Patient Access: Why Waiting is Healthcare’s Biggest Mistake

[00:00:00] Paul Wilder: And what I’ve seen decade over decade, ’cause I can actually say that now I’ve been doing this for a long time, is those who wait, I wouldn’t say they get hurt, but they lose advantage. And negative advantage is the same thing as getting hurt when the market moves fast. So I would say get connected and then start finding tools for the specific things that you’re looking for.

[00:00:19] Paul Wilder: It’s not like a sea-change moment when you into interop. It’s an incremental movement that leads other increments, movements that leads to general success.

[00:00:28] Brendan Iglehart: Welcome to Hard Problems, Smart Solutions, the Newfire Podcast where we explore the toughest challenges and the smartest solutions with leaders across technology and healthcare. I’m Brendan Iglehart, Staff Healthcare Architects here at Newfire Global Partners, and your host for this episode.

[00:00:53] Brendan Iglehart: For today’s episode, we have the pleasure of speaking with Paul Wilder, the executive director of the CommonWell Health Alliance. Paul brings more than two decades of experience in health IT leadership, deeply committed to transforming healthcare delivery through technology and data exchange.

[00:01:07] Brendan Iglehart: He’s at the forefront of driving nationwide interoperability, working to empower clinicians, practitioners, and individuals with robust data exchange services. Paul’s work at CommonWell aligns perfectly with our podcast mission to discuss the toughest challenges and the smartest solutions with leaders across technology and healthcare.

[00:01:24] Brendan Iglehart: He is known for his insightful perspectives on the complex world of health data from regulatory shift to the practical realities of implementation. Paul, thanks for joining us today.

[00:01:32] Paul Wilder: Great. Thanks for being here. Thanks for letting me be here. It should be fun.

[00:01:36] Brendan Iglehart: So to get started, Paul, I’m, I want to begin with your journey in health IT. So, you’ve had a significant tenure back at, before with the New York eHealth Collaborative before moving into your current role as the executive director at CommonWell. So what drew you into this crazy world of healthcare interoperability?

[00:01:54] Paul Wilder: Well, first I was drawn to healthcare starting technology that was quite outside. I was doing network support cellular networks kind of stuff, and immediately got pulled over and about six months into that first out-of-college job into records management. So, the, this is precursors to EHRs going back in the late nineties and there was the document flow and the fun thing about that one, I was young and got to travel on the country. That was fun. But, I really got a flavor for the business backend side of healthcare. I originally thought I was going to Med School, actually got accepted to one, decided not to do it, but always had an interest in healthcare in general.

[00:02:34] Paul Wilder: And I realized there’s multiple areas that people can help with. And the really fun part that I thought about then, but really thinking about more about now, is how much it affects your everyday life and how you’re influencing something that influences a lot of people around that you love, admire. And some people that you just want to be, you know, better humans going forward.

[00:02:50] Brendan Iglehart: For listeners who may not be familiar, can you explain a little bit about what CommonWell is and the role that you all play in this industry?

[00:02:57] Paul Wilder: Yeah, given the best generic part of healthcare is fun to play with ’cause you get to influence stuff and make things better. Interoperability i s the focus of CommonWell. CommonWell was founded 2013, so a little over a decade ago, by some preeminent electronic health record and other health information technology companies with the belief that data availability and exchange across providers was necessary for a better person-centric healthcare.

[00:03:27] Paul Wilder: And the original philosophy was that it can’t be a, or shouldn’t be, shouldn’t be a single vendor solution. ‘Cause patients see many different providers, different types of specialties, and they’re not picking by EHR, they’re picking by many other factors. So we were built with as a 501(c)(6), a trade association nonprofit type.

[00:03:49] Paul Wilder: And our goal was to make sure all the data was available every time a provider needs it across every healthcare entity across the country. And we continue to strive to do that with both within ourselves and across partners to move data from provider to provider and provider to patient and keep adding Ps, payers, public health. Keep going down the list.

[00:04:09] Brendan Iglehart: One of the things that was interesting when we were chatting last week in preparation for this podcast is that you were talking about how CommonWell has been on the forefront of enabling patient access to their own data for quite some time, which is, and currently a big topic within interoperability.

