Data Delirium? Drowning In Data, Starving for Information and Insights

Stephanie Broderick:
Hi. All right, we’re going to go ahead and get started. So, hi everybody, my name is Stephanie Broderick and I’m the SVP of Provider Solutions at Clinical Architecture. And I am really excited for this particular panel. We are joined by our friends from Kno2. We’ll let them introduce themselves in just a minute. And today we’re going to be talking about data delirium, Drowning in Data and Starving for Information and Insights. And it’s pretty provocative title that Therasa came up with. And so we’re going to let her talk about what that actually means. Without further ado, Therasa, can you go ahead and introduce yourself?

Therasa Bell:
You bet. I am Teresa Bell. I sit as the president and founder of Kno2. We’re one of the nation’s QHINs and serve as the largest communication network in the United States.

Stephanie Broderick:
Alright, and Charlie?

Charlie Harp:
I’m Charlie Harp and I’m the CEO of Clinical Architecture.

Dr. Peter Schoch:
And I’m Dr. Peter Schuck. I’m the Chief Health Officer for Kno2. Happy to be here.

Stephanie Broderick:
And in their side gig, they’re all a bunch of comedians as you will soon find out. It’s true. All right,

Therasa Bell:
Pays a lot better.

Stephanie Broderick:
So Therasa, can you go ahead and talk about this problem of drowning in data and difficulty with getting insights?

Therasa Bell:
Well, I think it’s a well-known fact that data now the equation of connectivity for movement of data has largely been solved. So we see data moving at scale, which means that the challenge of that equation has moved downstream. Meaning now that we have to know we have all this data moving, what do we need to do with that data and how do we actually gain valuable insights? As my Chief Health Officer likes to say to me, Therasa as a provider, more data isn’t better for me. What I need is meaningful data at the point of care, at the time that I need it. I route the right patient at the right time and the right workflow and that’s what makes it meaningful. So it’s really about solving that equation.

Dr. Peter Schoch:
And I would just say as a provider, I’ve never asked for more data, I’ve asked for more information, and that information has been very specific. But what I tend to get now is a ton of information or a ton of data that really has no context. It’s not in my workflow, so it makes it very difficult to do what I need to do.

Stephanie Broderick:
Dr. Shock, we had a really interesting conversation with you as we were preparing and you kind of went back through a historical representation of the data. Even though we’re exchanging data, the data has been wrong in the past, even when we weren’t as digitized as we are now.

Dr. Peter Schoch:
To me it’s not necessarily about we need to have data accuracy. A hundred percent agree with that. We need to know that a blood pressure is an accurate blood pressure and that multiple readings are precise and close to that same measure. But the truth is healthcare has been dealing with inaccurate data for a long period of time and that inaccurate data can come from a patient who doesn’t relate a history correctly or doesn’t use the right terminology, doesn’t remember the year, the time, et cetera. It can come from me. Fat fingering an entry of blood pressure into the EHR instead of one 50, a hundred eye fat finger of blood pressure to 160 over 90. It’s bad data, it’s wrong data. So however it, because we’ve been dealing with it for a long time, the challenge is we have so much data now, it’s not so much trying to get rid of bad data and make it perfect, we’ll continue those efforts, but it’s about filtering out the noise and finding the data I need so my colleagues don’t ask for a CDA full of a bunch of different information that’s not relevant to their visit.

What they asked for is the CT scan result that was done in the emergency room last Tuesday so that they can evaluate appropriately the patient with abdominal pain in front of ’em or the (PT/INR) so they can approve surgery for that patient. Those kind of things. So there’s specific pieces of information we’re looking for in all the noise of data that comes at us.

Stephanie Broderick:
And when we were first talking about this, I referenced Kno2’s unique place in the market and I labeled it as post-acute care and you guys corrected me. So can you talk about the market that you cover and why that market is so unique compared to other markets, your traditional hospital markets?

