the healthcare space, even as a medical student, even prior to medical school a bit, I worked on the lupus Janome project where I was a research data manager, uh, here in Oklahoma, along with the medical research foundation and, and was tasked with taking a 14 volume lupus patients chart, you know, stacked four feet high, uh, written on paper and putting that into a database so that, uh, the genomic analysis could be compared against the, the phenotype, uh, uh, results in the patient’s chart.

David (08:18):
And that really, he got my, um, interest up in trying to figure out, well, we have to make this electronic as the first step before we can do all the additional efforts. And then from there, I, I, I started a software company as a medical student, managed electronic referrals and, and, and, uh, electronic consultations or tele type of telemedicine then, um, did my degree in public health while I was a resident, uh, in new Orleans. And that really opened my eyes to one of the science of measuring quantifying and intervening on public health, uh, and during, and then I did a fellowship in informatics because I had already developed a fair amount of software in the healthcare space. I didn’t do the traditional informatics fellowship, which would be to learn how to code learn about terminologies and services and healthcare. And rather I learned about technology value assessment, which was deciding well, what is it worth investing in a particular piece of technology to get a return on investment in terms of live saved or years of life gain, or, uh, money saved and, and societal benefit.

David (09:27):
And that really helped me to frame my thinking and, and focus my thinking on the things that turned out to be most valuable. And one of the projects I worked on while there was a value proposition, a value assessment for interoperable data, this is 2003 for timeframe, and there really was not much interoperability. And the group I was with published a report that showed in excess of 80 billion a year, just with a few simple use cases, could be saved in healthcare by, uh, having the data move where it needs to go, uh, such as the right decision can be made. And so that really stuck with me. And as I continued through my training and my first early work in artificial intelligence and machine learning kinds of, uh, advanced clinical decision support and, and disease modeling, uh, what I realized was no matter how fancy the math got, no matter how accurate the algorithms and the tools got, they were only as good as the underlying data used to build them.

David (10:26):
And at that point, nobody had conquered climbed the hill of getting the data out of these electronic medical record systems in a structured way, normalized patient identity, so that the David Kendrick seeing hospital a and David Kendrick being seen at hospital B would be seen as the same David Kendrick and tie those records together, all of that, um, effort while the science was done for the most part, it had not been implemented. And so I came to this through the pathway of, of having to peel the in back layer by layer to realize that substrate, we all had to have was good, clean data flowing in a, in a close to a real time manner, actually, in order to achieve the healthcare delivery system we all want. And so that’s how I came to putting together a health information exchange. I hope someday to say this project is done and the infrastructure exists. And, and now we can go back to the advanced artificial intelligence and the other advanced algorithmic uses of data. Um, but until then, I’m focused on getting this, uh, turning the, the, the raw sewage of healthcare record data into clean water.

Stan (11:32):
So, uh, let’s turn the clock back a few years. And I recall that you can convened a group here in Northeast of Oklahoma that included the mayor of Tulsa and a whole bunch of people. And you managed to get some really big bucks from the government at that time, which is interesting because many people don’t think of Northeast and Oklahoma as, you know, Silicon Prairie or the Mecca of computer technology, but you managed to plan a pretty big stake. And what was that process like? And, you know, how did you corral all the people necessary? Because one thing I remember is people weren’t real, really interested in sharing data. The hospital didn’t wanna make it easy for you to go to another hospital. Doctors didn’t wanna make it easy for you to see another doctor and so forth.

David (12:22):
Yeah, no, it’s, it’s, uh, you’re right. This is a trip down memory lane. And of course, Stan, you were involved from the very, in fact, almost the very first day, I think on a steering committee, the, it helped bring this to light. So I, I, to give credit where it’s due, what I would say is, you know, we approached this project, there, there were several motivators in play at the time. First of all, the American recovery act was being considered after the economy tanked in 2008. And there was going to be a major investment in health. It infrastructure. So called high tech act was a part of that recovery act. And it invested about 36 30 7 billion in health information infrastructure for the nation. Uh, that, uh, as proposed was to build the quote unquote information, super highway for healthcare data to accomplish exactly what we’ve been discussing here, where records would move and be available wherever, and whenever they’re needed for care and service them.

