E Healthcare’s ‘Interoperability Guru’ Keith Boone Talks Health IT and Coming Advances

Keith Boone, Interoperability Guru for GE Healthcare

Mark Masselli: This is Conversations on Healthcare , I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well Margaret Pres. Trump met with the nation's gove rnors this past
week and got a pretty unvarnished assessment from a number of state executives on
what should be done with the Affordable Care Act . The president apparently sat down
with former political opponent Ohio Gov. John Kasich .

Margaret Flinter: Well Mark I understand that Gov. Kasich was pretty insistent that the
president consider the collateral damage to health care coverage and certainly inherent
to that the damage to many state budgets if there is a swift repe a l or defundin g of the
Medicaid expansion along with other aspects of the health law. And it might have struck
a nerve because during that meeting a number of advisors were called in including HHS
Sec . Tom Price many of whom will have a direct hand in shaping future he alth policy
under the Trump banner.

Mark Masselli: Gov . Kasich reportedly said that the president listened very carefully to
what he had to say and that the president had a “ very positive response ”.

Margaret Flinter: So we will see how all of this influences the discussion of rep e a l ,
rep lace or improve of the Affordable Care Act and health reform generally as we go
forward.

Mark Masselli: Our guest today though is an expert in the completely different approach
to improv ing healthcare Keith Boone is the Interoperability Guru for Health IT at GE
Healthcare .

Margaret Flinter: And he has just returned from this year’s HIMSS conference one of
the largest international gatherings focused on the rapidly growing realm of healt h
information technology . And we should have some very useful insight s into the
potential for health IT while we all seek what we call the Holy Grail of true
interoperability of health records .

Mark Masselli: Lori Robertson also weighs in the Managing Editor of FactCheck.org
examines miss tatement s spoke about health policy in the public domain .

Margaret Flinter: And no matter what the topic, you can hear all of our shows by going
to chcradio.com or find us on Facebook or Twitter because we lo ve hearing from you.
And we will get to our interview with GE’s Interoperability Guru Keith Boone in just a
moment.

Mark Masselli: But first here's her producer Marion O'Hare with this week's headline
news

(Music)

Keith Boone, Interoperability Guru for GE Healthcare

Marianne O'Hare: I am Marianne O'Har e with these healthcare headlines.

The president has had his say on the future of health care that is address ed to the joint
session of Congress the short of it changes are in store for the Affordable Care Act in
addition to the president's proposal a leaked version of the GOP Health Reform Bill has
revealed a few things that may cause concern for millions of Americans under the age
of 65 even as get insurance coverage through their employers . Speaker Paul Ryan's
proposals would cut a number of thing s primarily phasing out Medicaid expansion by
2020 replacing it with a block grant approach capping the amount of money spent on
each individual patient .

Also on the chopping block the essential benefits coverage that was required under
Obama c are no co - pa ys for host of preventive screenings and primary care visits , no co -
pay for birth control etc a nd also mandatory care for mental health and addiction issues
under the GOP plan insurers would not be required to cover all those things . And
attacks on medica l devices , health insurance plans and tanning beds would also go
away as well as a $4 billion tax on the pharmaceutical industry those taxes were put in
place to offset the cost of paying for the Affordable Care Act . And perhaps most
concerning for many o lder Americans not yet old enough for Medicare removal of the
provision that blocked insurers from charging more to older folks who are generally
sicker . F or mer Congressman Patrick Kennedy is concerned about what the current
health reform efforts will do to mental health and addiction services coverage in the US ,
Kennedy did not seek reelection after his own battle with addiction came to light he
seems he is focused his efforts on promoting mental health parity as well as addiction
support . Kennedy has re cently teamed up with Former Congressman Newt Gingrich
and activist Van Jones to battle the opioid crisis , n ow the leading cause of accidental
deaths in this country .

