FedHealthIT’s President, Susan Sharer, recently had the chance to sit down with Cognosante’s Chief Technology Officer, Erick Peters, to discuss interoperability, standardization, and the challenges facing Government today.
What are Some of the Challenges Facing Government Today?
One of the main challenges relates to data and the exponential growth of data both in volume and complexity. Thinking specifically of Healthcare, there are so many components that impact health including employment status, access to care, geography, genomic info, social determinants, data provided at the point of care, physical activity, and quality of sleep. There are data points measured by care providers and things we can measure every day at home. That latter points to some of the complexity, considering emerging sources and the sheer volume of what is available.
In Healthcare interoperability we want access to all of the data but it’s really hard because what we end up with is a junk drawer of information. The challenge is determining what is the most relevant but we want to ensure we don’t make assumptions as a technologist that a clinician wouldn’t agree with in terms of what is important or not. This is why it is critical to ensure those who are developing solutions are working closely with the people providing clinical care. There is no worse application than one that is delivered strictly by IT folks.
We also want to ensure we are providing a solution to the problem in a way that is approachable by human users, and that we are not bringing technology to the solution just for technology’s sake. This requires that we ensure we understand the problem, that in an Agile way we are incrementally checking back in with the end user to show them what we have, and to get meaningful feedback about their experience.
One example of critical strategic consideration is cloud strategy. Our approach to cloud is centered on delivering at scale so customers know there is low risk, ensuring our customers understand how to navigate cloud, and that we are maximizing the benefits of cloud. You have to look at how you apply the processing power at your disposal in terms of AI, machine learning and ensuring that what surfaces from all of that is meaningful, that it identifies the right trends and patterns.
Tell us About Your Role in HL7 and DaVINCI
Standardization of processes and clinical understanding is critical because of the complexity and number of people involved providing care. There are so many people trying to consume and understand health related information and what it means. Some of the standardization is focused on the canonicalization of data and its normalization to understand what it means. Some of the semantics are easier than others to manage. Getting into specifics of diagnoses, pharmacy codes, social determinants, cancer precursors, genomic info… part of standardization is understanding where you position it syntactically so it can be utilized.
We are a founding member in the DaVINCI project which is focused on getting all of the data together and organized in a meaningful way, bringing it together so it can be applied to solving a problem, looking at how information is brought to bear to influence the decision-making process.
Then, once you pull that data out, what does it mean and how do we apply it to a business process to solve a problem. There are many actors with varying interests and opinions which means it requires a large team with a broad spectrum of capability to ensure the data ends up in the right place.
We are also looking at the AI/machine learning space to see where our efforts in standardization might be surpassed by a machine’s ability to understand the meaning of data, and to represent that to the clinician to then apply human judgement. We also need to ensure that our efforts at interoperability serve the end user so the question becomes “where are technologies taking us that will simplify the process and bring out the value of the information?”
What are Some of the Challenges to Interoperability?
Interoperability remains a challenging. It’s about getting connectivity but also about getting normalization, speaking the same language. There is complexity on the claims and clinical sides and then we’re dealing with all of the policy and privacy mandates and requirements including who should be privy to information, for what period of time, for what purpose. We must understand what information means, share it only when it needs to be shared and share it in meaningful ways.
Privacy and data consumer identification are key. There must be ways to deeply and meaningfully de-identify information to allow us to find new meaning in the data, shared more broadly after de-identification. That is key and critical. There are also key roles for machine learning in understanding interfaces automatically so we can exchange data in whatever form we have it and then machine learning models will understand and correlate data on our behalf. Then the human decision maker can focus on what that data is telling us.
What are the Challenges in Legacy Health Records?
When you think of the amount of paper that exists and whether it can be consumed and deconstructed in way that we can understand the notes and dig into the unique identifiers, the effort of that process is huge.
The other challenge is that the ways we are capturing and structuring data have gotten so much better over time, with a focus on meaningful-use goals and interoperability standards and so how do you squeeze that older data into today’s view of the world.
Looking at aged data we need to look at how the patient was identified. It used to be by social security number. So how is the patient identified, how are we correlating old and new data. Data storage isn’t an issue, the issue is the difference in the lens and understanding how valuable 20-year-old data is compared with two-year-old data and who makes that ultimate decision.
Robots in Healthcare
There is ongoing development in humanoid robots with a view towards engagement, the experience of the end user, education and outreach. Instead of a kiosk that can only provide scripted and specific details, the opportunity to have an exchange that is more personal, to ask questions such as ‘tell me more about what I need and why,’ and to get that information back in a way that is more human and perhaps even adds an element of humor, is more approachable.
Thinking about use cases like pediatric education and outreach, how do you educate people about behaviors that would benefit them, sharing how they should think about nutrition, fitness, seeing their doctor, personal hygiene, care plan conformance and so on…. We’re talking about personal behaviors and sensitive discussions and information and the thinking is that kids and adults will receive information better in a technology world but through something more human and approachable.
Tell us About the Opportunity for Mobile Innovation
Mobile device awareness of lifestyle data is sort of “telehealth light.” There is mobile patient engagement around the calendar and regardless of location where the patient provides information that is clinically telling and helpful. All of that daily health data allows for proactive prevention, for diagnoses before symptoms occur, for the opportunity to improve quality of life and improve dollars spent.
The challenge is the wealth of information that is available. Does my doctor really want or need my health details daily? Probably not but a monthly update, sure, to know whether I am or am not following a care plan, whether there are any changes in my overall health or activity.
The ability to gather and standardize data, to have it protected by biometrics, it is an interesting opportunity as everyone is becoming more connected.
About Erick Peters
As Chief Technology Officer, Erick Peters is responsible for aligning Cognosante’s strategy, innovation, and solution development with current and emerging technology trends. Working within the Cognosante technologies group and across the firm for direct customer engagement, Erick supports numerous teams to lead the company’s technology evolution.
A technology-focused professional with extensive senior leadership experience and over 20 years of experience in enterprise solution development, solution architecture, and information technology security, Erick uses technology to solve functional challenges. His areas of expertise include technology innovation, enterprise architecture, systems engineering, software development, and solution delivery, supplemented by a decade of experience in health information technology. Erick has spent 15 years in senior technology roles, delivery successful IT solutions in support of active duty Service Members, Veterans, and beneficiaries of CMS services.