9. Healthcare Interoperability: Part 2 (Russ Leftwich)

Speaker 0 00:00:02 Welcome to data points, a podcast by InterSystems learning services. Make sure to subscribe to the podcast on your favorite podcast. App links can be [email protected]. I'm Derek Robinson and I'm Adam Coppola. And today we feature part two of our interview with Russ Leftwich, senior clinical advisor for interoperability here at InterSystems. <inaudible> welcome to episode nine of data points by InterSystems learning services. We're going to go straight into part two of our interview with Russ left, which this half of the interview features just Adam and Russ to listen to the first half of the interview. You can check out the most recent episode before this one, episode eight after part two of the interview, we'll come back and chat with Adam about some of the key takeaways as well as welcome. Jenny aims back to the podcast to discuss the upcoming fire dev days without further ado, part two with Russ left witch. So as of 2020 inter systems products support fire. So that's InterSystems Iris for health, which has meant to be a platform for app development and health share, which has meant to be an interoperability engine for healthcare facilities. Can you talk to us a little bit about what some of the applications using fire might look like? Speaker 1 00:01:35 So one of the principle advantages of fire is you can access just small data sets, small pieces of data, because most of the time in healthcare, that's all you really need for the care of a patient or for that matter. That's all a patient needs, uh, at any one time is just what medicines are being prescribed right now. What are the lab results, the cholesterol levels for the past year? Uh, you don't want to know everything about a patient very often. You just want to know some particular piece of data, and that's what fire is particularly useful for, uh, because of this idea of resources that are logical, but discreet data concepts, so a medication or a patient or a, uh, lab observation, uh, those you can express in fire, um, and you can query for just those pieces of data with far that makes the possibility of having applications and particularly a mobile portable applications, a whole new paradigm, uh, with fire that wasn't possible previously wasn't possible 10 years ago, uh, because you can just, uh, create an application around the small set of data that is of interest in a particular use case either to a clinician, to a patient or to somebody doing research. Speaker 1 00:03:22 Our, uh, technology and inner systems goes a large step further by including the ability to transform data that's in existing, uh, legacy standards into fire resources. So we can take in data from a healthcare system data that is in HL seven version two message streams, uh, which is I mentioned earlier that the most used healthcare data standard in the, in the world still is the way most data is represented in CDA documents, clinical document architecture, which is another, uh, HL seven standard, uh, data that's expressed in those, uh, clinical, uh, CDA documents can be, uh, consumed by inner systems technology and transformed into fire resources. All those fire resources can be stored together in a repository of fire resources. That is a part of our technology, and then can be queried by, uh, ref queries, uh, to get adjust the data that an application needs for a particular purpose. Uh, that's really a very powerful one. I believe I would say, uh, in what we can do with, with healthcare data inner systems technology is also capable of, of dealing with all four of the current release published versions of fire. So we can go from legacy standards to fire. We can go back to the legacy standards because some systems can still only consume data in those formats. Uh, and we can deal with the different, uh, versions of fire that are currently implemented outside of, uh, inner systems in the, in the rest of the world. Speaker 2 00:05:26 So we've gotten a little bit into the technical details of how fire is implemented in InterSystems products and to beyond, I want to take a quick step back and ask the question of how will, how will these changing standards, impact patients and clinicians and administrators. Speaker 1 00:05:46 So they have already started to impact, uh, clinicians, and to some extent, administrators, because it's fairly easy, create a fire application that works within your organization. And let you visualize the data that you already have. One of the big challenges for healthcare organizations is that it's not easy with the standard electronic health records of today, uh, to access the data that's in those systems. Other than to view it for a human to view it on a, on a screen that it shows an electronic version of, uh, uh, of a patient chart paper charts from the past, when you want to get to the data, uh, only specific pieces of data, the, uh, fire applications that have been created, allow clinicians to do that very readily and, and provide a much more, uh, useful view of the data in any, in a particular, uh, clinician specialist's workflow. Speaker 1 00:07:00 Uh, then the electronic health record would provide customizing an electronic health record for a particular specialty over the past couple of decades has been prohibitively expensive. So people had to sort of live with what, what they had, uh, and it wasn't ideal for clinical workflows, especially as those workloads got more complicated and the data got more complicated. Fire has already started to solve that problem, uh, the same for patients. Um, and we're just on the very, uh, leading edge of this, that patients are able to access their data and in a electronic records, um, uh, using a mobile app and the government has recently produced new regulations that say that healthcare organizations absolutely must permit patients to access their own data, uh, with those kinds of applications. And the ideal technology to do