Therasa Bell:
Yeah, I’ll take that one. So I don’t like the word correct, but it’s definitely post-acute in a lot more. But when started, when I started the company 13 years ago, we had very much of a targeted focus to providers that were not part of the equation for meaningful use. They did not receive incentive dollars. So we went after parts of the market to connect them to the continuum, including post-acute. So that includes facility-based care, home-based care therapies, so (PT/OTST), behavioral health, EMS, vision, dental, basically everything out of the hospital and making sure that those providers, while we were, I always say we went after the deep pockets of healthcare, those that sit in the health system and so forth, they solved that interoperability equation largely for themselves. We went after the rest of the healthcare to make sure that they could also connect. Knowing that as we looked forward 12 years ago that we had an aging population, a population that was growing sicker, we needed to make sure that those care segments were connected and moving data at scale because we had to address the healthcare equation for those particular sectors. So very much accurate that we cover the dominant player. We have roughly about 90% of (PT/OT), ST post-acute home where we bring them and connect them to the markets. But we also are very focused to the independent practice, smaller provider communities, make sure that they get connected also to the continuum

Dr. Peter Schoch:
And just building on that. So if you think of everything outside the hospital, generally speaking in a lot of those places, Medicare is a pretty good payer, whereas in the hospital, the commercial payers the better payer. So there’s a difference in terms of how they generate the revenue. Margins are much thinner outside of hospital facilities or acute care hospital systems. So there’s a lot of challenges and because of meaningful use and those margins, the investments in technology have not been as robust potentially as they have in the acute healthcare system market. There’s a gap there that we need to help close.

Stephanie Broderick:
When it comes to data usability and data quality in this particular space, what are some of the biggest pain points that you guys are seeing?

Therasa Bell:
Yeah, it’s a great question. And to Peter’s point, because they didn’t receive those incentive dollars, they really didn’t focus to many of the same things that meaningful use and so forth had the technology, the EHR providers focus to. So when we look at the data sets that sit in and each one keep in mind, I always say healthcare is not, people think healthcare, they think physicians. That’s what people kind of register in their minds. And healthcare is a wide word. So you look at PT, you have home, you have behavioral health, and each of those in themselves collectively had their own, they have their own sets of data that they manage. And when you look within the EHR, much of the data is still unstructured. So it sits in unstructured fields, it’s not codified. Some of the care segments don’t even have representation for coding. So it’s really about leveling up those groups so their data is exchangeable but meaningful those to the parties on the other side. So that’s the long-term equation that we took on to say, okay, we’re going to get ’em connected, we’re going to get ’em sharing their data, and then we need to level up their data so it’s meaningful to the care continuum and data coming at them that they get from the rest of the care continuum is also meaningful to them.

Stephanie Broderick:
And so Clinical Architecture and Kno2 have been talking, working on a partnership for the last four to six months. She just had to draw that out, didn’t she? Yeah, she did.

Charlie Harp:
Just a little salt, here’s a contract we’d like you to sign, it’s getting awkward, not to put you on the spot.

Stephanie Broderick:
And it really is around that space of leveling up. And so I know you guys did some outreach to your clients and can you kind of speak to the challenges that they’re looking for you guys to solve and how Clinical Architecture fits into that?

Therasa Bell:
Yeah, it’s definitely not, and forgive me for representing you here. When when I spoke with Clinical Architecture, I said, Hey, we’re going to bring on a unique set of challenges and need to work with you guys as a partner on how we address the needs of these market segments. And their needs probably has to do with a couple of things. One, where they’re at in their technology adoption, but also the set of providers that they have in their community. I’ll give you an example, SAT with one of our largest DHR providers that serve senior living, assisted independent living, an emerging area where care is actually happening in communities, but their needs are quite different than a home health provider. They have a need when they do an intake of a patient, often the patients walking in with their family. It’s a very different scenario, but they need information from the community key information that’s very, very shallow I’d say in terms of data, but medication, some of the basic information.
And then the rest of it is what can we do to make this care setting, this living setting for this patient meaningful. So looking at their social data, looking at different information that says in this community, this is how we’re going to make their life comfortable. Very different than a physical therapist that has a need to bring in core data, but they’re not, and maybe they should be, but they’re not looking as much at the medications. They’re looking at what procedure did they recently have, what just happened as part of maybe another visit at a physician’s office. Were they in a motor vehicle accident? There’s certain things they look for that become very different in each of the care segments that we represent. And that’s what we went to clinical architecture and said, this isn’t going to be terminology mapping, we’re not there yet. This group’s not there yet. It’s not that sexy, sorry to say, but we just have some basic data that we need to move into these care settings so they can transition patients meaningfully.

