Ep. 5: Mariann Yeager, MBA, CEO, The Sequoia Project. Topic: Interoperability

Kathy: Welcome to Episode 5 of the Smarter Healthcare Podcast. Thank you all so much for joining us for this informative episode on interoperability.

Today’s guest is Mariann Yeager, CEO of the Sequoia Project, a non-profit solely focused on advancing secure, interoperable nationwide health data sharing in the U.S.

Under Mariann’s leadership, the Sequoia Project supported the startup, growth, and maturation of two highly successful interoperability initiatives, the eHealth Exchange and Carequality, which now operate as independent non-profit organizations.

Mariann and I discussed the interoperability landscape today and the federal government’s final interoperability rule, which it just released.

Please enjoy our conversation.

Kathy: First off, Mariann, our podcast listeners come from all aspects of healthcare, not all of them are in technology. Could you start by explaining what interoperability is, and why everyone in healthcare needs to care about it?

Mariann: Certainly. It simply means the ability for our health records to be electronically accessible where and when needed, and across the many places where we receive care. And the reason why this is important to all of us is that timely information and access to information assures better decision-making, and that’s really an imperative in order to improve care and to support value-based care.

Kathy: Now can you tell me a little bit about The Sequoia Project and its role in interoperability efforts?

Mariann: We are a non-profit with a public good mission. We were really formed as a public-private collaborative, which means we have representatives from the private sector and government deeply involved in leading our work, so that we can advance the exchange of health records for public good. And we do that supporting a couple of different initiatives, one of which is we’ve formed a cooperative called Interoperability Matters, and this brings together stakeholders to really identify and prioritize the types of projects that we should really harness a brain trust in our healthcare field and health IT field, and to really focus in on trying to solve some of the challenging issues that exist and so we’ve had some great success over the past year doing so. In addition, we also support the Patient Unified Lookup System for Emergencies, or PULSE, and that is used by healthcare workers who are trying to treat individuals in the event of a disaster where they’re unable to receive care through the normal care delivery system, and then finally there’s a project that we’ve been working on in conjunction with HHS, specifically the office of the National Coordinator for Health IT, where we’re serving a coordinating role to help advance interoperable exchange of health records among health information networks, so it’s very exciting work.

Kathy: Now who are some of the stakeholders involved in interoperability?

Mariann: Well the stakeholders in interoperability are quite broad, and in order for us to be successful we really need an actively engaged community. So there’s strong leadership among providers across the continuum, among health plan consumers, health information networks, which facilitate the exchange of information among these different settings, as well as state government, federal government and public health, as well as technology service providers. So very, very diverse stakeholders are involved, and it’s important to have those varying perspectives at the table so that we can figure out together how to make this work a practice and in a way that meets the needs of all those who are really a key, a stakeholder to its success.

Kathy: And it seems like you probably need everyone’s buy-in into interoperability, otherwise you can’t really be completely interoperable?

Mariann: Exactly. You can’t really have one party agreeing to how it should work from a policy perspective or a technical or functional perspective if the other parties to this exchange feel differently, and so there’s a saying that information flows at the speed of trust, and so a lot of our work is trying to get the community to agree upon the rules of the road. What are the conditions under which they all feel confident and can trust that they can share information and access information from other places in a way that, where you might not have a direct relationship with the other party. So that’s really the focus of our work is trying to build these parameters, or rules of the road, around trusted exchange, and that comes in the form of various aspects of our work, some technical, some policy, and some operational.

Kathy: The Centers for Medicare and Medicaid recently released its final rule on interoperability. Can you share some details on what that entails and how this will help move interoperability efforts forward?

Mariann: So we are still very much analyzing and interpreting the rules, the final rule. And there are some important tenets of it and it’s going to take some time to continue to unpack, but I think the most important thing about the rule is that CMS is making very definitive strides in what their expectations are for providers and in establishing expectations for supporting interoperability, for improving individual access to that information, and also an expectation for certain providers to support encounter alerts as a key function of participating in the Medicare program, so it’s important because it makes it very clear that interoperability is the new standard of performance, and expectation, and that it’s not just a goal we need to strive toward but that now is an expectation as part of the Medicare program. And that also is accompanied by another set of regulations published by ONC that implements its obligations through a piece of legislation that was passed a few years ago called 21st Century Cures, and that also has an additional set of expectations for information sharing as well as implications for those who don’t, and that they’re – the implications there being potential penalties if one is found to be blocking information in a way that is unfair or triggers one of the violations of that rule. So I think the key here is that the government is setting the expectations for interoperability as the standard of care, and that we as an entire community need to build on the foundation of what we have been working on to date and really get to that next level.

Kathy: Now what are some of the bottlenecks right now in achieving interoperability?

Mariann: Some of them are really practical. So one of the bottlenecks is that we’re seeing that not all healthcare organizations are participating in information exchange. In fact, there are certain specialties, for instance, that have not been participating in health information networks, and that creates gaps when you’re trying to treat someone with certain illnesses, and you’re only able to receive the information from their primary care physician and certain specialists but not others you get an incomplete picture, and so that’s a big gap. And of course these are all solvable, right, the capabilities exist, but it’s again getting the community focused on and prioritizing, which these rules now prioritize, interoperability is important and there are specific expectations and implications if you don’t share information. The other one is around making sure that the patient identity matches, so when you’re requesting information from another organization, you want to know that they sent you the right patient records, so there are still some challenges to be worked out there. And probably the one issue that we hear about the most is making sure that there’s value in the information being exchanged that is not varying in quality. That there’s some consistency so that it’s usable, so again there’s some opportunities for improvement there. So those are probably the big three on top of mind.