[00:04:25] Brendan Iglehart: So can you explain a little bit about what you’ve been doing there and why it’s taken so long to get more visibility and focus on that sort of work?

[00:04:32] Paul Wilder: Yeah, we started 2013. It really was a treatment centric network provider to provider exchange. It was 2016 when we first added what we called, patient access. And sometimes in the standards called request, patient request. And I’ll be honest, the first couple years didn’t go amazingly well.

[00:04:49] Paul Wilder: We had two general headwinds. One, there wasn’t that much the tracks laid for provider-provider. We thought we were doing well in 2016 with a high number of thousands of connections. By the time I got here, and we go about two years in, so we’re around 2021, we were at tens of thousands, right?

[00:05:07] Paul Wilder: So we added in almost a factor from that point forward. And the reality is most patient access applications, or individual access as we like to call it now, or individual access services, they don’t work well if you can’t get to all the data. Because the patient is looking for their most recent thing.

[00:05:23] Paul Wilder: It’s a very atomic level entity. It’s provider Bob, provider John, provider Lucy, that has my data or hospital X, Y, or Z. And when that one’s missing, they kind of disengage. So you needed more of a network effect to make this work. The second part was the network itself was designed for provider to provider, and we didn’t actually write our agreements to give this data to patients.

[00:05:48] Paul Wilder: And those of you who are HIPAA experts and know things about healthcare data, you don’t move data to things. You’re not allowed to move them to without a contract staying as such. So we had to do a fair amount of retrofitting to get things up to snuff to be able to do patient access.

[00:06:02] Paul Wilder: Fortunately, the rest of the market or at least the industry or us as just citizens and active healthcare users said, Hey, we really want access to our data. And more and more people heard that and it started to appear in other networking frameworks, which increased, it increased the ability for us to take the time to focus and fix it.

[00:06:21] Paul Wilder: So we recently did that with one of our largest members being Athena just moved in their entire cohort of providers into our patient access aware application that is also TEFCA aware. And now we’re off to the races with people, I wouldn’t say playing catch-up, I think we’re all clotting to the same point at the same time, which is great.

[00:06:39] Brendan Iglehart: So, Paul, I know a lot of us in the industry have been tracking the recent administration’s movements around health IT, and specifically watching the recent RFI and events that have been held by CMS and ONCASTP. I think that you’ve been involved with some of those events in Washington.

[00:06:56] Brendan Iglehart: Do you wanna tell us a little bit about the kind of tone and conversation going on in there and what you expect to come outta those of those meetings?

[00:07:03] Paul Wilder: Yeah, there are really three major events that occurred. One goes back to May where CMS released an RFI, looking for commentary on the benefits of health IT and what are good apps out there, as well as other things related to technology and data interoperability. It culminated in a, well, actually the culminated was the end of the RFI the day you had to submit everything, but in the middle they did a listening session

[00:07:28] Paul Wilder: where they had the, the higher-ups of HHS, so this was Secretary Kennedy, then Dr. Oz from CMS side, down the line explaining what’s going on. Amy Gleason, et cetera. And the morning session was presentation, followed by a bunch of panels in the afternoon was more working sessions to figure out what to do next.

[00:07:45] Paul Wilder: The morning panels were full of people just banging the floor looking for better patient access. And you have to think about this for a second, realize that the people putting together this listening session had to have set a tone. They chose who to put up there. Right. And there were people they knew that were gonna say these things.

[00:08:02] Paul Wilder: You don’t have to, you don’t have to wind people up and tell ’em exactly what to say. Just get the right people. So the fact that CMS and HHS put a lot of people they knew they were gonna be focused on individual access on a stage during their big show is interesting unto itself. That says the administration is very interested.

[00:08:19] Paul Wilder: And then the conversation that happened after that, which then led to this idea of a CMS aligned network and a further event that happened a couple weeks ago at the White House where the CEOs and other officers of many of the companies are at that event, and actually a smaller group than that, were pledging to be aligned to CMS as we go forward with a significant focus of that being, how do we help patients make better decisions with better data?

[00:08:46] Paul Wilder: And I think in the first administration round of Trump, you saw financial data. There was an attempt to do getting price information, price transparency to patients, which I don’t think went as well as everybody wanted it to, but it was an interesting idea of more information, better decisions. And I think this is the next evolution to how about the clinical data, too?