David (13:19):
Uh, unfortunately as I always say about the, the, the program, it, it actually went further to, uh, buy every physician in expensive car than it did to build the information super highway, because created an incentive program for doctors to all have an EHR. There’s no question that was lacking in this country. I mean, most many practices have not even moved from paper yet. And so that was a critical first investment, but most and most the lions share of those funds unfortunately went to, were consumed by just getting doctors onto certified electronic health record systems. A tiny fraction of that funding held, however, somewhere in the billion and a half to 2 billion range was focused on interoperability and, uh, was made available through several programs, state hi program. Um, and the one we, we were successful in achieving was the beacon award or one of 17 communities nationwide selected to receive these beacon awards.

David (14:15):
And, uh, and those funds were leveraged to stand up the infrastructure at a community level. Uh, so I, I think, you know, the, the first step in all of it, once again, was to convene the community and say we are facing some challenges. Uh, as I recall in that meeting, you know, mayor Taylor, Kathy Taylor at was a great help in pulling that together immediately saw the value of the vision we proposed. Uh, and we put healthcare leaders from across the state of Oklahoma, including state agencies, tribal health systems, uh, employers as well in the room. And we basically said, here’s where we are. We’re at the bottom of all the lists. We are, you know, it’s us or Mississippi and almost every ranking. Uh, and we often say, thank goodness for Mississippi, uh, unfortunately, but, uh, but now we trade places with them often.

David (15:06):
And so our goal really was to sort of define the, a problem and get everybody’s head around the fact that though we might be competing health systems or competing insurance plans. Uh there’s, you know, it’s a race to the bottom, unless we ultimately improve the health of our community and create a situation where employers wanna bring jobs to our state. And in fact, I I’ll never forget, uh, Paul gr came, uh, he was at IBM at the time as our innovation officer, and he came to speak about, um, how, you know, IBM would love to bring jobs to a place like Oklahoma because, uh, you know, we had a re you know, a good workforce. We had low cost of living and high quality of life. Um, but, you know, we were, we were just a safe population, helpful was a challenge here. And, uh, and that really, I think, lit a fire under the participants to say, well, maybe we need to do something together.

David (16:00):
So that combined with the stimulus legislation and the, the, the, the threat of meaningful use, I won’t say threat, but the opportunity of meaningful use of health, it hanging over everybody’s heads, the need to, at those requirements. And then recognizing, as I often say that we didn’t have a utility, a public utility that could help us exchange data in a sense, we didn’t have a, you know, a water treatment plant. We didn’t have a, we didn’t have a power company, uh, that would, would, would stand in the middle and help us move data securely across the healthcare community. So that’s how we, you know, pulled the community together, um, energized the community around the, the, the cha the dual challenges of, you know, actually improving the health of our populations and helping providers to tackle with what was coming new, uh, uh, through the federal requirements, uh, as well as the new payment models.

David (16:52):
I that’s been a big driver, uh, which we may touch on later, the, the shift to value based payment models and the real, the pull that, uh, risk taking has, uh, towards, uh, or the drive that risk taking among providers, uh, pushes them towards needing this data, right? When, when a provider signs up in a, a value based payment model or a contract that, that, um, you know, where they’re at risk for the cost of care of the patient and their outcomes, it really aligns the providers, incentives and interests to need this data in order to know what’s the next most important step to take and to need it in real time.

Stan (17:31):
So, you know, there there’s a lot of stakeholders here, and right now, if I was listening to this and I didn’t know anything about a health information exchange, I would say, well, yeah, it’s a great thing for doctors. You know, maybe they can finally get rid of their fax machines, but if I’m, if I’m most of our listeners share one thing in common at one time or another, they’re all patients, what is in this, what’s in this for patients, can patients access this directly? Is it some kind of utility that’s, you know, behind some kind of curtain that they can’t get to? And what should employers be thinking about and insisting on that they would get from this public utility employees that pay for healthcare?

