Continuing to Overcome Barriers of Interoperability
The Velocity Interoperability Blog and Velocity Interoperability Podcast are sponsored by Velocity Health Informatics. Velocity provides both data quality and data integration as a service offerings to ensure that healthcare providers access the correct patient record with the right data for each patient they serve. See the introductory blog post. Visit Velocity on the Web and follow them on Twitter, LinkedIN and Facebook!
TODAYS GUEST Mark Belanger, Director of Advisory Services, Massachusetts eHealth Collaborative (MAeHC)
Mark joined us to provide more insights on how they are continuing to overcome barriers to interoperability. Specifically, we discuss the following with Mark:
- Will you describe your current role at the Massachusetts eHealth Collaborative?
- From your perspective, where do providers stand in terms of achieving interoperability?
- What can you tell us about your work in integrating behavioral health/mental healthcare, substance use treatment, community supports and primary care in southwestern New Hampshire?
- What are some common challenges that you see in your work?
- What recommendations would you share with provider organizations to help them overcome some of these barriers?
- If I anointed you US #Interoperability Czar today, what are the first 3-4 things that you would do to accelerate achievement of #interoperability?
- What’s on tap for you and your team for the remainder of 2017?
Previous MAeHC Interviews
- Micky Tripathi , President and CEO of The Massachusetts eHealth Collaborative, http://intrepidnow.com/healthcare/more-progress-on-interoperability-in-health-it/
- Pam Minichiello, Project Director of The Massachusetts eHealth Collaborative http://intrepidnow.com/healthcare/how-to-achieve-ehr-hie-and-interoperability-success/
About Mark Belanger
(from https://maehc.org/about/team/our-team/mark-belanger) Mr. Belanger is the Director of Advisory Services for the Massachusetts eHealth Collaborative. He has expertise in healthcare strategic planning and has deep experience helping senior public and private sector leaders align strategy, governance, policy, and health information systems. Mr. Belanger has taken a leadership role in the planning, design, launch, and operations for multiple state and regional health information exchanges and Regional Extension Centers including: the New Hampshire Health Information Organization (NHHIO); the Massachusetts statewide HIE (Mass HIway); and the Pioneer Valley Information Exchange (PVIX); the Regional Extension Center of New Hampshire; and the NY State REC. Mark is a skilled facilitator and is often called upon to set up and shepherd multi-stakeholder collaborative planning initiatives. Prior to joining Massachusetts eHealth Collaborative, Mark was a member of the Booz Allen Hamilton Healthcare and IT practice where he led healthcare strategy projects in the US and Australia.
(from https://maehc.org/about/overview) The Massachusetts eHealth Collaborative (MAeHC) has been helping organizations buy and implement EHRs, HIEs, and data analytics solutions since 2004. Founded as a collaborative of Massachusetts healthcare providers, payers, purchasers, and other health care stakeholders, we now serve customers across the country. Our business experience and technical expertise ensures success for clients as diverse as large healthcare networks, health information organizations, government agencies, foundations, and physician practices large and small.
The Velocity Interoperability Blog and Velocity Interoperability Podcast are sponsored by Velocity Health Informatics. Velocity provides both data quality and data integration as a service offerings to ensure that healthcare providers access the correct patient record with the right data for each patient they serve. Visit Velocity on the Web and follow them on Twitter, LinkedIN and Facebook!
Joe Lavelle 00:54 Welcome to the Velocity Interoperability Podcast brought to us by the gurus at Velocity. I am your host, Joe Lavelle and I am really looking forward to another thought provoking discussion where we further investigate data quality, interoperability and medical record remediation.
We’re going to get right to it today. We’re joined by Mark Belanger, Director of Advisory Services at The Massachusetts eHealth Collaborative. Mark, welcome to the show!
Mark Belanger 01:17 Thank you Joe, glad to be with you.
Joe Lavelle 01:19 Well, thanks for making the time to be us today. Before we start our discussion could you take a few seconds and give the audience an idea about you and your background?
Mark Belanger 01:27 Sure, thank you. I’m the Director of Advisory Services for The Mass eHealth Collaborative, I joined MAeHC about 10 years ago from the Booz Allen Global Health Group and together with Micky Tripathi we set up a strategy group within MAeHC. Today, our work is really focused on integrating care providers across the whole continuum. We help with just about anything at the intersection of healthcare IT, from strategic planning, to governance, to privacy and security, from clinical workflow optimization to technology deployment, and all the way through the measurement and continuous quality improvement.
Joe Lavelle 02:07 Mark could you describe a couple of your current projects?
