The Dish on Health IT

In this episode of The Dish on Health IT, host Tony Schueth is joined by co-host Alix Goss and special guest Amy Gleason, Strategic Advisor to Centers for Medicare & Medicaid Services (CMS) and Administrator of the U.S. Department of Government Efficiency (DOGE) Service, for a wide-ranging discussion on how health IT modernization is evolving under a pledge-driven, incentive-backed federal strategy.The conversation begins not with policy, but with lived experience.From Emergency Room to Interoperability AdvocateAmy shares how her early career as an emergency room nurse exposed the dangers of fragmented information. Providers were expected to make critical decisions without access to complete patient histories, while patients, often in pain or distress, were unrealistically asked to recall complex medical details.That professional frustration became deeply personal when her daughter went more than a year without diagnosis for a rare autoimmune disease, juvenile dermatomyositis (JDM). Multiple specialists saw pieces of the puzzle, but no one could see the full picture across charts and settings. Amy reflects that if today’s AI tools had been applied to her daughter’s complete longitudinal record, the condition may have surfaced sooner.That experience shaped her philosophy. Technology must converge with policy and trust in ways that tangibly improve care.Why Pledges Instead of Rules?Tony presses on a central theme. Amy has argued that we cannot regulate our way to success. Why pursue voluntary pledges instead of federal rulemaking?Amy explains her frustration returning to government in 2025 to find interoperability policies she helped draft in 2020 still not fully effective until 2027. Seven years is an eternity in technology. Meanwhile, the industry had technically complied with numerous mandates including Meaningful Use, Cures Act APIs and CMS interoperability rules, yet many workflows still felt broken.In her view, regulation created a floor but not always real transformation.The CMS Health Tech Ecosystem Pledge was launched as a different model. The federal government used its convening power to articulate a clear vision and challenge industry to deliver minimum viable products within six to twelve months rather than years.Initially announced with roughly 60 companies, the pledge initiative has grown to more than 600 participants collaborating in working groups. The three initial patient-focused use cases include:Improving data interoperability“Killing the clipboard” through digital identity and QR-based sharingLeveraging conversational AI and personalized recommendations for chronic conditions such as diabetes and obesityAmy describes live demonstrations at a Connectathon showing OAuth-enabled data retrieval, QR ingestion into EHR workflows and AI-powered recommendations built on patient data. The goal is not perfection by the first milestone, but real-world minimum viable functionality that can iteratively improve.Alix notes that from the standards community perspective, this approach feels aligned with long-standing calls for industry-driven collaboration, though it remains early to measure widespread impact.Carrots, Sticks and Rural HealthThe discussion turns to incentives.Amy outlines the administration’s carrots and sticks strategy:Stick: Enforcement of information blocking, with penalties up to $2 million per occurrenceCarrots: Financial incentives such as the $50 billion Rural Health Transformation Program and the CMS ACCESS Model, which pays for technology-enabled outcomesThe Rural Health Transformation Program directs money to states with expectations that ecosystem-aligned interoperability and app participation be incorporated into funding proposals. CMS retains oversight and clawback authority to ensure funds support rural providers.The ACCESS Model represents a significant shift. Technology-enabled care platforms can register as Medicare Part B providers and be paid for measurable outcomes in tracks such as cardiometabolic disease, musculoskeletal conditions and behavioral health. Providers remain in the loop and receive compensation for referral and care plan oversight.Alix underscores that rural providers face steep financial and workforce constraints. Standards participation, implementation and technology upgrades require resources that are often scarce. The success of these incentives will depend on whether they reduce burden rather than add to it.AI: Evolution, Risk and RealityAI becomes a central thread of the episode.Amy compares AI adoption to autonomous vehicle models. Some scenarios allow tightly controlled automation, such as medication refills, while others require a human in the loop for higher-risk decisions. She points to a Utah prescription refill pilot as an example of bounded automation, where malpractice coverage and clearly defined use cases mitigate risk.When Tony asks who owns risk in this evolving landscape, Amy emphasizes the need for light but clear regulatory pathways rather than fragmented state-by-state oversight.Patients, she notes, are already there. Millions are asking health-related questions weekly through AI tools. The more pressing issue is ensuring those tools are grounded in structured medical data rather than incomplete memory or unverified inputs.She shares a striking story. Her daughter was excluded from a clinical trial due to a misclassification of ulcerative colitis. By uploading her records into an AI model, they identified a more precise diagnosis, microscopic lymphocytic colitis, which did not disqualify her from the trial. For Amy, this demonstrates both the power and inevitability of AI use.Alix adds caution. AI is only as strong as the data beneath it. Dirty, inconsistent and poorly structured data limits performance. Standards and terminologies remain essential to fuel high-fidelity models and safeguard trust.FHIR, Deregulation and the Data FoundationThe conversation addresses an emerging tension. If regulatory burdens are being reduced, does that signal less need for structured standards like FHIR?Amy candidly admits she initially wondered whether AI might reduce the need for FHIR altogether. After discussions with labs and technologists, she concluded the opposite. Standardized data dramatically improves AI performance and reduces error.Deregulation is about removing unnecessary burden, not abandoning foundational data structures.Alix reinforces that FHIR enables discrete, normalized data capture that supports both legacy transactions and AI evolution. While future innovations may emerge, today FHIR remains the backbone for scalable interoperability.Prior Authorization and HIPAA ModernizationThe episode dives into prior authorization modernization across medical and pharmacy domains.Amy notes growing interest among pledge participants to expand into pharmacy prior authorization testing, diagnostic imaging, real-time benefit checks and bulk FHIR performance testing.Alix provides insight into ongoing work within the Designated Standards Maintenance Organizations to incorporate FHIR-based approaches into HIPAA-named standards, particularly for prior authorization. She highlights testing beyond Connectathons, including implementer communities and real-world pilot efforts.Both stress the importance of public comment periods and industry engagement, describing participation as a civic responsibility for health IT professionals.Trust as the Core EnablerThe final segment centers on trust.Amy explains that the ecosystem initiative aims to reinforce trust through:Stronger digital identity verification such as Clear, ID.me and Login.govCertification frameworks such as CARIN and DIME for patient-facing appsA new national provider directory to replace fragmented provider data sourcesTransparency dashboards showing data requests, volumes and purposeRather than replacing frameworks like TEFCA, she describes the pledge model as an accelerator layered above the regulatory floor.Transparency acts as sunlight, enabling visibility into who is accessing data and for what purpose.Final TakeawaysIn closing, Amy urges providers not to sit on the sidelines. Too often, she says, providers feel change is imposed on them. The pledge environment is designed as an open forum where they can directly shape what works or does not work in real workflows.Alix echoes the call. Standards require participation. Organizations must allocate budget and staff to engage, comment and collaborate. It truly takes a village.Tony concludes by framing the episode’s core message. Regulation establishes baseline expectations, but voluntary movements can demonstrate what is possible before mandates reach the Federal Register.Across pledges, payment reform, AI evolution and trust frameworks, the episode underscores a consistent theme. Modernization in health IT depends not only on policy direction, but on shared accountability and active participation from every stakeholder in the ecosystem.Listeners are reminded that POCP is available to support organizations in understanding the implications of federal initiatives, enforcement priorities and their strategic implications. Reach out to us to set up an initial consultation. The episode closes, as always, with the reminder that Health IT is a dish best served hot.Prefer video? Catch episodes on the POCP YouTube channel

In this episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by colleagues Mary Griskewicz, Regulatory Resource Center Lead, and Janice Reese, Senior Consultant and Program Manager of FHIR at Scale Taskforce (FAST), for a wide-ranging discussion on two major proposed rules released in mid-December 2025: the HTI-5 proposed rule from the Assistant Secretary for Technology Policy (ASTP) and CMS’s latest proposal on healthcare price transparency.Rather than treating these rules as abstract policy exercises, the conversation focuses on what the government is trying to accomplish, how these proposals may reshape the interoperability and data access landscape, and why stakeholder participation during the comment period is not optional if the industry wants workable outcomes.Setting the Stage: How Proposed Rules Become RealityThe episode opens with a level set for listeners who do not spend their days in the Federal Register. Mary walks through how proposed rules originate, typically from legislation or executive policy, and how they move from proposal to public comment to either a final rule, an interim final rule, or, in some cases, a complete pause or reset.She emphasizes a point that often gets overlooked: every public comment is read and reviewed. The agencies group and analyze the comments section by section and respond to themes and concerns in the final rule text. Janice builds on this by explaining that the comment period is where high-level policy intent meets operational reality. The most effective comments are not lengthy manifestos, but specific, experience-based feedback that highlights feasibility issues, sequencing challenges, and unintended consequences.HTI-5: From Experimentation to ExecutionThe discussion then turns to HTI-5, with Mary outlining the core problem the rule is trying to address. Prior certification requirements placed a significant burden on vendors, often locking innovation into long development cycles while the market waited for updates. HTI-5 seeks to modernize this approach by reducing prescriptive certification requirements and relying more on modern, open architecture, particularly FHIR-based APIs, to enable faster, more scalable data exchange.Janice frames HTI-5 as a clear signal that the industry is moving out of the experimentation phase and into execution. By reinforcing a “FHIR-first” direction while pulling back on some certification detail, the rule implicitly raises expectations for real-world performance. As FHIR becomes the default, security, identity, consent, and trust cannot be treated as optional or inconsistently implemented components.From a FAST perspective, this shift is critical. HTI-5 creates the regulatory space, but the infrastructure and implementation guidance needed to make trusted interoperability work at scale must come from industry-led collaboration. Janice explains that FAST’s work on security, identity, consent, and national directory services is about operationalizing trust so organizations are not reinventing these foundations on their own.Information Blocking, Automation, and Trust at ScaleA pivotal moment in the conversation centers on HTI-5’s clarification that information blocking explicitly includes automated and AI-driven access. Mary underscores that automation is now central to how data moves across the healthcare ecosystem. When access decisions are embedded in APIs, workflows, and algorithms, trust becomes the defining requirement.Janice expands on this by noting that the issue is not just whether data can be accessed, but whether access is appropriate, provable, and governed. As automation increases, expectations shift toward accountability, auditability, and consistent enforcement of identity and consent. FHIR APIs, once viewed as certification checkboxes, are becoming the primary channel for data exchange across networks, including consumer-facing applications.Stakeholder Impacts: Vendors, Providers, and PayersThe episode then walks through how HTI-5 affects different stakeholder groups. For health IT vendors and digital health companies, Janice describes a trade-off: fewer certification guardrails provide flexibility but also remove a layer of protection. Vendors will be judged less on formal compliance artifacts and more on how their systems perform across networks at scale, including security, identity management, and reliability.Mary cautions that vendors should not interpret HTI-5 as traditional deregulation. With HTI-6 already on the horizon, organizations that underinvest now risk facing more stringent outcome-based expectations later. Tony reinforces this point, arguing that the real risk is collective. A single high-profile failure due to weak security or identity practices could undermine trust across the ecosystem and invite a regulatory response that affects everyone.For providers and health systems, the shift means becoming more informed consumers of technology. Certification alone will no longer guarantee interoperability or trustworthiness. Providers will increasingly need to ask vendors how solutions perform in environments beyond a single one and how identity, consent, and security are handled across organizational boundaries.From a payer perspective, Mary explains that while HTI-5 does not directly change prior authorization requirements, it fundamentally reshapes the data access environment. As FHIR APIs become the default, plans will be expected to exchange data more dynamically and through automated workflows. This raises expectations around timeliness, quality, and trust, and accelerates a shift from managing transactions to managing trust at scale.Price Transparency: Compliance Without ClarityThe conversation then transitions to CMS’s proposed price transparency rule, with Tony noting the absence of POCP’s usual price transparency expert and setting expectations for a higher-level discussion. Mary explains that this tri-agency proposal builds on earlier rules by clarifying standards, easing some reporting burdens, and refining requirements around machine-readable files, metadata, and reporting timelines.While these changes offer some relief to plans, Janice highlights a deeper challenge. Making pricing data available does not make it meaningful. Without consistent ways to connect clinical concepts to billing codes and pricing structures, patients and employers are left with technically accurate but practically unusable information. True transparency will require better integration of pricing data into real-time workflows, supported by APIs, governance, and trust frameworks.Mary also reminds listeners that employers are a critical stakeholder often overlooked in these discussions. As purchasers of coverage, they rely on usable pricing data to understand utilization and manage costs, making their perspective essential during the comment period.The Closing Message: Comment, Participate, Get InvolvedThe episode closes with a strong call to action. Mary urges listeners to “get off the bench” and engage, regardless of which rule is at issue. Comment periods directly affect compliance programs, product roadmaps, and competitive positioning. Janice reinforces that policy alone cannot solve interoperability challenges. Progress depends on shared implementation guidance, testing, governance, and sustained participation in standards organizations and multi-stakeholder initiatives, including FAST.The final takeaway is clear: HTI-5 and the price transparency proposal are not just regulatory events. They are inflection points. Organizations that participate now can help shape outcomes that are achievable, scalable, and trusted. Those that sit out will be left reacting to decisions made without their operational realities at the table.Listeners are reminded that both proposed rules have comment deadlines in late February, and that POCP is available to support organizations in understanding the implications and crafting effective comments. The episode closes, as always, with the reminder that Health IT is a dish best served hot. 