Dr. Peter Schoch:
Yeah, I would add to that and say that largely healthcare over the last 50 years has not been focused on the workflows that are important to providers. And I use that term ubiquitously not just to mean MDs dos, but anybody who’s on the frontline providing healthcare. Healthcare has been focused on those things and technology has not been focused on solving those workflow problems in the past. The data is unique, the way the data needs to be presented and when it needs to be presented as unique and we’re hoping that we can solve some of those problems. We always talk of this idea of interoperability being a composite of data movement and data magic data movement. That’s the pipes, that’s the connectivity, that’s our primary book of business. That’s what we do. But there is an opportunity to do some data magic as it comes across the network in transit, the network, so that we’re removing noise and transforming data into information and making it more easily digestible to have the end at the edge work their magic on that data, how it’s ingested, how they present it to the provider, those types of things.

Therasa Bell:
Well, I’d say there’s another part to that, sorry Stephanie. So we’re talking about the receipt of data into our care settings. They also need to be data givers. So if they want to participate in the networks, they have to meet their reciprocity requirements. So we’re looking at their data. That’s kind of phase two of our relationship to say what can we do with their data to make it meaningful back into the health system, back into the community when they’re serving up document types that aren’t necessarily even used. I’ll use an example. Emergency medical services. They transport a patient, I pick up a patient, I transport a patient, I create a data standard that’s called a nemsis file. Anybody know what that file is? We know, we know it intimately and it has a lot of data, but they transition of that nemsis file to a CDA into the ER as that patient’s being taken care of. Really, really important. In post-acute, they have assessments, right? Medicare mandated assessments. They’re actually composed into what’s called the Dell standard. It’s DEL. Anybody know that standard? Here’s another problem we have in healthcare. So here we have all these data types and these data formats. Once we get outside of mainstream healthcare, we have real problems to solve and real gaps to close in data and data closure.

Stephanie Broderick:
Yeah. So Charlie, I was actually going to throw it to, because I wanted to play on what Dr. Shock was talking about, right? Data movement and data magic. Can you talk a little bit about the data magic because I think that that’s where we come in.

Charlie Harp:
Absolutely. I think when you think about healthcare and data, data is produced by a lot of different people for a lot of different purposes, and the liquidity of that data, the usefulness of that data is something that really depends on the consumer. It’s like the blind men and the elephant. You can have people that, for example, a provider wants a summary of something they can find that’s useful. They don’t want to look at 1800 pages of historical data. They probably don’t want to pull up a genetic report and read the DNA sequence to decide what they should do next. And I think that one of the issues we have is that we selectively go after data. We selectively focus on quality, but the idea of data liquidity is all the data we produce should be useful. We should try to mitigate the uncertainty of that data, and that means the people producing data have to put enough work into it or work has to be put into it so that anybody receiving it can make use of it.

That’s the whole point of interoperability. So when you start thinking about exchanging and sharing information, if I’m producing data, I don’t know if the person’s going to use it, is going to be an AI, a large language model. I don’t know if it’s going to be a provider or someone, a physical therapist. And so the idea is we really have to be more focused on the usability and quality of the data we produce. Because one of the sad things about healthcare is people care about the data they get. They don’t so much care about the data they send. And so if we can get to a place where we reduce the amount of work and at the very least have visibility into the quality of the data, because the other thing that I think happens a lot is that people are in denial of the quality of the data.

They think the data’s good, but as we mu things together, if we create data for particular purpose and we try to translate that into another purpose, I don’t know how many people looked at their own medical record and said, I don’t have that, or what is this thing? I’m not allergic to that. It’s because the way the data moves around. And at the end of the day, the other big problem is there is no data steward for our data. Everybody’s got to deal with what they have to deal with. And in Clinical Architecture, our focus has been how do you provide better quality across that entire ecosystem and how do you make it workable because there is so much data, that’s the other problem. There is so much data and you can’t point at a provider or a patient or someone at an insurance company and say, oh, by the way, you’re responsible for making this patient’s data good. It’s kind of a collective effort that we have to work together on.

