Tim Zoph, Chair, KLAS Interoperability Measurement Advisory Team, Chapter 2

What a difference a year makes. In the fall of 2015, the organizers of the first KLAS Cornerstone Summit weren’t sure if industry leaders would even show up, much less stick around long enough to provide input. Luckily, their fears were unfounded. Not only did a dozen CEOs show up, but they gave enough feedback to get the ball rolling on a groundbreaking interoperability survey that KLAS hopes will provide some much-needed answers. We spoke with Tim Zoph, Independent Chair of KLAS’ Interoperability Measurement Advisory Team, about what they’ve learned from the preliminary survey results, the roadmap being developed to more effectively measure interoperability, and why he believes this is only the beginning.

Chapter 1

Chapter 2

• FHIR & Project Argonaut — “There’s a lot of promise.”
• The need for “more contemporary standards”
• Beyond acute & ambulatory care — “We went to tell a compelling clinical story.”
• Interoperability survey as a baseline
• Accountability scoreboard — “The bar is pretty high.”
• ONC’s participation
• Next steps for KLAS

Bold Statements

The indication is that we’re going to engage patients in contributing to their health and health records through sensor-based technology and mobility. Therefore, we’re going to need a more contemporary interface standard.

We don’t want just technical or process measures; we want to really understand whether it is making a difference in care. In other words, can we avoid the duplicate testing? Can we improve time to diagnosis? Can we make better decisions about patients because we have more complete information? We don’t just want to tell a compelling technical story; we want to tell a compelling clinical story.

Part of our challenge the first year was to try to keep everybody in the room. With interoperability that’s not easy, because sometimes it coalesces around certain groups, and we didn’t want that to happen. We wanted this to be collaborative and represent as neutral an industry measure as we could find.

We need to learn from what we did in MU and say that technical measures aren’t all unique. We’re raising the bar with how it is we are beginning to look at the industry in terms of is the information really getting to where it needs to be, is it being used appropriately, and is it making a difference?

Gamble:  You mentioned FHIR, which is something that really seems to be emerging. What are your thoughts on the potential it has in terms of inoperability?

Zoph:  In the upcoming interoperability report, you’re going to see that the most predominant way we exchange data today is through public health information exchange. But in many ways, the early technology and architecture of those are challenging and oftentimes not effective, so what we really need are more contemporary standards.

If you look at other industries, they use application programming interfaces (API) simply because they are cheaper, more effective, can be tailored to the right context for which the information is needed, and they’re more dynamic. And there is a desire for healthcare to get to more contemporary standards. One example is Project Argonaut, which is working through a lot of the early demonstration projects. Although it’s not as mature as everyone would like it to be, there is a lot of promise around it.

I think you’re going to see a combination of the traditional standards in health information exchange and the public exchanges continuing, but I think you’re going to see a layering on of a more dynamic and more cost-effective way of interfacing between systems. And that will take on this next-generation standard which is what other industries are doing; they’re dynamically exchanging information using API-based standards.

The other thing that’s important is if you think about mobility, we’re exchanging a lot of information today, and a lot of it is native to what happens in the health delivery system. But the promise going forward for population health, for precision medicine, for management of chronic disease, is that patients will be a dynamic part of this process and will be contributing to their record. And the indication is that we’re going to engage patients in contributing to their health and health records through sensor-based technology and mobility. Therefore, we’re going to need a more contemporary interface standard if, in fact, we’re going to rise to that technical challenge. So it will need to come as we think about broader contributions to interoperability into the record.

Gamble:  Right. And the interoperability roadmap — that’s going to be a work in progress for quite a while?

Zoph:  It is. It’s going to be expanding in dimensions of technology, and so we want to look at medical devices and other systems that may be really important to interoperability are not being measured currently, and it’s going to expand in terms of our horizons of health delivery. Today it’s mostly ambulatory and acute care organizations — we want to go to post-acute, maybe go out to the patients so we’re going to sort of expand their horizons, and I do think we have the appetite to add clinical measures. When the day is done, we don’t want just technical or process measures; we want to really understand whether it is making a difference in care. In other words, can we avoid the duplicate testing? Can we improve time to diagnosis? Can we make better decisions about patients because we have more complete information? We don’t just want to tell a compelling technical story; we want to tell a compelling clinical story.

People came to the Cornerstone Summit because we understand how important this is to care delivery. We understand that these transitions of care today are less than optimum because the information isn’t present. So I believe people weren’t in that room simply to rise to the technical challenge, but because they understand that this is what’s necessary in order to create a true system of care in this country.