[00:09:04] Paul Wilder: Maybe the two together start to move the needle? Understanding that the first tools probably won’t do as much as you wanted to, but you have to start every journey with a step. And a significant step would be getting the ability for apps to get data in patients’ hands so they can start doing something with it.

[00:09:20] Brendan Iglehart: You mentioned Amy Gleason and just then, um, who was the acting head of the newly formed department of government efficiency or DOGE, under the federal government. And obviously she comes from a background in, in healthtech. So I’m curious for your perspective on someone like her, who’s known for really getting things done, how do you think her tenure and involvement in this will impact the outcome?

[00:09:41] Paul Wilder: Well, there’s two things. She has she has a good patient story in her daughter’s story, which is for those who have not seen it. I won’t give you a full summary, but you can find it on the interweb looking up Amy Gleason story. Amy Gleason, CMS, YouTube, whatever you wanna find it on. And she does a good job of delineating a, you could think of a generic patient with a rare disease and without data and AI tools and the like to be able to process that data, how things were missed.

[00:10:09] Paul Wilder: And I think there’s a lesson in there that, providers, i n the past you would, you have seen some resistance to some adoption of technology. For example, we saw an initial bad reaction to like direct messaging, provider to provider direct, but then they tried applying patient to provider and we skipped that and went instead to portal conversations.

[00:10:29] Paul Wilder: And when you start to learn as people are generally pretty nice, people don’t abuse your, you know, my, my mobile phone number’s in my signature line for my email, and no one calls it, right. , No one bothers people that way. They have other ways of communicating and I think they realized after that push of communication direct to patient, that they’re not gonna get abused as much.

[00:10:47] Paul Wilder: Maybe it’s time to think about using technology in a more augmented way. But Amy in particular, is like, no, go do it faster. You’re hurting healthcare, you’re hurting yourself actually by not allowing patients to supplement what you’re doing. And her brain in terms of doing things faster but efficiently and effectively, on top of the passion to do it from her own personal story, is usually the kind of secret sauce you need to move things.

[00:11:15] Paul Wilder: And you put someone in a central position where they can convene people and blast through what I, I usually call the first mover disadvantage of network effects, the first guy does all the work and a lot of people follow in after, i s significant. Like that kind of the beat of the drum being consistent across many parties who normally compete and don’t wanna be synced with each other is very powerful when you’re trying to develop network of x.

[00:11:40] Brendan Iglehart: Speaking of building out networks, one of the big developments that I’ve really tracked from, from my side and the customers that we worked with in the last couple years is the rollout of the On Behalf Of designation with Carequality, which I understand that you had a hand in originally developing that concept.

[00:11:56] Brendan Iglehart: Can you tell us a little bit about, on behalf of our OBO and a little bit of the story about how that came about?

[00:12:02] Paul Wilder: Yeah. I wanna see healthcare move faster too. And you can imagine running a trade alliance, which is supposed to be supportive of trade and not just the entries, entities are in it right now. It’s supposed to be also supportive of the next thing to enter. I kept thinking of what are we missing, right?

[00:12:20] Paul Wilder: If I just, if all we did was work with our primary EHRs and the like, t hat’s great. They’ll fund the enterprise and we’re a true nonprofit, we make too much money, we give it back. I was like, who else needs help? And I kept looking to the startups and the neat little things being developed at the edge that are the first step to their existence.

[00:12:39] Paul Wilder: And I had done some accelerator type things in my past as well. And how did you do an accelerator in healthcare? Usually it was by getting your first customer, right? You would link them up with a technology set and say, Hey, I’m bringing this preeminent academic in as a pilot customer to help you develop and go forward and then get more contacts and go from there.

[00:12:57] Paul Wilder: But when you start looking at patient stuff and littler tools, it doesn’t fit as well. Like we’re talking like, one person, one diabetic, we need to move faster and get things going. So I said, why i f providers are hooking up their EHRs at scale, and we’re getting the data to the network, we’re solving the data availability problem, right?