This episode of The Dish on Health IT features Denny Brennan, Executive Director of the Massachusetts Health Data Consortium (MHDC), in conversation with host Tony Schueth, CEO of Point-of-Care Partners (POCP), and co-host Ross Martin, MD, Senior Consultant with POCP. Together, they examine how MHDC is translating national interoperability policy into practical, statewide action, specifically around the CMS-0057 rule.After brief introductions, the conversation quickly turns to MHDC’s long history and why it matters. Founded in 1978, before the internet, MHDC guided Massachusetts through nearly every major health IT transition: HIPAA, Meaningful Use, ICD-10, and now interoperability and automation. Denny explains that this continuity has created something rare in healthcare: sustained trust across payers, providers, vendors, regulators, and associations. That trust, he notes, is what allows competitors to work through shared infrastructure problems that no single organization could solve on its own.From there, the discussion turns to why the MHDC community chose to coordinate and support members in their CMS-0057 compliance journey, versus just letting each member organization go it alone. Denny emphasizes that while healthcare is regulated federally, it functions locally. Each state has its own mix of insurers, hospital systems, rules, and market pressures. In Massachusetts, where long-standing relationships already exist, MHDC saw an opportunity to move faster, test real workflows, and generate lessons that could inform efforts far beyond the state.The discussion then moved to how work to improve prior authorization became such a high-priority focus. Denny describes how the process has grown into one of the most disruptive administrative burdens for clinicians. Rules vary by plan, criteria change frequently, and the information providers need is often hard to access in real time. The result is defensive behavior. Offices routinely submit prior authorizations “just in case,” often by fax or phone, simply to avoid denials and treatment delays. That inefficiency, he explains, ripples outward by slowing patient care, driving up providers' overhead, and requiring health plans to spend more time and resources processing and reviewing the required PA alongside the unneeded submissions.The financial impact quickly becomes apparent. Denny points to evidence showing that administrative costs consume a massive share of U.S. healthcare spending, with prior authorization playing a meaningful role. If automation is implemented through a neutral, nonprofit infrastructure, MHDC believes there is a much greater chance that savings will flow back into premiums and public program costs rather than being swallowed by inefficiency.Ross adds an important dose of realism. Prior authorization friction, he notes, is not always accidental. In some cases, operational complexity functions as a utilization control mechanism. That creates a built-in tension between access, cost containment, and patient experience, and helps explain why national reform has moved slowly despite widespread frustration.At that point, the conversation shifts from why this is broken to how MHDC is trying to fix it. Denny walks through MHDC’s operating model: convene the full ecosystem early and often. In a recent deep-dive session, roughly 60 representatives from health plans, providers, and the state participated in a working session focused on what an automated prior authorization workflow could realistically look like. MHDC brought a draft framework to the table. The community pressure tested it and surfaced workflow conflicts, operational blind spots, and policy misalignments that no single organization could see on its own.That collaborative process, Denny explains, is the real engine behind adoption. When stakeholders help build the solution themselves, implementation becomes a shared commitment rather than a compliance exercise. It also reduces resistance later because decisions are not delivered top-down. They are constructed collectively.The discussion then turns to FHIR adoption and why, while real, progress has taken time. Denny traces the turning point back to the 21st Century Cures Act, which reframed patient access to health data as a legal right and categorized data blocking as a regulatory violation. That policy shift, combined with the growing maturity of API-based interoperability, created the conditions for real-time data exchange to finally move from theory to practice.Ross provides a historical perspective from the standards side. Earlier generations of health data standards were conceptually elegant but extremely difficult to implement consistently. FHIR changed that equation by aligning healthcare data exchange with the same API-driven architecture that supports the modern web. He points to accelerating real-world adoption, particularly from large EHR platforms, as evidence that FHIR has entered a phase of broad, practical deployment.Although pharmacy prior authorization falls outside the formal scope of CMS 0057, Denny makes clear that MHDC could not ignore it. For many physicians, especially in oncology, dermatology, and primary care, PA for prescriptions is far more frequent and far more disruptive than PAs for medical services. If MHDC solved only one side of the problem, much of the daily burden for clinicians would remain unchanged.Pharmacy prior authorization, however, introduces a new level of complexity. PBMs, pharmacists, prescribing systems, payers, and patients are all involved, often across fragmented workflows. Denny explains that the challenge looks less like a pure technology gap and more like an orchestration problem. It is about getting the right information to the right party at the right moment across multiple handoffs.Ross shares insights from the pharmacy PA research work conducted with MHDC and POCP. One of the most striking findings was the massive year-end renewal surge that hits providers every benefit cycle as authorizations tied to prior coverage suddenly expire. He also reflects on a recent national electronic prior authorization roundtable, where deep stakeholder discussion ultimately led most participants to conclude that today’s technology alone still is not sufficient to fully solve pharmacy PA. The tools are improving, but the problem remains deeply multi-layered.As the episode winds down, the tone shifts toward practical calls to action.Denny challenges the industry to separate where competition belongs from where collaboration is essential. Contract negotiations may be adversarial by nature, he notes, but interoperability initiatives cannot succeed under the same mindset. Real progress depends on bringing collaboratively minded people into the room. These are people willing to solve shared infrastructure problems even when their organizations compete elsewhere.Ross builds on that message with a longer-term challenge: sustained participation in standards development. Organizations cannot sit back and hope others shape the future on their behalf. Active involvement in national standards organizations is critical. This is not for immediate quarterly returns, but to influence the systems everyone will be required to use in the years ahead.The episode closes with a clear takeaway. MHDC did not wait for perfect conditions. It moved when the pieces were good enough, tested real workflows with real stakeholders, adjusted in the open, and began sharing lessons nationally. In an industry often slowed by fragmentation and risk aversion, this conversation offers a grounded look at what forward motion actually looks like when collaboration, policy, and technology finally align.You can find this and other episodes of The Dish on Health IT wherever you get your podcasts, including Spotify and Healthcare Now Radio. If you found this conversation valuable, share it with a colleague and be sure to subscribe so you never miss an episode. Have an idea for a topic you would like us to cover in future episodes? Fill out the form and tell us about it. Until next time, Health IT is a dish best served hot. 

In this episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by colleagues Brian Dwyer, POCP’s Business Strategy Lead, and Seth Joseph, Managing Director at Summit Health Advisors, to unpack their takeaways from the HLTH25 conference in Las Vegas. Together, they reflect on the energy of the event, the conversations shaping the future of health IT, and interviews recorded live from Podcast Row.The trio kicks off by comparing notes on how HLTH has evolved from a flashy innovation show to something more grounded, a space where serious conversations about interoperability, investment, and operational impact are starting to take hold. Seth notes the event’s “coming-of-age” moment, where hype gave way to maturity. Brian agrees, adding that the buzz of startups pitching and investors circling was balanced by a sense of realism about implementation and outcomes.AI dominated every conversation, but with a more pragmatic tone than in years past. The hosts discuss how AI is shifting from novelty to necessity, moving from “AI for AI’s sake” to purpose-driven use cases. Interview clips from leaders like Taha Kass-Hout with GE Healthcare spotlight “agentic AI,” where autonomous systems could act as trusted colleagues in care delivery, even participating in tumor board decisions to help extend expertise to rural or underserved regions. The group connects this to the ongoing challenge of ensuring data quality and interoperability as the foundation for any AI success story.Laurie McGraw of Transcarent and Kyle Kiser of Arrive Health bring different but complementary perspectives. Laurie underscores AI’s potential to bend the cost curve only if applied safely and effectively, while Kyle highlights the growing complexity of affordability and the need for intelligent systems to help patients and providers navigate fragmented benefits and prescription pricing. Seth and Brian note that the shift toward patient empowerment, fueled by AI and transparency, could signal a broader cultural change in healthcare where consumers wield more influence.The discussion expands into value-based care with insights from McKesson’s John Beardsley, who questions whether the industry has truly cracked the code after two decades of running at value-based care and interoperability. John also raises an important tension: small innovators are doing exciting things with AI, but scaling those solutions across full workflows remains the real test. The hosts debate whether new payment models, potentially powered by AI-driven insights, could finally make value-based care viable.Policy and regulation also take center stage as Christopher Chen, MD, MBA, Chief Medical Officer at the Washington State Health Care Authority, shares how state and federal efforts are aligning to accelerate interoperability, reduce provider burden, and modernize prior authorization processes under CMS-0057. The hosts reflect on the importance of federal leadership to align incentives across payers, providers, and technology vendors, echoing lessons learned from the early days of ePrescribing.Other memorable interview moments include John Beardsley’s commentary on the CMS Interoperability and Patient App Pledges and how better understanding how NCPDP and FHIR standards bridge pharmacy and clinical data silos could help move the needle. Brian and Seth build on that theme, envisioning a future where agentic AI and patient-facing apps work together to drive true engagement and accountability for health outcomes.In the final stretch, the hosts revisit recurring topics such as physician burnout, administrative burden, and structured data chaos, tying them back to the industry’s broader need for smarter implementation and aligned incentives. From Christopher Chen’s relaying an anecdote about seeing structured data turned into unreadable images that are faxed in to Arrive Health’s use of AI to prevent unnecessary transactions, the episode surfaces a consistent theme: technology alone won’t fix healthcare, but when paired with aligned incentives, collaboration, and business transformation, it can finally make measurable progress.The episode closes with optimism. Tony, Brian, and Seth agree that while the system is strained, it’s also full of momentum, from maturing AI applications to government action and renewed industry alignment. As Tony puts it, “There’s a lot to be hopeful about and a lot of work left to do.”Listen to the full episode to hear interviews from the HLTH25 floor, including thought leaders discussing interoperability, agentic AI, and the real-world changes needed to make healthcare innovation stick.Share The Dish on Health IT from Spotify, Apple Podcasts, or Healthcare NOW Radio, Watch extended clips on the POCP YouTube channel

