Faces of eHi

Laura Crawford

Laura Crawford, M.I.S.

Advisor, Global Patient Outcomes and Real World Evidence

Eli Lilly and Company

Q&A with M.I.S.

What are the most pressing challenges facing us in healthcare today?

I believe the top two most pressing challenges are these:
1. Geographic and economic disparities in access to quality care.

2. Inadequate impact of innovation due to interoperability barriers: it is still true that it takes an average of 17 years for a medical innovation to become regular practice in care. All stakeholders -- patients, providers, payers, research – will win if we improve knowledge transfer in our health ecosystem.

What are the steps needed to transition to precision medicine?

We need to increase the medical knowledge base by evolving the clinical trial model to become more patient-centered. We need faster recruitment, better flow and impact of trial evidence for individual patients, and we need for clinical trials to become a clinical care option.

Precision medicine is in large part about accurately applying population health insights to individual health decisions. We need technical and cultural interoperability so that we can access intelligently filtered, contemporaneous, relevant evidence at the point of health decision.

Because most of our health behaviors take place outside the healthcare delivery system, we need to be able to easily connect patient-generated and other real world data to clinical data so that we can make decisions based on the whole data story of each individual patient.

Where do you see the future of healthcare?

I believe the future of healthcare is a rapid learning health system where research insights flow more efficiently to the point of health decision and our experiences, preferences, and values as patients better inform research so that the health ecosystem can become more patient-centered, learning from real experience. Research and practice will evolve to be more patient-centered and data and insights will flow efficiently and appropriately between them.

In this learning health system, our complete medical histories will be readily available -- wherever and whenever needed. We will begin to use data from our health behaviors that take place outside of delivery and research as part of our input to shared decision-making. Patients will have nimble and flexible control of our own data. The world’s best medical evidence will be available and intelligently filtered at the point of decision, translating population insights to the individual patient.

In the U.S., the Office of the National Coordinator for Health IT has an operational learning health system as its pinnacle goal for 2024; building of this network of networks is beginning!Read more..

Harold Paz

Harold Paz

Executive Vice President and Chief Medical Officer


Q&A with

What are the most pressing challenge(s) facing us in healthcare today?

One of the challenges we are facing is the shifting nature of “who” is directly buying healthcare. We think increasing numbers of marketplace participants will be making their own buying decisions in the market, with an increasing amount of choice as the market moves. Payer-based relationships are also changing. Payer-hospital agreements (fee-for-service) are migrating toward a system of community-based collaboration (local health care system faces a value-based payment structure).

In the next 5 to 10 years, how do you see the U.S. managing the health of a population?

Looking at this problem from an insurer’s perspective, we see that our role is evolving from a fee-for-service and business-to-business focus to a consumer-driven focus on value. Our success is dependent on our ability to partner with providers. We think the same dynamic will be present industry-wide. As part of our solution, we developed Healthagen, an Aetna company, to offer a wide range of health information technologies, care management services and population health management solutions designed to improve health care quality, control the overall cost of care and make it easier for patients to engage in their health care. Clinical integration will also be essential. Through our clinical integration services, we help enable care collaboration, eliminate waste and inefficiency and deliver high-quality outcomes. Last, we see the need and are taking steps to enable care management services that manage patient care holistically through a focus on utilization and disease management, drug therapy and personalized health support.

Where do you see the future of healthcare?

We see a health care model of shared accountability. Accountable care provides a path toward financial stability. We believe there is already enough money pumped into the healthcare system. As much as 30% of spending is waste. We believe a hallmark for the future of health care will be improved overall efficiency. Our goal is to help providers create incremental value by becoming more efficient, improving quality and satisfaction (what we call the triple aim). If we are successful, there will be plenty of benefits to share with providers, members and plan sponsors. At Aetna, we are ready to aid providers in shifting as quickly as they are capable of moving to a value-based model.Read more..

 Dan Haley

Dan Haley

Vice President, Government and Regulatory Affairs, Assistant General Counsel

Athenahealth Inc.

Q&A with

What is the most pressing interoperability challenge today?

The greatest challenge to interoperation in healthcare is the relative lack of will to interoperate. There are a number of sub-challenges wrapped up in that: the continued lack of a compelling ‘business case’ for interoperation, for one. Well- intentioned law and policy that inadvertently discourages information sharing, like overbroad application of the Stark Laws and the Anti-Kickback Statute, or the unnecessarily complex maze of hoops and hurdles that is HIPAA compliance, for another. And of course there is the unfortunate fact of our nation’s anachronistic health IT infrastructure, which still relies primarily on pre-internet technology platforms. Happily, increasing market pressure for systemic interoperation is steadily generating the will to overcome each of these sub-challenges.