And it won’t be without its challenges. When I was at Northwestern, we didn’t build the information systems so that the information would stop at the boundary of our health system. The intent was that information would follow the patient and we could really manage and rise to broader care coordination, because over time, population health is where this country needs to go.

Gamble:  Overall, when you think about the first summit and the second one, is KLAS satisfied with the progress that’s been made in a year?

Zoph:  Yes. To be honest, at the initial summit, we were wondering, can we even agree to get people to do a survey together? Can we get everyone in the industry to have some consensus around putting together a survey that our vendor and provider community would agree with? Part of our challenge the first year was to try to keep everybody in the room. With interoperability that’s not easy, because unfortunately, sometimes it coalesces around certain groups, and we really didn’t want that to happen. We wanted this to be collaborative and represent as neutral an industry measure as we could find.

So at the first conference, we were saying, ‘Can we actually pull this off?’ and we did. For the second conference we actually had results, so I was fairly confident, but you’re always a bit nervous to say, will people find the information useful? Did the survey tool as we actually envisioned it get administered appropriately? We actually affirmed the survey and are going to continue with it, so I think the second conference may have been just as important, because now we have a baseline. We have a survey that will modify and go forward. We have a roadmap. So I’m far more confident now, at the end of this conference, that we can keep the industry together around a set of measures that we can agree on.

We also have a scorecard coming out where we’ve agreed to be held accountable for how we’re going to measure our progress, and I can tell you, the bar is pretty high. It’s not a softball. And so I think you’ll see through the scoring mechanism that comes out that we’re appropriately measuring ourselves, but it also indicates we have a long way to go. Sometimes tough measures are not easy for everyone to take, but I think it’s honest and it’s aspirational, and hopefully it will pull us forward. And that will inspire providers to be better, inspire vendors to have better solutions, and inspire people to recognize that ultimately our measure has to be, did we make a difference in care?

I think when you see the measurement framework, you’ll see that yes, it has some technical aspects to it, but importantly, it has aspects around workflow and around impact to patient care, and that’s where we need to be. We need to learn from what we did in Meaningful Use and say that sometimes technical measures aren’t all unique. We’re raising the bar with how it is we are beginning to look at the industry in terms of is the information really getting to where it needs to be, is it being used appropriately, and is it making a difference?

I will tell you, it’s not easy. Anybody who was in the room at KLAS will tell you that we were worried we’d be able to keep everybody for the full conference the first time around, and as were starting to accumulate results, we didn’t want people to say the survey wasn’t worth it. But we didn’t hear that, so we’re cautiously optimistic. We got some really good feedback from the survey for year two modifications and we’ve got a roadmap and a scoring tool, so we’re feeling pretty good about it.

And getting participation from ONC was great; I think they’re going to value these measures. They get asked a lot about interoperability at the national level, and oftentimes it ends up as a finger-pointing exercise, so the fact that we have a measurement framework that people can agree on will hopefully neutralize some of the finger-pointing and get people working together.

Gamble:  So it seems like you’re off to a strong start, and even though there’s a way to go, it’s progress that the industry hasn’t really seen. I’m sure that’s been encouraging.

Zoph:  It is. This is a challenge for KLAS because they had me to talk to clinicians and really into the depths of the organization, where before it was more that IT leader for CMIO. They’re a trusted neutral party in the industry that has a lot of measurement experience and credibility, and I really applaud them for stepping up, because this was not without risks. And I give them a lot of credit for applying resources. They’ve had to complete 500 survey conversations over the last year — that’s a lot of hours and a lot of effort. It’s new territory for them, so I give them a lot of credit.

Gamble:  Now that you’ve established a baseline, it’ll be interesting to see where things go from here. But I think it’s really significant having that framework and that roadmap.

Zoph:  Absolutely. And ONC has said they’re looking to rely on others to put measurement frameworks together that they can reference, so I think they recognize that there’s some industry consensus about how to do this, and they appreciate it as well. So I’m cautiously optimistic that we’ll continue to have participation and fairly strong support from them around our industry efforts.

Gamble:  I’m sure it was very encouraging to have ONC present.

Zoph:  They were there for the whole session, and Dr. Vindell Washington spoke to the group that night. I feel like that stakeholder group will only grow, because perspective is really critical, and so there was pretty strong consensus that keeping our advisory committee together and potentially doing annual conferences around this makes sense.

Gamble:  Right, getting a broader view makes sense. Well, this has been great. Thanks so much for your time, and I look forward to speaking with you again soon.

Zoph:  Thank you, Kate.