In this episode of The Dish on Health IT, POCP CEO and host Tony Schueth sat down with Dr. Julia Skapik (SVP & CMO at PurpleLab, practicing physician, member of the HL7 Da Vinci Clinical Advisory Council, and outgoing HL7 International board chair) and Dr. Steven Waldron (Chief Medical Informatics Officer at the American Academy of Family Physicians and Co-Chair of the Da Vinci Clinical Advisory Council). Together, they explored how clinicians are shaping interoperability and standards development through the HL7 Da Vinci Project’s Clinical Advisory Council (CAC).Tony opened by framing the discussion: interoperability looks different at the point of care, and the provider voice is critical in making standards practical. Julia and Steve introduced themselves by highlighting both their clinical work and their roles within Da Vinci. Julia described her experience with clinical data exchange and Data Exchange for Quality Measures (DEQM) work, and Steve explained how his decades in clinical informatics led him to co-chair the CAC.Why HL7 Da Vinci Project ExistsSteve provided a primer on HL7 and the role of implementation guides in constraining optionality, so standards work in the real world. He emphasized Da Vinci’s collaborative model—bringing payers, providers, and vendors together. Julia added that Da Vinci’s strength lies in defining practical, feasible solutions the government can later adopt into regulation. She noted this industry-led, government-leveraged approach is why Da Vinci solutions have gained traction.The Da Vinci Project CAC’s RoleJulia explained the CAC gives clinicians a venue to contribute without the unrealistic expectation of weekly hours of standards work. The council distills provider feedback and ensures workflows make sense in practice. Steve underscored its strategic role: CAC members participate in Da Vinci’s steering committee (though without voting power) and help produce content that reflects clinician priorities.Clinical Challenges and OpportunitiesWhen asked about top challenges, Steve focused on accelerating adoption. Clinicians are tired of multiple payer portals; they need solutions that simplify, not add layers. He noted Da Vinci studies early adopters to identify what’s working and how to spread best practices. Julia brought in her day-to-day frustration: being blindsided when payers second-guess treatment plans after the fact. For her, seamless data flow at the point of care would let providers close loops quickly and reduce burden.Progress to DateJulia highlighted how Da Vinci has reduced tensions between payers and providers by creating space for collaborative problem-solving. She pointed to patient access and real-time eligibility/coverage checks as areas where providers feel real relief. Steve added that having clinicians consistently “at the table”—via CAC, open invitations, and health system involvement—is a big step forward, even if imperfect.Workflow Alignment and UsabilityThe conversation then turned to the CAC’s recent report on usability and workflow. Julia stressed that standards must fit into diverse care settings. Training, audit data, and clarity about why data matters are crucial—otherwise, boxes won’t get clicked, and data quality suffers. She provided examples, such as prior authorization questions, that should be resolved automatically to avoid burdening providers. Steve expanded on the strategic approach: learning from innovators, cataloging obstacles (like ROI calculation), and identifying opportunities (education, ROI tools, developer engagement). He illustrated how real-time prior auth workflows must account for triaging between clinicians and back-office staff, not just “dump” everything on providers.Prior Authorization Pain PointsBoth guests dug deep into prior authorization. Julia cited a successful MultiCare Regents pilot and her own frustrations with stuck ePA requests and payer variability. She described patients enduring multiple unnecessary visits due to PA roadblocks. Steve echoed this, recalling clinicians’ frustration with nonsensical requirements (e.g., annual PA for diabetes test strips). He argued that half-measures—like real-time denials without alternatives—aren’t enough; systems need to provide actionable options to avoid delays in care.Policy and RegulationThe panel then addressed broader policy topics. On CMS’s recent digital ecosystem pledge, Steve was skeptical: pledges are good, but clinicians want action and alignment across TEFCA, QHINs, and standards. Julia compared pledges to past attestations—checking boxes without measuring outcomes. Both agreed that alignment of business cases with regulatory requirements (as in CMS-0057) is key to sustainable progress.When asked about price transparency and quality measures, Julia shared insights from her PurpleLab work on claims analytics, arguing that integrated data can drive smarter decisions for providers, payers, and patients. Steve stressed the importance of transparency to spur competition among clinicians and the promise of moving beyond claims data toward richer clinical data exchange via Da Vinci’s CDex and PDex work. Julia added a practical note: today, provider office care coordinators and payer care coordinators rarely communicate. Standards that connect those two sides could be transformative.Final ThoughtsSteve’s call to action: clinicians should engage where they can—whether by advocating within their organizations or learning through Da Vinci’s education tracks. Julia encouraged listeners to press their vendors and payers: “What are you doing with Da Vinci? Will you support these solutions on my behalf?” She emphasized that early involvement is both strategic and practical as regulations like CMS-0057 loom.Tony closed by thanking Julia and Steve for bringing the clinical voice to life and reminded listeners that interoperability is a dish best served hot.Related MaterialsHL7 Da Vinci Confluence PageAccelerating DV Adoption by Providers – CAC Insights ReportCAC Statement on Prior Authorization Burden Reduction BallotHL7 Da Vinci LinkedIn PageHL7 Da Vinci Project: MultiCare & Regence Case Study on Early Implementation & Real-World ROICatching FHIR: Lessons Learned from Achieving the First Prior Authorization Automation via HL7® FHIR®

In this episode of The Dish on Health IT, Tony Schueth and Rob Dribbon are joined by Neikisha Charles Director of Quality Improvement and Risk Management of Bedford Stuyvesant Family Health Center (Bed-Stuy), a federally qualified health center (FQHC) in Brooklyn, NY. Together, they dig into common misconceptions about FQHCs and shine a spotlight on the opportunities they present for strategic engagement across the healthcare ecosystem—especially for health IT and life sciences organizations.Neikisha opens with her personal journey: starting as a data analyst at Bed-Stuy in 2021 and quickly rising into her current leadership role because of her knack for using data to drive quality improvement. Her story illustrates the increasing sophistication of FQHCs and sets the tone for a broader conversation about how these organizations are evolving.To help orient listeners who may not fully understand the role of FQHCs, Neikisha provides a clear definition: FQHCs are federally funded community-based providers mandated to offer care to all residents in underserved areas, regardless of insurance status. They are deeply attuned to social determinants of health and committed to removing access barriers for vulnerable populations.Rob adds context from his years in pharma, highlighting the unique value proposition of FQHCs—namely, their holistic and integrated approach to care. He urges listeners not to overlook these organizations simply because they’ve historically focused on commercial health systems.Neikisha then debunks a major myth: that FQHCs only serve uninsured or homeless patients. In fact, Bed-Stuy primarily serves Medicaid-managed populations, but also sees commercially insured and uninsured individuals, offering services on a sliding scale. Services range from primary care and mental health to dental, podiatry, and optometry, along with extensive care coordination and social support services.When asked what health IT vendors and life sciences companies may be missing, Neikisha makes it clear: FQHCs are not tech or data-poor. Bed-Stuy uses a robust EHR (eClinicalWorks), the Azara DRVS population health platform, and Artera for two-way patient communication. These tools aren’t just window dressing—they are integrated into care delivery to close gaps, improve compliance, and monitor population health in real time.She offers a compelling case study: When colorectal cancer screening rates began to drop, Neikisha led a data-driven campaign using Azara to identify noncompliant patients, Artera to send targeted outreach texts, and a partnership with Exact Sciences to offer Cologuard kits to patients by mail. The result? A 12.3% increase in screening compliance over 18 months.Rob underscores the significance of this approach—not just the smart use of technology, but also the community-level relationships and the trust that make this kind of intervention effective.The discussion then shifts to interoperability. Neikisha notes the complexities of data exchange and the importance of dedicated roles like a Director of Health Integration to manage relationships and reporting. Bed-Stuy is connected to a regional health information organization (RHIO), uses platforms like Azara to track transitions of care, and maintains read-only EMR access with key partners to streamline care coordination. While true vendor-agnostic interoperability remains elusive, FQHCs are actively working with what’s available.Tony brings the conversation back to the bigger picture: What gaps do vendors and life sciences partners need to close? Neikisha points to the need for better education about what FQHCs actually do and who they serve. She challenges companies to co-create solutions with FQHCs—offering tools that reflect real-world workflows and support sustainable partnerships rather than transactional engagements.The episode wraps with both Rob and Neikisha emphasizing the untapped potential of FQHCs. With over 30 million Americans relying on them for care, these organizations are not fringe players—they are essential infrastructure. And as Neikisha puts it, they’re “here to stay.” To partner successfully, the first step is simple: reach out, learn what’s needed, and build something meaningful together.Related ContentWhat Are FQHCs, & Should Life Sciences Manufacturers Even Care About Them?HIT Perspectives May 2025: FQHC Myth vs Fact Bedford Stuyvesant Family Health Center Brooklyn NY - Primary Care Services 

In this episode of The Dish on Health IT, host Tony Schueth sits down with two of the industry's sharpest minds leading the charge to fix one of health IT’s most persistent headaches: digital consent management. Janice Reese, Senior Consultant at Point-of-Care Partners and Program Manager for the FHIR at Scale Taskforce (FAST), and Mohammad Jafari, Co-Lead of FAST’s Consent Work, offer an unflinching look at why consent is still so messy—and what it’ll take to make it scalable, interoperable, and actually work for patients.The conversation kicks off with a reality check. While the question “Who can access what data and when?” might sound simple, it quickly falls apart in practice. Consent today is often paper-based, fragmented, non-interoperable, and rarely computable. Mohammad explains how even digitized forms—often scanned PDFs—are barely better than paper when it comes to machine-readability and cross-system portability. The burden lands on both sides: patients are stuck filling out redundant forms at every touchpoint, and providers face access barriers that can delay or limit care.But the episode isn’t just a critique, it’s a roadmap forward. Janice and Mohammad walk listeners through how FAST is approaching consent differently. Rather than focusing on the content of specific consents (like for research or behavioral health), the team is building a foundational infrastructure: a FHIR-based implementation guide that supports core consent operations, like requesting and revoking consent, delegating authority, and syncing consent decisions with digital identity and security frameworks. In other words, FAST is working on the plumbing that everyone else can build on.What sets this work apart is its real-world grounding. The team has prioritized broad stakeholder input through public calls and is actively incorporating lessons from pilot participants. Janice highlights that many organizations don’t even know where to start—some have APIs, patient portals, or identity systems in place, but lack a cohesive strategy for managing consent. That’s where FAST can help, not just with standards but with education and architectural guidance.The discussion also tackles the elephant in the room: policy fragmentation. With states having vastly different rules—sometimes even conflicting ones within the same region—scaling consent can feel impossible. But rather than trying to standardize policy, FAST is focused on standardizing structure. That means creating frameworks flexible enough to accommodate policy differences without hardcoding for each new rule change. Mohammad notes this kind of flexibility is key to making systems resilient and future-proof.Both guests agree that the time to act is now. Technology has matured, regulators are engaged, and public expectations for privacy and control over personal data are higher than ever. As Janice puts it, the stars are aligning. With CMS showing growing interest in digital identity and consent, and with FAST’s security IG set to be required for FHIR under TEFCA in 2026, organizations can’t afford to sit this one out.Whether you’re a health plan, HIE, health tech vendor, or public health department, this episode makes one thing clear: scalable, patient-centered consent management isn’t just possible—it’s already underway. And FAST is laying the groundwork.To get involved, attend a public call (2nd & 4th Fridays at 1:00 Central/2:00 Eastern), reach out to Janice directly at janice.reese@pocp.com, or contact the team at fast@hl7.org. Now’s the time to shape the future of consent—before it shapes you.

In this episode of The Dish on Health IT, host Tony Schueth and payer interoperability expert Kendra Obrist sit down with Rob Alger, SVP of Health Plan Technology at Kaiser Permanente, for a candid and sweeping conversation about payer interoperability, AI, FHIR, and the realities of health IT innovation at scale.Rob kicks things off by discussing Kaiser Permanente’s unique care and coverage model, highlighting how it streamlines internal coordination and shapes investment priorities. He notes that, unlike many other health plans, Kaiser’s vertically integrated structure allows for fewer administrative hurdles, particularly in areas like prior authorization.The conversation then turns to CMS-0057. While Rob acknowledges Kaiser must comply like everyone else, the regulation presents less of a lift for them due to their internal alignment. That said, both he and Kendra agree: the success of any interoperability initiative hinges on provider adoption, and that remains uncertain.Looking ahead to 2025, Rob shares Kaiser’s strategic focus on simplifying healthcare experiences, especially by leveraging AI to remove friction from both clinical and administrative processes. One standout example is their ambient listening tool from Abridge, now rolled out across 40 hospitals and 600 medical offices, which is allowing clinicians to focus more on patients than keyboards. It’s one of the fastest clinical tech adoptions Rob’s ever seen.Naturally, the discussion shifts to FHIR. Rob puts it plainly: “FHIR is non-negotiable.” Regulatory mandates have solidified its role, but he wonders whether the industry will eventually want to use FHIR or continue reacting to policy. Kendra and Tony weigh in, noting signs of growing pull once organizations recognize the potential. They agree that multi-stakeholder efforts like Da Vinci Project and FHIR at Scale Taskforce (FAST) are helping to build real-world traction by solving for shared use cases.When asked why Kaiser stays engaged in these initiatives, Rob makes it clear it's about shaping standards early, staying ahead of the curve, and making smarter, future-proof decisions, especially when it comes to vendor selection.The episode then revisits AI, with Rob outlining Kaiser’s guiding principles: human in the loop, bias mitigation, and responsible governance. He explains that while Kaiser isn’t trying to build every tool themselves, they aim to be excellent adopters, using AI to free up clinicians and call center reps to operate at the top of their license. It's less about chatbots and more about smarter workflows, ambient data capture, and preserving session context across modalities.Data quality surfaces as a recurring theme. Kendra highlights increasing payer interest in tackling inconsistency and fragmentation. Rob acknowledges Kaiser has an edge due to its standardized EHR system, but insists no one is immune to the challenges, especially when AI is in the mix. As he puts it, “If your data’s not clean, you’re not going anywhere.”As a member of the Council for Affordable Quality Healthcare (CAQH) board, Rob brings a unique perspective on industry-wide infrastructure and collaboration. He explains that CAQH, originally formed by major health plans to tackle non-competitive operational challenges, has evolved into a key player in both standards development and practical solutions like coordination of benefits and provider directories. That dual focus—advocacy and action—resonates throughout the conversation, especially as Rob underscores the importance of shared investments in foundational infrastructure that lift the entire industry.The discussion then touches more specifically on directories and the potential of shared infrastructure for non-competitive areas of healthcare. Rob emphasizes that while payers care deeply about directory accuracy, the solution likely involves more human accountability than tech alone.In closing, the trio shares their perspectives on under-discussed industry challenges. Rob flags cybersecurity as a growing threat, especially in light of recent ransomware attacks. Kendra and Tony shine a light on consent and pharmacy interoperability, two areas that, while not headline-grabbing, could unlock major gains in care coordination and equity.Rob’s parting call to action? It’s time for the industry to align on clinical policy. Competing on utilization rules isn’t sustainable, and getting consensus on what’s appropriate care could help streamline prior auth and improve patient trust.Kendra wraps by urging payers to suspend disbelief and start planning for a world where APIs and data exchange work as intended. Dream a little, and then build accordingly. 

