<v Jordan Cooper>We are here today with John Hoyt, former executive vice president for HIMS, the healthcare Information and Management System Society, Hymns, analytics. The hymns is the largest US not-for-profit, healthcare or association in the United States, which is focused on providing global leadership for optimal use of information technology. Well, John was at hims organization, had over 55,000 members. John is also the former CIO of Martha Jefferson Hospital. John, thank you so much for joining us today.</v>

<v john hoyt>Thank you for having me. It's my pleasure.</v>

<v Jordan Cooper>So, John, one topic I'd like to just jump right into is a value of comparing yourself to others in the market. Hims as many of our listeners will know.</v>

<v Jordan Cooper>Has events around the world in with HIMSS's offices in the United States, Europe, events in South America Middle East also has an office in Asia and hosts hosts exhibitions around the world. In the past you've mentioned that quote patient data in Europe goes far beyond blood pressure and BMI, but includes socioeconomic indicators of health like access to healthy food choices. The ultimate goal would include both a shift to prevention rather than treatment and connecting data from different care settings ideally.</v>

<v Jordan Cooper>The patient's record would include everything from primary care to Hospice and public health information. End Quote. John, would you care to elaborate on the differences between US and European models of care and the value in general, of comparing yourself to others in the market?</v>

<v john hoyt>Certainly that subject is what we call here social determinants of health. I found that in Europe, notably in Northern Europe, the Nordics, Finland, Sweden, Norway, Denmark, Iceland.</v>

<v john hoyt>Yeah, that's it. They are more oriented to collecting that holistic data as part of the electronic medical record. In fact, the tender for an EMR for Finland as of about 2016 required the bidders to collect and utilize social determinants of health. And in my conversations with people from the Ministry of Health of Finland.</v>

<v john hoyt>They wanted it. They asked me questions like the following. Does your EMR collect information on your availability to get fresh vegetables and fruits nine months a year?</v>

<v john hoyt>Can you walk to a grocery store to get fresh vegetables and fruits?</v>

<v john hoyt>Are you going to a dentist? Has your child had any problems at school?</v>

<v john hoyt>And I was just astounded that this was a routine expectation.</v>

<v john hoyt>More than six years ago.</v>

<v john hoyt>Uh, for part of the family, his medical history. So that was a good eye opener for me to determine to see how the Nordics perceive these things. They also clearly were ahead of the United States and information sharing. Yes, they have the privacy regulations, etcetera like we do. They know about our HIPPA laws because they have equivalents, but they see their. I'm gonna say this is my opinion.</v>

<v john hoyt>They're stronger in their commitment to health, is a public value. It's a public service and thus sharing it is an absolute necessity and they don't see other hospitals as strongly as we do as competitors, so.</v>

<v john hoyt>You know, that's what that's how I was.</v>

<v john hoyt>Of what I'm made aware of what was going on in in the Nordic countries and they're sharing.</v>

<v john hoyt>They are aware that the United States Healthcare is a competitive.</v>

<v john hoyt>Game and they don't perceive that as something they wish to do.</v>

<v john hoyt>Interesting.</v>

<v Jordan Cooper>So for for our CIO in the United States who are listening to this episode.</v>

<v john hoyt>Right.</v>

<v Jordan Cooper>Are there any? And given that we're not going to be changing our general competitive environment in the United States and we're not going to adopt AA, Northern European Social Democrat type, political, social, cultural, society, social norm, how would you suppose CIOs of American hospitals today can learn any lessons from what's going on in other parts of the world?</v>

<v john hoyt>I think the answer is somehow measuring continuity of care. Are we?</v>

<v john hoyt>Still failing to complete a complete continuity of care record for patients if there are places where records are not being shared because they're not available.</v>

<v john hoyt>Then we have work to do and it is on the CIO leadership of CHIME and hymns to continually push for open sharing of a electronic medical records for the sake of continuity of care.</v>

