Tom M. Gomez ~
Today we talk with Tom M. Gomez who is an entrepreneur for Digital Media, eHealth & Medical Devices. He is also founder & CEO of BrainShield Technologies, Inc.
Category: EHR Press
Date: December 9, 2009
Dr. Eric Fishman: This is Dr. Eric Fishman with EHRtv and today we’ll be speaking with a very interesting gentleman, Tom Gomez. He is Founder and CEO of BrainShield Technologies and he is also an entrepreneur-in-residence at FIU. He deals with a large number of subjects in e-health including the NHIN and we'll be discussing a number of these issues with him today. So Tom, tell us a little bit about your background and why you have this interest in information technology.
Thomas Gomez: Thank you for having me, Eric. Eric, I'm an entrepreneur. I've been involved with various ventures primarily focused on digital objects and the transition from the analog to the digital world. My interest in e-health and health care comes from two different aspects of my previous work, one having to do with e-health venture that I was involved with back in 2000 when the web md's were spawning. I was helping build a physician's portal with about 20,000 members.
The second thing is my activity in the medical device space where we're working on some innovative concepts around the treatment and care of pressure ulcers. It does tie back to what we're doing with meaningful use because as you're well aware, pressure ulcers is a terrible disease, preventable and the data capture at point of care is not as good as it should be. So the work I'm doing with the medical device really became the inspiration to get back into the game so to speak and I realized how far we've come in eight years. I revisited the assumption, some of which we're playing out, so here I am looking at e-health a very different way.
Dr. Eric Fishman: And I understand that you have an interesting perspective based upon these previous user experiencing how entrepreneurs are dealing in the year 2009 for instance with the new phenomenal initiative put forth because of the HITECH Act.
Thomas Gomez: Exactly. And to be clear, I got involved with this long before the $59 billion arrived in the market opportunity trials.
Dr. Eric Fishman: That number keeps getting bigger and bigger.
Thomas Gomez: It keeps getting bigger and bigger and hopefully, the benefits will be much bigger than the money the government is spending. I'm a believer in this. I looked at what I'm doing today and what is referred to today as meaningful use a little differently. I looked at concepts such as the patient centered medical home, PCMH. I've looked at AHRQ activity. The patient centered medical home, the concept if you look at it and take it apart in pieces, it's about putting the physician back in control of the participants in the continuum of care. The physician today is disadvantaged because of the silos of information around. So think about a physician with the use of electronic health records being able to see a unified view of the patient, to be able to direct the care that happens, not just in his office but through the referrals he makes, the specific people who manage the care of the patient - the dietician, the nutritionist or the physician that he has referred the doctor to - but he's getting paid for a healthier patient. He's getting paid for keeping the patient away from the office, not for the patient coming into the office. So there is payment reform that has to happen but that's an issue the government and others will handle. But looking at the concept as such, I think it's a compelling concept and those are the things that have been the driving forces in my thinking around the entrepreneurial ventures I'm involved with.
Dr. Eric Fishman: So, Tom, obviously meaningful use has not yet been defined but we're getting closer and closer. Why don't you give us a couple of sentences specifically about the subject of meaningful use?
Thomas Gomez: Great. If you take the matrix as it exits today, the 13 pages or so, you're looking at three things that stand out, computerized physician order entry, patient communication and reporting to public health agencies. Now, patient communication and reporting to public health agencies doesn't just stop there. It's about what they can measure from it. So for those of us trying to seek out what meaningful use will really mean, I suggest to you take a look at what is already being done. Take a look at what the HRQ is doing, take a look at comparative effectiveness studies, take a look at the way in which the evidence based research centers are building technologies for federating data to allow for decision support. Take a look at patient centered medical home. These are the breeding grounds from which we will start to see, at least my humble observation, meaningful use criteria as 2011 comes to pass and we're into the 2015, 16, spots.
Dr. Eric Fishman: And you personally have some very specific and significant experience in that interchange of information and if you'd care to discuss getting it, as you call it, from the edge into a cloud.
Thomas Gomez: Great. So today, let's look at EMR systems and personal health record platforms. EMR systems traditionally, have been very physician centric as a platform.
Dr. Eric Fishman: Right.
Thomas Gomez: Personal health record platforms are very patient centric and you need to connect these two. I wouldn't call it silos because there is information being exchanged in the background but nevertheless, there is a patient and a physician that must communicate and share the information in their respective corners. And so, in order to make that happen, a physician, while sitting in a clinical frame of reference, must have the comfort to look at a patient's personal health record database. It is, in a lot of ways, user generated in today's form. It is not pushed down from EMR systems. It's actually a patient aggregating their own health records.
Dr. Eric Fishman: And the patient must be able to control which portion of that is visible by various participants.
Thomas Gomez: The first part of it is how do you share that information in a controlled manner and people like Microsoft and others are doing a very good job of creating platforms on which applications developers can actually create solutions that patients can have control over.
Dr. Eric Fishman: And then the entrepreneur fits in?