In this special HIMSS25 recap episode of The Dish on Health IT, host Tony Schueth, CEO of Point-of-Care Partners (POCP), is joined by co-hosts Brian Bamberger, POCP’s Life Sciences Lead, and Vanessa Candelora, Senior Consultant and Program Manager of the HL7 Gravity Project. Together, they break down the biggest themes from the conference, covering interoperability, artificial intelligence (AI), FHIR adoption, and the growing focus on improving data quality in healthcare innovation.HIMSS25 once again proved to be a crucial gathering of healthcare leaders, vendors, and policymakers, drawing nearly 28,000 attendees. Vanessa notes the continued focus on interoperability and trust, with a clear divide between experienced stakeholders refining their strategies and newcomers trying to grasp the fundamentals of FHIR. Brian, a HIMSS veteran, points out that first-time attendees often struggle with the complexity of both the conference itself and the discussions around health IT’s latest advancements, particularly AI and its real-world applications.To add perspectives from the conference floor, Tony introduces a series of interviews with HIMSS25 attendees and industry leaders, including Anna Taylor, Associate Vice President, Population Health and Value-Based Care of MultiCare, Erin Weber, Chief Policy & Research Officer, CAQH, Mariann Yeager, CEO, The Sequoia Project, Matthew Holt, Founder/Writer of The Health Care Blog, and Lynne Nowak, Chief Data and Analytics Officer. Each interview provides insights into the real-world implementation of interoperability and FHIR, the evolving use of AI, and how data privacy and governance are shaping health IT strategy.FHIR adoption was one of the topics covered in the interviews. Some, like Mariann Yeager and Erin Weber, expressed optimism about FHIR’s expanding role in clinical data exchange, while others, such as Anna Taylor, highlighted persistent scalability challenges and limited adoption for administrative functions like prior authorization. Matthew Holt offered a broader view on data exchange, arguing that while data mobility has improved, the real challenge is how organizations actually use and integrate that information. Vanessa underscores that while FHIR is gaining traction globally, large-scale implementation remains a work in progress. The panel agrees that translating theoretical frameworks into real-world adoption is the next crucial step.AI was another dominant topic, with a mix of enthusiasm and skepticism surrounding its potential. The HIMSS interviewees discuss AI’s growing role in streamlining administrative workflows, summarizing patient records, and enabling ambient listening for clinical documentation. However, as Brian bluntly puts it, the “magic” of AI is still far from reality—many tools promise seamless EHR integration but lack the ability to write back into clinical systems, requiring manual intervention. Lynne Nowak and others emphasized that AI’s effectiveness is directly tied to data quality—bad inputs will only lead to bad outputs. The consensus? AI has real potential to enhance workflows but cannot replace clinicians, and health IT leaders must focus on governance, usability, and ensuring AI supports, rather than replaces, human decision-making.As the conversation wraps up, Vanessa highlights the critical role of policy and strategic innovation in shaping the next wave of health IT progress. With new regulatory shifts and uncertainty around TEFCA, organizations must stay agile while ensuring that patient privacy, data integrity, and consent management remain top priorities. Brian brings the discussion back to life sciences, stressing the importance of leveraging patient insights and real-world data to drive treatment adherence and improve outcomes.HIMSS25 reinforced that while FHIR, AI, and interoperability remain hot topics, the industry is now at a critical inflection point—shifting from theory to execution. Organizations must filter out hype, focus on data quality, and build scalable solutions that improve both clinical and administrative functions.For those who couldn’t attend HIMSS25 or want a deeper dive into what’s next for health IT, this episode provides a comprehensive breakdown of the major takeaways. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or your preferred platform. The podcast is also available on HealthcareNOW Radio. Full video versions are also available on POCP’s YouTube channel. As always, health IT is a dish best served hot. 

In this episode of The Dish on Health IT, host Tony Schueth leads an engaging discussion on pharmacy interoperability, a topic at the center of a recently published POCP white paper funded by the NCPDP Foundation and supported by Surescripts. Joining Tony as guests are, John Hill, Executive Director of the NCPDP Foundation, and Larry King, Director of Intelligent Prescribing at Surescripts, to unpack the white paper’s findings and explore the future of pharmacy’s role in patient care.The conversation begins with Tony laying the foundation for the discussion by defining pharmacy interoperability as the seamless, bi-directional exchange of health information between pharmacy care settings and the broader healthcare ecosystem. This connectivity ensures that data flows effortlessly without adding complexity to the workflows of pharmacists or other providers. Tony highlights the POCP white paper, which outlines critical opportunities and challenges in achieving this vision. The document calls for leveraging standards and technology to integrate pharmacists as key contributors to care teams, addressing  medication management and broader clinical services.John Hill and Larry King bring their unique perspectives to the conversation. John shares insights into how the NCPDP Foundation is focused on grants that expand the pharmacist's role, improve patient safety, and enhance access to care. He emphasizes that the white paper marks a pivotal step toward identifying gaps in interoperability and opportunities to engage pharmacists more fully in patient care. Larry draws from his experiences as a pharmacist and industry leader, highlighting the complexity of patient needs and the roadblocks that prevent pharmacists from working to the highest and best purpose of their license. Both guests underscore the need for workflow-friendly solutions to reduce administrative burdens and allow pharmacists to spend more time on meaningful, patient-centered work.The discussion delves into the growing role of pharmacists, who are increasingly stepping beyond dispensing medications to provide direct patient care services, including immunizations, chronic disease management, and comprehensive medication reviews. Tony and his guests agree that pharmacies are uniquely positioned to fill gaps in care, especially in underserved areas, and to offload basic services from overburdened primary care practices. However, for pharmacies to step into this larger role, significant progress is needed in interoperability, reimbursement models, and technology adoption.A key focus of the conversation is the critical role of standards in enabling interoperability. John elaborates on how NCPDP works to ensure data can be exchanged seamlessly, highlighting their collaboration with HL7 on standards like the eCare Plan. He explains that standards not only ensure data consistency across systems but also reduce the burden on users by integrating into existing workflows. Larry adds that Surescripts’ efforts to implement interoperable solutions, such as Qualified Health Information Networks (QHINs) under TEFCA, demonstrate the potential of standards to create a nationwide framework for secure data exchange.The guests also discussed the importance of using sustainable financial models to incentivize investment in interoperability. Larry points out that while there are some reimbursement programs for clinical services, inconsistencies remain a significant barrier. Both guests stress that the industry must develop scalable payment models that align with pharmacists’ expanded roles and address the technology investments required to connect pharmacy systems with the broader care continuum.Emerging technologies like AI are also prominently featured in the discussion. Larry shares how Surescripts is leveraging AI for tasks like parsing patient instructions and monitoring network activity for compliance issues. John highlights NCPDP’s efforts to explore how AI can support standards adoption and governance. Both agree that while AI offers enormous potential to optimize pharmacy workflows and enhance clinical insights, it must be implemented cautiously, with safety and security as top priorities.As the episode nears its conclusion, the guests reflect on the ideal future state of pharmacy interoperability. Larry envisions a world where patients experience seamless care, with providers and pharmacists having immediate access to comprehensive, accurate health information. This would eliminate redundant data collection, reduce errors, and enable faster, more informed decision-making. John echoes this vision, emphasizing that interoperability can empower pharmacists to operate at the top of their licenses, improving patient outcomes and addressing provider shortages.Tony closes the discussion by encouraging listeners to take actionable steps, such as engaging with workgroups like NCPDP’s Work Group 20, reviewing the POCP white paper, and participating in industry initiatives that drive interoperability forward. John and Larry emphasize the urgency of acting now, describing this as a once-in-a-generation opportunity to create lasting change in healthcare delivery.For more insights and resources, including links to the white paper and details on key industry initiatives, check the episode summary. Subscribe to The Dish on Health IT on Apple Podcasts, Spotify, or Healthcare Now Radio to stay informed. Let’s continue the journey toward a more connected and efficient healthcare system—because health IT is a dish best served hot!Reference Links: POCP Pharmacy Interoperability Whitepaper: https://info.pocp.com/pharmacy-interoperability-whitepaper NCPDP Foundation abridged results report: https://ncpdpfoundation.org/pdf/PharmacyInteroperability_AbridgedResults.pdf  NCPDP Foundation website (for grant proposals in connection with the CTA of future opportunities for grants): https://ncpdpfoundation.org/home.aspx  NCPDP Standards website (for encouraging involvement/collaboration in WGs in connection with the CTA of getting involved/supporting the mission): https://standards.ncpdp.org/  Surescripts Blog, "Ready for Action: Advancing Pharmacy Interoperability": Preparing Pharmacy with Technology to Participate in Healthcare Interoperability | Surescripts  

In this episode of The Dish on Health IT, Host Tony Schueth, CEO of Point-of-Care Partners (POCP) and Co-host, Kendra Obrist, Payer Strategy Senior Consultant with POCP, welcome Anthony Murray, Chief Information Officer of MRO, to tackle one of health IT’s most pressing topics: payer-provider data exchange and interoperability.The discussion begins with introductions and a light-hearted acknowledgment of the traditional friction between payers and providers. Anthony shares his journey from pharmaceutical work to leading MRO’s efforts in clinical data exchange. He emphasizes the enduring challenges in interoperability, including siloed systems and the complexities of real-time data sharing.The conversation then shifts to the evolving patient-centric approach. Anthony and Kendra explore how technology like patient portals has improved engagement but highlight gaps in bidirectional data exchange. They dive into the payer-provider dichotomy, with Kendra explaining how payers are shifting their mindset to view data holistically as patient data rather than isolated categories like claims or provider information.Later, the trio examines successful payer-provider collaborations, such as Anthony’s example of a client achieving a 63% improvement in quality scores through seamless digital connectivity. They also spotlight the Da Vinci Project and other initiatives driving innovation in the space.The regulatory landscape takes center stage with a discussion of the CMS-0057 rule, which aims to streamline prior authorization and bolster interoperability. Both Anthony and Kendra share candid views on the challenges of implementing these changes and the opportunities they present for strategic advantage.Closing on a forward-looking note, Anthony calls for active industry participation in shaping health IT’s future, urging stakeholders to engage in accelerators and public comment opportunities. Kendra envisions a healthcare system that embraces real-time digital experiences, aligning with the expectations of younger generations.Tune in for actionable insights and spirited dialogue about the future of health IT and interoperability!Key Themes:Challenges in payer-provider data exchangeOpportunities in patient-centric interoperabilityRegulatory impacts, including CMS 0057Examples of successful collaborations driving innovationStrategic shifts in viewing data holisticallyListen now to explore how collaboration, technology, and regulation are reshaping health IT! Find us on Apple Podcasts, Spotify, and Healthcare Now Radio, or watch on the POCP YouTube channel. Don’t forget, health IT is a dish best served hot! 