Anti - biotic resistance is poised to become the world's leading killer by the year 205 0 t he
World Health Organization just released its list of most deadly bacteria to be on the
lookout for among the most dangerous bacteria known today are those that cause
tuberculosis and bacteria responsible for gonorrhea for which there is almost no known
t reatment left that works , the World Health Organization urging global pharmaceutical
industry to accelerate the pace of research in this critical area .

A nd it's long been a problem prescriptions and the lack of compliance is estimated
about 50% of those who received prescriptions don’t follow the protocols for those
prescriptions giving rise to bad outcomes . Researcher solicited more than 50,000
participants giving them one of three kinds of reminders of pill bottle cap w ith a digital
timer a standard pillbox or no special gadget , a nd then they tracked their prescription
refills and found that the interventions really didn't do much at all . The researchers
found patients wh o don't have solid routines around medication taking don't benefit all
that much from these additional cues suggesting a more effective intervention might be
needed , how about a spoonful of sugar to help the medicine go down !

Keith Boone, Interoperability Guru for GE Healthcare

I am Marianne O'Hare with the se healthcare headlines.

(Music)

Mark Masselli: We are speaking today with Keith Boone Interoperability Guru for GE
Healthcare , i n his role Mr. Boone oversees the architecture for GE's value - based
product lines , a longtime member of HL Seven International Board and advisor to the
Office of the National Coordinator for Health IT . He is an author and editor of over two
dozen books on standard guides including the CDA Book which examines the HL
Seven Standards for c linical documents . Mr. Boone has contributed significantly to the
advancement of interoperability of healthcare products around the world , he earned his
Master's of Bio Informatics at Oregon Health and Science University , Keith welcome to
Conversations on Healthcare .

Keith Boone: Thank you.

Mark Masselli: Keith you just returned from one of the largest gatherings of health
information technology professionals the HIMSS Conference where there were
thousands of experts in the field , a number of large sta keholders . And each year they
discuss trends and opportunities to improve utilization of health information through
electronic and digital platforms . What were some of the more significant takeaways
from this year’s event and what in your view are some of the more significant remaining
barriers to interoperability ?

Keith Boone: There is a big paradigm shift coming in interoperability that has to do with
API requirements in current regulations that E HR systems need to follow starting next
year . And so you can see that in both the different standards organizations that I've
been working with and where the vendors who build those systems are putting their
efforts . Over the last few years two of the ACAs [PH] that I've been working with very
closely have been focusing almost all of their attention on APIs. The stuff that is been
relying on pre - API interoperability paradigms getting less attention the API work gets a
lot easier for vendors and implementers to use . And so that’s going to flow down to
users of healthcare providers for using health IT and also their patient s, so you are
going to start to see that coming out of a lot of product later this year because of a
regula tory deadlines to have that before we get into 2 0A team [PH] wh ere MIPS and
MACRA comes into play . What we are going to still see is barriers , is the ability for
anybody other than the healthcare provider to write data to the patient records so the
first round of APIs that are coming out enable others to read the data and be able to
really start to move it in a very big way . But we are going to see some catch up as
people start to figure out , well okay now that we have all these APIs who do we let start
writing to the recor d and how?

Keith Boone, Interoperability Guru for GE Healthcare

Margaret Flinter: Well Keith that sounds like kind of a good news and maybe not 100%
so good news scenario and you have certainly been involved in setting standards for
Health IT both in United States and globally through your work with HL 7 an d with the
Office of the National Coordinator . We had HL7’s CEO Charles Jaffe on the show last
year talking about the enormous challenge organizations have been facing and building
easily deployable and expandable IT infrastructure . And one thing we would like to ask
you about his how are emerging standards like FHIR advancing interoperability and
how’s the industry responding to a new tool like that?

