Earlier this month, five organizations launched the Care Connectivity Consortium to facilitate the secure exchange of electronic data in real-time at facilities across the country. The vision, according to Kaiser Permanente EVP and CIO Phil Fasano, is for providers to have all of a patient’s information at his or her fingertips during the encounter. But before that vision can be realized, there are a few key questions that need to be answered, primarily in terms of reimbursement and standardization. In this interview, Fasano talks about how the nation’s largest non-for-profit health plan and care provider plans to deal with the reimbursement issue, how it is preparing for Meaningful Use, how it handles budgeting and project prioritization, and why data sharing is so important.
- Kaiser, Mayo, Geisinger, Intermountain & Group Health form the Care Connectivity Consortium
- What is the Holy Grail of health information exchange?
- The state of standards
- Cracking the sustainability code on cross-organizational HIE
“If a Kaiser patient happened to show up in Group Health’s offices and needed care, the physician he is seeing would have the ability—after being granted some immediate permission by that patient—to access their medical record… so that they’d have the facts that they need and the background they need to provide world-class healthcare.”
“If we agree on standards and we agree on the information that’s necessary to exchange to be the basic elements that are necessary when treating patients, ultimately we can exchange that data.”
“What activities like the Care Connectivity Consortium force us to do is converge many of those standards, so that as we exchange information, we’re confident in the quality, the integrity, and the security of the information, and we’re confident that we can reliably exchange interoperate between systems.”
“I believe we’re going to be successful because we have a common goal. And the goal is that we want, as organizations, the best health care possible for our patients, regardless of whether our patients are in our system or somewhere else in the country and requiring care.”
Guerra: Thank you for being with me today, Phil. I’m looking forward to chatting with you.
Fasano: Thank you very much, Anthony.
Guerra: Let’s start off by talking about the interesting project you have going with Care Connectivity Consortium. The Consortium will utilize standard-based health information technology to share data about patients electronically, and includes Mayo Clinic, Geisinger, your organization, InterMountain, and Group Health. Why don’t you give the listeners and the readers an overview of that project and then we’ll drill down a little bit.
Fasano: Sure, I can tell you that from our perspective, it’s very exciting news. We’re absolutely thrilled to be with such good company focused on doing this work, which I frankly believe is substantially and fundamentally important for the future of the health care industry. The group decided and announced our partnership through this Care Connectivity Consortium with the intention of electronically connecting our medical records. Each organization has independently done some great and pioneering work on an individual basis to really get to the level where each of our organizations are quite proficient at using these electronic medical records for the benefit of our patients within our systems.
What the announcement indicated is that we’re now going to work together in a collaborative fashion using standards and technology approaches that enable us to connect electronic medical records for the treatment of patients toward that end and toward that benefit where we share in real-time their electronic record—from their primary care physician to anyone across our system who might be treating a patient on behalf of the other system. And by that, I mean that if a Kaiser patient happened to show up in Group Health’s offices and needed care, the physician he is seeing would have the ability—after being granted some immediate permission by that patient—to access their medical record at Kaiser Permanente. So that they’d have the facts that they need and the background they need to provide world-class healthcare.
Guerra: So for example, let’s say a Kaiser Permanente patient who has a record in the Epic System winds up at the Mayo Clinic, and a physician from the Mayo Clinic would then be able to view into your system and view that record still in the Epic format. Is that the idea?
Fasano: Actually, what would occur is that if they showed up at the Mayo Clinic and that physician requested on their behalf the medical record from Kaiser Permanente, basically they would electronically reach out and touch the record at Kaiser Permanente. The information we’ve agreed to share between all of our systems would then become immediately available and they would see it and view it within their system. So the data would be transferred and they’d be able to actually read that information.
Initially, the kind of information we’re looking to share has to do with pharmaceuticals and some basic background information on the patient themselves as well as some limited set of the patient record as an initial pilot. We’d hope to expand that pilot and the content of the medical record to be more complete over time.
Guerra: Do you know off the top of your head what systems these other organizations are using? Obviously you’re an Epic shop, and I think InterMountain is a home-grown product. But what about Mayo, Geisinger, and Group Health—are they vendor shops?
Fasano: I’m not immediately knowledgeable on what each organization is using. I believe one other organization is also using Epic, the others are using other vendor solutions, and some are using a mixture between vendor solutions and their own medical record applications.
Guerra: What do you see as sort of the Holy Grail of information exchange? In my mind, one of the things I’ve thought was that, for example, if you’re an Epic shop, you would be able to export that Epic record and send it over to, for example, a Cerner shop. It would somehow get translated and the Cerner shop could import it into their system, populate in the Cerner record, and all the fields would map. Is that the Holy Grail or is that not even where we need to be going?
Fasano: You know, I think that’s quite directionally correct. When you think about this, obviously, we have to lay down some standards and agree on standards so that we can exchange information on behalf of patients. Kaiser has done some of that with our pilot work with the veteran’s administration over the past couple of years. And that work is based on the NHIN standard.
You may also note that just last year, we donated our Convergent Medical Terminology (CMT) to the country and more broadly around the world for access and usability by others. And we anticipate that CMT will enable medical records to be more interoperable as organizations choose to adopt the use of that dictionary, if you will.