In this lively recap of the HLTH 2024 conference in Las Vegas, The Dish on Health IT dives deep into the event’s biggest topics with host Tony Schueth, CEO of Point-of-Care Partners, and guest co-host Seth Joseph, Managing Director of Summit Health and contributor to Forbes.com. Known for its forward-looking focus on healthcare innovation, HLTH 2024 was packed with discussions on artificial intelligence, data interoperability, data security, and the emerging technologies shaping the industry.Tony and Seth kick off the episode by reflecting on HLTH’s unique vibe, contrasting it with other industry events like HIMSS. They offer honest reactions to the glitzy atmosphere and networking opportunities that HLTH provides and discuss how its “futuristic” focus is a magnet for healthcare investors, entrepreneurs, and thought leaders. Seth provides a candid look at the range of perspectives on AI in healthcare. While excitement around generative AI applications remains high, he notes a growing willingness to challenge its real-world impact and value, marking a shift from last year's unbridled enthusiasm to more cautious optimism. Tony echoes this sentiment, observing that AI and other tech innovations will only prove their worth when they meaningfully improve patient care and operational efficiency.Throughout the episode, Tony shares exclusive clips from his one-on-one interviews with several key industry leaders who each offer unique insights into the conference themes and the road ahead for health IT. The interviews include:Bevey Miner, EVP of Consensus – Bevey shares her views on HLTH as a stage for innovation and the importance of collaboration in advancing health IT solutions.Frank Harvey, CEO of Surescripts – Frank discusses the critical role of data and interoperability in healthcare, and how AI could streamline data exchange and improve patient outcomes while noting the limitations of isolated “point solutions” that need a more holistic approach.Tim Pletcher, CEO of MiHIN – Tim emphasizes the importance of regulatory compliance, particularly with TEFCA, HTI-1 and HTI-2, as well as the need to build trust across state lines to enhance data-sharing frameworks.Charlie Harp, CEO of Clinical Architecture – Charlie dives into the challenges of data quality and the vital role of accurate, clean data in effective AI applications.Brian Anderson, MD, CEO of CHAI – Brian brings a thoughtful perspective on responsible AI use in healthcare, stressing the need for realistic expectations and industry-wide collaboration to ensure AI’s impact matches its promise.Tony and Seth revisit the recurring theme of interoperability, an area of focus for POCP. They discuss its complex challenges and how data standards and regulatory shifts are beginning to create a more integrated system. Highlighting Blue Shield of California’s partnership with Salesforce on prior authorization as a standout announcement, Tony notes the significance of innovations that simplify administrative burdens on providers and reduce care delays for patients.The episode wraps up with Tony and Seth’s thoughts on HLTH’s atmosphere, especially the mixed reactions from attendees about the conference’s glitzy setup. While some question the balance between style and substance, Tony appreciates the energy and enthusiasm HLTH brings to healthcare, believing it encourages important investment and public interest in health IT. Seth offers a dose of realism, pointing out that while glitz can attract attention and funding, the true test will be in the hard work and strategic planning needed to implement these innovations at scale.For those eager to hear about the latest in healthcare innovation, this episode delivers a nuanced take on HLTH 2024, blending high-level industry insights with grounded observations on where health IT is—and isn’t—making an impact.

In this episode of The Dish on Health IT, Tony Schueth, CEO of Point-of-Care Partners, and Kim Boyd, Regulatory Resource Center Lead, are joined by Pam Schweitzer, former Assistant Surgeon General of the United States and current Chair of the NCPDP Foundation Board of Trustees. Together, they deliver an in-depth discussion on critical topics impacting the health IT landscape, including interoperability, public health data modernization, and evolving healthcare regulations.The episode begins with introductions from Tony and Kim, highlighting Pam’s extensive career in healthcare, ranging from her leadership roles in the Indian Health Service and the Veterans Affairs (VA) system to her current position as chair of the NCPDP Foundation. Pam reflects on her experience overseeing the transition from paper to electronic health records and how this complex shift required the coordination of multiple healthcare departments, including radiology and labs.Pam shares her insights into how policy changes, such as CMS 0057 and the HTI-2 proposed rule, are shaping the future of healthcare interoperability. The trio discusses how these regulations, aimed at improving data sharing between payers, providers, and public health systems, will ultimately drive real-time data exchange. They also emphasize the importance of infrastructure, standards, and innovation to support these efforts.As the discussion moves forward, Pam talks about her work on public health initiatives, particularly around pharmacy interoperability, maternal health, and the broader impacts of nutrition and food supply on community health. Kim and Pam also explore the evolving role of pharmacists in public health, especially in rural areas where they often serve as the primary healthcare providers.The conversation includes key steps for modernizing public health data systems, such as addressing the data silos between healthcare and public health systems. Pam emphasizes the need for greater collaboration and data sharing to enable a more effective public health response, especially during crises like pandemics or natural disasters.Pam, Kim, and Tony also touch on the role of the Trusted Exchange Framework and Common Agreement (TEFCA) in promoting data fluidity and expanding the integration of pharmacists and other healthcare stakeholders into the broader healthcare ecosystem.The episode wraps up with Pam expressing her optimism for the future of health IT and public health interoperability, while stressing the importance of ongoing collaboration between stakeholders, from policymakers to healthcare technology vendors. Kim adds that the evolution of pharmacy practice and regulatory changes are driving significant improvements in patient care and medication management.Listeners can tune in for a deep dive into the intersections of health IT policy, pharmacy standards, and public health modernization, with practical insights from leaders in the field. This episode is a must-listen for those interested in healthcare interoperability, the impact of CMS and ONC policies, and the future of public health and pharmacy integration.Catch the full episode on your preferred podcast platform, including Apple Podcasts, Spotify, and Healthcare Now Radio, or watch the video version on YouTube.Other resources you may be interested in:Healthy People 2030 – Data and Information Systemshttps://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructurePublic Health Infrastructure - Healthy People 2030 | health.govhttps://health.gov/healthypeople/objectives-and-data/browse-objectives/public-health-infrastructureStrategies for Public Health Interoperability | PHDI | CDChttps://www.cdc.gov/data-interoperability/php/public-health-strategy/index.htmlMarch 27, 2024 – Draft 2024-2030 Federal Health IT Strategic Planhttps://www.healthit.gov/sites/default/files/page/2024-03/Draft_2024-2030_Federal_Health_IT_Strategic_%20Plan.pdf2023 – Infrastructure for Scaling and Spreading Whole Health – Health Informaticshttps://www.nationalacademies.org/our-work/transforming-health-care-to-create-whole-health-strategies-to-assess-scale-and-spread-the-whole-person-approach-to-health 

Welcome to "The Dish on Health IT," a podcast brought to you by Point-of-Care Partners, a leading health IT consultancy. Each episode features a rotating panel of senior consultants and guests who discuss trends and innovations in health IT, providing insights and recommendations to help organizations leverage advances to solve their business problems.In this episode, POCP hosts Tony Schueth, CEO of Point-of-Care Partners, and Pooja Babbrah, PBM and Pharmacy Lead, are joined by Shivani Patel, Executive Vice President of Patient Access Operations and Technology Solutions at Asembia. Together, they delve into key topics including specialty prescribing, pharmacy interoperability, TEFCA, and consent management, highlighting how technology, policy, and process improvements can drive positive changes in healthcare.The conversation kicks off with an introduction to specialty prescribing. Shivani explains that specialty prescribing involves treatments that are typically more complex than standard prescriptions due to factors like high cost, special storage requirements, and adherence challenges. She points out the logistical gaps and barriers in the specialty space, such as prior authorizations and communication challenges between stakeholders. Pooja adds that the lack of a standardized definition for specialty medications further complicates the process, leading to delays and confusion.Moving on to pharmacy interoperability, Pooja describes it as the ability to share clinical data between pharmacists, providers, and other stakeholders. She emphasizes the importance of providing pharmacists with the right information they need, instead of overwhelming them with excessive data. For instance, pharmacists should not have to sift through 500 pages of patient records to find relevant information. Instead, they need targeted, pertinent data to improve patient care and streamline processes.The discussion then shifts to TEFCA (Trusted Exchange Framework and Common Agreement), which aims to fill information gaps in the healthcare system by setting standards for data exchange. Shivani and Pooja discuss how TEFCA can enhance transparency and interoperability, helping pharmacists and other stakeholders' access and share necessary patient information more efficiently. Shivani notes the potential of TEFCA to establish a universal patient identifier, which could significantly improve data sharing and patient care coordination.Consent management is another crucial topic covered in this episode. Effective consent management is essential for pharmacy interoperability and ensuring patients' privacy and data security. Shivani and Pooja explore how consent management can be improved to make the sharing of patient information more seamless and secure. They emphasize the need for standardized consent processes that allow patients to control their data while ensuring that relevant information is accessible to healthcare providers.Throughout the episode, the panel highlights the role of technology in improving the prescription journey. Shivani discusses how Asembia uses technology to support the industry by connecting stakeholders and providing tools to manage patient care better. This includes everything from prior authorizations to benefit checks and copay cards. Pooja underscores the importance of industry collaboration and transparency to create standardized solutions that benefit all stakeholders.Towards the end of the episode, Shivani shares insights about the Asembia Summit, an annual event that gathers industry stakeholders to discuss trends and innovations in specialty pharmacy. She invites listeners to attend AXS25, the next Asembia Summit, which will take place from April 27th to May 1st, 2025, at the Wynn Las Vegas. The event offers a premier forum for learning, networking, and exploring the latest advancements in the industry.Tune in to this episode to gain a deeper understanding of the complexities of specialty prescribing, the importance of pharmacy interoperability, and how collaborative efforts in technology, policy, and process can enhance healthcare delivery. Don’t miss the insights shared by industry stakeholders on why they attend the Asembia Summit each year. For more information and to suggest future topics, email us at podcast@pocp.com or tweet us at @POCPHIT.