David (18:15):
Yeah, exactly. So, so I would say this of my health from the beginning, we, we felt that governance of robust governance was critically important. And so our, our heuristic for establishing governance was basically that there were three perspectives that mattered in deciding what this was going to become and how it would be used, or those who receive care and services. So patients, those who deliver care and services, the providers who are just talking about, and those who pay for care and services, those employers, health plans, et cetera, governments, for example, to pay for care. And, uh, by keeping that in the, in the, in focus in governance, it means we have the conversation, this conversation, you and I are having all the time in our meetings. Uh, every project, every, every new direction for the, for the health information exchange effort is vetted against those three perspectives.

David (19:10):
So, um, I’ll tackle the employer side of the question first, or the employer or health plan side. Uh, you know, those are groups that ultimately hold the risk for the quality of the healthcare that’s delivered to their populations in addition to the patient, of course. So having a healthy workforce is critically important, not overpaying for healthcare services, and certainly not paying for mistakes errors that might happen in healthcare that lead to new infections or missed diagnoses, or, you know, treatments that were unnecessary. Those things should, should never fall to the employer or the, the payer. Uh, but, and as a matter of fact, they now do in the payment models we are in today. And so I, you know, if, if I’m an employer, uh, or somebody accountable for the care, the cost of care and the quality of care delivered to the population, I very much want the records, whatever data is needed at decision time, it needs to be there.

David (20:10):
Um, and I, more than that, I want that data subsequently available to me to prove to me the quality of the care and services that we’re delivered so that I can know when I’m purchasing something. When I’m writing the check for a 10% increase, or, you know, a, a, a new procedure for a patient that that procedure is happening in the highest quality facility happening in, by the highest quality provider. Uh, and that the error rate is, is low to, to nail. And the only way to get to that is to have the data available in real time to those providers, making decisions available in real time to patients who are needing to make decisions and available in aggregate long haul to measure quality and help providers make iterative improvements in quality. It’s not possible to just snap your fingers and make everyone a top tier surgeon or hospital or clinic. Uh, they, they, you know, as with any industry, you need iterative steps for improvement. The, the feedback from this real time data is critical for that. Do you, oh, go ahead.

Stan (21:13):
Do you see my health as being a tool that patients or employers can use to select where they get their healthcare?

David (21:24):
Yeah, I, I really do. I mean, I think one of the challenge we have with healthcare data, uh, these days is that it’s locked away in separate electronic health record systems and, or it’s in a health plan. Uh, that’s, that’s, that’s, um, you know, got claims or administrative data, and those two worlds don’t touch one another. And then the employer has a whole different perspective on it, which is essentially what they, they have purchased as a plan and what, what bills they pay. I feel like, and, and I think we would all agree that the, the, the data itself should be gathered dispasionately. And one of the great advantages of a health information exchange model is that that data flows in all the time. So when a blood pressure is taken within about a minute, it arrives in my health. When a note is written and signed by the doctor, then about a minute, it arrives in my health.

David (22:15):
And so what, what winds up happening with the health information exchange is it also becomes, um, a, a, an independent third party that has the information without bias, without a thumb on the scales. It just has the blood pressures. It has the hemoglobin A1C has the other variables that are necessary to measure quality and assess performance. Uh, and, uh, I, we have really talked about, you may recall from the very beginning, we talked about it being a trusted third party for measurement, um, because because of that independence of the dataset now, in terms of patient to using it directly, uh, you know, one of the, we, we posed that question very early on to the governance of my health. And what we realized at that point was the data is really technical and clinical. It would be like, you know, an electrical engineer’s diagram, trying to be read by, by me, for example, it’s not an electrical engineer.

David (23:10):
And, uh, and so getting that last mile to the patient is the, is kind of the next frontier figuring, well, how do we present this data in such a way that, that, that we separate what is unnecessary for the patient to have to understand and grapple with, from what is really important for them to focus on for decisions. And that’s kind of where we are with health information changes. A number of them do make records available to patients as of course, many clinics do. Uh, the challenge one challenge, I think for patients is that just like doctors, uh, the, the patients have to look up their records in four, five or six different places to have access to all their data electronically. So at least that gap can be immediately closed by health information exchanges, but then there’s the question of, you know, helping patients interpret what it means for a radiologist to suspect something in, you know, and what they may view as a casual statement in a, you know, in a CT scan reading, but that a patient might read is devastating news or highly, you know, highly concerning news. And we, we just, we can’t do harm by providing the data. We’ve gotta shape it in such a way that’s productive for patients to interact with it and make decisions.

