Interoperability in Healthcare: Is It Living Up to The Hype? [Podcast]

28 Jan Interoperability in Healthcare: Is It Living Up to The Hype? [Podcast]

If you work in healthcare, you probably heard of the word “Interoperability” at least once, or perhaps too many times. Whether you heard it from a co-worker or your favorite healthcare influencer, health data interoperability is becoming more important than ever. But does it live up to the hype?

In this episode of the Precision Insights podcast, Dave Wolfe weighs in on the current state of interoperability in healthcare and the increasing role of pharmacogenomics. He also highlighted some of the key drivers of interoperability in healthcare. 

Let’s dive into our conversation with Dave Wolfe!

Table of Content (Click a question to jump to it directly)

• Can you tell listeners a bit about yourself? And how did you get into pharmacy and healthcare IT consulting?
• What does interoperability in healthcare mean to you, and where do you think the industry is in terms of progress? 
• Do you think everyone in the United States will be able to see his/her prescription history in the future? 
• Are there any challenges you have seen or encountered around the implementation of technology in healthcare?
• Wouldn’t a return on investment (ROI) from the reduced adverse drug events, and improved effectiveness cover the cost of some harmonization across the 35 or 37 disparate systems? 
• What are your thoughts on the increasing role of pharmacogenomics and the challenges that are associated with that?
• The challenge now perhaps is not necessarily looking at the evidence, but dealing with that volume of pharmacogenetic information. What are your thoughts on this? 
• Do you think organizations or colleges are responsible for educating health professionals on pharmacogenomics? Who do you think should be doing the education? 
• Can you share a little bit about the initiatives you are doing at FusionRx LLC and would like to do there?

Can you tell listeners a bit about yourself? And how did you get into pharmacy and healthcare IT consulting?

I’ve got one of the most diverse pharmacist backgrounds that you’re going to hear. I didn’t do the traditional retailer or hospital route. I started in the pharmaceutical manufacturing industry after I graduated from pharmacy school. Then, I spent many years working in the in-home health care, and home infusion space, which was the precursor to specialty pharmacy focused on rare chronic diseases.

Next, I spent some time as a consultant and acted as the VP/General Manager of CVS. As VP General Manager and later VP of Strategy, I ran the specialty division that became CVS’s first foray into Specialty Pharmacy called CVS Procare. Like many ventures, we merged with another division. Everyone who’s at the level of Vice President or above was displaced. 

So there I stood, which was about 18 years from now, saying, “Okay, what am I going to do next? Do I want to continue down this path as an executive in the Specialty Pharmacy space or try something different?” That’s when I decided to start my own company, FusionRx LLC.

Ironically, a colleague of mine ran a pharmacy management company. They had a new hospital opening up, and they needed to build a pharmacy system. I chuckled, and I said, “Well, I have had IT specialists report to me, but I’ve never done it myself.” And my colleague said, “Oh, you can do it, Dave.” So I rolled up my sleeves and built the pharmacy system for him. Since then, I have worked with different electronic health records over the years, for example, Meditech, Siemens, Cerner, and a little bit with Epic, and McKesson. 

Then, I ventured into some other areas in IT staffing. I acted as the Vice President of Professional Services, which I was in charge of placing the right consultants on the right projects. I did some joint venture work with an academic medical center and a data analytics company where I took a significant project from concept to our first customer. Currently, I’m still doing consulting, with healthcare providers, primarily health systems, focusing on CPOE (Computerized Provider Order Entry) optimization. I’m also leading a project on automated dispensing cabinet implementation, including the conversion from one vendor to another with a health system. Over the last couple of years, I’ve gotten much more involved in pharmacogenomics. I wanted to figure out how we can put all these pieces together as we make great strides in that space.

We’ve heard many key opinion leaders in healthcare talk about the buzzword, “Interoperability.” What does interoperability in healthcare mean to you, and where do you think the industry is in terms of progress? 

That’s a great question. As you mentioned, it continues to be the buzzword. Interoperability means a system can work or communicate with the parts or equipment of another system. 

I was looking back through some papers that I’ve written. I wrote one in 2005 that was in response to the Institute of Medicines Report on the electronic health record (EHR/EMR) and what functionalities should EHRs have. 

So way back then, people were looking at interoperability. There were eight core functionalities for an electronic health record system, and the tenets include:

1. Health information and data  
2. Result management
3. Order entry which turned into CPOE (computerized provider order entry) as we referenced earlier 
4. Decision support
5. Electronic communication and connectivity—how do we connect with these disparate systems 
6. Patient support
7. Administrative processes
8. Reporting in this population health management. 

All of these functionalities include interoperability.

Way back in 2003-2005, we were talking about interoperability. We’re gradually getting there. For example, we’ve standardized the HL7 (Health Level 7) transactions so that health systems can speak to one another and application can speak to one another in a standardized nomenclature. 

On the medication side, we’ve also made some strides in RxNorm—for instance, how we communicate drug data across platforms. To be honest, my gut is that we keep talking about interoperability, but we’re not there yet. It’s a behemoth effort to do that.