Dr. Peter Schoch:
A couple of things, if I can’t say on both of those points, one on trace’s point around the data and the post-acute space and reciprocity, what they share back with the network, there is a uniqueness in the post-acute space that is incredibly important to understand as we begin to understand that 80% of what determines whether you’re sick or healthy and therefore how much healthcare service you need and how much it costs to care for you is related not to the presence or absence of clinical disease, but it’s related to social determinants of health, comorbid behavioral health conditions, environmental conditions and so forth. And you think about the amount of time that a home care nurse spends in the home of a patient versus the time I as a primary care physician spent with that patient in my office four times a year for 15 minutes, maybe 30, where they’re in there for an hour to two hours, two to three days a week for 60 days. There is an enormous amount of data that’s incredibly important that we haven’t created great standards in terms of recording and then sharing, but we have the potential to share that back and it really will impact the healthcare system in a very positive way as well as patients.

Charlie Harp:
I thought you said you didn’t want more data.

Dr. Peter Schoch:
I don’t want more data. I want the right data, I want information. And that to me is we’re going to flush

Therasa Bell:
The system,

Dr. Peter Schoch:
Separate that out from the noise. The other thing, I think that from my perspective, it goes back to I think what Charlie was saying about data. I’m looking for very specific things that are very specific to a care setting, a provider type, and maybe even a diagnosis. And when we get good enough to take the data that’s coming at us, filter it in a way that provides that information to the right provider at the right time, man, now we’re really moving forward. But I think we’ve got a lot of work to do to get there.

Therasa Bell:
There’s kind of a unique phenomena happening where we’ve, based on our data needs, based upon what we have known them to be historically, and as we speak with our different provider communities, and I’m going to use PT as an example, again, they have some very core data needs that they’ve asked for. So we have some basic data needs that we look for and then we say, well, what if you had access to, for instance, their social information? What if you had access to their medications? How would that change your plan of care? How would that change what you are doing? And it’s like they hadn’t even thought about it, but as we take PT and we take MSK models and we drive them back into primary care, those things become very relevant. But opening up new data outlets for people, as much as we say it’s about the right data at the right time, there’s also opportunity to bring more data in that’s meaningful that I’ve never had access to before, that will impact care dramatically in terms of what I draft for a care plan. And those types of watching people’s eyes open as we’re sitting with PTs or home providers are saying, you mean not only can I have basic data like their meds, but I can also see more about this patient in a meaningful way That’ll absolutely change what I do for care delivery.

Dr. Peter Schoch:
I just keep parsing this word data and I know it’s a big thing, a Clinical Architecture, big thing that you use all the time. As a provider, I really don’t want more data. Data to me is just a bunch of data elements that don’t mean anything to me. Information is those data elements in context presented in a relevant setting that allow me to parse them appropriately to make clinical decisions. When I do that regularly enough, it becomes knowledge and knowledge over time becomes wisdom. Physicians want that lifespan. I don’t want to be down here spending my time down here. I want to spend my time between information and knowledge gain wisdom because that’s where we impact our patients. So I think about I’m giving

Therasa Bell:
You more data,

Dr. Peter Schoch:
It’s happening. I don’t want more data. Give me the right data. Please give me the right data. It’s happening.

Charlie Harp:
We’ll try to make it right. If you pull us in, we’ll try to make it information for you.

Dr. Peter Schoch:
I think it’s really important. That’s exactly right, Charlie. I think that’s really important. I think we underemphasize that piece, right? Aside from data accuracy, just take deduplication consolidation of information, if you guys can do that. As it transits the network, you’ve lessened my workload significantly and allowed me to focus on what you do and need to. I do want to focus on this. We’re focused on outcomes, and I’m a clinician, and I hope you spot me that I got into this to do the right thing for patients and improve clinical outcomes. But we also need to understand healthcare as a business. And there are business fundamentals that giving information at the point of care can really improve whether it’s productivity, whether it’s provider burnout, any of those things. But they’re very significant and they have a real ROI in healthcare. And I have to say the translation of clinical information at the point of care is the most transformational thing that can happen to healthcare in my lifetime. I’ve been in healthcare almost 40 years as a provider health system executive, and now working for a technology company, I don’t understand clearly, but it really will be the most transformational thing we can do in healthcare.