As this world evolves, it is my belief, and I think others would share it, that many organizations will be able to seamlessly share patient information and do so regardless of the medical record of choice in the individual system, so we can have very different medical record systems. But if we agree on standards and we agree on the information that’s necessary to exchange to be the basic elements that are necessary when treating patients, ultimately we can exchange that data.
Guerra: Do you have any more thoughts you can offer around standards? In the release, it mentioned you were using “the latest national IT standards.” You mentioned NHIN—can you give any more detail around where you think standards are, where they need to go, or even more specifically, with CCDs, what are your thoughts around standards?
Fasano: As you probably know, and I’m sure anyone listening would know, there are numerous standards across the medical profession for medical information. Some folks will refer to HL7, some will refer to Convergent Medical Terminology, and other folks will refer to other standards, all being very relevant, and in many cases, quite relevant in the individual areas of the healthcare industry. What activities like the Care Connectivity Consortium force us to do is converge many of those standards, so that as we exchange information, we’re confident in the quality, the integrity, and the security of the information, and we’re confident that we can reliably exchange interoperate between systems.
Ultimately, the standards will begin to converge. Many organizations will determine the best standards for exchanging the types of information that we’re looking to exchange, and over time, it’s my hypothesis and belief that we’ll arrive at a point where the industry will converge on some core standards for sharing medical information that allow us to do it seamlessly, in real-time, and do it in a way that preserves the reliability and integrity of the information and guarantees security.
Guerra: So the size of these organizations that are involved in using the basic standards that are out there—do you think over time the refinement of those through actual use could create the sharper standards that we need?
Fasano: I think the entire industry is going to go through a lot of learning these next few years. We’ve learned a lot, certainly, throughout our history in this industry. Now, as organizations are beginning to move to a new standard—which is that of being in the business of real-time healthcare, where technology is an enabler to care and a fundamental element that’s expected to be present whenever a physician is meeting with a patient—it’s going to be incumbent on us to ultimately converge and be able to exchange medical information in real time. And to do that, we’re going to have to come up with core standards that the industry can agree on.
Guerra: Your organization is a closed system where you’re also the payer, correct?
Fasano: That’s absolutely correct.
Guerra: One of the real challenges we’ve seen around what you’re doing is developing a cross-organizational HIE–usually we talk about two but you’ve got five organizations, so this is the Holy Grail people have been trying to get to. And they’ve had trouble finding a revenue model when we’re talking about systems that are not all-in-one. I believe that Geisinger and InterMountain are closed systems, but I’m not positive. Do you know if all these organizations are closed systems? And is that why the financial dynamics work in this case, and may not work in other cases where the payer and the provider are separate entities?
Fasano: Actually, I don’t believe that’s true at all. Now, the premise may be true; Kaiser Permanente, for example, is primarily integrated and that is our model—that’s our core model. We do work with outside providers. We do work with outside hospitals across the country, and as a consequence, we have some payer and provider relationships in those particular situations, as do every one of these systems. We also work with the community clinics which are outside of our organization and clearly have payer and provider relationships there.
Going beyond that, when you think about the question you’re asking, which is to say, “Well, you guys are all unique and as a consequence integrated, and you have the payer and the provider under one roof, so it’s going to work for you and for others.” I would assert that because we’re independent organizations, we’re quite representative of the larger community of health care that, on both the care delivery side and on the payer side, will not only have to interoperate our medical records for the benefit of patients, which is what the Care Connectivity Consortium is all about, but ultimately, if my patient shows up at the Mayo Clinic, Mayo wants and will expect that we’ll reimburse them for the care that our patients receive. And we would certainly establish a payer-provider relationship as a consequence of that.
So I believe we’re going to be successful because we have a common goal. And the goal is that we want, as organizations, the best health care possible for our patients, regardless of whether our patients are in our system or somewhere else in the country and requiring care. And one of the ways we firmly believe that our patients will best be cared for is the fact that their electronic medical record and all of their relevant patient data is present regardless of who the provider is, whether that provider is within our own exclusive system, a provider in our broader network, or a provider in one of the organizations that have decided to participate in this consortium.
Guerra: Okay. But for other entities, there has been a problem finding a revenue model across organizational HIE investments, and when you’re shoring up your own hospital with your ambulatory network, that makes sense—that’s the feeder of the patient flow, and that makes sense from a revenue point of view. But organizations have trouble finding the revenue model. Do you think that can be overcome? What are your thoughts on that?
Fasano: Well, I think that for organizations that are in pursuit of a revenue model, this is probably an important day, because we’re not really looking for revenue as a consequence of doing this.
We believe, fundamentally, and as I said earlier, that this is really an important step for the industry. It opens the door to a world and a future where every patient will have their information always present and in real-time, so that any provider they see is going to be able to give them best care and have their health in mind. The payment model for services—which clearly, any provider will render services on the basis that is medically appropriate for a patient at any moment in time—has been long established with respect to the claims that that provider would issue to the insurance organizations with which the patient has their relationship. That won’t change; this activity won’t change that relationship from a funding source, but your question gets to the root of how do you pay for connectivity, and we have not at all explored this as an activity that’s in pursuit of revenue. What we’re all agreeing to do is collaborate, and fund that collaboration from our individual organizations with a higher purpose in mind, which is really better patient care.