Stan (24:21):
Do you ever see a point where the day do you use can be matched up against clinical guidelines? Like, you know, when does a patient need to take a statin to prevent a heart attack? You know, all those things are now based on data and calculations that that doctors make or should make, and they don’t often get back to the patient, but do you ever see the point point where my health could independently alert patients that, oh, you know, you are, you know, you, you had a poly up remove from your colon five years ago. So you really have an indication to have another colonoscopy now and not wait to 10 years, or, you know, you just had another cholesterol test done and it bumped up your risk of a heart attack. And, you know, rather than waiting for someone else to figure it out, you know, the system based, based on algorithms could alert me.

David (25:17):
Yeah, no, I that’s, you know, one of the important things about the creation of my health is that we started with the knowledge that we needed to use the data in that these more advanced use cases like supporting value based payment model success and, and, uh, you know, uh, enable providers to take risks successfully, meaning manage populations better, uh, that set our bar higher for the data quality and the breadth of the data that we needed than if we were just trying to make sure a lab result was available, right? And, and by setting that bar higher, it’s had us focus on data quality, uh, cleaning is identity resolution for patients such that we can build those decision support algorithms, uh, on top of that, and we’ve been doing really since 2012, I guess, was the first time we started, uh, providing decision support of that type. We currently, for example, calculate care gaps, patients who are overdue for mammograms or colon cancer screenings or, or other things, and those are based on a simple set of rules, uh, that, that go into the data and assess, you know, across this population of four, four and a half million people, uh, everybody who’s eligible for all these prevent care events, meaning to identify ’em and then alert their doctors or alert their health plans.

Stan (26:33):
What happens if you alert their doctors, but they don’t get it done. Is there any fallback that, you know, my health can come in to save the day?

David (26:42):
You know, uh, that, that is a great question. And one that we were very careful with, the way we manage in my, uh, you know, trust trust is a multi-headed beast, right? I mean, there needs to be the trust from patients that this data is secure and being used to their benefit, that has to be there also be a, has to be trust from hospitals and health systems that it wouldn’t be used to, um, undercut their ability to compete in the marketplace and from health plans similarly. And so we, we, we play a very, um, we sit in a very middle ground and in, so for example, I mentioned patient access to records, really, the first time we brought to governance, Hey, what do you think about my health, have a patient portal and sharing that to patients. And all the providers said, you know, we do that right now.

David (27:29):
We, we wanna continue to own that for the moment. We’ve kind of moved beyond that now, but that’s where it was in 2012 and 13, um, SIM you know, a similar situation is the case with quality measurement and gap assessment. Right now it’s the business between a health plan and a provider, or between an employer and a health plan as to what are the benchmarks for performance and what performance has to be met, and what are the penalties or rewards for meeting that performance? My health is just happy to sit in the middle and be that independent party saying, yes, this is what performance was. We’re very careful to try and keep to that middle without encroaching on the business relationships, like sort of our mantra early on has been, nobody should compete on the data and what the data says. Everybody should compete on how innovative on the innovative ways they might use the data to improve healthcare and outcomes.

Stan (28:20):
So I wanna move to, uh, another aspect of my health that I personally think is the, is the single most exciting thing that my health is doing, that isn’t being done by doctors isn’t being done by health systems, isn’t being done by clinics. And that is talking about the social determinants of health, you know, for those who are listening. Now, it is said that medical care determines about 20% of your health outcomes and social determinants like appropriate shelter, safety, food, education, finances, really go to determine more like 80% of your health. And, you know, the health statistics in Oklahoma and Mississippi probably reflect the social deter urbanness of health, as much as availability of healthcare, you are working on a project now that actually is looking at social determinants and trying to rectify any problems where those social determinants could impact a person’s health. Tell us about that.

David (29:25):
Yeah, sure. I, I agree. It is one of the most exciting things, uh, that, that, that we are working on currently. It’s, um, it’s been discussed, you know, social determinants have been recognized and discussed for decades now. Uh, and it’s just now becoming possible to do something meaningful, to both gather the information about the need and to address those needs in a meaningful way. So let me back up to 2015 and 16, uh, my health there, they’re, you know, there’s the center for Medicare and Medicaid innovation, which is created under the affordable care act. And they are, has with, uh, testing, innovative models of payment and care and service delivery, and those models that bear fruit, meaning savings or improve quality. Uh, the, the director and secretary of health can, can with a stroke of a pen, make them payment models for Medicare largest payer in, in, I think the world, uh, certainly in the us.