Mark Belanger 02:10 Yeah, some of our bigger showcase projects over the last few years have been supporting the launch and the deployment of the state wide HIV in New Hampshire and in Massachusetts. We’ve also done a lot of work with the pediatric groups surrounding Boston Children’s and helped them with integration technology, and right now we’re supporting the integration of primary care, mental health, and substance use treatment in Southwest New Hampshire.
Joe Lavelle 02:39 Great, thanks for that Mark. The main point of our show here is interoperability and being that you’ve done all this great work in the last few years, from your perspective where do providers really stand in terms of achieving interoperability?
Mark Belanger 02:53 I think from a provider point of view, if you’re asking a provider where they stand, I think they would think we’re right at the beginning. A lot of work today has been on laying groundwork. So many of the big EHR implementations are now in the rear view mirror. The majority of clinicians and their staff are using the EHRs and some of them are even on their second iteration of the EHR systems. The HIE pathways are starting to be laid and many are in place, but I think the main clinical islands still remain. We have a lot to do still to get down the integration care path, and interoperability and integration go together pretty tightly. So I think we’re just at the beginning.
Joe Lavelle 03:39 I agree with you. As I get into Healthcare 25 years ago I had no idea it would take 25 years to get to where we are today. I naively thought that we were where every other industry was 25 years ago. Mark, you mentioned some of the projects that you’re doing, what can you tell us about your work in integrating behavioral health, mental healthcare, substance abuse treatment, community support and primary care in South-western New Hampshire?
Mark Belanger 04:06 New Hampshire has an 1115 waver from CMS. This is great, it allows the state government to work with the providers in New Hampshire to really innovate around how they deploy services for the Medicaid members. SO work in New Hampshire is really completely focused on care integration. They are basically taking out a population of Medicaid members that have some sort of a behavioral health indication, so that means they are either seeking help for a mental health condition or they are seeking treatment for substance abuse, many of them have co-morbids as well. So we’re looking at trying to treat the whole patient and we’re saying how do we connect care providers together in a way where they can integrate care?
In the Southwest Region, it’s pretty big. We have around 25 provider organizations that are primary care, mental health or substance use disorder providers, and then we have another 35 plus organizations wrapped around them that are supporting things like housing and food security or county nursing homes, the justice system or even working with the prison systems to try to tie together all of those providers.
On the technology side we have to be wildly flexible, because we have a whole bunch of different requirements and we have a big range of like IT maturity from complicated complex IT systems like that at Dartmouth Hitchcock all the way down to some small mental health offices that are still operating in paper.
Joe Lavelle 05:44 Mark, what are some of the most common challenges you’re seeing across the projects that you guys are engaged in?
Mark Belanger 05:51 I think the biggest challenge is that the physicians aren’t out in front a lot of the time. You’ve probably seen this in your 25 years Joe. We’ve often have the IT people stepping up to the plate and trying to drive large complicated change from the IT seat. And I think most areas an IT person would much rather be in a supporting role, and having the clinical people really pushing the envelope on integration. Then having the IT people come in there and help them where IT is good at things, making things better, faster and more efficient, cheeper and replicating processes.
So that’s the root of every challenge, I think it’s just having the physicians take the reins and to start to really drive integration. There are other challenges. Healthcare delivery is just playing hard, it’s complex there’s many different parts and roles, and all of these roles have been around for, in many cases for a hundred years or more. Changing healthcare requires slow, deliberate and detailed attention, whereas other industries even as complicated as finance is not nearly as complicated to turn as health care. I think having patience and persistence is what we need to move through these things.
Joe Lavelle 07:12 The best way I have ever described this challenge Mark, is we’re both old enough we went through Y2K with Healthcare organizations, as we did the inventory of applications for big, medium small health systems in Y2K, many health systems, I just give an average, a middle size health system had 250 applications that they were required to manage. Now, some of these applications only had 7 or 8 users, more of the applications had 20 to 25 users and some were enterprise applications. But those same IT Departments for middle sized health system were 65 people. So they didn’t even have a one to one person to application ratio. Then out of those 65 people they had helped, those people and network people and desktop people, and so there’s just no way an IT department can be experts at all the applications they’re required to support and manage.
And since Y2K, it’s only gotten way more complicated now that everybody has an EHR and EMR they’re connected to at least one probably many, and it’s just, the complexity is out the window. The last thing I want to be today is a CIO of a healthcare organization. What are your thoughts about all of that?