The special episode of The Dish on Health IT episode provides insights and coverage from the recent HIMSS24 conference. Hosts Pooja Babbrah, the PBM and Pharmacy Lead and Jocelyn Keegan, Payer/Practice Lead with Point-of-Care Partners dig into their observation from HIMSS24 before reacting to stakeholder interviews from the floor of the Interoperability Showcase on topics ranging from the impact of the final CMS interoperability & prior authorization, benefits of API adoption and pharmacy interoperability opens with a montage of HIMSS24 attendees. --NOTE: The sound quality of the kiosk interviews is not ideal. If you prefer, you can watch this episode on video for close captioning of the kiosk interviews--The episode opens with a montage of HIMSS24 attendees sharing what they find valuable about attending HIMSS. Pooja Babbrah then opens the episode explaining that she and co-host Jocelyn Keegan share their key takeaways and insights from the biggest health technology conference in the industry. Jocelyn started the conversation off by sharing her observation that the work over the last 15 years to forge scalable connections to improve data fluidity has been fruitful and reached a tipping point. Importantly, the conversations we heard at HIMSS24 showed an acknowledgment as important as data fluidity is the content of what we are exchanging, and that data quality is just as important. Jocelyn then shared her second observation which is that we need to build a skillset and pool of resources who can do the next phase of work that is needed. She shared that when she worked in the financial industry which was at the time transitioning to interoperability and automation, they had to hire and develop the critical thinkers needed to think through how to best leverage technology, approach change management and do the abstractions needed to be successful. Health IT is at a similar place; we probably need more clinical informaticists because how we use technology in clinical workflows is extremely important, but we also need operational experts to help pull through how shifts in one workflow should get pulled through in others. She went on to say that we need people understand data mapping and why clean data is so important. Pooja thanked Jocelyn for her insights before sharing her own. She mentioned that she heard talk about whether ViVE and HIMSS could both survive because they occur so close together, and are big investments for companies to make to attend or exhibit. She shared that her view is that they are different enough in programmatic and attendance mix that she believes they both have value and will survive. Adding to Jocelyn’s point about data quality, Pooja added that data governance and sending the right data to the right people at the right time versus just sending a data tsunami. Pooja continued by adding that it’s also important to meet people where they are. This was clear at the post-acute care listening session. Some care facilities are not yet FHIR-enabled, some can send data via FHIR but perhaps are not yet API-enabled, how can we meet those facilities where they are even if they aren’t using cutting-edge technology? Most stakeholders are going to be somewhere on a spectrum of tech adoption. We need to be flexible in how we do things. Pooja went on to say that another observation is that the importance of consent management will continue to grow, and that real work is starting to be done to figure out what patient-centered consent management might look like. We need to be able to exchange the right data at the right time with the right people, but we need to ensure we have the right consent to go along with it. Pooja mentioned some industry initiatives on consent including the HL7 FHIR at Scale Taskforce Accelerator, which has launched a new consent project. Public meetings for the FAST Consent project have launched and will be held regularly. A consent learning lab was held at HIMSS24 for the second year in a row. Pooja expressed that she attended both last year's and this year’s events and she could feel a shift including the presence of regulators who were in the room. She explained that the conversation focused on actual work and progress being made in California and Florida as well as a huge focus on the role of consent in connecting health data and human services data.Next Pooja and Jocelyn listened and reacted to stakeholders who stopped by the POCP Kiosk in the Interoperability showcase to give their perspectives on the final CMS prior authorization & interoperability rule, API adoption, and pharmacy interoperability. Interviewees at the kiosk included:Colin Banas, Chief Medical Officer for DrFirst, shared insights on medication management and prior authorization.Polina Vaserman, Vice President of product Management with MHK, discussed the complexities and proposed improvements in prior authorization final rule.Lathe Bigler, Vice President of Clinical Network Services at First Databank provided perspectives on leveraging FHIR APIs for improving price transparency and patient care.Lenel James, Business Lead - Health Information Exchange & Innovation, Blue Cross Blue Shield Association, highlighted the use of FHIR APIs to enhance data accessibility for all stakeholders, including patients, payers, and providers, underscoring the importance of making healthcare data available across the care continuum to improve service delivery and care coordination.Melanie Marcus, Chief Marketing and Customer Experience Officer at Surescripts highlighted the role of pharmacies in expanding care access and the necessity for interoperability and policy support.Kathryn Ayers Wickenhauser, Sr. Director of Community Strategy at DirectTrust discusses the critical role of pharmacists in delivering care and the role of Direct Messaging can play in supporting this work. Themes from the interviews and host response include: CMS Interoperability and Prior Authorization: There has been broad acknowledgment of the positive progress this final rule will make towards enhancing interoperability and refining the prior authorization processes is widespread, with some hoping for additional policies to go even further.Healthcare Ecosystem and CMS Policies: The industry acknowledges the complexities of medications requiring prior authorization. There's an expectation for CMS to broaden its research and policy scope to include specialty medications, recognizing their critical importance.Impact of Technology and Innovation: The importance of adopting standards like FHIR for improving healthcare interoperability is emphasized. Leveraging technology and standard adherence is highlighted as crucial for enabling effective communication among healthcare stakeholders, reducing administrative burdens, and improving patient care quality.Pharmacy’s Essential Role: Pharmacies are spotlighted as key to healthcare delivery, especially in underserved areas. There's strong advocacy for improved pharmacy interoperability and integration into the care team, stressing the need for policies, payment reforms, and access to health information to support their expanded role.Using Existing Technologies: The discussions promote the practical use of existing technologies and workflows to address healthcare delivery challenges effectively. This pragmatic approach centers on solving immediate patient care and business problems with available tools and sharing successful industry practices to foster broader adoption.Future Directions and Collective Engagement: A desire for ongoing engagement with health IT innovations, with a focus on interoperability, is clear in future industry events. The importance of collaborative efforts within the community and across the industry is underscored as critical for driving advancements in health IT and interoperability.After Pooja and Jocelyn listened and reacted to the interviews, Pooja shifted to close out the episode. She took a moment to reflect on the rich dialogue and insights shared by professionals across the healthcare ecosystem. She acknowledged the collective and collaborative effort that is fundamental to advancing health IT, underscoring the critical role of technology, the growing importance of pharmacies in the healthcare delivery ecosystem, and the collective anticipation for the evolution of policies concerning specialty medications and the work toward a better way to manage consent. With a nod to the resilience and spirit of innovation that defines the HIMSS conference, Pooja expressed gratitude for the contributions of all speakers and participants, celebrating another successful year of sharing, learning, and collaborating. Looking ahead with optimism, she voiced enthusiasm for the next HIMSS, where the community will reconvene to delve deeper into healthcare's pressing issues, explore new advancements, and foster further collaborations that promise to shape the future of health IT.

In this episode of The Dish on Health IT Podcast, hosted by Tony Schueth, CEO of Point-of-Care Partners, the evolving role of pharmacists in the healthcare ecosystem is explored. Tony introduces the episode by highlighting Point-of-Care Partners as a health IT consultancy known for its deep expertise and trusted, objective perspective. He is joined by co-host Pooja Babbrah, a recognized expert in pharmacy standards and interoperability, and special guest Bob Katter, President of First Databank (FDB).The conversation begins with an exploration of the increasing number of clinical services offered in pharmacy settings and how technology can enhance pharmacists' ability to operate at the top of their license. The importance of integrating pharmacists more significantly into the care team, especially to improve access to care in rural areas and support patient health outcomes, is emphasized.Bob Katter shares insights into his journey in health IT and pharmacy sectors, reflecting on the significant advancements in electronic prescribing and the adoption of electronic health records (EHRs) since the early 2000s. He also acknowledges the challenges and opportunities that lie ahead.The episode delves into the transformative role of pharmacists during the COVID-19 pandemic, highlighting their contributions to administering vaccines and treatments. Bob notes the legislative and regulatory changes at both state and federal levels that are expanding pharmacists' scope of practice, allowing them to take on more responsibilities traditionally reserved for physicians.Bob discusses FDB's partnerships and initiatives aimed at supporting pharmacists in their expanding roles, including a project with a major pharmacy retailer focusing on drug utilization review (DUR) processes. He shares observations from his visits to pharmacies, noting how pharmacists are increasingly involved in direct patient care beyond their traditional dispensing duties.Furthermore, the episode touches on international perspectives, mentioning Canada's "minor ailments" program that allows pharmacists to diagnose, treat, and prescribe for certain conditions. This program is highlighted as an example of leveraging pharmacists' skills to address physician shortages and improve patient access to care.The conversation pivots towards the role of standards development organizations like the National Council for Prescription Drug Programs (NCPDP) and Health Level Seven International (HL7) in supporting the expanding clinical services provided by pharmacists. Bob Katter acknowledges the importance of these organizations while emphasizing the need for cooperation among industry players to utilize these standards effectively. Pooja Babbrah highlights innovative efforts, such as work group 20 at NCPDP, which focuses on care coordination and the potential for expanding the use of existing standards to include pharmacists in key patient care transitions, such as Admit, Discharge, Transfer (ADT) notifications.The discussion then explores the application of artificial intelligence (AI) in healthcare, with a particular focus on FDB's initiatives. Bob Katter details how FDB leverages AI, including natural language processing (NLP) and generative AI, to enhance data curation, improve existing solutions, and collaborate with customers on developing new solutions to longstanding industry challenges. He underscores the potential of AI to streamline processes such as medication reconciliation and the authorization of specialty medications.Pooja Babbrah expresses enthusiasm for the innovative use of AI in specialty medication automation and enrollment, emphasizing the importance of reducing the time it takes for patients to access necessary treatments. She mentions recent regulatory developments and the ongoing challenges in automating prior authorization for specialty medications due to their complexity and the dual coverage under pharmacy and medical benefits.The podcast concludes with an invitation for any final messages or calls to action for the industry, emphasizing the collective vision and efforts towards automating and improving the delivery of healthcare services, particularly in the specialty medication domain. The dialogue throughout the episode reflects a shared commitment to leveraging technology and collaboration to enhance pharmacists' roles, improve patient care, and address the systemic challenges facing the healthcare industry.In the final moments of the podcast, Bob Katter expresses his enthusiasm for the future of healthcare and encourages those at the beginning of their careers to consider the immense opportunities within the industry. He reflects on the significant advancements already made, such as nearly universal EHR adoption and electronic prescribing, but emphasizes that the greatest impacts for caregivers and patients are still on the horizon. Katter points to the rapid development of clinical science, including pharmacogenomics, and technological innovations like AI and cloud computing as driving forces behind these future advancements.Pooja Babbrah shares this excitement, reminiscing about the early days of e-prescribing and looking forward to the next wave of innovation. She highlights the potential for pharmacists to practice at the top of their license, the reduction of burdens on pharmacists, and the integration of pharmacists into the care team as key areas of opportunity. Both Katter and Babbrah view the current moment as a new beginning for the industry, akin to the excitement surrounding the initial push for e-prescribing, but now with even greater potential for innovation and improvement in patient care.The podcast concludes with a thank you to the guests and a reminder to listeners about where they can find episodes of The Dish on Health IT, signaling an optimistic outlook on the future of health IT and its capacity to enhance healthcare delivery and outcomes.Stakeholders interested in monitoring state laws related to advance pharmacy practice can explore the POCP Regulatory Resource Center’s Pharmacist Advanced Practice Subscription as well as other subscription services. Other Reference Links: https://www.fdbhealth.com/about-us/press-releases/2022-08-25-fdb-launches-fdb-navigohttps://www.fdbhealth.com/about-us/press-releases/2022-03-15-fdb-launches-fdb-vela--a-new-eprescribing-network-to-deliver-greater-choice-and-value