David (30:21):
And, uh, so that’s a really important tool and they devised the model called the accountable health communities program in which they proposed that patients receive social needs screening for food, need, housing, transportation, domestic violence, and public utility service needs at the point of service at the point of care. So when a patient checks in for healthcare services and that for those patients that had a need, uh, that they receive immediate referral to a custom list of resources, meaning food pantries or housing shelters, or whatever that were tailored to meet their needs. And for those individuals with, uh, that use the ER, more than once in that among the Medicare population and the Medicaid population, they would get a concierge type service, a health navigator to help them navigate these social services and get them plugged in while that program was announced. And, uh, the, you know, my health looked at it and said, this is something we could really do, but we didn’t pursue it actively until we heard from the community.

David (31:24):
And sure enough, both in Oklahoma city and across the Western part of the state and in Tulsa across the Eastern part of the state organizations began coming to my health, saying, we want to do this program. It looks important for our population. It was everything from the mental health community to, um, you know, the, the tribal systems to lots of different communities approaches about this. And so my health put in the application on behalf of the route 66 coalition in Oklahoma, and this model was, uh, it turns out incredibly difficult to me because there was a questionnaire that had to be asked to the patient. And when we did time and motion studies on, it took about 15 minutes for patient just to ask the questions and get their score. And so when it came time to roll out the model in the, in the community, I should say, we rewarded the program for starters, that was a good win.

David (32:15):
Uh, and there were about 34 sites, I think, nationwide. And as we began to roll it out, no clinics, no emergency rooms, no hospitals could use it because it was basically the full length of the visit just to assess the, the social needs of the patient, uh, much less connect that patient into the social services that they needed. And so we really had to step back and think about it, and it took months to really think about, well, what are the unique assets we had as a health information exchange that would enable us to automate, to scale, to streamline this process and make it into something manageable, such that it could be done, not just here in Oklahoma, but as a national solution potentially for social needs. And the, the solution we landed upon was to recognize that as a health information exchange, our most, one of our most significant assets is that we know within about a minute of a patient registering for care in a clinical setting, we get an alert about that and in that alert of the patient’s demographics.

David (33:15):
And so we were able to work with not just HIPAA and, and O C and the departments of health, also the FCC to get permissions, to use that information, to, to deliver a screening directly to the patient’s mobile phone. So when our patients in Oklahoma check in to a clinic or an emergency room, or a hospital that participates in this program, the patient will almost immediately be given a text message on their phone that offers them the ability to screen themselves for potentially additional services that they could get. And we received the results of that screening in pretty close to real time. We score them and before the patient’s even been roomed or put back to see the doctor, they’ve usually been, uh, had the, uh, list referrals given to them on their phone, to social service agencies that meet their needs. And so what this means in Oklahoma is that in more than 120 locations across the state, uh, as soon as the patient registers their screen, they’re offered services, if they have a need. And then for those that have, you know, ER utilization, uh, issues, they’re also come connected with a, with a, um, a navigator.

Stan (34:24):
Do you, do you ever see the point where the health information exchange can sort of in a predictive way, let’s say I go into the doctor’s office and L let me preface that by saying that so many people have health insurance, but are functionally uninsured, because they really can’t afford their deductible. They’re out of pockets. They’re, co-payments their co-insurance and so forth. Do you see a point where my health could recognize health of it, like the prescription of a very expensive drug? And at that point, you know, offer patients some kind of social service help in, in being sure they can afford it, because as everybody knows, you know, three outta four people with diabetes don’t necessarily take all their medications and a lot of expensive drugs aren’t used, even though they’re life saving or health saving, just cuz people can’t afford them.

