Ann Fishman, with EHR TV, interviews Mark Dente, MD, Chief Medical Informatics Officer Healthcare Information Technology of GE Healthcare.
Ann Fishman: I am Ann Fishman. This is HIMSS 2012. I have the honor of being with Dr. Mark Dente, Chief Medical Information Officer at GE Healthcare. Doctor, thank you so much. I’m looking forward to talking to you.
Mark Dente:Great. Look forward to it.
Ann Fishman: There is a lot going on in Health IT in 2012. It seems that payment reform is at the top of everybody’s agenda. Speak to that if you would.
Mark Dente: Not to be overdramatic about it but there was a seismic shift last week when United Healthcare announced that it was moving away from its Fee-For-Service schedule to a pay for – performance pay-for-value schedule. Basically, everyone in our industry immediately got into the population health business whether they realized it or not. So what really it’s talking about is saying and it’s a good thing by the way. I think it’s a wonderful thing for our patients. It’s a wonderful thing to really start to think about how do we understand the value of a coordinated care process? How do we bring together all the different data elements, all the different care delivery, people that are in our world whether for it’s home health, all the way to the surgical suite, make sure they were all coordinating that care with our patients. And then really start to think about going longitudinally across a segment of patients to understand where the best outcomes are coming from. If we have the data, which is what we’re all doing here today with Informatics and data acquisition and all that, you can now start to look for really best trends. Isn’t that what we all want for our patients, anyway? Now, practically, there are some challenges. Practically, it’s going to be, “Gee, you know what, how do I get there from here? How do I make sure that I have the right information and what is the right information?” Historically, the relationship with the physician and a hospital is “Please, doctor, send me your patients.” And now, there’s going to be business relationship. “Hey, doctor! We are a multispecialty practice or a surgical center. We now have to have a contract in place. So are your revenue cycle systems are your billing systems robust enough to handle all of these back office things and as a biomedical informaticist for 19 years, I never ever thought I’d care about a billing system and now I do.
Ann Fishman: There was a headline in Health IT News on Monday that said “HIPAA 5010, A Train Wreck Coming.” Is that accurate?
Mark Dente: I don’t. I don’t think it’s a train wreck coming. I think it’s a challenge only because there are so many different programs ending at the same time. So you have Meaningful Use criteria. The fact that there was little bit of delays. New criteria was supposed to come out today and it was delayed a little bit. That’s okay. There are so many different programs though going on at the same time that is hard for the scale of the institution to be able to absorb these many changes. So the facts in this concept of going to like an ICD-10 code which is really going to help us in the long run getting more granular information, again, so we can start to take better care of our patients, in and off itself is a positive thing. And actually, I think the delay that might come into ICD-10 – I mean I am not sure what the delay is but I have to get somebody that knows that little bit deeper than I, but that delay is actually going to be helpful because it will allow the institutions to kind of prepare a little bit more time. And I think so, if you take it in aggregate, it’s probably not a train wreck that is going to occur, and I think it’s also okay that it got too late.
Ann Fishman: Is it significant that the AMA is basically asking for a moratorium, though, on ICD-10? Does it reflect a reluctant or even an inability on the part of the U.S. physicians to adapt to these new requirements?
Mark Dente: Well, that’s an interesting question. And I don’t have the crystal ball. So the AMA has what their thoughts are around that, and they’re making some absolutely valid concerns and then I also look at other segments of the industry that are saying, “Gee, we really do need to get off of the historic system that we have and move to where other parts of the world have already been doing because it allows us to get a better level of information that we could then do work on for our patients.” So it’s one of these – it’s the big elephant and what the elephant looks like depends on what part of it that you’re touching. So it’s one of those, those challenging aspects.
Ann Fishman: GE?
Mark Dente: I think from a GE perspective though, and this is what I’m pretty comfortable with, we needed to make sure that our technologies are ready. We needed to – almost all of our technologies are ICD-10 ready now. So whatever occurs, whenever it occurs, I want to make sure that people are comfortable that we’re going to be out there to support their needs going forward.
Ann Fishman: Can you deconstruct ACOs, Accountable Care Organizations a little bit?
Mark Dente: Wow that’s a great question. The concept of Accountable care and where we’re all going with that and what that really means, I almost like to take a step back and then breathe. Instead of calling it Accountable care, let’s just call it some type of payment reform that’s looking for quality outcomes as the measure because Accountable care has a little bit of a connotation of “Gee, this is a CMS program.” I look at our industry. I look at – again, I mentioned it in the beginning of this interview what I did announce. I look at other payers that have acquired hi-tech technology that basically are data aggregating solutions. Some of us have been around a while and have little bit of gray hair now and remember back in the 90s since bal- capitation and everyone had these capitated programs. And those capitated programs really didn’t survive. And the difference between now and then was then they were looking at claims data as part of the reason why it didn’t survive was how do you analysis on data that wasn’t really accurate enough to get the clinical level that you needed? Today, we have EMR data. We have a lot of EMR data and it’s codified. I think that some type of payment reform is here to stay. I think the good news is that when you look at like Centricity Practice Solution with an embedded enterprise data warehouse, we have 25 million lives, HIPAA compliant anonymized lives that we can now do benchmarking for. We can now look for signal for detection.