Point-of-Care Partners (POCP) Dish on Health IT hosts, Pooja Babbrah and Jocelyn Keegan welcome special guest Laura McCrary, President and CEO (Chief Executive Officer) of KONZA National Network. KONZA was recently designated as one of the first five Qualified Health Information Networks, or QHINS (Qualified Health Information Networks), to participate in the Trusted Exchange Framework and Common Agreement (TEFCA)Laura McCrary speaks with hosts about: Why KONZA pursued QHIN statusInsight into the QHIN processHow KONZA's status as a Health Information network since 2010 forms their approach as a QHINKONZA's initial Membership mix, and What's new or surprising in the TEFCA Common Agreement version twoBefore digging into the meat of the episode, Jocelyn Keegan introduced herself briefly as the payer practice lead at POCP, program manager of HL7 Da Vinci Project and devotee to positive change building and getting stuff done in healthcare IT. She added that her focus at POCP is on interoperability, prior authorization and the convergence of where technology, strategy, product development and standards come together.Jocelyn ended her introduction by saying that she has had the honor of seeing Laura McCrary present on several occasions and that her pragmatic approach is refreshing and that she is looking forward to hearing how KONZA will be building on their already vibrant HIE (Health Information Exchange) footprint as a QHIN. Next Laura introduced herself sharing that she has been working on interoperability strategy in Kansas and then expanding to nationwide over the last 4 decades. She started her career as a special education history teacher. Early in her career she realized that while these children were in her care, she should have some basic information about medications or conditions so she could be informed and able to ensure everyone was well cared for. Of course, nobody shared medical records with teachers and parents didn’t have access to their kid’s patient records either. Making sure special education teachers or at the very least the school nurse could access necessary clinical information at the point of care became a passion of hers which led to an early success in her career which was working with the University of Kansas Medical Center setting up one of the first telemedicine programs in the public-school systems. Because of this work, since the early 2000’s, elementary kids in Kansas City, KS inner-city public-school systems have had access to basic health and telemedicine services. The telemedicine project helped Laura realize that technology really could bridge access gaps if we built and employed a robust technology infrastructure.When asked about KONZA’s mission and reasons for becoming a QHIN, Laura shared that the name “KONZA” is named after a Kansas prairie that is one of the most beautiful prairies in the nation. The way KONZA originated in Kansas around 2010 is a bit different than how other HIEs started. Most states at that time received federal funding through the American Recovery and Reinvestment Act to establish health information exchanges.Kansas was different in that instead of standing up a state-sponsored exchange, they actually encouraged a private-public partnership and opened the floor for any organization who wanted to do business as a health information exchange in Kansas could so as long as they meet a set of very rigorous accreditation requirements, which included some pretty innovative ideas for that time.For example, one of the things that was required was that the health information exchange needed to share all information with patients. As early as 2012, Kansas HIEs were required to have a personal health record for patients where they could access any data that was in the health information exchange. QHINS must also do this by offering “individual access services” and KONZA has already been doing this for over a decade. In addition to sharing data with patients, Kansas also required data sharing of HIPAA (Health Insurance Portability and Accountability) approved treatment, payment, and healthcare operations data with payers as it relates to their members.  Laura continued by sharing that today, 4 exchanges do business in Kansas, and they all work together as well as connect to other exchanges. KONZA also expanded to be able to serve patients across state lines as Kansas residents cross over into Missouri quite often to consume healthcare. Because of this history and background, Laura shared that becoming a QHIN was a natural progression and a way to support their mission to make sure all participants have access to their own or their patient’s data. Pooja asked Laura about the process of becoming a QHIN. Pooja acknowledged the stringent requirements for QHINs and mentioned challenges discussed at the ONC Annual meeting in December.Laura shared KONZA's experience, saying they initially thought it would be like Kansas certification requirements. However, the application process involved demonstrating sustainability, financial viability, high trust certification for security, and proper information sharing using IHE protocols. KONZA became a candidate QHIN in February of the previous year, requiring the development of a project plan addressing technology conformance testing and demonstrating business viability.Laura emphasized the challenge of meeting high-level requirements, including safety, security, project management, and board governance. Notably, QHINs must have 51% of their Board of Directors as members, ensuring those participating in the network make decisions about the business model. KONZA reached 49% and welcomed a new member from a public health organization in January. The ongoing process involves meeting the remaining requirements to become a fully certified QHIN.Laura said the process of becoming a QHIN is a continuous work in progress. While they successfully crossed the finish line and are in production, she emphasized the need for ongoing changes to advance interoperability and data sharing. Laura highlighted the importance of QHINs working together as colleagues and federal leadership setting expectations for the national network. After four decades of working on the project, she expressed great satisfaction with the current state of progress.Pooja inquired about the impact of the diverse functional areas of the first group of QHIN designees on their operations. She expressed curiosity on behalf of Point of Care Partners, highlighting KONZA's background as a health information exchange in Kansas and seeking insights into how this background influenced KONZA's role as a QHIN.Laura responded by emphasizing the significance of diversity among QHINs as a valuable asset. She expressed excitement about the potential for innovative solutions to emerge from the diverse backgrounds of QHINs, enabling a departure from a one-size-fits-all approach. Laura expected the development of exciting and innovative solutions unique to each QHIN's diverse background.Pooja then invited Jocelyn to share her thoughts. Jocelyn expressed appreciation for Laura's insights, noting that knowing more about Laura's background made sense. She highlighted the importance of Laura's background in approaching long-term transformation. Jocelyn commended the incremental progress and permanent change advocated in the industry, aligning with Laura's pragmatic approach.Jocelyn acknowledged the mix of QHINs as fascinating and emphasized the importance of meeting people where they are. She recognized the relay race nature of the journey, with December marking the start of a new phase. Jocelyn predicted the challenge of creating compelling business cases and exploring the evolving business model for QHINs. She expressed interest in seeing the progress reports as end users transition from the HIE world to the TEFCA world.Laura emphasized the importance of KONZA serving as the QHIN for Health Information Exchanges (HIEs) and growing out of the HIE space. She expressed the belief that onboarding HIEs to their QHIN is crucial for expanding access to a broader set of data, benefiting patient care. Laura highlighted the critical role HIEs play in meeting the healthcare needs of communities, states, and regions.To ease this onboarding process, KONZA actively reached out to HIEs. Laura shared her personal commitment by mentioning that she had personally spoken with every HIE in the last six months. Additionally, KONZA planned to initiate HIE office hours to engage with HIEs and discuss the onboarding process to the QHIN. Laura conveyed a strong sense of responsibility, stating that if HIEs were not successfully onboarded to QHINs, she would personally feel like they had failed. She recognized the significant value and commitment HIEs have provided to their communities and stressed the importance of building upon their established connections and capabilities.Jocelyn initiated a discussion on expanding endpoints and the role of payers in TEFCA. She acknowledged Laura's insight into the base requirement in Kansas that involved having payers at the table, filling gaps in understanding about payer participation in national programs. Jocelyn expressed interest in understanding the implications of active payer participation, especially with recent rules requiring payers to provide data to providers.Laura provided a comprehensive response, highlighting the common inclusion of payers in HIE networks and the evolving landscape outlined in TEFCA requirements. She emphasized that recent rules, including prior authorization, point towards increased payer participation in the QHIN model. Laura praised ONC's efforts and leadership, acknowledging the challenge of absorbing the vast amount of information released.Laura discussed the significance of two specific SOPs (Standard Operating Procedure) dropped on Friday related to delegation of authority and healthcare operations. She encouraged stakeholders to focus on t

Thank you for tuning into The Dish on Health IT’s 2023 end-of-year recap. Point-of-Care Partners' (POCP) subject matter experts, including, Pooja Babbrah, Pharmacy and PBM Practice Lead; Jocelyn Keegan, Payer Provider Practice Lead; and Kim Boyd, Regulatory Resource Center Lead, gathered to discuss their top 3 health IT milestones for 2023 and their expectations for 2024. They also delved into the highly anticipated final version of the Interop 3, focused on advancing interoperability and improving prior authorization rules. Offering insights and advice, they guided listeners on approaching the initial review of this significant final rule. Point-of-Care Partners extends warm holiday wishes and a Happy New Year to all. Host, Pooja Babbrah kicked off the episode informing listeners that this episode will be a special format. POCP has subject matter experts galore so this episode will bring together a small group of POCPers to look back at 2023, discuss what 2024 will have in store and talk a bit about the anticipated final Interop 3 rule.Cohosts Jocelyn Keegan, recently honored as the DirectTrust Interoperability Hero, and Kim Boyd, a contributor steeped in policy knowledge and serving as POCP’s Regulatory Resource Center Lead, introduced themselves before the trio transitioned to the main discussion.They contemplated a format for the day, aiming to dedicate the first half of the conversation to a round-robin, where each would share their personal top three events or trends from 2023. Pooja referenced the HIT Perspectives 2023 trends article, outlining POCP's collective trends. However, today's discussion allowed each participant to present their individual lists before delving into the much-anticipated final rule.Top of FormKim initiated the round robin by expressing that her top priority is healthcare interoperability, acknowledging its vast scope emerging from the 21st Century Cures Act and beyond. Within this expansive interoperability landscape, she highlighted the advancements within the FHIR community, predicting a swifter adoption of FHIR than previously witnessed. Her second ranking milestone revolves around artificial intelligence and machine learning, particularly their rapid uptake and integration into policy. Kim anticipated a more robust policy oversight of AI in the future. Her third notable milestone encompasses telehealth and telepharmacy, noting that the COVID-19 pandemic significantly increased patient reliance on remote visits for healthcare.Jocelyn followed, emphasizing that her list complemented Kim’s perspective, offering a different angle. Her primary inclusion highlighted the industry's transition into implementation mode in 2023, witnessing real-world progress and widespread adoption of FHIR at scale.Jocelyn provided examples supporting these observations. The first involves the reaction to the proposed attachments rule, released alongside the prior authorization proposed rule. While many organizations expressed their belief that attachments might not be crucial for future progress, the responses to the Interop 3 proposed rule were predominantly positive.Her second HIT milestone relates to AI but primarily focuses on acknowledging and addressing the baked-in bias potentially inherent in AI and other advanced technologies. She highlighted the steps included in the HTI-1 proposed rule, aiming to mitigate bias and initiate discussions on ensuring the unintentional disruption of the path towards equity.Jocelyn's third milestone centers on TEFCA, highlighting the progress made and the anticipated clarification expected in 2024 regarding its scope and limitations.She connected TEFCA back to the first topic, emphasizing the necessity for alignment between the TEFCA infrastructure, rule framework, and the emerging API world. There have been ongoing discussions and industry feedback stressing the need for better alignment between the FHIR roadmap and the TEFCA roadmap as the industry shifts towards more real-time interactions.Finally, Pooja presented her list, with pharmacy interoperability holding the top spot as her absolute milestone. She expressed her honor in participating in the HITAC Pharmacy Interoperability Task Force, emphasizing POCP's long-standing advocacy for integrating pharmacists into continuity of care discussions. She highlighted the importance of this focus in bridging access gaps, facilitating genomics testing, and building momentum for sharing data with pharmacists. This includes ensuring their access to patient records and their ability to share data with the broader care team, a significant development.Her second and third priorities revolved around emerging trends in pharmacy with broader implications. Second on her list was Pharmacogenomics, involving genetic testing to discern the effectiveness or ineffectiveness of certain medications for specific patients. Pooja's third priority was digital therapeutics, an area where POCP has already made strides. She noted the growing emphasis, not only for pharmacies in understanding how to administer these therapeutics but also for payers in determining coverage policies.The discussion then pivoted to sharing reactions and perspectives on each other’s lists. Kim expressed her delight in hearing pharmacy interoperability as Pooja’s top priority. She highlighted the dichotomy within the healthcare ecosystem, emphasizing the divide between pharmacy services and NCPDP standards on one side, and clinical services with HL7 standards, including FHIR, on the other. Kim noted the increasing convergence between these realms, particularly with enhanced collaboration between NCPDP and HL7. She anticipated continued advancements in NCPDP concerning pharmacogenomics, digital therapeutics, social determinants, and the flow of relevant health data.When questioned, Jocelyn emphasized the criticality of integrating pharmacy into data flow and recognizing pharmacists as integral members of the care team. She stressed the impact of provider shortages in recent engagements with the US healthcare system.Jocelyn echoed Kim’s perspective on the alignment of pharmacy and clinical standards, emphasizing their collaborative synergy rather than competition. She emphasized the need to ensure the right patient data reaches the appropriate care team members, including pharmacists, at the opportune moment, asserting that this alignment significantly enhances patient care.Jocelyn highlighted that technology is designed to facilitate transitioning from one standard to another. She emphasized the increasing significance of robust data exchange, particularly the exchange of quality data, between payers and pharmacies as the industry transitions towards value-based care.Agreeing with Jocelyn, Pooja explained the challenges in integrating pharmacists into value-based care contracts consistently. However, she noted that as data exchange between pharmacies, other healthcare settings, and payers improves, barriers diminish. Pooja underscored the broader benefits of enhancing pharmacy interoperability, emphasizing advantages not only for pharmacists but also for providers and payers.Highlighting the pivotal role of pharmacists, Pooja stressed their potential as invaluable resources for gathering social determinants of health data. She emphasized their significance in care delivery, identifying patient needs, and facilitating connections with community services. Given the frequency of pharmacist-patient interactions, she emphasized the criticality of collecting and sharing this information with the broader provider team.The conversation then shifted to the Interop 3 – Advancing Interoperability and Improving Prior Authorization rule, expected to be released by the end of 2023 or early 2024. Kim initiated the discussion, focusing primarily on the prior authorization aspect of the rule, acknowledging its broader scope.Kim emphasized the crucial need to establish transparency and automation to address the delays in treatment caused by prior authorization or impeding patients' understanding of their coverage when a PA is not approved. The rule encompasses various APIs facilitating exchanges among payers, providers, and patients, utilizing the Da Vinci implementation guides.Regarding industry feedback on the proposed Interop 3 rules, Kim highlighted the notably high volume of comments, predominantly expressing overwhelming positivity. Approximately 68% of the comments agreed with the rule's intent. Although some HIPAA-related concerns were expressed, very few disagreed with the rule overall, which was intriguing given its extensive scope. Providers consistently voiced their desire for a more efficient prior authorization process, advocating for faster turnaround times and increased transparency regarding reasons for denial.Kim underscored the significance of the inclusion of the patient access API, stressing its value for all individuals as patients. She emphasized the importance of augmented access and transparency, not only concerning clinical information like test results but also regarding payer information related to coverage and reasons for prior authorization denial.Jocelyn aligned with Kim’s overall assessment and expressed disappointment over the proposed rules' omission of automation for specialty medications or treatments covered under the medical benefit. She highlighted this overlooked area, expressing disappointment at its continued exclusion.One thing that brought Jocelyn immense satisfaction was the inclusion and acknowledgment of the Da Vinci Guides' role, which significantly boosted morale. There has been noticeable maturity and widespread adoption of Da Vinci guides this year.Jocelyn expressed surprise at the absence of staggered deadlines in the proposed Interop 3 rule. From the Da Vinci community perspective, strong opinions have been consistently voiced to all HHS colleagues—ONC and CMS—over the past couple of years, emphasizing the importance of promot