If you go to hospital A, they may be on one electronic health record, Cerner, and if you go to hospital B, they may be on Epic. The two systems don’t talk to each other at this point. It’s disappointing to me as a health professional, but I understand the complexity that is involved. I had a recent situation where I had two applications that I’m trying to implement at the same time. Someone told us we could use the same ADT feed (Admission discharge and transfer feed). Later, we found that the data elements they are looking for are different. Although we standardize some components, we are still requesting different information that requires additional interoperability. 

Do you think every US citizen will be able to see his/her prescription history in the future?  

I think we’re getting closer to seeing that happen. As I said, we are taking the necessary steps to standardize how we communicate. Through active or health information protocols, we can have a standard interface or a common way of communicating with one another electronically. 

The real question is, how do we get to the ultimate goal—an interoperable portal. I think there is a steady rise in the empowered patient or consumer. Patients are getting much more involved in their care. I think patients are going to require an interoperable system because they are not satisfied with the current state of healthcare. 

Our podcast host, Prof. Martin Dawes, added, “We hear those same stories in Canada as well. In fact, in a meeting earlier today, we were talking about how patients expect healthcare providers to be able to see all the information there is about their health. Patients were quite shocked when we told them we couldn’t see their prescription history. And patients were making an analogy of using their smartphones to look up what medications were prescribed to them before.”

The new wave of empowered patients will drive interoperability in healthcare. The expectation is there, and the technology is nearly there. Hopefully, within a few years, we will achieve interoperability in healthcare.

Are there any challenges you have seen or encountered around the implementation of technology in healthcare?

I think I have touched on one example earlier. We were implementing a prescription surveillance tool that tied in closely with the automated dispensing machines. The idea was that we could use the same feed, the ADT feed, on the ADC (Automated Dispensing Cabinet) to meet the needs of the other applications under the company. 

As we started doing the testing, the elements were not the same. Therefore, we had to build another ADT feed. So the challenge here is that most people think an ADT (Admission, Discharge, and Transfer System) is an ADT feed, which is not the case. That was just a minor example, but the hospital client that I’m working with now has about 75 different systems. 

Trying to communicate with each of those disparate systems in a real-time manner is one of the challenges. Nonetheless, the cost is always the issue of implementing a new technology solution. There are the costs of implementation, the software itself, and maintenance.

As we are moving data into cloud-based platforms, it will help improve the cost basis, but interoperability remains a critical issue.

Wouldn’t a return on investment (ROI) from the reduced adverse drug events, and improved effectiveness cover the cost of some harmonization across the 35 or 37 disparate systems? 

You and I see that. Sitting in the CFO’s office, it’s a matter of dollars and cents. The amount of money that companies are spending is astounding as you look at adverse drug events and deaths from poor medication management. There are some soft dollars that we need to quantify and qualify and get that message out to the employers. Adverse drug events cost hundreds and millions of dollars— approximately $136 billion annually. 

As we look into the employee population, it could be someone with depression; for example, the number of trial-and-error that goes into treatment can worsen his/her conditions, lead to hospitalization or death. If employees can do a pharmacogenomic (PGx) test that could shorten the timeline to effective therapy, productivity will increase, days lost from work will significantly decrease. 

If employees can do a pharmacogenomic (PGx) test that could shorten the timeline to effective therapy, productivity will increase, days lost from work will significantly decrease. Healthier and happier employees will then bring in more customers, and the excitement just goes through the roof as these employers start talking about the ROI of pharmacogenomic testing. Employers couldn’t believe that the ROI data from pharmacogenomics is available now, and they can use it. Next thing we know, they are about to negotiate with their insurers to require pharmacogenomic testing as a part of their plan. Because it’s not only going to help employees get better faster but also improve the bottom-line of the business through reduced absenteeism and healthcare costs.

(Related Post: UnitedHealth Group Covers PGx Testing: What Employers Need to Know)

It’s already challenging for physicians when they have patients with polypharmacy and multiple diseases. What are your thoughts on the increasing role of pharmacogenomics and the challenges that are associated with that?

The time is now to start incorporating pharmacogenomic information into the point of care. The field of pharmacogenomics has clinical data backing it now. Around 5-10 years ago, pharmacogenomic data wasn’t as robust. Fast forward now, we can show that pharmacogenomic test results do matter through clinically-relevant evidence. 

However, the key is to educate healthcare providers who need to understand how all these health data work and how they affect each other. We can’t look at an individual’s health information in silos. We also can’t look at the pharmacogenomic data alone. Similar to doing a full-on medication therapy management (MTM) session, we have to look at the whole patient, including the lab values, comorbidities, diagnosis, and medications they have tried before. During an MTM session, we review what drugs they have taken in the past, what adverse drug events or side effects they have had with the medications.

It’s an exciting time that we can use these clinically-elegant data today to create personalized medication plans for patients. Some of the challenges are, how do you integrate that? Does it become part of the clinical decision support tool? Or does it become an add-on that is a different application? Regardless, we need to take the necessary steps to educate providers and professionals to understand what those data mean. Many don’t understand it at this point, not even pharmacists. They don’t teach it in school yet, but they will be in the next year or two. As for the primary care physicians, they heard about it, but haven’t put it into practice yet. Most primary care physicians think that pharmacogenomic data is what the oncologists use. However, the relevance of personalized care for the general population is substantial.