Charlie Harp:
Well, and if you think about it, we’re at a point where the number of providers is shrinking the aging, the population is aging. There’s more comorbidities, more things happening. We have access to incredible amounts of compute at this point. We have generative ais, we have analytics, we have all these tools, and there’s great potential for technology to take some of the burden off of a provider and bring them insights of things they just don’t have the time to know or the ability to see in the small amount of time they have to care for patients. And if we can’t get the data information conversion, all these tools are either going to give us information that leads us in the wrong direction or not really help us because there’s only so much time that a human being can spend trying to work through something. So to me, the biggest challenge we have, and the reason why it’s so critical right now is if we don’t do something like this, all this investment in technology that we’re putting across the whole continuum of healthcare is not going to pay off.

Therasa Bell:
We don’t have a choice. I mean the healthcare system, besides the technology, we’re on the cliff. This healthcare system is on the cliff of bankruptcy on multiple fronts, and we have to address

Charlie Harp:
That. You’re going to panic people. It’s okay.

Therasa Bell:
It’s bankruptcy. It’s okay, bankruptcy. We don’t have a choice. We’re all doomed. We’re backed into a corner. And normally those types of environments create change fast. And that’s where we’ve demonstrated our ability to change fast with covid came back out of that. But we’re in this position where we have an urgent need. We have to fix healthcare. We don’t have a choice.

Dr. Peter Schoch:
I would just add one thing because I think it speaks to the relationship between Kno2 and Clinical Architecture and the value of that relationship. If data movement and data magic is key to interoperability, and that’s the full fruition of interoperability, the ability to do the work on the data as it transits the network is absolutely critical to achieving those ends. There’s no way we’re going to do it without that. It’s, it’s a perfect marriage.

Stephanie Broderick:
Great. Well, you actually kind of teed me up for it. I was going to ask, how does the partnership between Clinical Architecture help providers move beyond just using the data to actually getting the insights from the data? So how do we take them from drowning to actually being able to use and leverage their data?

Dr. Peter Schoch:
I would tell you, I think we’ve touched on a lot of those things, and I’ll summarize my takeaways and love to have Charlie and Therasa add to it. But number one is removing the noise. Absolutely removing the noise by de-duplicating, consolidating information as it comes through. I think that’s number one. Number two, enhancing the data where we can, improving the quality of the data and then presenting that data in a manner in which it is most easily digestible by the edge system, whatever that system is, the R, et cetera. And then I think the edge has to come into the play and the edge has to say, okay, we’ve got good data in a manner we can digest. How do we present that now to the person who’s using that data such that it’s in their workflow, they don’t have to go look for it and that it’s timely. They can make a decision in a timely manner. I think those are the things that I look for in that regard.

Therasa Bell:
I would say there’s Kno2 underneath our API, we have about 70 EHR vendors that have one or many different EHR products. And again, they represent the space as touched on. And what they have historically done to manage the data problem is they haven’t. So when they integrate to our API, we send them back, let’s say five to 10 CDAs on a patient. As that patient’s referred in, they’re converting it to A PDF every one of them. And so then they get attached in the patient’s record and they hope a clinician happens to find the right information as they look through it. And that was part A of the interoperability equation. We bring in part B, not to make you in the lesser position, but together we solve the interoperability equation. Where in line, now I bring those CDAs in to Peter’s point is that we pull out the data that we need and now we make it consumable to that technology vendor because they have a huge weight. They’ve never touched data like this. PDFs were the easiest things because what they could bring into the workflow, now I can get to the data I need and get there fast to start really impacting healthcare. And that combination of the partnership does that.

Charlie Harp:
I also think that one of the things that we struggle with as an industry, and we’ve been working for the last year on this Patient Information Quality Improvement Framework and the PIQI Alliance. And what’s funny is when we say things like, well, we’re going to measure the quality of the data in an objective way, so we can tell people your data quality is 65%, you’ve got 27 critical problems that stop your information from being usable when you share it. And what I hear over and over again is no one’s going to care and no one’s going to fix it. But the truth is we have to care and we have to fix it because just like we want to receive good data, we have to be a good neighbor. Just like when you guys say if you want to get data, you have to give data, but the next step is it has to be good data.