Mark Belanger 08:32 I agree. I think something’s have moved since then. I think the applications have gotten a little tighter. I think there are fewer applications and those are starting to work together. But the chaos that you’re describing from that time is kind of moved to the connectivity later now. I think all of the optionality’s out here on how do I get information from others, and how do I navigate that as a CIO? I’ve got direct secure messaging offered by, say my state health information organization, maybe I have a private health information organization that’s collecting things in a big clinical data repository, I may have a view in into three or four different hospital systems, if I’m trying to access records.
And then I’ve got Carequality and CommonWell coming down the pipe with quite a bit of promise for doing query-based exchange. Now a CIO has to start making some pretty hard decisions on which ones of those to resource, and like you said I’m already challenged in that role to figure out where I put my people. But how do I pick and choose among those things that might have success? Now that’s where we are today I believe.
Joe Lavelle 09:43 Do you have any recommendations, just general recommendations, for provider organizations to help them overcome some of these challenges we’re talking about?
Mark Belanger 09:51 I do, I always prefer going really practical, like I believe in getting down to one or two really simple problems that you can solve, and then try to crack those, and go as far as you can. For example, you maybe a VNA or a Home Health Organization. Your biggest problem might be that you’re sending some very highly qualified nurse out in the morning to drive 25 miles and show up at somebody’s house, and to find that person was admitted to the hospital the night before. That’s a very narrow problem that you can solve with technology.
You might be a primary care provider and you’re trying just to figure out how to make sure you can coordinate with the hospital after a discharge of a patient, so then you don’t end up having a medication issue or you want to make sure you follow up properly on what’s happened there.
So I think in every one of the cases, it’s to try not to crack the whole thing, try not to figure out the whole problem, but to look at one or two very very small cases that would be most important to your patients and to try to work on those with technology.
Joe Lavelle 11:04 Mark, I don’t know if you know this, but I’m very powerful person. When I noticed the industry didn’t have a czar over ICD-10 and we just kept on delaying and not really making progress. I anointed myself and fellow social media rock star’s Steve Sisko as czar’s of ICD-10, so if I were to anoint you as the czar of interoperability now, what are the three or four things that you would today to accelerate the achievement of interoperability?
Mark Belanger 11:31 That’s great. First thing is I would democratize my role, I don’t think this can be done from a top down czar. I think this is all about setting the conditions in the market to get things to move towards integration. I think our best bet right now is to continue down the road of accountable care and to start simplifying, greatly simplifying the way we pay for healthcare, and get that lined up. I think a lot of the work that comes from making those changes will flow right through and we’ll start to see, if I’m to read the tea leaves, we’ll start to see people that see it’s in our best interest to do what they want to do anyway, which is to integrate care around the patient, because they really do want to do that and those providers once they see that they don’t have to fight uphill to do that, will start to do so.
And I think the IT vendors will start to be able to innovate again. If we are not pushing standards from the government, but we’re starting to let the market flourish. The clinicians are going to make it pretty clear where they want to go with things once they start integrating more closely. That’s the way it works in every other part of the economy. I thinks it’s just kind of fixing some of those markets and those systems problems will go a long way if they are moving the bar.
Joe Lavelle 12:54 What’s on top for you and your team for the rest of this year Mark, what are you working on?
Mark Belanger 12:58 Our biggest things that we’re working on right now is integration challenge. We know that there’s a lot of uncertainty in the markets right now and people aren’t sure what the directions going to be from the government. They are falling back to what’s the right thing to do in absence of all of that. And the right thing to do is to integrate care, the right thing to do is to prepare for whether they are going to called ACOs or IDNs or whatever they are called, but groups of people that want to work to better health care, better care for patients to help them work together. We are working on all levels. We’re trying to advise senior leadership of both governments and providers on where to head, and then we’re right on the ground side by side with the providers, the foundation for anything to be able to measure outcomes in a deep way. We’re going to work on all of those fronts for the next year and beyond.
Joe Lavelle 13:58 Perfect. Mark, it was so great to have you on the show today. Thanks for sharing your wisdom with us.
Mark Belanger 14:04 Oh, thanks for having me Joe. I really appreciate the time.
Joe Lavelle 14:07 Absolutely. Before we wrap our conversation, we want to thank the great folks at Velocity for sponsoring the show once again. Please go to www.velocityhealthinformatics.com to find out more about the innovative ways that they are solving the data quality and interoperability needs of their clients.
And now on behalf of our guest, Mark Belanger, I am Joe Lavelle, and we’ll be back soon with another informative episode of the Velocity Interoperability Podcast. See you then.
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