[00:13:17] Paul Wilder: The data is going to be there. What I was missing was, who else needs to use this data, the supply and demand. I said, can we hook up these applications to the network? To get the same data to accelerate their ability to do what they need to do. Iinstead of integrating to one hospital or to one ambulatory practice,

[00:13:35] Paul Wilder: why don’t they hook up to all of them and do that without having to hook up through the high primary EHR ’cause it’s expensive and time-consuming? And I was more worried about the time-consuming, to be honest. I mean, it’s fine for, again, we’re a trade association we support trade. I’m not against people charging for services that’s fine.

[00:13:51] Paul Wilder: You just don’t want it to be a barrier. And so I felt like we weren’t getting the right tools in front of the right people. So we built this OBO. If your EHR, if your EHR is already connected, why can’t you connect every other product you bought that is for treatment purposes? All of them. In the dermatology app that takes a neat picture from your iPhone and sends it up to some AI tool to do a skin lesion check.

[00:14:12] Paul Wilder: Why shouldn’t it have access to your history of skin cancer, family history, and the like? To better inform the answer of what it’s about, to help suggest in that clinical decision support thing it’s doing. And do it cheaply. And by cheaply we make the network an interface engine. Everybody can access the same information at the atomic level of you, Brendan, Paul, whatever it is.

[00:14:32] Paul Wilder: There was some resistance at first and unfortunately it got changed a little bit in the way it got word that people found loopholes to use it for, semi-abusive things. And we were still addressing that trust issue today. But I still stand behind the idea that we need more access, not less.

[00:14:50] Paul Wilder: And we just need to do it safely and securely so that, we maintain trust and provide the right solutions to patients.

[00:14:56] Brendan Iglehart: Paul, when we think about the future of patient access to their own data, obviously there’s a lot of different applications for that, including data correction, which was one that I have experienced as a patient myself. You know, seeing things in my own patient record that is, is incorrect, and then trying to take steps to address that.

[00:15:13] Brendan Iglehart: Why is that specifically such an important aspect of kind of unlocking data for patients that ultimately they, they should have the right to use?

[00:15:24] Paul Wilder: Yeah. At the risk of giving the standard answer at every technology conference, and especially healthcare conferences, AI, so we got this artificial intelligence thing going on, and I think it’s important to remember how AI actually works, right? It’s statistic space, right? It’s taking… when you do an LLM and have it write an RFP for you in Copilot, or whatever you use,

[00:15:46] Paul Wilder: it’s just aware of what kind of words go together when it’s, look through the history of time of everybody writing things and gives you a suggestion that seems to be within the confines of what you’re looking for. And when you get to healthcare data, it’s doing the same thing. Going back to the days of Watson and other early precursors where we are today.

[00:16:05] Paul Wilder: The one thing you don’t wanna do is confuse it. We, you’ll hear people talking about AI hallucinations and it starts to fill in data gaps. Another problem is when it has a piece of data that doesn’t belong and it doesn’t always know what should go around it or ignore it. So if you have errors, bad things can happen.

[00:16:24] Paul Wilder: Lemme give you an example. I had a shot, a flu shot last season and my record said I had gotten HPV vaccination. Now, it is actually more common these days for or for especially younger males to get HPV vaccinations, but not very common for a 48-year-old male to do that. And my doctor would probably look over that, if he was looking at fantastic cancer drugs that would be the all-end-all to cure prostate cancer

[00:16:53] Paul Wilder: it’s available and says, but what if that prostate cancer drug material said it’s contraindicated to people who have the HPV vaccination? My provider might skip it, but the AI provider may not know what to do. And so it’s statistical analysis. We’re gonna start suggesting different therapies.

[00:17:10] Paul Wilder: Could underweight the perfect drug, right? Everything else could fit in, but this thing is a bang-out criteria and bang-out means eliminate it at all costs. You don’t want that. And there are various things that, little tiny nuances, little nudges you can do that make the model messed up. Providers can do the same thing.

[00:17:27] Paul Wilder: They already have clinical decision support tools on their side, and contraindications X is contraindicated to Y. You can’t have these two things together. Automatically set off red flags. Right? So that would be, that’d be an extreme example, but it could also say there is no data on this. Anything that decreases that Superdrug now being not a Superdrug, because of my potential biochemistry and the things I have in it. So I think it’s really important that we have the right data. I mean, today, most of us probably worry about the wrong data being things we get billed for, right? I didn’t have this done. I don’t want to pay my $20 co-pay.