<v Jordan Cooper>So on that topic.</v>

<v Jordan Cooper>You can't share data unless you can technically share data. I wanna speak for a second about the role of interoperability in driving hims ratings and maturity models in relation to specifically with relation to semantic interoperability and the format of data elements. Can you speak about what hymns role has been in promoting interoperability where you see United States was where you see we are and where you think we need to be with interoperability.</v>

<v john hoyt>Yes, hymns was one of the leaders, as was chime in the United States, and promoting interoperability and tearing down our walls and semantic interoperability is the goal to which we're all heading. That is, do I understand the information that you just sent me electronically? And can I operate on it and what that means is if you send me allergy data from a patient that I did not have.</v>

<v john hoyt>Can I then take that data and run it against a current prescriptions to see if all of a sudden we learned that a patient is in fact receiving a medication to which you just said he potentially could be allergic? So that is a huge goal and we have to to move forward with that. Another such interoperability, which we are not doing today.</v>

<v john hoyt>It is regarding a patient consuming the medications to which the for which they've been prescribed. If you prescribe a medication.</v>

<v john hoyt>And the patient never picks it up at the pharmacy. Are you aware of that?</v>

<v john hoyt>You know the is there a query and response mechanism with the pharmacy benefit managers to do that? We're not doing that yet in the United States.</v>

<v john hoyt>If they do fill a prescription in 30 days, do they renew it? So those are the goals to which we are are should continue to strive because we are short on that here, is it Dylan, United States, it's tough.</v>

<v john hoyt>But we can do it.</v>

<v Jordan Cooper>So one thing that has been driving interoperability over the last decade and 1/2 and during all your time in leadership in hymns, was driving adoption of of meaningful use. The High Tech Act under President Bush and Obama driving general adoption, implementation use payments, meaningful use payments. So and that brings me to the topic of M RAM, which is an acronym from Hymns that stands for electronic medical record adoption models. You have inpatient outpatient models.</v>

<v Jordan Cooper>I think this is something that you worked on. In particular, would you please care to elaborate on HIMSS adoption models?</v>

<v john hoyt>Absolutely. So we started with the inpatient EMR adoption model in 2008. We had our first top stage client. The model was actually introduced in 2005. We did not have a stage seven. That's the top until 2008. I joined in 2008 and then I took over responsibility for the program in 2010, we.</v>

<v john hoyt>Have modified the model periodically through the years as we have to and then we added an outpatient model and then we added an analytics model.</v>

<v john hoyt>The EMR adoption model is a tool to compare yourself to others in how well you're implementing and utilizing electronic medical records it.</v>

<v john hoyt>Like all products.</v>

<v john hoyt>It has a product lifecycle. the United States is now quite well adopted, past tense into electronic medical records. So as the model continues to be matured and modified by my successors.</v>

<v john hoyt>It will have to work to retain its relevance, since the United States has so well and thoroughly adopted electronic medical records. I think the next issue is what we're talking about. Interoperability and continuity of care and the hymns actually did under my direction create and interoperability, excuse me in a.</v>

<v john hoyt>Our continuity of care maturity model and it was successful in Europe and in Southern Asia, has not been that widely adopted in the United States and there's room for it to be more utilized in the US.</v>

<v Jordan Cooper>So these maturity models and for our listeners who are unaware of which are defined as how mature for or fully deployed a hospital is with information technology. When you were working on them, I believe there were three kind of verticals, continuity, care, acute care and ambulatory care. Would you care John to elaborate on what the maturity model of continuity of care is and what it was attempting to achieve and to what extent we've been successful in that.</v>

<v john hoyt>Yes, the intent of it was to show weaknesses in adopting the full interoperability and exchange of records for the benefit of patient care.</v>

<v john hoyt>Ohh.</v>

<v john hoyt>We had some early successes in measuring it in little.</v>

<v john hoyt>I should say communities are Prince Edward Island for example, in Canada. I believe as I recall that printed our island has 9 hospitals and all the physicians and all the hospitals are could be connected to one enterprise and that was their goal. Iceland 's another example believe it or not. I mean that's a country with.</v>