Ann Fishman: Do you think we’re going to get better medical care when everyone has an EHR and all of these changes are complete?
Mark Dente: You’re talking to a computer geek physician, right? So my wife is the first one to tell me, “You’re the only one who thinks your job is interesting,” right. So when I look at that and I really start to say, and I mean this sincerely now, yes. Now I think that there are challenges, I think that we have to make sure that institutions, clinics that are smaller, that don’t have the resources of a 40 or 50 person practice, that don’t have the IT infrastructure have to chose the right solution. I think the regional extension centers that are in place are wonderful, wonderful resources for the smaller practice that really needs to make sure they are veiling themselves of those type of resources to help them kind of get the benefit that a larger organization would have. But yes, the reason why, anytime we can start to make sure each one of us knows what’s going on, our goal in life is to prevent that needless adverse drug effect. Our goal in life is to make sure that we’re coordinating that care across the continuum of this patient whether it’s inpatient or outpatient. I actually really believe this. I think within the next 10 years, the vast majority of data that’s going to come in on our patients will probably come outside of the bricks and mortar of the healthcare setting. It might be remote monitoring of chronically ill patients in the home and how that data comes in. It might be, “Gee, you know what, we noticed that you were buying a whole bunch of tissues and over-the-counter decongestants at Wal-Mart, are you catching cold?” I mean we can really think outside the box going forward. To get there though, and this is not – this is not really dramatic, other industries have made this leap and we’ve made the leap at GE and we’re proud of this fact. You have to get off of the best of 1970s technology. And a lot of our industry is still driving the best of 1979 in terms of this underlying architecture of software. We have embraced we have invested heavily in Services Oriented Architecture. That is how you are going to be able to take legacy applications that have made huge investments and we’re not saying you’re going to turn those off by any stretch of imagination. We’re saying if you layer in a technology, you now have innovation open. Who knows that young company that can come up with the next best breakthrough in care delivery and they no longer now have the burden of all the normal software development because they can use a software development kit to write to a platform like Caradigm and what we’re doing with Microsoft and Amalga, right? I mean this is where innovation is going to come from in the future and GE embraces it.
Ann Fishman: Well, since you brought up Caradigm, let’s talk about that. I think it is a very significant partnership. I know there’s a lot of backend partnering and collaboration, but this is a joint venture.
Mark Dente: Yeah.
Ann Fishman: Would you talk about what it means?
Mark Dente: I’d love to. So Caradigm is again, a 50-50 joint venture between Microsoft and GE. I think it’s really one of the best bringing together of technologies that I’ve seen. And again, a lot of years of doing this in a long time, what was really innovative was saying, “Gee, what did each partner bring that added value? Does one and one really make three here? And if not, why do it?” So that was the rigor. There was a lot of rigor that went around this. The second aspect is “What was really the innovation aha?”. Amalga, which is a great technology Services Oriented Architecture out there, or we think that we believe internally years now prior to even thinking about this type of relationship, we knew we had to make the leap from legacy development style to Services Oriented Architecture and they fit the bill. What we brought to the table is years and years of great research with Mayo Clinic, Intermountain Healthcare, some of the luminaries like Brent James and Stan Huff, and what we can do in saying advanced clinical decision support. If you have the right data, how can you start to think about going from today’s world? Do I have my Diabetic Foot Exam and the alert for that absolutely, appropriate to the future? How do I do something like truly advanced Acute Respiratory Distress Syndrome protocols that have a 90% fatality rate that an institution like Intermountain has, has basically got it to about a 60%, so they have saved 40% of the people. 40 people out of hundred are alive because they can run that protocol at that institution, right. That takes really sophisticated underlying pinnings and that’s what this organization will bring.
I think from the rest of our portfolio, we’ve also embraced that as well. So we are doing research right now with the Centers for Disease Control. Our Centricity Practice Solution leveraged its enterprise data warehouse with 25 million lives, approximately twenty-four-and-a-half million lives. And we worked with the CDC to say how can we start with the surveillance monitoring for the N1H1 flu virus back a few years? And we were able to help them understand, “Hey, here’s the outbreak pattern. Here’s what we need to target resources. Here’s what the local Department of Public Health needs to be notified,” because we are seeing it sooner and we were able to leverage this technology. So those are some of the really exciting things that are going on at GE.
Ann Fishman: Surveillance seems to be a buzz word this year.
Mark Dente: Yeah.
Ann Fishman: Is this the new trend?
Mark Dente: Well, it’s a trend – it might be new for some but we have been doing it for years. I’ll tell you, it’s etiology for us has a really interesting path. Where did they come from for us? GE makes jet engines, okay? GE makes a lot of things. I think I’d make – I think I have a GE dishwasher in my house but I probably don’t – I don’t know it, but we make jet engines. When those engines are turned on, we stream data, we bring that out, and what we do is that engine is now analyzed and any one slice of that data at any one given point in time might look normal. It is, not look. It will be within normal limits. It’s only when you get enough of this information and it’s normalized, it all talks the same language that you can actually go back through and start to build algorithms to look for signal that might be very, very subtle and in fact, what we are able to find was that by putting normal, normal, normal, normal together, it could be predictive of a failure in the future. Tremendous.