[00:18:00] Paul Wilder: This was supposed to be an annual exam, why do I have a co-pay? It’s supposed to be free. And those guy, oh, it’s coded wrong. You like, okay, you fix it. Fix it to an annual wellness exam and not just a normal office visit. And that’s fine for the $20, a hundred dollars, a couple thousand dollars even, you pay.

[00:18:13] Paul Wilder: But the clinical stories could get really messed up if we confuse the AIs. And it is, you could argue whether it’s the future or not, but it’s definitely a factor. So getting data into the hands of patients is the most likely way to make sure the data is accurate. ’cause I probably care more my data than anybody else does.

[00:18:32] Brendan Iglehart: And on the topic of AI, Paul, as we continue to see, meaningful advancement toward making data more liquid for different use cases, involving including those that patients are directing, how do we make sure that patients stay protected or that f olks’ privacy is respected in this whole process.

[00:18:50] Paul Wilder: You know, I saw, we talked about the events that happened and then there was the big White House event. And I don’t, it doesn’t really matter where you sit in the political spectrum, I did see something disturbing happen that happened that, that day. There was an article put out by a, what I consider a good media outlet, that talked about the federal government is trying to make a system to collect all your data.

[00:19:11] Paul Wilder: Big tech is getting into your data, be careful and got quotes from some preeminent professors about the security and privacy concerns alike. And the irony there was the dialogue was exactly opposite that, right? The dialogue was, we want big tech to do the right thing, to get data into your hands so that you can control where it goes, right?

[00:19:34] Paul Wilder: We’re not trying to collect it for ourselves. We’re trying to collect it on your behalf and then let go of it, right, put it into the storage thing of your choice, into the application of your choice. And you do what you wanna do. If you wanna be in a research study, you release it. Right? That’s not, we’re trying to get in the middle.

[00:19:51] Paul Wilder: So I think we’ve banged around the edges of security and privacy for a long time, but I think the current push right now has the right philosophy. The danger of securing privacy around healthcare data is, you gotta be really careful just not disclosing data that might help you. You kind of have to trust your provider to do the right thing.

[00:20:15] Paul Wilder: And we, if we go too far, making it locked up, that you have to anatomically every piece of data one element at a time, I think we are actually gonna negatively affect care. Because patients have not been given their data for so long, they don’t quite know what’s important and what’s not important.

[00:20:32] Paul Wilder: And so, if you start scaring people that your data’s flying around everywhere, and then say you have control, the a knee-jerk reaction could be to not give it to anybody and you could be doing yourself serious harm, which actually is a lesson. The lesson here is get the data to the patients faster. We have to get past that episode.

[00:20:50] Paul Wilder: We have to get past that, that fear bubble as quickly as possible to get back to the right balance. And we see in everything, there’s often an overshoot. I’m, I would not be surprised, if we give patients all their data and we give them audit capabilities to know where it’s flying that many people will shut it down first.

[00:21:07] Paul Wilder: ’cause they don’t understand how to control it. And then we had to bring it back up. But that’s gonna happen. So you might as well do it now. ’cause doing it later is worse.

[00:21:13] Brendan Iglehart: And also on the topic of data liquidity as I think we talked about, there’s a number of different factors in that beyond just the technology factors that have made that challenging in healthcare to date, but w ith the advancement and adoption and rollout of FHIR by different vendors, we’re seeing some kind of other technology pieces of that being addressed as well.

[00:21:33] Brendan Iglehart: So what’s your kind of vantage point on the current state of FHIR rollout and where that stands to advance in the coming years?

[00:21:40] Paul Wilder: FHIR has finally taken some leaps forward. I do think it’s interesting. You mentioned security and privacy, right, went right to FHIR because I think they’re actually very linked in a way that isn’t always obvious to the average consumer. The primary link here is there’s a fair amount of security and privacy control embedded in HIPAA and other state and federal laws.

[00:21:58] Paul Wilder: About minimal necessary. Don’t share more than you need to particularly when you go outside our provider relationship, right, so that be to your payer, it could be to public health and whatever. And sending a document with all your data, it makes it difficult to redact what I’m not supposed to send.