<v john hoyt>8 hospitals, Singapore country with 35 hospitals. These places are and are ideal for utilizing the continuity of care maturity model and they in fact, did look at that model and you began using it.</v>

<v john hoyt>But the whole idea to answer your question was to show where we are weak are we weak in government support are we weak in.</v>

<v john hoyt>Interoperability of detailed pharmaceutical data or an allergy data Etcetera. That's what we were trying to show with the continuity of care maturity model, which was rolled out.</v>

<v john hoyt>Almost 8 years ago.</v>

<v Jordan Cooper>And what were some of the lessons learned where were the weaknesses.</v>

<v john hoyt>In the United States, the weaknesses since we only had one or 2 case. Studies the the weaknesses were still around interoperability with an entire.</v>

<v john hoyt>More than a local area, but like a state or region. You know, and so the vendors have stepped up. Cerner within Cerner Meditech within Meditech epic within epic. But it's the cross vendor, especially in ambulatory that we're still weak at what we saw in Europe and I'll notably say France and the Nordics were far out achieving the United States in this aspect and we saw that as well in Singapore.</v>

<v john hoyt>And New Zealand interesting enough, but you see, those places are smaller and they're more able, but it's their whole attitude and expectation about sharing data their attitude is of course, we share data? Why wouldn't you it's for the benefit of the patient.</v>

<v Jordan Cooper>So one on the topic of interoperability. There's many different topics that we can cover about why there may be weaknesses or inadequate interoperability. It could be due to a lack of federal standards. Maybe that they're varying standards and each state. Maybe there are regional. HIE should be should there be a national HIE are there technical challenges in just sharing different kinds of data dicom images?</v>

<v john hoyt>Yeah.</v>

<v Jordan Cooper>HL 7 is there or a HTML code is are there different so I'd like to ask you to elaborate on what some of the challenges have? I think many of our listeners are kind of aware of? What some of the challenges have been interoperability, but how do you see us overcoming some of these challenges? What should CIOs in healthcare delivery systems in the United States be considering if they do want to improve interoperability and then what kind of cases could they make to their teams that yes, we are competing with these other hospitals but we should still join.</v>

<v Jordan Cooper>A regional HIE? How do you make that case to your leadership team?</v>

<v john hoyt>Yeah, that's a great question.</v>

<v john hoyt>The challenges are technical and going to these meetings, is sometimes like going to the IRS and going through that detail of audits. They are difficult and they're challenging hymns are sponsors annually. A connector thon and they're done around the world as well in Europe and Asia, these connected phones where the vendors.</v>

<v john hoyt>Provide employees and they all work on scenarios to show that they can indeed connect and trade not trade share data for patient care where the what's the role of the CIO stay involved in this area, or if that's not your Forte. You have people on your team or in your organization that need to be involved in these local and regional efforts for interoperability.</v>

<v john hoyt>Be involved at at the hymns.</v>

<v john hoyt>Interoperability showcase, which is well over an acre in size within the hymns annual conference and see how sharing can be done.</v>

<v john hoyt>And we need to start measuring ourselves and we can go back to the continuity of care maturity model, which still exists.</v>

<v john hoyt>Take on the challenge you know engage someone at Hims to work with you. On that model to see where your strengths and weaknesses are for your health system and your region.</v>

<v john hoyt>CIO 's can work with other CIO in their region to.</v>

<v john hoyt>Utilize the continuity of care maturity model and show each other what they all could do to improve. There are some good examples in the United States. There's just not enough.</v>

<v Jordan Cooper>Are there financial incentives adequately aligned in the US to promote interoperability?</v>

<v Jordan Cooper>Do you have?</v>

<v john hoyt>Not that I know of I do not see any incentives for that.</v>

<v Jordan Cooper>And would and then to change that would it require an act of Congress or is there. Some private sector solution that could align incentives to promote interoperability.</v>