(Related Post: How Can Pharmacogenetics Be Helpful to Doctors [Podcast])

We are seeing more insurance providers covering pharmacogenomic testing for a restricted group of patients such as those who have depression and anxiety disorders and failed on at least one medication. The challenge now perhaps is not necessarily looking at the evidence, but dealing with that volume of pharmacogenetic information. What are your thoughts on this? 

Absolutely! First of all, it’s exciting to hear that insurance companies are now recognizing the importance and validity of pharmacogenomic data. And insurers starting to pay for pre-emptive testing is a big step versus most cases which are paid out of pocket and not part of an insurance plan.

I think the snowball will start to roll in other relevant disease states as well, such as diabetes and cardiovascular diseases. How many times have we seen patients who were taking statins, and they experienced muscle aches? We could have avoided that right out front with a pharmacogenomic test. I thought if I had done a pharmacogenomic test early on, I would have avoided three months of misery.

Do you think organizations or colleges are responsible for educating health professionals on pharmacogenomics? Who do you think should be doing the education? 

I think it’s the type of work FusionRx and GenXys are doing, It’s about becoming an evangelist for pharmacogenomics. About two years ago, I started exploring the pharmacogenomic space. Part of it was my frustration with MTM. It also goes back to my father’s experience. He was discharged on 15 different medications. The healthcare providers did a great job with him upon discharge, but then nobody followed up with him after that. 

Then, I started looking at the CPIC guidelines to validate these pharmacogenomic test results for my patients. The pharmacists should be the ones interpreting pharmacogenomic data because they understand pharmacodynamics, pharmacokinetics, how the body works with a drug, and how the drug works on the body. There’s no better profession to advocate for this. The challenge is that the pharmacists don’t get reimbursed for it. The pharmacists often have some flu shot quota to meet for the month, so they don’t have time to spend an hour reviewing medications with the patient. 

Some studies that I’m working on with the Albany College of Pharmacy and Health Sciences are exploring the possibility of quantifying the time pharmacists take to do a comprehensive medication review, including pharmacogenomic counseling. We want to measure the effort and get paid commensurately with that effort. Again, it’s pushing the rope a little bit. But I still think it’s our responsibility as professionals as well as innovative thought leadership companies such as GenXys Health Care Systems to enlighten the practice. 

I know the schools are open to it too. I took a pharmacogenomic certification sponsored by the University of Pittsburgh. The university has been working on pharmacogenomic education for about 4-5 years. Still, there are only a handful of schools that are doing this type of continuing education. 

Can you share a little bit about the initiatives you are doing and would like to do at FusionRx LLC?

My current company, FusionRx, has historically been focused on pharmacy systems, electronic health records, and putting those puzzle pieces together. I wanted to find some tools which pharmacists can use to improve patient care. My ultimate goal is to provide a personalized medication plan for the individual, patient, customer, consumer, whatever the right word is. 

The genesis of the name FusionRx was fusing all the data to make pharmacy a better practice. A synonym for interoperability if you will!

Now, we have the right tools we can use. We can enhance those tools and integrate them into an app on the patient’s phone. What better system is there for a patient to see their own data and what information does the patient want to see? Is there nutrigenomic data? Is there epigenomic data that the patient and the healthcare provider want to see integrated into this accurate health profile? So that’s where my passion lies. I think we’re there today at an early stage.

FusionRx has now started a consultancy practice focused on the needs of the future. I will be reviewing patients’ pharmacogenomic data with them. I am also in discussions with some self-insured companies on incorporating pharmacogenomic testing into their employee health programs. What excites me the most is getting a healthcare application to enhance the use of pharmacogenomic data and get the quality up to the level the patient wants to see.

Conclusion

We started this discussion on interoperability in healthcare. Large health systems and EHR companies are working hard to get to the point where disparate systems can speak to one another. Patients want it. Healthcare providers want it. The legislation is trying to mandate it. But until that nirvana happens, we can continue to move forward. We can have the empowered patient come in with their health information. I think the healthcare providers are more welcoming to that then they were 15 years ago. They are also favorable to any interoperability which increases the efficiency and quality of care.

Together, empowered patients and educated healthcare providers are driving the movement from population health to personalized health.

We love hearing your enthusiasm about such a complex issue, and the solutions you have produced over your career. We look forward to seeing more coming from you, Dave!

About Precision Insights podcast

The Precision Insights podcast is a podcast series consisting of inspiring conversations around precision medicine with industry thought leaders and innovators. Every two months (and sometimes more), we share the most cutting-edge technologies, processes, and initiatives in precision medicine. If you’re a patient, healthcare provider, employer, or someone simply interested in precision healthcare, you’re sure to find something useful in each episode. We hope that you’ll join our listeners and start taking control of your health, or implement precision health into your workplace/clinics a result!

The Precision Insights Podcast is proudly made by the GenXys team. Feel free to get in touch with us, we would love to hear your feedback, ideas, or thoughts.