[00:22:15] Paul Wilder: Imagine you’re getting a mortgage. And the bank requires to know your current salary and they wanna know it from your gross income from last year’s, uh, tax return. Sending your 110 page tax return to get line one is a little silly, right? That’s a way over disclosure of a lot of things about you when they only needed one number.

[00:22:35] Paul Wilder: And today most exchange is being done via documents. These large things with a whole bunch of data in them. It makes it much more difficult to assert this is the minimal necessary for the purpose. And I think that is a huge advantage of FHIR there. There are public health departments out there that are on the sidelines.

[00:22:53] Paul Wilder: During COVID. During COVID, we allowed public health departments over Carequality and therefore over CommonWell as well to access data about COVID patients that they were following up with through the networks using the treatment lane. And I say the treatment lane. ’cause the treatment lane, the treatment use case is the most open public health, not as open.

[00:23:13] Paul Wilder: So they said, just go through the treatment lane, we know it’s you, it’s cool. And they said, what about the minimal necessary? I said, you tell us this data is minimal necessary for this, and we’re good. Only two states figured out how to talk to their AGs to figure out they’re allowed to make that request.

[00:23:27] Paul Wilder: Right? That minimal necessary for this use case was everything and will only keep. They didn’t know what to do. So we need the ability to be more atomic or more focused on the data we exchange ’cause everybody’s actually trying to do a pretty good job on the security and privacy. It’s just hard to do when you have a blunt force instrument of a massive document.

[00:23:47] Paul Wilder: So I think FHIR goes a long way there. It also allows for more current information, ’cause a lot of documents are created at the end of exams, at the end of encounters. There’s a ton of advantages. I will say though I am not… FHIR is the panacea solution for interoperability. It solves some problems and it helps with some things, but we still have a lot of our things to work on, including just laying the tracks and the philosophical change from holding data to exposing data as the right thing to do.

[00:24:17] Brendan Iglehart: We’ve talked a lot about the kind of current advancements in interoperability and the progress that’s being made that advances a number of different use cases. Here at Newfire, we obviously serve a lot of different innovators, including those in the digital health space vendors that just sell to health systems and payers and things like that.

[00:24:32] Brendan Iglehart: So, what’s in this broad world of interop? Like one mistake that you see organizations make most commonly when they approach data exchange that really ends up hurting them in the long run?

[00:24:44] Paul Wilder: Waiting. I think waiting is the worst thing you can do. There’s this desire to say I’ll jump in when X. And for a while it was jumping in when there was enough data, right? If you went back when I first started doing this, going back to 2009, 2010, the adoption of interoperability and connecting provider-provider was pretty low to the point that if a provider pressed the button, the likelihood they found data for the patient in front of ’em was actually relatively low.

[00:25:12] Paul Wilder: Now the problem is flipped. There’s too much data, right? So all these documents are flying around and they do have a fair amount of duplication right within them. So it is sometime difficult to work with. But waiting for technology to make that better, for example, waiting for FHIR, like I got news for you, the documents we sent around today are pretty well coded, right? They’re just, we were lazy. There’s a lot of industries that do this. They bandaided knowing that the other side may not have a good parser. We made a human readable format version of it, and that’s with all display on the screen you get a discharge summary, which has a human readable displayed version.

[00:25:44] Paul Wilder: Underneath that human readable thing is a machine readable version that has lab results and times, and all the stuff you would need to do like a lab chart showing how things changed over time, both inpatient and then before inpatient and after, you can show the differences in between. But we’ve seen people now look and go, there’s too much data.

[00:26:03] Paul Wilder: Everybody’s gotta organize it better or I’m not coming in. And what I’ve seen decade over decade, ’cause I actually say that now I’ve been doing this for a long time, is those who wait I wouldn’t say they get hurt, but they lose advantage. And negative advantage is the same thing as getting hurt when the market moves fast.

[00:26:21] Paul Wilder: So I would say get connected and then start finding tools for the specific things that you’re looking for. It’s not like a sea-change moment when you into interop. It’s a incremental movement that leads to other incremental movement movements that leads to general success.

[00:26:37] Brendan Iglehart: And on that topic uh, what are, what’s a capability or tool in the interop space that you feel is most underutilized or overlooked by folks looking to do data exchange?