The podcast "The Dish on Health IT" is brought to you by Point-of-Care Partners, a distinguished health IT consultancy. In the opening minutes of the episode, the hosts, Pooja Babbrah and Jocelyn Keegan, set the stage for a dynamic conversation focused on the HL7 Da Vinci Project and its real-world implementation results.Introducing their guests, they warmly welcome Anna Taylor, Associate Vice President of Population Health and Value-Based Care at MultiCare, and Heidi Kriz, Director of Medical Policy and Medical Management at Regence. Both guests are not only accomplished professionals but also members of the HL7 Da Vinci Project, where they play pivotal roles as early implementers of the Da Vinci Fast Healthcare Interoperability Resource (FHIR) Implementation Guides.The hosts underscore the key themes of the episode, which revolve around sharing insights from early implementation projects, understanding the tangible benefits and returns on investment, and exploring how their experiences in the Pacific Northwest can serve as a model for nationwide FHIR adoption.As the hosts and guests delve into the discussion, they shed light on the core issues they are working to address. Heidi Kriz highlights the existing silos in healthcare, where payers and providers often work independently, using different data standards and requiring access to multiple portals. They recognize the need to promote a common language and reduce the administrative burden of healthcare processes. A major area of concern is prior authorization, which often leads to delays in care. Their aim is to make the process more transparent and incorporate it into the provider's workflow, thereby automating several steps that currently require manual intervention.Anna Taylor supplements this perspective, emphasizing that their goal is to find a many-to-many solution that involves multiple stakeholders. With thousands of members to care for and thousands of providers to collaborate with in the MultiCare Connected Care ACO. To navigate the complexities of these relationships, they aim to streamline data administration, allowing more resources to be devoted to direct patient care. Open standard APIs, like FHIR, play a pivotal role in this quest for a comprehensive, interoperable solution.Jocelyn Keegan highlights the significance of implementation guides within the Da Vinci Project. She underscores the importance of repeatability and the need to get information to where it's needed, thus improving overall efficiency and user experience.The hosts and guests underline the role of collaboration as the linchpin of their endeavors. They emphasize the necessity of involving diverse stakeholders, including providers, patients, community organizations, and other contributors to the healthcare ecosystem. The objective is to create a harmonious and collaborative environment that benefits all parties involved.Heidi Kriz shares the story of how Regence, from a business perspective, became engaged in the Da Vinci Project. The organization's CEO and leadership recognized the need to enhance the member's experience, particularly regarding the prior authorization process. This realization prompted a series of discussions and plans to implement collaborative, interoperable solutions.In the early moments of this podcast, the stage is set for a conversation that promises to explore healthcare's complexities, emphasize the role of collaboration, and advocate for interoperability. The guests, Anna Taylor and Heidi Kriz, offer valuable insights from both the provider and payer perspectives. They highlight the need for automation, standardized processes, and the creation of a seamless healthcare ecosystem, ultimately aiming to enhance the patient experience and streamline administrative tasks.When asked about key insights or any “aha!” moments.  Heidi shares that it was realizing the power of collaboration between a payer and a provider. The ability to come together to solve complex healthcare transactions and streamline processes marked a profound shift in their approach. The synergy between MultiCare and Regence in tackling a common goal was a testament to the potential of collaboration in the healthcare ecosystem.Heidi's second aha moment came when they went live in October 2022. After years of hard work and dedication, seeing their vision become a reality was truly amazing. The initial results were already impressive, but Heidi recognized that they were just scratching the surface of what could be achieved in terms of process automation and instant information delivery.She also highlighted the importance of involving patients in the process. The ability to provide timely information to both providers and members, enabling them to make the best decisions for their care, was a transformative idea.Another valuable lesson for Heidi was the necessity of embracing failure as part of the innovation journey. Adapting and making changes based on feedback and evolving needs was crucial, even if it meant not getting everything right the first time.As for Anna, her aha moment was realizing that the combination of a business-centered approach and the right technology expertise was key to success. It wasn't a matter of choosing between one or the other; both were essential. This perspective underscored the importance of collaboration between these two aspects of healthcare organizations.Anna also shared the concept of the "magic button," where providers found immense value in a simplified, streamlined process. The idea of having a single point of access to manage transactions and receive instant responses became a game-changer, simplifying the lives of providers and driving home the importance of automation.Both Anna and Heidi spoke about the remarkable return on investment they experienced. Anna cited the Data Exchange for Quality Measures (DEQM) implementation, where they saw immediate returns by closing quality gaps and receiving financial incentives. The investment in developing these open standard APIs proved to be worthwhile, not only in terms of financial gains but also in making providers' lives easier.The discussion revealed that the journey to healthcare transformation through initiatives like the Da Vinci Project is challenging but entirely feasible. Success hinges on a combination of collaboration, transparency, and a willingness to embrace change. The ability to iterate and adapt is essential, and organizations that strategically invest in these initiatives will position themselves for long-term success in the evolving healthcare landscape.In this podcast segment, Anna Taylor and Heidi Kriz discuss their experiences and insights regarding healthcare interoperability and the impact of open standards and APIs in the healthcare industry.Anna emphasizes the importance of embracing open standards and APIs, highlighting their potential to transform the healthcare landscape. She encourages organizations to take a close look at their current processes, especially if they are spending a significant amount of time and money on old-fashioned ETL (Extract, Transform, Load) packages. By adopting open standards and APIs, they can free up their employees' capacity, transform their culture, and ultimately improve healthcare.Heidi adds that the risk of not adopting these technologies is greater than taking the leap. She cites the staggering amount of money wasted due to the lack of open standards in healthcare and emphasizes the potential for financial savings and enhanced patient care through interoperability. She also stresses that putting patients and people at the core of healthcare is vital.Both Anna and Heidi underscore the importance of community collaboration, particularly through organizations like Da Vinci, which provide resources and support for implementing open standards and APIs. They encourage organizations to start small, focus on foundational changes, and build a culture of transparency and collaboration.As they conclude, they invite more providers and partners to share their success stories and experiences, urging the community to come forward and tell their stories to inspire and educate others.In summary, Anna and Heidi emphasize the transformative power of open standards and APIs in healthcare, the necessity of community collaboration, and the need to embrace change to improve healthcare for all. The discussion also highlights the significant impact these technologies can have on productivity, transparency, and patient care in the healthcare industry.Learn more about this and other Da Vinci Project Implementations: Da Vinci Roundtable Presentations: https://confluence.hl7.org/display/DVP/Da+Vinci+Video+PresentationsCMS Presentation: Catching FHIR: Lessons Learned from Achieving the First Prior Authorization Automation via HL7® FHIR® - https://www.cms.gov/files/document/hiig-august-2023-isc-speaker-slides.pdfFierce Healthcare Article: https://www.fiercehealthcare.com/payers/regence-multicare-team-fhir-enabled-prior-authorizationRevcycle Intelligence: https://revcycleintelligence.com/features/how-a-better-prior-authorization-process-is-rising-from-fhir News Coverage:KLAS Points of Light Award: https://www.mcg.com/client-resources/news-item/mcg-regence-multicare-klas-points-of-light-award/ 

In the latest episode of "The Dish on Health IT," brought to you by Point-of-Care Partners, a riveting conversation unfolds as the hosts, Pooja Babbrah and Jocelyn Keegan, welcome a distinguished panel of guests from the National Council for Prescription Drug Programs (NCPDP). The episode begins with warm introductions, setting the stage for an in-depth exploration of the cutting-edge developments and innovations in the realm of Health IT.They kicked off the episode by introducing themselves, shedding light on their roles and professional backgrounds. Jocelyn Keegan shared her primary focus on payer-provider collaboration and prior authorization, setting the context for the exciting discussions to come.The spotlight then shifted to their esteemed guests from NCPDP, including Lee Ann Stember, President and CEO, John Hill, COO and Foundation Executive Director, and Christian Tadrus, Vice Chair of the NCPDP Board of Trustees. Each guest provided a brief glimpse into their professional activities, highlighting their significant contributions to the healthcare landscape.Lee Ann Stember, serving as the President and CEO of NCPDP for the last 43 years, is recognized as a leading figure in the healthcare standards development landscape. Her dedication and unwavering commitment to enhancing patient care and healthcare efficiency through enhanced pharmacy standards and workflows. John Hill, the Chief Operating Officer of NCPDP and Foundation Executive Director brings a wealth of experience and insight to the table. John's multifaceted role in managing NCPDP's operations and spearheading the Foundation's efforts demonstrates his commitment to driving positive change in healthcare. His role as a pivotal liaison between NCPDP and various stakeholders underscores his dedication to fostering collaboration for the betterment of healthcare systems.Christian Tadrus, the Vice Chair of the NCPDP Board of Trustees, is an instrumental leader in the organization's strategic initiatives. As a key player in the coordination of care and innovation workgroup, Christian is at the forefront of efforts to bridge the gap between pharmacists and other healthcare stakeholders. His deep understanding of the evolving role of pharmacists in healthcare positions him as a thought leader in driving healthcare interoperability and innovation.The conversation shifted to the topics of the day and the guest were asked to elucidate NCPDP's mission and its remarkable milestone accomplishments. Lee Ann eloquently explained NCPDP's role as an accredited standards development organization, driving healthcare interoperability and ushering in a new era of efficient healthcare solutions.One of the key highlights of the episode was the discussion surrounding the National Facilitator Model pilot. This groundbreaking initiative is designed to provide real-time prescription testing and immunization data, revolutionizing public health and care coordination. The hosts and guests underscored how this model could streamline healthcare processes, enhance patient outcomes, and elevate overall efficiency. Read the research findings from Phase 1 of NCPDP’s National Facilitator Model Pilot:  https://ncpdpfoundation.org/pdf/NationalFacilitatorModel_Phase1_Report.pdfA significant theme that permeated the conversation was the evolving role of pharmacists in healthcare, especially during the pandemic. Pharmacists have taken on an expanded role in clinical services, including administering tests, treatments, and immunizations. This paradigm shift underscores the critical need for healthcare interoperability.The episode also unveiled a new workgroup, the Coordination of Care and Innovation (CoCI), which aims to bridge the gap between pharmacists and other healthcare stakeholders. The objective is to ensure that standards are aligned to support the evolving role of pharmacists in patient care. Watch this video for an overview of NCPDP’s new CoCI, Work Group 20. https://rebrand.ly/NCPDP-WG20-mem00In conclusion, this captivating episode of "The Dish on Health IT" offered a comprehensive overview of NCPDP's mission, milestones, and innovative endeavors. The National Facilitator Model pilot emerged as a beacon of promise for healthcare efficiency, while the evolving role of pharmacists highlighted the need for robust healthcare interoperability. The introduction of the Coordination of Care and Innovation workgroup symbolizes a pivotal step in unifying healthcare stakeholders. The key takeaways and calls to action include supporting NCPDP's three-year plan, emphasizing interoperability, health equity, and public health, and encouraging collaboration to drive positive changes in healthcare delivery. Learn more about NCPDP’s Work: Phase 1 Research Findings, NCPDP’s National Facilitator Model: Pilot:  https://ncpdpfoundation.org/pdf/NationalFacilitatorModel_Phase1_Report.pdfUniversal Patient Identifier (UPI), powered by Experian Health’s Universal Identity Manager (UIM) and NCPDP Standards™: https://ncpdp.org/upi.aspxCoCI, WG20 Overview Video: https://rebrand.ly/NCPDP-WG20-mem00NCPDP Work Group Meetings and Events: https://www.ncpdp.org/Events-Calendar.aspx