Keith Boone: So there's a joke that we have about a lot of different expert based
professions you k now doctors , lawyers , computer architects you get three of them in the
room you wind up with four opinions, right. It ’s hard to build things when everybody
doing the work has to be an expert , there's all this complexity that you have to deal with
an d so t he work that HL 7 had been doing on their HL 7 Version 3 standards was just
that kind of thing. CDA standard s simplified a lot of that for us and we launched a lot of
the work that we were doing in interoperability because eliminated a good deal of that
complexity b ut w hen will look at something like HL7 FHIR which is the emerging APIs
that's nearly the rest of it. So there's fellow by the name Grahame Grieve who works at
HL & as a product manager for FHIR who took the lessons learned from what we've
been doing over the past decade . And many of the simplification effort and alternatives
that spawned [PH] directly in to FHIR and he showed everybody how experts could just
not apply their knowledge to make complicated stuff work but actually hide the
complexity for developers . And so once you get the developers and implementers
working on this stuff , the implementation space became something that non - expe rts
could do , and that's reduced a lot of the nonessential complexity that it possible really
for high school students to play with APIs and learn how to build apps in the healthcare
space.

Mark Masselli: Well maybe high school students are playing with them but physicians ,
nurse practitioners and the other s are having a lot of difficulty , you know just sort of a s a
frame of reference back in 2009 the HITECH Act passed tens of billions of dollars are
given out to the industry to move over to electronic he alth records along the way to
continue to receive those dollars you have to get the meaningful use criteria . But then
you have got these large forces the American Medical Association really pushing back
on this because they say we simply aren't able to ma ke good use of the dat a they are
generating . Where i s the disconnect between that clinicians ’ adoption of health
information technology and their ability to meet meaningful use ?

Keith Boone, Interoperability Guru for GE Healthcare

Keith Boone: So it's interesting . What you have to look at is what those w ho are
successful have done with the data to understand it you need more than just a
availability of data , the data you're working with needs to be accurate , appropriate , but
most of all it needs to be actionable . And so there's these steps betwe en generating
data and producing outcomes so as we talk about a learning health system data doesn't
just produce outcomes you have got to do a lot more. You start off getting the data so
you can learn what ’s going on , once you learn what's going on now yo u can start to act
in action is what produces outcomes . So the organizations that are actually figuring out
how to use the data to act are the ones that are being successful . You need health It's
and necessary infrastructure to build that system , data is n't the answer , but the answer
is in the data . You have to start with some sort of analysis or synthesis to show the
relationships of data to outcome s you do that with analytics but you can't just like get the
information in the learning now you need to a ct . And to act is to change , anyone who's
been through change management course going to tell you change i s hard.

Margaret Flinter: Right. Well I think I am going to have to remember this quote that
data is not the answer but the answer is in the data , and in healthcare a lot of the
answers may come with technology but not necessarily so. But some that we follow
with great interest are telehealth and telemedicine , remote patient monitoring , precision
medicine , artificial intelligence tools . And the structures of all of our healthcare
organizations are chang ing a s well certainly with the growing focus on value - based care
and Affordable Care Organizations , what health market trends do you think are the most
poised to facilitate improved outcomes , b etter healthcare and better value and where
does health IT come into play with all that?

Keith Boone: So one of the big changes that you talked about accountable care , right,
that’s coordination between providers and the payers getting different stakehol ders
engaged in a way that's going to improve outcomes . So you have public health and
providers working together , you have providers and payers working together and that is
the thing that's really going to change . But when we move away from sort of these
distinctive little silos and start working together as a system that's what's going to make
the outcomes happen , a nd health IT comes into play because it's that technology that
enables the data movement between all of the different stakeholders .

Mark Mas selli: We are speaking today with Keith Boone, Interoperability Guru for GE
Healthcare , in his role Mr. Boone oversees the architecture for GE's value - based
product lines , a longtime member of HL 7’s international board . Keith, one of the
conversations that loomed large at the HIMSS conference was the uncertainty in the
health industry around Trump administration's next steps regarding health reform as
well as the repeal and replacement have been in Congress and many participants said

Keith Boone, Interoperability Guru for GE Healthcare

that in spite of the shifting political landscape value - based care and growth in the health
IT space will require bipartisan support . And I think we've certainly had many people on
the show who have advocated that we need to move forward with both s ides of the
aisle , what are your thoughts about the political changes in how they might vote for the
IT world ?