And the question I always ask is most people don’t really measure the quality of the data that they’re getting from someone. So the reason they may not be fixing it is because they might not know. Because when they originally started sharing the data, they were doing it because they had to do it. They had to meet certain requirements, they had to check the box to participate in meaningful use. They didn’t really wonder if the data was actually going to be consumable or usable by somebody. But now we’re at the point with all the pipes we’re setting up to share with each other where what’s the whole point of sharing data if nobody can use it?

Stephanie Broderick:
That’s right. And to go back to Therasa, what you were talking about with reciprocity that’s come up a couple of times during the show, are they required to reciprocate and provide their data back?

Therasa Bell:
Yes, absolutely.

Stephanie Broderick:
Okay.

Therasa Bell:
They have, there’s two sets of requirements and the market set. If you have a certified technology, you’re required not only to respond, but also by 2026 conform to the USCDI present that back, that is not true yet of non-certified EHRs. But they still, if they want to participate in the networks, they still have to respond. That reciprocity requirement for anybody, any of our participating in those networks, you have to respond.

Stephanie Broderick:
Okay. Now, you guys have obviously gone through the difficult work of becoming a QHIN. How has that changed this equation? Has it made the data overload better or worse?

Therasa Bell:
It’s just magnified it. I mean, it makes more and more, right? I mean, TEFCA, as it starts to get its legs underneath there, already see millions and billions of transactions going across the other networks like Care Quality, TEFCA, makes the problem even larger. If you want to say it’s a problem, it solves one part of the equation, but it makes the problem larger. And so that data in transit transformation critical with TEFCA coming on top of that.

Stephanie Broderick:
Okay. And Charlie, can you talk a little bit about consolidation and deduplication and what we’re able to do in those areas?

Charlie Harp:
Yeah. I think when you think about the transformation of data, there’s the notion of I’m getting multiple messages and I want to take those messages and combine them into a single stream, and then I want to roll them up to a point where I can decide if I can consolidate that information. And it changes based upon the domain. It changes based upon the use case. The whole idea of summarization might be take the 795 codes that could mean diabetes and just roll it up. I just want to know if the patient’s diabetic, I don’t need to know all the variation of diabetes they’ve experienced over their entire life in every terminology that a provider has selected. I think that when you think about this, the other problem we’re starting to have or I think we’re going to have is people sharing data that was shared with them.
You get this whole idea of conceptual echo, which really compounds the duplication problem because you start sharing data with somebody, they start sharing your data back with you. And so that’s one of those things where I think as an industry, you probably have to stop sharing data. That’s not our data and we have to hope, or I wouldn’t say hope, I would say expect that the other people that are data producers are sharing their data within the same ecosystem as we are, so we don’t have to reshare their data because it makes Peter’s problem worse, because now without the ability to consolidate and de-duplicate, he’s going to get the same lab result from 14 different places. He may not even know where it originally came from.

Dr. Peter Schoch:
And I want to be cautious a little bit from a provider perspective. I agree with all the comments that have been made. I think, however, I don’t want to leave anybody paralyzed to not move forward with data exchange or connectivity. And the reason I say that is because there is enormous work to be done in data usability, data integrity and data magic to get it presented in a way that needs to. But there is enormous value in exchanging the data that we have now and moving forward with the data that we have now. And I don’t want us to be paralyzed in a moment of we’ve got to get to perfect before we make any progress at all, because we’re going to kill the healthcare system in doing that, right? We’re not going to be available to do what it needs us to do. If we wait for perfection, we need to do it in parallel.

Charlie Harp:
We can’t improve if we don’t start.

Therasa Bell:
That’s right. Yeah,

Dr. Peter Schoch:
That’s exactly

Therasa Bell:
Right. Well, it’s happening today, right? So people say, oh, we don’t want to do that until we have really perfection. It’s like, well, the data’s being shared today. It’s just being done in ways that are so burdensome and expensive, either in fact-based workflows or point to point connections that’s being done. So like it or not, it’s being done. So why don’t we use what we have to share data in its imperfect state, albeit imperfect, and continue to make progress. As Charlie pointed up.