Kathy: You talked about how healthcare providers, how some of them are not participating in interoperability – what would some of the reasons be? Would it be from a competitive standpoint? Or they don’t have the time or resources to do so?

Mariann: I think there are a number of different reasons. The primary one is that there are certain healthcare provider organizations that are resource-constrained. So long-term behavioral health is a great example, where it does take some changes in technology platforms, in  well-resourced organizations it’s a little easier for them to prioritize, and others, it might just be a level of awareness or an impetus to exchange, it’s not necessarily for business reasons, but they’re just, we’ve been on this trajectory to get our healthcare ecosystem connected, and some are lagging further behind, and so what I believe the impact of the rules will be is upping the priority to create the impetus to exchange more readily.

Kathy: What are some of the interoperability successes that you can share with us?

Mariann: Well, we’ve seen that there has been great success in building up regional and national health information networks that are sharing ten, hundreds of millions of records every month, and that’s exciting because we’re seeing the progress there and that our community is becoming much more interconnected. We think that there has been great success in interconnecting those health information networks, much like in Telecom, where if you have your cellphone and you use one carrier you can make calls to others that use different carriers, we’re starting to see that happen more and more. And through care equality is an initiative that we have helped initiate and that has taken off with great success and now operates under its own governance. And we also see success in being able to leverage this national health information network infrastructure to support other endeavors, such as I mentioned earlier, with PULSE, there is an opportunity to now leverage this information sharing that is used for day-to-day treatment purposes to also have that information accessible to emergency healthcare workers who are treating people in shelters and outside the normal healthcare delivery system, which is important.

Kathy: Now, in a pandemic like we’re currently experiencing, do you think that - are there certain ways that interoperability can really help out?

Mariann: Yes. The challenge is trying to stand up these capabilities in communities that have not implemented a system such as PULSE. It’s very challenging to respond in the midst of a pandemic or an emergency. That said we are working very diligently with the government agencies in a number of states to try to expand access to PULSE, again, for the public good, this was an open source-developed system that was made to be adopted by other states. It’s currently utilized and implemented in California, and we’re working with a number of other states. It’s important particularly during a pandemic because there could be large numbers of people that are seeking care outside of the normal healthcare delivery system, if capacity is exceeded, and you need a way to access the records, their medication history, their health history, and Pulse is a really easy way to do that. So we’re working with other federal and state agencies to see what we can do to do our part and aid in these response efforts.

Kathy: Are healthcare clinicians finding value in the information that’s being exchanged today?

Mariann: We always said we knew we were getting some traction when the providers started complaining about the data and we’re there. So there’s enough information being shared for them to discern and say, “Well great it’s here I’m so excited but what do I do with this data that’s not exactly as valuable as it needs to be?” And that again is an opportunity and it’s solvable, but it’s going to take some real coordination among the various stakeholders to make that happen, so that’s, again, a really high priority for us as a country and for the work that we do here at Sequoia and for, to really be successful and achieve the aims of interoperability, the data itself has to be valuable. And we’ll know we’re successful when clinicians get that data and are able to do something meaningful with it. This is an area where we know that there is a need for improvement, and it’s going to take several years probably to continue to make progress on that, but that’s definitely an area where we see an opportunity for improvement.

Kathy: Now are there certain trends in healthcare that you think will most impact interoperability efforts, either in a good way or a bad way?

Mariann: I think there are several important trends, and I think these recent regulations and ever-evolving interpretation of those regulations, because they’re here to stay, will have a profound impact on interoperability, because they’re the mandate to share information. And we’re going to learn a lot over the next several years, and on an ongoing basis, but that really is shifting the focus not from if we can share information but how and when it will be shared on an everyday basis. So I think that’s really important. And we also see the other big trend is the focus on enabling us as individuals to more readily access our information and that is also part of that mandate. So those are probably two significant trends that I think will really push innovation forward and also again shift the question from should we share information, can we share information, to how quickly, how efficiently, and how much we can increase the value of that information sharing.

Kathy: Now what does nirvana look like to you in terms of interoperability and do you think we’ll be able to get there?

Mariann: I do think we’ll be able to get there, there is no question. I think nirvana is when, I know at Sequoia we spend a lot of time thinking about the plumbing, you know the technological aspects of it, and standards, and policy underpinnings, and we spend a lot of time on sort of this background foundation. We will be successful when this work’s at scale and we don’t have to focus on the plumbing so much, and we’re getting close. I mean it’s very exciting opportunities and there will always be a need for evolution and change and I think it’s just an exciting opportunity that we have right here right now to really make that shift to make interoperability a day-to-day reality.

Kathy: Great, well, thank you Mariann for your time today.

Mariann: Thank you very much I enjoyed it.

Kathy: Thank you all for listening to this episode of the Smarter Healthcare Podcast. If you like what you hear, please subscribe on your favorite podcast app, and don’t forget to rate and review us!

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Thanks for joining us today!