Ann Fishman: Fascinating.
Mark Dente: It was the aha. My goodness that’s what we do in healthcare. So how do we get that to you? We got that to you. We have all this healthcare data. What can we do to go from today’s world, what we see here, I need to get my alert done to tomorrow’s world, I want to be predictive about disease state so I can intervene sooner. I want to think differently about how we’re going to do congestive heart failure studies.” Why should a patient that has congestive heart failure routinely ends up in an Emergency Department at an end stage four to five times – four times a year? It’s a very uncomfortable situation. They get admitted. Huge cost to society. What if we started to do analytics from home data, put it into a database, start to do analytics against this stuff, and they will go, “hey wait a minute, this guy is getting into trouble. Get a case manager on the phone.” And say, “Hey, Mr. Smith, are you taking your medicines correctly? We want to see you tomorrow.” Isn’t that wonderful? And that’s what GE is doing.
Ann Fishman: Well, doctor, I have a tough question to ask you.
Mark Dente: Please.
Ann Fishman: Is this new paradigm pharma-centric, physician-centric, or patient-centric?
Mark Dente: That’s easy. It’s patient, right? And anyone that doesn’t think it is patient isn’t approaching the topic or the concept or the idea in my view, correctly.
Ann Fishman: Okay.
Mark Dente: Okay.
Ann Fishman: Is this new paradigm have a chance of suppressing or undermining patient autonomy?
Mark Dente: No. actually now, here’s the challenge. No, it doesn’t.
Ann Fishman: Okay.
Mark Dente: First of all, you always have to make sure that because a lot of this research – and it is research. So most of what we’ve talked about today is here today. I mean we’re very transparent at GE. We want to make sure that people understand that this is what’s available. When we start to do this advanced data analytics, this is research that we’re doing. It may never come to market because it’s research. We’re hoping that this will work. Now, it’s done on anonymized data. We make sure that we’re maintaining the patient privacy and security. What it really does though is we really want to encourage patient engagement. I think taking not one slice of this but maybe taking the research we’re doing to look for signal for really disease, predictive disease states and then coupling that and I think this might be a really great area to do more research in with social networking, social media to engage our patients and now you bring these two together and now we can drive patient compliance. A lot of our patients within 30, 60 days of being prescribed their medicines really aren’t taking it the way they were originally prescribed and they might not be taking it at all. If we can think differently about how do you reach that patient, that consumer – that consumer now and especially if we’re talking home health and things like that, that’s the aha breakthrough that will really help drive quality of life disease benefit but also really bend the cost curve of what it’s going to cost to maintain our aging population. Our population is aging and we need to make sure that we can afford to do all of these wonderful breakthrough therapies.
Ann Fishman: Doctor, what would you say the theme of HIMSS 2012 is, if you could pick one?
Mark Dente: I look around here and I think it is the theme that data matters and, not that it didn’t matter prior but I think with Meaningful Use, I also think with payment reform, this issue of “How do I manage not only my patient and go deep in the medical home concept?” Medical home concept is how does all of this feed into one different all the different care providers take care of my one patient and then now we’re in this world of population health management, really because we have to go across these patients to be successful requires that data integration. So it’s data integration, the ability to deal with population health, and obviously taking care of our patients. So I think those will be the trends that I’ve seen this year that are really exciting.
Ann Fishman: One last question.
Mark Dente: Please.
Ann Fishman: I just want to make sure I cover it. Do you have a product to cover the spectrum of provider groups from the small to the large?
Mark Dente: We’re very fortunate. Yes, we do. And it even goes beyond that. I think part of the strength when you look at why and how and what we’re doing with something called “healthy imagination”. We’ve had some TV commercials about it. And it’s really about how do we think differently about care now and really be breakthrough thinking in the future. It’s really saying “What can we do about taking the breadth of the portfolio and bringing it?” So we can take care of that individual physician and all the way through the largest of the large. And we do it not only clinically but we also do it from the perspective of, again, this payment reform.
I mentioned it earlier, twenty years in the industry basically, I never really gave a heck of a lot about business processes. I’m a researcher. I want to think clinically. Well, what I really need to also do though is to be able to provide a solution set that our users, our customers can not only take clinical attributes from this and be successful but also have the ability to do all the contracts, everything we talked about, that relationship shift, that seismic shift, “Doctor, just send me your patients to” “Doctor, we are now in business together”. And yes, we have all of that here. And I want to say thank you again for just allowing me to share some time with you.
Ann Fishman: Well, thank you. It’s a brave new world.
Mark Dente: It is.
Ann Fishman: I think we’re going to get through it though.
Mark Dente: Good.
Ann Fishman: So doctor, it’s really an honor to talk to you.
Mark Dente: Oh, pleasure.
Ann Fishman: So this is Ann Fishman at HIMSS 2012 with Dr. Mark Dente, Chief Medical Information Officer at GE Healthcare. Thank you.