<v john hoyt>The private sector solution is going to be around measuring how well regions and healthcare institutions are doing it and one such tool is that continuum of care maturity model.</v>

<v john hoyt>The only</v>

<v Jordan Cooper>I.</v>

<v john hoyt>well this is not my core strength, but I I see information blocking as a negative incentive if you do this you're in trouble. So you know OK. That's an incentive of sort but there's not as much. There's not the competition in it. Like we had with the EMR adoption model you know, I wanted to show that I had a higher score than the other hospitals in my market it. We're not there yet, with in the United States with that.</v>

<v john hoyt>No.</v>

<v Jordan Cooper>And I think maybe it's fair to say that in the United States. Healthcare organizations respond well to financial incentives and so we have very adequate EMR adoption due to the MU payment. The IU payments that we saw over 2008 to 2020 or so and and and penalties as well. Would you hypothesize that it would take payments from public and private payers in order to?</v>

<v Jordan Cooper>Move us closer to interoperability and regional exchanges.</v>

<v Jordan Cooper>Umm.</v>

<v john hoyt>Yes, I think that's absolutely correct. I'd love to see that we do have some incentive for those for example, Medicare Advantage plans and other plans were the hospital and health system is at financial risk. If you do fully cooperate and exchange information. You may find that you can cut your costs. You don't need to do. The MRI because you can pull one in from an organization who did it, you know last week.</v>

<v john hoyt>That is not an overt incentive, but it's those efforts could in fact, lead to cost reductions and allowing you to have some.</v>

<v john hoyt>Operating margin on on that risk insurance plans.</v>

<v Jordan Cooper>There is one topic as we approach the end of this episode that I would like to broach which very much plays into what we've been discussing today so kind of wrapping up the topic is change management.</v>

<v Jordan Cooper>Internal stakeholders are various different motivations and desires. We've kind of alluded to maybe a CFO caring about is there a financial penalty reward for doing this and if not why should I compared to improving patient outcomes or managing population health, which may be incented by risk sharing model.</v>

<v Jordan Cooper>To our CIO is listening today? What would you say to them about how to?</v>

<v Jordan Cooper>How to kind of direct change management in their organization in order to promote interoperability and continuity of care?</v>

<v john hoyt>Wow.</v>

<v john hoyt>All of us have had experience over the ages in.</v>

<v john hoyt>Audits auditing of medical records or electronic medical records now.</v>

<v john hoyt>When there is right, there an opportunity to find. When did I not obtain data from an outside organization when I could have?</v>

<v john hoyt>That's hard, it's taking an audit.</v>

<v john hoyt>I think that's one such thing that we should engage in in ourselves look internally. When am I not exchanging information. When I could have this patient says they went to you know this other.</v>

<v john hoyt>Medical Group they're not part of our system.</v>

<v john hoyt>Did we get that data if not?</v>

<v john hoyt>That's a failure point, so I think that's continued and that's a you know it's a post care audit.</v>

<v john hoyt>The other thing is setting the expectation that I will constantly do this.</v>

<v john hoyt>As part of a day-to-day use of electronic medical records have the physicians tell us that they expect us to be involved in collecting this data have the medical staff demand. It you know this patient says they're going to some other physicians outside of ours. We don't have the records. We don't have their prescribing patterns. Etcetera and I have the medical staff demand this.</v>

<v Jordan Cooper>Well, I thank you, John. I think we've covered a lot of ground today with interoperability, continuity of care. We spoke about adoption models, continuity of care, maturity models and generally the direction that HIMS has been moving over the last decade or so.</v>

<v Jordan Cooper>So for our listeners, I just wanna remind you, we've been listening to John Hoyt, the former Executive VP for Hims Analytics and former CIO of Martha Jefferson Hospital. John, thank you so much for joining us today.</v>

<v john hoyt>Thank you. I enjoyed it. Conversations is great. Thank you very much.</v>