that, uh, is fire. And the government has actually said in their regulations that were published just, uh, uh, within the past two months that fire API APIs are the required mechanism for patients to access their data, uh, or to authorize an app to access their data on, on a clinician or some other entities behalf, uh, about, uh, two years ago, uh, Apple health kit created the ability for patients to download a limited set of, uh, data to their iPhone, uh, as fire resources with not really their entire record, as some of the articles that were published suggested it was actually just a small but important part of their data. Speaker 1 00:08:57 And it could only be downloaded to their iPhone where iOS apps could then access it. But that was the beginning. There are now, uh, hundreds of hospitals in the U S that offer that capability to, uh, patients with I-phones. But, but as I say, this is just the leading edge of it over the next two to three years, I think it will be a commonplace for people that have, uh, apps on their mobile devices that access their own data, uh, or share it with someone that they have, uh, authorized to consume their data, which might be another clinician like, um, uh, analytics platform. It might be a researcher who's researching some condition that this patient has Speaker 2 00:09:46 You given us a lot to be excited about moving forward. Is there anything else that you want to add to what you've said? Speaker 1 00:09:53 Yeah, let me mention one other way that fire is already being used and leveraging that ability that I mentioned to just pick out particular pieces of data that are of interest. One of the, uh, already useful innovations with fire is around, uh, clinical decision support. Clinical decision support is increasingly important as the amount of data and the complexity of data increases and the human mind just can't process. All of that data in many instances, uh, on its own decision support is not new it's existed for decades. Uh, even before computers, there was decision support in the form of charts and manuals that, uh, doctors carried in their pockets to look things up. And then when electronic health records evolved, a decision support became part of those electronic health record systems. Uh, but the problem was the decision support was embedded in each implementation of each electronic health record. Speaker 1 00:11:10 Uh, if some new information, some new guidelines came along, uh, it took a long time to update the decision support in all of those different systems. And to some extent they were each customized for the organization they were in. Now, we come to the day, the era of fire and decision support services can be web services outside the electronic record. So many different electronic records might use one decision support service, uh, that is specialized for a particular area of clinical care. And that decision service can get the data about a particular patient that is needed. We call that, uh, the patient context, uh, how old is this patient? What is their, uh, laboratory value for something, what is their gender and so forth? What are their diagnoses? The decision support service needs to know some set of data about this individual to, uh, offer a recommendation. Now we have fire as a way to export that patient context data out of the electronic record in a consistent format using, as I've mentioned, a data model that all of the systems share. So that one decision support service is getting it context, data from many different electronic health records in the same exact format being fire. Uh, and then it can pass back a recommendation. Um, once again, using fire as a standardized way to encode that recommendation, if you will, back to the, uh, electronic health record system where the patient's record exists. Speaker 2 00:13:11 I think this circles back to our earlier conversation about the range of standards in healthcare, because we started talking about terminology bindings, where you're coding specific pieces of data for descriptions. We've talked about fire, which is a data standard for a data standard for resources. And now we're talking about CDs hooks, which is an entirely different type of standard. It's a, it's a support standard, it provides data, but it also, you consume data while it's working. Speaker 1 00:13:41 So, yeah, CDs hooks is a part of the fire architecture that has evolved over the last three or four years. And CDs hooks is the part of the decision support that sits in the electronic record system and identifies events that are triggers for a decision support service, and knows, uh, what data is needed by that a decision support service. So we collect that data from the EHR and passes it to the decision support service outside that EHR as fire data. So CDs hooks is the part of the, of the decision support that sits in the EHR, uh, and, uh, runs in the background. If you will looking for events that would, Praeger some particular piece of, uh, of decisions or a medication order. And, and there is a, a concern about that particular medication being given to patients who have, uh, uh, decreased kidney function. So the CDs hooks, uh, checks to see if this individual has decreased kidney function and, uh, invokes the decision support if they do. That's sort of the basic concept of CDs hooks, uh, as they consistent way to link out to outside decision support using part Speaker 0 00:15:19 Two. And we will talk to you soon. Speaker 1 00:15:21 Yeah. Great. Thanks for the opportunity to talk about data standards. If I stop people on the street and say, I want to talk about data standards, they look at me kind of weird. Speaker 3 00:15:37 All right. So thanks again to Russ and Adam for doing part two of that interview, which had a lot of interesting stuff, Adam, what were some of your key takeaways from, from part two specifically, but really the whole thing. Uh, if you have any major insights takeaways, things that you found