Keith Boone: So the health IT laws and regulations that come out of the HITECH Act
that were written in the law at the beginning of the Obama Administration were taken
verbatim from an executive order that came out fo u r years before in the Bush
Administration . And that language comes in large part from the prior decade of
bipartisan work a nd so health IT people understand and agree needs to adv ance to help
us all solve the problem . So while we seen lots of discussions around policy change ,
we haven't seen people complaining about what HITECH has been doing or has
accomplished . And whether or not ACA is repealed or rewritten or remains largely
unchanged , the focus on using health IT to reduce costs to something that everybody is
going to continue to agree on and will remain .

Margaret Flinter: Well Keith in your very popular Twitter feed I think it's
@motorcycle_guy you have recently posted a v ery interesting quote from HIMSS a 165
million wearable devices are in the global marketplace now and yet virtually none of
them are connected to the Electronic Health Record and Patient Portal still pose a
challenge for many patients and also their providers . So how can developers bring
together wearable devices and Patient Portals ?

Keith Boone: So I think portals are a dead - end they are other passages to data that is
simply par ked somewhere portals don't really move data they just sor t of give you a way
to get to data that sitting still . What's interesting to me in APIs is what APIs enable not
only for just providers but for patient s so I want my data and I want my data to come to
me and I want to be able to use that data just like pr oviders want patient data to come to
them and they want to be able to use that data . And so data that move s is data that
adds the greatest value and since we see health IT changing to deal with that the
applications that move the dat a the networks that en able that movement are going to be
the biggest winners .

Mark Masselli: You know the shift to electronic and digital platforms has also led to a
significant spike in health system hacks , this is an area with no simple solution , what in
your view needs to happen to improve health data security and are we missing a
fundamental piece of the cyber security infrastructure ?

Keith Boone, Interoperability Guru for GE Healthcare

Keith Boone: Security is tricky and it's an area that I leave to experts but I will say that
this isn't just a health IT problem we ’ re simply more sensitive to it because of the
legislation or regulation we operate under . But the problems we ’ re seeing in healthcare
are appearing throughout IT in general , right , you look at it hacks and leaks they're not
just affecting health IT you ha ve major corporations losing tons of customer data .
Fundamentally , right , we ’ re all using the same Internet to move data around and that
Internet was built on standards developed in 1960 and we've added layers upon layers
to deal with security over the ye ars . There was a time when you first got on the Internet
you'd never use your credit card , I can ask you the question how many of you have
b ought something on the Internet in the last week , and I think everybody would probably
say yes . We gone the Intern et to the point where things were secure enough that we
felt good using a credit card purchas ing we ’ re going to get to the point where we learn
how to secure the data and prevent the hacks etc. And the way we learn is occasionally
we make mistakes and we see that things happen p eople are out there they are working
on addressing this . There are new security technologies that are getting put in to place
and their advancements to Internet technologies that really need to get applied this is an
area where the healthcare space can't be laggards behind the rest of the IT industry in
adopting new technologies to secur e the data.

Margaret Flinter: We’ve been speaking to day with Keith Boone Interoperability Guru at
GE Healthcare where he oversees the architecture platforms that promote health data
interoperability . You can learn more about his work by following his blog on Healthcare
Standards motorcycleguy.com or follow him on Twitter @motorcycle_guy or follow GE's
work in this space at GE Healthcare . Keith, thank you so much for joining us on
Conversations on Healthcare today .

Keith Boone: Thank you .

(Music)

Mark Masselli: At Conversations on Healthcare, we want our audience to be truly in the
know when it comes to the facts abo ut healthcare reform and policy. Lori Robertson is
an award - winning journalist and managing editor of FactCheck.org, a nonpartisan,
nonprofit consumer advocate for voters that aim to reduce the level of deception in US
politics. Lori what have you got fo r us this week?