Stephanie Broderick:
So we hear this a lot at Clinical Architecture, that FHIR solves everything. So I’m going to ask you guys, I probably

Therasa Bell:
Should my microphone down leave.

Stephanie Broderick:
So I love the fact that in the conversations we’ve had, they get a little bit saucy. So I’m throwing out a saucy question. What are your guys’ thoughts? Does FHIR solve everything?

Dr. Peter Schoch:
No.

Therasa Bell:
The fascination with FHIR is fascinating to me. It’s a 14-year-old standard. So just to be clear on that. But bad data from the source is bad. Data is bad, data is bad data. Whether I put that into a FHIR resource or I put that into a CDA document. But related to the FHIR question, FHIR has very specific use cases that are very good. So does sharing a document, sharing a CDA? Absolutely. And it’s a combination that will solve the healthcare equation. It’s not an OR statement, just like interoperability. Communication standards aren’t an OR statement. We need push-based communication. We need query-based communication. We need it all to cover the needs of healthcare. And it’s never or, but we love, we love the bandwagon stuff. We go to the next FHIR absolutely has its place. It is not the end all be all, and it is incomplete.

Charlie Harp:
I think that when you think about interoperability, there’s physical interoperability, which we pretty much got under control these days. We’re not running around with floppy discs anymore. We’re not using auto dials to call to each other with a modem. There’s canonical interoperability because every single system out there has its own schema, its own model, the way it collects data. And so you take data out of your schema, you canonically align it to some kind of message format or a syntax, and you do the best you can to line it up into that syntax. And then you also have to say, well, the codes that I use in my silo are different than the codes you use in your silo. So I have to do that alignment as well. FHIR is good because it creates a standard message container. But I’ll give you, for instance, the other day we were looking at a problem with a FHIR message moving through because the ethnicity and marital status codes weren’t showing up.

It’s because they were in OBX, they were result messages in the source system, so they weren’t being canonically aligned into those buckets in the FHIR model. So FHIR is just an envelope and every other standard, it’s an evolving envelope. So you can’t just say, oh, I’m going to make everything FHIR. I was in a meeting yesterday where somebody said, for PIQI Charlie, why don’t you use FHIR? And I said, FHIR right now is 13% of the traffic in healthcare. Everything else is CCDAs V2, and I can’t create something that’s going to be useful in 2030. I need something that’s going to be useful right now. And then the next question was, and I’m going to say this out of school, but Stan Huff was in the room and the person just kept hammering me FHIR, FHIR. And Stan raised his hand and said, what version of FHIR? Version three, version four, version five, version six. And I mean, that’s the whole point of a standard. A standard gives something that we can all agree on for the exchange, but it’s not a permanent thing. It’s a container. And we have to decide how we put the data in the container, how we get out of the container and how we put it to work on our own ecosystem. So it doesn’t solve all the problems. It gives you a solution for an agreement of how we’re going to share data along with things like USCDI.

Dr. Peter Schoch:
Love the simplicity of the container analogy because it’s not only there are various containers that you use for different situations or different circumstances and FHIR, CCDA, et cetera.

Charlie Harp:
There was a bunch of ’em I never heard of that Therasa started with earlier. I’ve never heard of those either. Charlie, I’m not sure they exist. The quat loop, the I don’t. Guadalupe,

Stephanie Broderick:
Is that what you said?

Charlie Harp:
I’m making stuff up. That’s a river, I think.

Stephanie Broderick:
All right. I’m going to put out my final question. So what does the landscape look like over the next three to five years for post-acute care out of hospital care, the market that you guys represent?

Therasa Bell:
I’m going to take it from the technical side. Yeah, that’s great. No, I’m going to do clinical. I decided I’m going to do clinical. You do that,

Dr. Peter Schoch:
You do that, and I’ll do the technical. We’ll see how it goes. We’ll see how it goes.