really interesting. Speaker 0 00:15:50 Thanks Derek. Yeah. I think Russ did a great job of summarizing the new ONC and CMS final rules on interoperability. I think those are going to be pretty big moving forward. My understanding is that we won't see too many new requirements for providers or payers apart from the information blocking aspects and the new APIs that are required to be exposed. A lot of these rules have been designed so that contracts don't have to be renegotiated and users don't have to worry too much about their data getting into new hands, except for the third party apps, which they, the end users themselves have to authorize. So InterSystems Iris actually will be able to support providers, payers and these third-party apps at all levels with user and role-based security and InterSystems Iris and support for all these different APIs. Speaker 3 00:16:40 Cool. And I think, uh, it was good to see after part one where, which was a lot of conceptual, a lot of the history, a lot of the evolution of the technology to fold into part two, which kind of talked about InterSystems technology specifically. Um, and I think another thing for me that jumped out in part two was the connection of kind of what the impact is on clinicians and doctors and medical staff, right? Because like I had mentioned in part one of the interview that I have, I have friends and colleagues that I went to school with that are in that field and they don't know anything about the standards and the, and all the technology that is underneath some of these front end systems. So it was interesting to hear Russ's perspective on that and kind of flushing out, you know, what's really involved and, and where the impact kind of ripples through to the actual users and the end users of these applications and medical facilities. Speaker 0 00:17:28 I agree. I think we're going to see some, I think we're going to see some really creative uses for this in the future. Speaker 3 00:17:33 Cool. So we're also joined by Jenny Ames, who is the manager of the online learning content for data platforms. Uh, Jenny, you might remember was on episode one. Jenny, has it gone? Yeah. Hi Derek, how are you? Good. So, uh, we wanted to bring Jenny in as well for the topic that Russ and Adam, uh, interviewed about in part two specifically, but really the whole thing. Um, and I know Jenny, you could offer your thoughts on the interview with Russ, but we also have, uh, some other topics that we're going to bring you in as the expert to discuss that with some interesting things that are coming up for InterSystems. Speaker 4 00:18:05 Yeah. Um, well, first of all, Russ is fantastic. He knows his stuff and it's, it's so great to have him be able to be on this podcast and, and share some of the things that he says, you know, are going on now and, and for in the future. So rest is great to work with. We've one of the other things that we worked with the rests on lately is kind of preparing for, uh, fire dev days, that's coming up. Um, and that's coming up June 15 to the 18th and we're pulling together a bunch of, uh, resources to be able to support this, but it's, it's actually remote this year, which is really exciting. Cause I think there might be some opportunities for, um, other people who might be new to fire or experts in fire. It really spans the board on people being able to be there. So I'm really excited about this event coming up. Speaker 3 00:18:51 Yeah. So, uh, it's with a lot of events that were probably previously planned to be in-person onsite events, another challenge, obviously to create a virtual event, but what are some of the, you know, a, it might remove some barriers for some people that maybe wouldn't have gone to an onsite event or, or traveled or whatnot. Um, what are some of the reasons that people should look into attending this event if they can, uh, to really get the benefits of fire dev days? Speaker 4 00:19:16 Yeah. Um, so there's lots of really great benefits. First of all, there's experts from, um, a ton of different organizations that are coming to speak, people that have built, uh, applications on fire. They start from basic to some really cool applications of how they're using fire to really impact their facilities. We actually have someone from InterSystems, who's going to be speaking Patrick Jamison, who's the product manager for InterSystems Iris for health. Um, and he's doing a presentation on API management with fire, uh, which is a really interesting topic. Um, so that's, um, the Thursday at two 45, but I it's, I've seen him do some presentations in the past on, on this topic in particular. And I think it's going to be a good one. Right? Speaker 3 00:19:56 Jenny and attendees of dev days expect anything from learning services. Speaker 4 00:20:00 Yes, actually. Um, so, well, we've partnered with a few different other groups, so it's not just learning services, but, uh, we've put together a page specifically for those interested in fire and InterSystems technology to get started. That is on, uh, our new, getting started health sites. It basically shows a bunch of resources, um, exercises use case videos and ways to get started with using fire with specifically, uh, InterSystems Iris for health. But yeah, it's, I'm excited for how it's coming together and I'm hoping that it will help with, uh, people who are new to our technology. And also for people who are just interested in using fire with our products that haven't done. So before. Speaker 3 00:20:38 Nice. And we'll, we'll make sure we put the URL to that in the podcast description. So you guys can check that out, which as Jenny said is, uh, eventually probably going to just be a generic kind of place for information on fire within InterSystems, Iris for health. So good stuff. Thanks for the update, Jenny. And thank you, Adam, for, uh, interviewing Russ. So that's all we have for episode nine and we'll see you next time on data points. Speaker 5 00:21:01 <inaudible>.