Thomas Gomez: Exactly. There's one opportunity for entrepreneurs. For example, through Health World you can actually authorize an application and then cut them off if you choose not to share anymore with them. The second part of it is how do you validate the providence of the information in that personal health record database. That's where physicians will battle with touching that information because PHR platforms are really not under HIPAA governance. I mean, if it's controlled by an insurance company it is, if not, they're a business associate. A physician is looking at it from a legal perspective together with all the utility that comes from the action. So the opportunity for entrepreneurs is, how do you marry these two components in a collaborative way.
Dr. David Kibbe has referred to this concept as clinical groupware and it's used quite a bit. You're familiar with Dr. Kibbe's writings and what he advocates.
Dr. Eric Fishman: Of course.
Thomas Gomez: So the opportunity for entrepreneurs, one is around bringing the information at the edge to a network of notes as in the physician's practice and then enabling the physician to transfer that information or exchange that information with a larger network whether it's a regional health information organization or a state HIO or the NIN directly. The effort of the FHA, in terms of the connect software is in line with that objective. So again, another big opportunity for entrepreneurs to really understand and look at how connect software can be used to allow for this exchange of information among various constituents. There are companies for example, Merck that has built in connectors. There are a few others, I'm just drawing a blank here, bear with me but nevertheless, the opportunity for entrepreneurs is to help develop solutions that will make this data portability a reality.
Dr. Eric Fishman: And do you believe that the entrepreneurial community is effectively approaching this or are they looking at the large quantities of dollars and looking for a simple band-aid to capture the money or do you think that the real where the rubber meets the road at the database structures have been taken care of?
Thomas Gomez: Well, first of all, these databases are controlled. If you're an EMR provider, you're going to control the database. So while technically possible to have bi-directional exchange, the question is do they want to pull and not push or are they willing, if there is a business case, to have that bi-directional transfer of information.
Dr. Eric Fishman: I'd asked that question of Hugh Zettel about three years ago and he said clearly, even at that time, that it is not a technical issue getting the information from one place to another but rather a business commercial issue.
Thomas Gomez: It's a business issue and in fact people like Peter Newwirth at Microsoft, he has said the very same thing. I mean, software is a different world. It can do all the things you want it to do. It's the business cases that need to resolve itself. But for entrepreneurs, if you can take a holistic approach as opposed to just kind of looking at this application layer and say, OK, I'll launch an application around diabetes management. If you don't beg the question where is that data coming from, who is going to proxy that information, is it somebody at the nucleus of the clinical care system as a physician or is it a patient just pushing it out and then making it available to physicians to come and access that data.
Dr. Eric Fishman: You're involved with universities and clearly, they have different paradigms. They have different methodologies of approaching subjects. Are they trying to put any additional scientific rigor into these processes?
Thomas Gomez: Well, medical informatics as such has been around for many years as you well know. The books have been written. I think there will be some revisions and new chapters written which is where we're headed. What I have come to learn is that there's definitely an interest on the part of academia to have a holistic approach to looking at this data aggregation problem obviously. They realize it's not just a technical issue. They can extract from multiple databases and move it around but the opportunity in academia really is around, for example, creating curriculums that feed off the regional extension center grants.
If you look at the ARA funds and what is going out to regional extension centers typically, you'll see a scenario where somebody who is a REO organization, an organization that used to be a REO will start to take some lead governing spots but if you read the subsections of it, they're looking to universities and libraries who really know what an educational curriculum will be all about. And universities with medical schools and hospital affiliations then become the perfect environment in which you can actually draw upon the experiences of affiliated physicians and hospitals and then incorporate that into a curriculum that people at the university level can use in promoting health care information technology. So part of what I'm involved do that, to bring an industry perspective to bring an entrepreneur's perspective.
Dr. Eric Fishman: You’re the glue that holds it together
Thomas Gomez: To bring it together because most of academic research usually doesn't have a business model. It has a budget. They have an operating budget. If we're going to accomplish a few things around health information technology, the opportunity is here to feed off the traditional funding that academic institutions were awarded. And now with the RAO grants, there's billions of dollars to take that and build it as a viable business group that perhaps the university can spin off.
Dr. Eric Fishman: And so Tom, time is running short.
Thomas Gomez: Yes.
Dr. Eric Fishman: Tell us, if you would, maybe the top three things that you think health information technology should be trying to accomplish at this point.
Thomas Gomez: The first thing I'll say is there are enough standards out there, so don't try to create a proprietary standard. Try to understand what is being done with those standards, follow the initiatives and build solutions around those standards. The second thing I would suggest is to actually collaborate with the larger industry partnerships that a university typically has, to draw upon their skills and their expertise in, for example, health information exchange and make them partners in your effort as you seek out the grand opportunities from the federal government. The third also important thing I would suggest is to develop curriculums in medical schools that are focused on the meaningful use of electronic health records.
I was reading about I believe Georgetown a couple days ago that did a complete revamp of their curriculum. I think it was Georgetown. Medical schools really need to look at this and create a curriculum in the early years where it's not about just assigning a cadaver but you're assigned an actual electronic medical system that you start to learn and use which becomes part of your portfolio.
Dr. Eric Fishman: It would be a dismal event to come out of medical school today not understanding health information technology. Tom, I thank you.
Thomas Gomez: Thank you very much, Eric.
Dr. Eric Fishman: Been a pleasure.