What does athenahealth do differently to support providers?

In a word: everything. Our service model is as different from a traditional, static software EHR as an iPad is from my grandmother’s Sony Trinitron TV. We could watch Lawrence Welk re-runs on either one, sure, but the range of services available on the iPad is vastly larger. Because athenahealth offers its services on a cloud platform, we are in contact with our clients—literally—24 hours a day, 365 days a year. We interact with care providers in real time, helping them use our services to their highest potential. Anyone who doubts that basic assertion should take a look at our clients’ Meaningful Use attestation rate (98% for 2014 Stage 2, significantly greater than double the national rate). Better yet, come to our headquarters in Watertown, MA and reality check me in person. Open invitation.

If you could make one policy decision to change the healthcare system, what would it be?

Nearly all health IT policy proceeds from the assumption that a heavy government hand is necessary to correct the obvious and pervasive deficiencies in health IT. I think that perspective confuses cause and effect to some extent. Is it a coincidence that the only genre of information technology that has an entire federal bureaucracy dedicated to it lags roughly a decade behind the rest of the information economy?

The proposition that broad-based care coordination is necessary to successful health reform is one of the few true points of bipartisan agreement in healthcare policy. I think it is beyond debate that a robust, interoperating health IT system is an essential precondition to achieving broad coordination of care. If I could dictate one policy decision, I would have the federal government declare victory for the MU program based on its success in accelerating adoption of health IT, and then step away to let the market ‘solve the interoperability problem.’ More has happened in the past two years to move toward a truly interoperable ecosystem than happened in all of the prior years. I am very concerned that in its haste to define a policy solution to a problem that is already being solved in real time, the government will inadvertently stall or even reverse the progress that has been made by voluntary industry associations like the CommonWell Health Alliance, which is today enabling information sharing between and among competing vendors’ EHR platforms.

Barring that, government should extend the same Stark and AKS waivers broadly that it applies within the discrete contexts of value-based models (like ACOs), allowing for a sustainable, two-sided market for information exchange. One way or another, government should get out of the way and let the market work.Read more..

Drew Schiller

Drew Schiller

CTO & Co-Founder


Q&A with

What is the most pressing challenge facing data exchange? How is Health IT related to that challenge?

Patient-generated mobile health data is a nascent and rapidly growing market. Healthcare innovators, including the world’s largest consumer electronics companies, are leveraging exponential increases in hardware capabilities to yield new data types and measurements that have never been available to the provision of care. The most pressing challenge facing data exchange is building an infrastructure that can transmit, accept, and utilize these dynamic, disparate data sets, while maintaining context and reliability.

What does Validic do to impact or help this challenge?

Validic connects patient-generated data from digital health apps, wearables, and in-home medical devices to the healthcare system. Validic provides one simple connection point that standardizes and normalizes the data, enabling the client’s platform to remain flexible to deliver all information relevant for patient care. Without Validic, healthcare companies must choose which devices or platforms to support given limited resources. With Validic, healthcare companies can remain device- and platform-agnostic, receiving patient-permissioned data from any device, application or platform the patient chooses to use.

Finish the sentence: eHI is important to me because...

…it brings the right stakeholders to the table to help align incentives around how to improve patient care. Many of the most intractable problems in healthcare can be traced back to misalignment of near-term objectives.Read more..

Mario Hyland

Mario Hyland

Senior Vice President & Founder, Inc.

Q&A with

What is the most pressing challenge facing data exchange? How is Health IT related to that challenge?

The greatest challenge facing data exchange today is ensuring a consistent standards-based implementation that allows organizations to share and be interoperable. The standards are evolving. That means we need to work to adopt the latest standards while also ensuring backward compatibility until everyone catches up.

What does, Inc. do to impact or help this challenge?

AEGIS offers the Developers Integration Lab (DIL), an automated, open source, cloud-based, always available, Testing as a Service (TaaS) solution for health information exchange standards conformance and interoperability testing.

Finish the sentence: eHI is important to me because...

…it provides direction to an industry badly in need of it. eHI is in the process of supporting the industry in developing a number of roadmaps for 2020. One of those is around interoperability.Read more..