Enabling Healthcare Interoperability, Will Tesch, HealthLX
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This document provides an overview of HealthLX, a company that aims to enable healthcare interoperability. It discusses the current challenges around data integration and exchange in healthcare. HealthLX offers a managed healthcare integration platform (HIP) that can connect different data sources, including claims, EMRs, devices, and applications. It also provides data governance and integration services to help automate processes and enable use cases like population health analytics and case management. The platform aims to help payors and providers achieve better care coordination and support the Triple Aim of healthcare.
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Enabling Healthcare Interoperability, Will Tesch, HealthLX
- 2. Expectation Management • I am not a Clinical Trials Expert • I am a fan…. for the work Foundry Health with Brock, Josh and the team. They are disruptors in an industry that needs massive disruption. • I built a professional services firm that focuses on solving big ugly problems. We have several healthcare customers and chose to solve the biggest and ugliest problem in Healthcare – Interoperability with a managed services offering called HealthLX. • With that…. I am about to bore you. 10/14/17 HealthLX Confidential 2
- 3. Data-Integration Landscape … today. • Tools – Online (Redox) or On-Prem (Intersystems, Pilotfish, etc.), Custom coding still prevails… • Data Exchanges (System-centric) • HIEs are largely failing because they’re incentives are not ‘Patient-centric’ • EHRs are siloed but claiming broad capabilities • ACOs require Payer-Provider integration beyond traditional use cases of shared PHI interchange • Evolution happening with new repeatable data design patterns as a managed service. • ‘Dataflow’ Standards continue to be shifting (FHIR, Commonwell, Others); Process flow standards are slower to adoption. • Blockchain movement is absolutely gaining momentum • Legacy will not disappear for a long….. Time. à Poor Governance • Externalizing Reporting for compliance or contract reasons requires data agility from source systems. 10/14/17 HealthLX Confidential 3
- 4. A few key realities… 10/14/17 HealthLX Confidential 4 Interoperability and data exchange are driving technology buying decisions at 36% of healthcare organizations ~ Survey by TechTarget The International Committee of Medical Journal Editors (ICMJE) believes that there is an ethical obligation to responsibly share data generated by interventional clinical trials because participants have put themselves at risk. In a growing consensus, many funders around the world—foundations, government agencies, and industry—now mandate data sharing. ~ ICMJE Obtaining an individual’s consent is strictly tied to the Helsinki declaration7,8(http://www.wma.net/en/30publications/10poli cies/b3/index.html), which provides the good practices that should follow any stakeholder conducting a clinical trial. Point 26 of the Declaration states that each participant should be informed of the aim, methods, sources of funding, conflict of interests, affiliations of the researchers, anticipated benefits and risks and post-study provisions, and these conditions must be met to obtain freely-given informed consent. Among those and of major importance, informed consent should be documented by a signed and dated written consent, which is particularly meaningful with Blockchain technology. ~ F1000 Research Don’t worry about people stealing your ideas. If your ideas are any good, you’ll have to ram them down people’s throats ~ Howard Aiken
- 6. The Disconnect Today’s Healthcare System includes many disparate technologies, that creates: - Multiple siloed systems & sources of truth - Duplicate processes - Lack of system openness - Lots of ad-hoc w/ no governance - Lack of scalability - Complex data patterns & sets (administration, clinical, financial, lab, radiology, pharmacy etc.) How do I get that to fit into today’s fast-paced, consumer driven market: - Need accurate & up-to-date information at finger tips • Demographics: Patients, Providers, Facilities, Payors • Transactions: Billing, Administration, Clinical - Need to remain compliant (Not only security, but also data quality) So I can: - Automate operational processes - Pull multiple data sources together to determine clinical, population & operational analytics - Ensure the best patient care © 2016 HealthLX | Confidential
- 7. The ‘Connect’ – Achieve Interoperability We believe in supporting the Triple Aim of healthcare: 1. Improving the patient experience of care 2. Improving the health of populations 3. Reducing the per capita cost The HealthLX Platform is used for: ü Payor Operational Efficiencies (Drive Automation & Lower Operational Costs) ü Case Management (Up-to-date patient & clinical data at my fingertips for better care) ü Revenue Cycle Management (Real-time transactions to promptly collect payment) ü Population Health & Analytics (Ingest multiple data sources to preform analytics) ü Lab Data Ingestion (Ingest Lab data into Payer Data Vaults for Member Analysis) © 2016 HealthLX | Confidential
- 9. Data Connection & Governance Manage & Monitor Data Flow at the Transaction Level Manage Connections & Integration Environment Connect Critical Data Sources & External APIs Connect & Manage Data Transactions Complex Data Orchestration Technology - Open source data management engine, supports high volume transactions - Connector libraries - Custom - Industry standards - Third-party/community - Data flow monitor & system management Services - Architectural & data flow guidance - Implementation & integration services - On-going support & management services © 2016 HealthLX | Confidential
- 10. Sales Support Integration Services and Support On-going Support Enabled by full service & support portfolios, branded as you wish Partner Support Client Support We are a technology partner Partnership Development - Licensing - Private Labeled - Configuration Partnership Services - Implementation Support - Integration Support - Ongoing Client Support - Monitoring Support Partnership Management - Sales Support - Product Support - Technical Planning © 2016 HealthLX | Confidential
- 17. Interoperability Payor Management ü Imagine receiving patient & clinical data ahead of claims submission! Case Management ü Imagine knowing where a patient is in real-time and receiving up-to-date information as they move around treatment! Revenue Cycle Management ü Imagine receiving scheduling data ahead of time, to receive payment the day of treatment! Population Health & Analytics ü Imagine feeding your analytical tools with clinical, patient wearable & claims data! © 2016 HealthLX | Confidential
- 19. 10/14/17 HealthLX Confidential 19 Partner HIT solution as a Platform - Integrations 19 Simple ADT Complex ADT CCD PDF Import CCD Data Import CCD PDF Import Note Transfer Task Transfer In-Home Monitor Interpreta Integration TruCare Platform 300+ Web Services TruCare Linx TruCare Linx Benefits § Advanced workflow configuration § Data governance § Upgrade maintenance EMRs Home Services IVR Systems Member Portals Mobile Apps Provider Portals HIE In Home Monitoring RX Apps Governance Error Remediation Data Cleansing Message Enrichment Simple ADT CCD PDF Import CCD PDF Export Note Transfer Task Transfer Custom Connector Development Production Roadmap Legend:CRM Integration Complex ADT
- 20. Member Status Check Member Service Authorization Claim Submission Member Health Information • Call • Fax • Portal • Call • Fax • Portal • .PDF Document • Manual Entry & Review • Verify Member Info • Verify Provider Info • Verify Benefits • Subject to Error • Not Timely • Difficult to Navigate • Inefficient Payor OperationsProvider Operations © 2016 HealthLX | Confidential Current Processes Use-Cases: Operational Manual Work Flows
- 21. ü ADT’s auto populate ü Automated authorizations ü Member scheduling data ü Easy to access & view up-to-date patient health information Listen Connect Translate Orchestrate Enrich Deliver Monitor Member Status Check Member Service Authorization Claim Submission Member Health Information Use-Cases: HealthLX Automated Workflows © 2016 HealthLX | Confidential Payor OperationsProvider Operations Automated Processes