[00:26:48] Paul Wilder: There are two things that that are, that apply there and I’m a little surprised ’cause they seem almost obvious. And I’ll be honest a fair amount of entities have recognized this and are starting to fix it. But the data is large. The data sets are not tiny. They do take time to move. The movement of my data from one provider or a collection provider to another is generally not a good thing to do interactively. Interactively, meaning I click the button and I see it come up. It takes a little bit of time. I’m amazed at how many EHRs that I consider relatively mature, don’t have a pre-access workflow, you know, like a, a prefetch that is based on triggers. Most healthcare and a lot of people think about healthcare as having, different types of encounters,

[00:27:32] Paul Wilder: you have a thing, your ambulatory, your wellness exam every year, you have specialty stuff, you have inpatient that’s scheduled, then you have things that go through the emergency department alike. We often focus in interop, or at least in the beginning, we focused on the ED stuff. I don’t know anything about this patient

[00:27:46] Paul Wilder: so I’ll hit this button to go find something out about them before I start a workup. And that makes perfect sense. If the person’s coming through the ED, absolutely positively get their allergies before you start injecting penicillin or whatever you’re gonna do. That makes perfect sense. But there’s so much information between episodes and most of the tolerance for delay amongst most clinicians is incredibly short. Three seconds and you’re gone. I’d say a second. Most people don’t like the application. You have to prefetch stuff. And then if you prefetch it, based upon the scheduled exam for tomorrow or the scheduled exam for next week, ’cause again, most of it’s not emergent, most is planned a little bit or at least sometimes a lot.

[00:28:25] Paul Wilder: And from there, pre-chart some of it do something what, what do computers do for us? Computers are programmed that do things that are monotonous, that advance our cause. Make the computer do some work. Have it pre-chart out medication history so you can do reconciliation faster and say These are all duplicated out,

[00:28:44] Paul Wilder: I see four things that look relatively current. Hello, Mr. Patient or Miss Patient. Which one of these are really currently active? What’d you take today? And I see four things that are candidates. As opposed to, tell me everything that you wanna tell me about yourself. Use the data to pre-stage that, that first interaction so you can get to the meaty stuff.

[00:29:02] Paul Wilder: I think the great power of interop and data availability in healthcare is gonna be allowing for providers to work to the level of their capabilities. By having more time to interact with the patient. The data and the computer should help get out of the way, not in the way if done correctly.

[00:29:18] Brendan Iglehart: Paul, thanks so much for a thoughtful and insightful conversation. Before we close it out today, what’s one last piece of advice that you’d offer healthtech leaders and innovators to navigate the sometimes confusing world of interop and to drive great outcomes for patients?

[00:29:34] Paul Wilder: Well, first of all the main thing I have to say, especially if you’re on the startup side, is be prepared for a longer haul than you’d like. We think of healthcare going fast. Healthcare technology does not change as fast as you think it does. There are some brilliant engineers I’ve met who worked at amazing institutions that paid them a boatload of money because they were PhD, computer science, super geeks that saw healthcare as a place that needed help and said, I’m gonna go over there and help this thing.

[00:30:02] Paul Wilder: And what you find out when you get here is there is bureaucracy partially for a reason. It’s a science, not just a technology and science, it’s actually an artful science, right? It’s not, you’re not gonna get the same result from two different providers. So there’s some artistic license involved here and there’s a lot of regulation.

[00:30:20] Paul Wilder: Be prepared with your VC and whatever money you’ve got, it’s gonna take a couple years to get traction. And I’m not saying that doesn’t mean you shouldn’t start. It just means be ready. I often talk about leadership and how you should act with your staff and employees and how you interact with others.

[00:30:38] Paul Wilder: Be fair, but also understand what’s going on. And healthcare is a it’s a hard industry to crack into. You need to get that those first customers, but be patient. You have to have a good sense for how long to stay the course before you pivot. Over pivoting in healthcare sometimes makes you irrelevant ’cause no one knows what you do.

[00:30:58] Brendan Iglehart: Paul, thanks again for joining us and for sharing your perspective. And to our listeners, I hope you’ve gained valuable insights into the ongoing challenges and promising solutions in healthcare interoperability, especially unique opportunities around patient access and the future of data exchange.

[00:31:14] Brendan Iglehart: Thanks again for joining us on Hard Problems, Smart Solutions, the Newfire Podcast. Until next time.