Therasa Bell:
I’ll say from post-acute specifically, I would give you different answers. Three to five years is one that’s not that long. We’re already in Q2 of 2025, which is scary. But three to five years is leveling up technology, getting on the networks, getting their data really usable to be more and more usable. So it can be translated at the point of care. And it’s also about possibly getting them incentive dollars. So they can do all of that, but three to five years is really about leveling up that side of the market so they can be on a level playing field with the rest of the market and get there.

Dr. Peter Schoch:
So I don’t know what calendar you’re operating by, but I’m still in the first quarter. I just gained three weeks by looking at my watch. I was really, let’s took about two years off my life. I’d say from a clinical perspective, just a healthcare system perspective, the time for post-acute has never been more important than now. And their prominence in the healthcare ecosystem has never been more important than it’s going to be over the next decade and a half for all the reasons that you hear an aging population that will age into Medicare, Medicare advantage and will utilize services out the side, the hospital at a much higher rate than we have traditionally seen over the last two to three decades in healthcare. The importance of there being able to be bi-directional exchangers of information in that ecosystem is going to be incredibly, incredibly important. Remember that we all really sit down and think of epics and others as systems of record with all the valuable data that they’re holding. Well, every post-acute EHR or every EHR that’s in the ambulatory setting is going to become an equivalent system of record if they’re not already because of the volume of services they’re going to be providing. And they’re going to need to be capable of bi-directional exchange at a high standard so that the information actually is there to serve the providers who care for those patients.

Therasa Bell:
To that point, we’re bringing on in the next two years by contracts, we have contractual obligation, our EHR vendors serving those spaces, we’ll be bringing on 150,000 organizations live on TEFCA in particular on the TEFCA network for communication. So you’ll see a vast shift in the focus is to his point on Epic and getting all the focus, it’s going to absolutely shift and say, there is a massive amount of data sitting here and Charlie’s job is going to get a lot harder before it gets easier, and that’ll be our fault.

Charlie Harp:
The story of my life, my goal in the next three to five years is I want every single system of record that is pushing data out into the universe to have a score that allowed a credit score to determine whether or not their data’s actually valuable as data becomes monetized, whether or not their data is useful, and whether or not it’s worth connecting to them. I think that right now, I’m an optimist. I’m a little Pollyanna when it comes to people. I think that if people know their data’s bad, they’re going to want to make the data better. They’re want to be a good partner in this whole ecosystem because there’s no point in connecting all these pipes if what we’re pushing through it is not potable water. We want to be able to deliver water through our pipes and not sewage through our pipes. We want people to want it. We want people to drink it, and we want them to share it with us so that we can make it better. And my goal the next three to five years is to at least make that visible so you know what you’re drinking when you’re looking to pull something in.

Therasa Bell:
He didn’t say that in prep.

Charlie Harp:
You

Therasa Bell:
Didn’t use that in analysis. When

Charlie Harp:
You’re thirsty, you’ll drink anything. So that’s my goal. I really would like it because I think if people realize what’s going on, they’re going to work to make that content better.

Stephanie Broderick:
All right. Any final thoughts before we go to questions from the audience?

Dr. Peter Schoch:
We’ll know who you are if you ask a question. There are only a few of you there. Yeah,

Stephanie Broderick:
It’s going to get awkward. All right. Do we have any questions?

Therasa Bell:
Do we have anybody that wants to sing?

Dr. Peter Schoch:
Anybody have a joke they want to share with the group? No.

Charlie Harp:
Three Informatics is walk into a bar.

Stephanie Broderick:
Oh my God. Have you guys ever noticed how many analogies around interoperability somehow tied to water and pipes? Water and pipes?

Therasa Bell:
I’ve never got the sewer part of it, but now I did. That was,

Dr. Peter Schoch:
That was incredibly graphic and concerning to me.

Stephanie Broderick:
Incredibly graphic. Alright, so we’re going to go ahead and wrap this up. I’d like to thank our wonderful panelists and our friends from Kno2 for joining us on our Data Quality theater. And we are really excited about what the future holds with a partnership between Kno2 and Clinical Architecture.

Dr. Peter Schoch:
Thank you all very much.

Stephanie Broderick:
Thank you.

Dr. Peter Schoch:
Thank you. Thank you.