Lori Robertson: President Donald Trump made the curious claim that “Obamacare
covers very few people” in fact the number of uninsured Americans has fallen by 20
million since the healthcare law was enacted . That’s a ccording to the National Health
Interviews Survey published by the Centers for Disease Control and Prevention . Trump

Keith Boone, Interoperability Guru for GE Healthcare

made the claim in a speech to the Conservative Political Action Conference and went
on to say that it was necessary to “ Deduct from the number all of the people that had
great health care that was taken away from them ”. The latest CDC report shows that
the number of uninsured Americans of all ages decreased from 48.6 million in 2010 --
the year the ACA was enacted -- to 28.2 million for January through Sep tember 2016.

T he country now has the lowest uninsured rate on record , 8.8 % , t he rate was 16 % in
2010, and it has been declining every year since. The number who selected an
insurance plan through HealthCare.gov during the open enrollment period that ende d
January 31 was 9.2 million and another 2.8 million signed up on the 12 state - based
marketplaces as of December 24 a nd then there’s the expansion of Medicaid which 31
states plus Washington D.C. have implemented.

Trump referred to people who had their h ealth care taken away from them. In 2013
some Americans received cancellation notices for their specific individual market plans
that no longer met minimum benefit requirements under the ACA. An Urban Institute
study from December 2013 estimated the number getting such notices at 2.6 million , a
RAND Corporation study from 2015 found that the vast majority of those with individual
market insurance in 2013 were still insured in 2015 .

And that’s my fact check for this week, I am Lori Robertson Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy Center at the
University of Pennsylvania. If you have a fact, that you would like checked, email u s at
www.chcradio.com . We will have FactCheck.org's Lori Robertson check it out for you
here on Conversations on Hea lthcare.

(Music)

Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Well more than 20 million
Americans have gained coverage under the Affordable Care Act, some 30 million
remain uninsured and many of these are either immigrants or without the resources to
purchase coverage. While most can access primary healthcare in the nation’s
community health centers and safety net hospitals, many more with complex conditions
simply can't afford to access to specialty care. Entrepreneur Jayanth Komarneni
decided to create a virtual way to bypass the system and founded the Human Diagnosis
Project. A network of volunteer specialist around the country offering virtual consults f or
the neediest patients.

Keith Boone, Interoperability Guru for GE Healthcare

Jayanth Komarneni: The Human Diagnosis Project is an online system built by the
worlds’ doctors to understand the best steps to help any patients. We realize that there
is an opportunity to develop a system that can ultimately help solve the problem for
those people who won't have access to specialty care.

Margaret Flinter: Dr. Shantanu Nundy is the Director of the Human Diagnosis Project .

Dr. Shantanu Nundy : The way this system works is safety net providers can freely
excha nge electronic consultations with volunteer specialists from around the country so
that the expertise that those specialists have becomes available.

Margaret Flinter: It's estimated that roughly 35% of specialists visits can be done
virtually. The Human Diagnosis Project offers an opportunity to create real savings in
the healthcare system while effectively brining treatment to millions that are most
vulnerable.

Jayanth Komarneni: So there is a very real and large portion of situations in which
providing an electronic perspective on that given problem will actually solve that
problem for many patients.

Margaret Flinter: The Human Diagnosis Project has earned re cognition as a finalist in
the McArthur Foundation's 100&Change competition , a free online portal making safety
net providers serving underserved population to specialty care expertise, improving
outcomes for millions of uninsured and vulnerable patients a nd improving care
outcomes in the process, now that's a bright idea.

(Music)

Margaret Flinter: This is Conversations on Healthcare, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Healthcare, broadcast from the campus of WESU at Wesleyan
University, streaming live at www.wesufm.org a nd brought to you by the Community
Health Center.