David (35:20):
Yeah. You know, I, I definitely that’s a possib. Um, certainly I’ve worked with systems where we’ve, uh, been able to recommend in real time alternative, uh, prescriptions. Sometimes there just aren’t any, uh, that are available to certain for certain treatments. Um, but, but absolutely the opportunity exists, uh, you know, in the, in this data set to identify, um, you know, on a individual patient level basis opportunities for reducing the cost of their current prescription, uh, burden or, you know, maybe even to help direct to lower cost providers. Uh, those are all things that can be done. But the key element to this, uh, you know, to come back to the core is the clean flowing data that’s happening in real time. The, the model we put out there for social needs screening, the most important thing about that is we started way back in line, uh, among the 34 30 regions that were, that were rolling this out, cuz they simply put a human in a practice and they began the screenings and we had to develop all the relationships and the policies and the governance pieces deal with the FCC and get all that in place so that we could launch this broadly.

David (36:30):
We now are screening twice to three times as much as any other community in region. Uh, and throughout COVID our screening program was not affected because as patients, you know, a system shifted to telemedicine, we were able to, we, you know, patients still had their phone and they were still getting their screenings, whether they were at home or anywhere else to, to meet their needs. So that we’ve now delivered screenings to 2.1 million people in our, from, from as zero standing start in, uh, 2000, you know, August late, late 2018. And so that substrate of data is not just, uh, for me. I mean obviously we use it to help meet the immediate need of the patient, but we also provide it as feedback to the patient’s doctors, uh, and other providers. So that, so that when they write that expensive prescription, they have the data that tells ’em, don’t consider this expensive prescription in this patient.

David (37:24):
You need to be working with something on the $4 formulary from these, from these pharmacies or this patient has a transportation issue. So it’s not enough to write a prescription. You gotta make sure to get it delivered as well. So their point about whether we could use the set in aggregate, we could definitely identify those high, high cost items. But I think the workflow we’ve established with the sort of outbound data from the clinical setting and now directly from the patient and then the inbound back to the practice setting allows the practices themselves and the providers to be a part of the team. And in correcting those, uh, those either out ofAnd costs or non ideal solutions problems,

Stan (38:02):
I got, we we’re running short on time, but I got two important questions for you. So you’ve become a rockstar in the age of COVID you are now, you know, much like the weather report every day, you’re giving a health report at least once a week to the press talking about COVID statistic. And there’s nothing like a pan to make a health inform exchange in the forefront, move it to the forefront of people’s minds. Can you tell us a little bit about what the health information exchange has been able to do in the age of COVID that we wouldn’t have otherwise?

David (38:40):
Sure. Uh, so, so the, the health information exchange is all across America, not just here in, in Oklahoma, but, but all of us, uh, they’re about 75 nationwide. Uh, all of us receive, uh, critical health information in close to real time. And guess what that’s exactly what you need for early detection and address addressing a, a pandemic and outbreak of any kind. And so, uh, I think it was March 8th, my health received its first of 2020. My health received its first COVID 19 lab test result and continued to received them since literally millions of them. And we began monitoring for those building dashboards. We reached out immediately to the state health department and others at the state offer support and services. Uh, and I can remember vividly, uh, on a, on a call. I think it was with folks from the state, uh, presenting a dashboard that was already robust and thousands of patients in it and a geographic map showing where COVID was hot and was not hot in Oklahoma.

David (39:44):
Uh, and the, the somebody said, wow, this is amazing. How did you do this so quickly? And I said, we didn’t, we spent a decade or more putting together the, the people in the community, the trust relationships, the policy see so that this data can be shared. And what you’re benefiting from now is the fact that all of that work has already been done and we could immediately pivot to being a part of the COVID response. So we’ve been doing, uh, weekly briefings, both one for the public and one for the press. Uh, and then I did every other day briefings during, uh, most of the last year for the governor’s response on team and the state health department, uh, on COVID so that we could identify. And we did identify several outbreaks in, uh, you know, facilities where, uh, it wasn’t obvious immediately that there was an outbreak because the patients were sent to multiple hospitals.

David (40:32):
But when the data all came together in my health, you had a group of patients with the same address. It was pretty obvious is where the outbreak was occurring. And we tended to have that 48 to 72 hours before anybody at, at, at state agencies would be aware of it. So yeah, no, it’s a tremendous opportunity and value proposition for health information exchange in general. Uh, the CDC has some fairly antiquated processes using surveys to do these things using, you know, faxed records, phoned in reportable conditions and such. And, uh, we are the health information exchanges in this country are offering the infrastructure to plug straight into the health departments for live reporting on these things as they occur. And we think it positions, you know, this, the nation and the human rates generally for a better response to the pandemic outbreak.

Stan (41:21):
So final question. What do you see by health doing in 10 years that you’re not doing now? What do you think you will be doing that you should? And what do you think will be an difficult to achieve and will we ever get to see you on the 10 o’clock news giving the health report right after the weather report?

David (41:44):
Wow. Uh, so let’s see in 10 years is a long time. I think back to 10 years ago, we were negotiating a, a, uh, policy that would allow us to exchange the first data. Right. And so, uh, I’m hopeful that, you know, this work seems to happen very slowly until you get out and drive a stake and measure against, see if you’re moving. Uh, but what I hope for the nation and for, for my health in specifically, uh, in the next 10 years is to finally achieve, uh, uh, a statewide complete coverage. We’re at about 80, 85% now of healthcare delivery, but not to stop at health, but to, to really con you know, think about health and wellbeing as the objective, uh, of this data. And to begin, you know, be reporting as you point out almost like a weather report or dashboard that anyone can access.

David (42:40):
What is going on with health in Oklahoma? What does healthcare look like? So when I need services, what are the highest quality places I can get them? And the most cost effective places I can get them. And also how can I help myself, uh, with health, by having access to my record and motivating the use of that data to guide me long before, you know, my weight becomes diabetes long before my blood pressure becomes high, but when I’m still in the early prevented stages, but also I want to get beyond healthcare into social services and, and, you know, we need to make education run better. We need to make industry run better. All of those things go better when people are, are, are healthy and, and they have a good sense of wellbeing. And, and I think this infrastructure can certainly, uh, is a, is a critical component of that.

David (43:28):
Now I would add one more really important thing here that we haven’t talked about at all, but this same infrastructure is the place we should be generating new knowledge, right? I mean, when we do randomized control trials for drug treatments, cancer, or heart disease or whatever field we do them in they’re enormous investments, they’re expensive. And they’re once, once conducted, they’re only really, uh, relevant to the community they were done in the specific population they were. And this asset we’re building by building health information exchanges around the country, which we’re now in the process of connecting to one another so that patients can expect their data. In fact, in Oklahoma, we receive data from 40 other states, if an Oklahoma goes to get care anywhere else in those 40 states, that data also comes back to Oklahoma to be used on their behalf. Hmm. Uh, by expanding and building on that, we’ve got perhaps the world’s most significant research asset for improving the human condition for testing and validating new interventions and treatments and therapies for being able to detect much earlier on when, when there’s gonna be a problem, because the population size will be so big that we’ll have a significant issue detected quickly.

David (44:40):
Um, I, I think that’s really the, the, the future is we’re gonna optimize the delivery of care as we’re doing today and have a learning health system where today’s data when comes tomorrow’s to decision support, but we’re also gonna leverage that so that new knowledge can be generated, uh, in, in a much closer to real time fashion and become, uh, guidance for, for tomorrow’s decisions, uh, uh, around lots of disease. I think the answer for cancer, the answer for heart disease, the answer for many of the things that, that affect the human, you know, the cause of human condition, uh, are, uh, is already in the date. We just gotta get it organized and make it useful.

Stan (45:20):
As a good friend of mine says, the data must become information. The information must become suggested action. And the suggested action must have measurable outcome. I’d like to thank you. I just wanna make one comment to our listeners. As some of you have been thinking about what about my data? My health has an extraordinary structure to protect privacy and to keep the data where the data needs to be. And to be sure it isn’t where the data shouldn’t be. David, I’d like to thank you. And I like to have you back in 10 years, if we could to find out what you’ve actually accomplished in this futuristic do, and thank you all for listening. And we hope to get back to you next month with another interesting story, take care and be sure to get that vaccine. If you have it,

Narrator (46:08):
We hope you’ve enjoyed the time with our very own doctor stand for 360 degrees of healthcare with Dr. Stan Schwartz, a part of zero studios tune in subscribe and review our podcast to keep current with the ins and outs of the medical and healthcare industry from the inside out.

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