PODCAST #22. EMR Interoperability and Data Standardization Issues Amid AI Adoption in Healthcare
Welcome to another CareMinds podcast episode featuring Sameer Desai, Senior Director of Engineering and Product Management at Verona Health. In this two-part episode, Sameer Desai shares his invaluable insights into the limitations of Electronic Medical Records (EMR) in addressing interoperability challenges comprehensively.
Sameer Desai’s expertise allows us to delve into the specific hurdles smaller and niche healthcare practices face in achieving interoperability. With over 12 years of experience in software development and HL7 C certification, Sameer Desai has extensive knowledge of EHR systems and their intricacies.
Throughout the episode, he sheds light on slower adoption of the FHIR standard and the cumbersome process of custom integrations they must endure to overcome interoperability challenges.
Let’s dive right in!
The Role of AI in Healthcare and Addressing Data Standardization Challenges
“I think we have heard about everybody transitioning to FHIR. Now, especially in the space I work in, we are going across 50 different EHRs. When you look at the FHIR standard, the maturity of FHIR APIs across EHRs varies a lot.”Sameer Desai – Senior Director of Engineering & Product Management at Verana Health
According to Mr. Sameer Desai, the problem of lack of standardization has persisted over time. While there are standards in place, most healthcare providers consider them guidelines rather than strict requirements, leading to issues.
He mentions the transition to the FHIR (Fast Healthcare Interoperability Resources) standard, which many in the industry adopt. However, the maturity of FHIR varies significantly across different EHR systems. For example, one EHR may populate all the required fields correctly, while another may not adhere to the same structure or location for data population.
Mr. Sameer Desai also highlights the challenges faced in specialty areas like ophthalmology, where specific EHR systems may lack the resources or capabilities to implement the FHIR standard. Thus, some EHR systems can communicate effectively using standard formats, while others lack the capabilities or resources to do so. This presents a dilemma for building an inclusive AI program that accommodates all EHR systems, regardless of their size or resources.
He emphasizes the importance of enabling participation in AI advancements for all healthcare providers, not just those who can afford or have implemented systems like Epic. However, the customization of workflows within EHR implementations adds another layer of complexity to the FHIR framework. This is because even two Epic implementations may differ in appearance and data organization. Critical information may be stored in notes rather than standardized fields in certain fields like neurology, further complicating data extraction for algorithm development.
Mr. Sameer Desai acknowledges that such diverse data formats pose a challenge, despite recognizing that healthcare data is valuable, akin to oil. Still, it is not uniformly accessible or structured across all EHR systems. He underscores the need to address these issues and achieve standardized data formats to facilitate the development of accurate algorithms, predictions, and improvements in care quality and drug development.
Exploring the Relationship Between the Adoption of FHIR Standard and EMR/EHR Efficiency”
Mr. Sameer Desai expresses his perspective on adopting the FHIR standard and its limitations. He mentions that FHIR is still in its early stages of development and does not address all types of problems in healthcare data interoperability.
He provides an example of their current focus on helping providers submit MIPS reports, which involves administrative aspects of data. Specifically, he mentions the challenge of reconciling medications when patients visit healthcare providers. This type of specific information may not have an exact place within the FHIR standards, as FHIR is primarily evaluated as a clinical data standard. However, he notes that FHIR is also evolving to encompass financial and initiative spaces.
“So I think in the newer world, we expect, like now, we’re going to do something with images; we’re also going to do something with genomic data, which will always result in different formats.”Sameer Desai – Senior Director of Engineering & Product Management at Verana Health
Mr. Sameer Desai emphasizes that healthcare data goes beyond just clinical information. The data requirements become more extensive as the industry shifts from transactional to value-based healthcare. They must consider factors beyond diagnosis and disease treatment, such as socioeconomic factors. The scope of data expands to include non-healthcare-related information. Progress must be made toward achieving standard formats.
Looking ahead, Mr. Sameer Desai mentions integrating images and genomic data, which will introduce further variations in data formats. However, he highlights that the challenges extend to the core clinical data, which is not yet standardized. He believes that the pace of FHIR standard adoption will help address these issues, noting that larger DH organizations have already taken the leap, and he expects others to follow suit.
Challenges in Data Plumbing: Addressing Development Obstacles for Integrating Diverse EHR Systems
“So at some point, you have to take a hit to convert that to a common model where you can apply these algorithms at scale and move forward.”Sameer Desai – Senior Director of Engineering & Product Management at Verana Health
Mr. Sameer Desai expresses his opinion on the challenges and significance of working on healthcare data interoperability. He believes that although this job may not appear shiny or exciting to most engineers, it is crucial for the healthcare industry. Waiting for everyone to adopt the same standards is not feasible; therefore, immediate action is necessary to solve the problems at hand and make progress. He emphasized the need to address the challenges faced in the healthcare space today.
According to Mr. Sameer Desai, the challenges in this field start with technical problems such as establishing connections and sharing data, which can be solved through APIs or direct database connections. However, the real challenge arises once the data is in the environment and needs to be understood. This requires collaboration with EHR vendor partners, who may have different priorities and may be hesitant to cooperate, especially when dealing with startups that lack the leverage of larger organizations. Convincing EHR vendors to work together and establish a common data model becomes crucial, particularly when working across multiple entities.
Another obstacle is the operational aspect, where people become more dependent due to the complexity involved. Working with multiple EHR systems (30 to 50 in this case) requires finding a common data model to apply machine learning and analytical algorithms at scale. Operational challenges also arise from capturing data within EHRs, as different systems may have varied data entry and organization approaches.
He provided an example of the complexity involved in medication reconciliation, where different EHRs use diverse methods such as procedure codes, flags, reverse flags, or note templates. Human involvement becomes essential in resolving such discrepancies, leading to a greater need for larger teams to handle multiple EHR systems effectively.
“It’s also about figuring out these operational things – where does it make sense to invest in automating, and where does it make sense to actually just have people do it?”Sameer Desai – Senior Director of Engineering & Product Management at Verana Health
Additionally, Mr. Sameer Desai mentioned the complexity at the practice level, where non-standard EHRs allow unstructured notes, and each provider or nurse practitioner may have a way of documenting information. These technological and operational challenges require balancing automation and human intervention, depending on the specific situation and the value derived from solving the problem.
He concludes by emphasizing that all startups encounter these challenges, and the key lies in finding a happy balance or a happy medium. This balance involves determining the value of solving problems and deciding whether automation or human effort is the most suitable approach. Mr. Sameer Desai considers achieving this balance to be an art or science in itself.
Unveiling Verana Health’s Strategies for Tackling Standardization Challenges in Healthcare”
Mr. Sameer Desai shares his perspective on Verana Health’s unique position and approach to solving healthcare data challenges. He believes that Verana Health has a distinct advantage in working with societies and specialties, enabling them to leverage their influence with HR vendors. By collaborating with these societies, Verana Health can request additional support in terms of data mapping and establishing connections with HR vendors.
Mr. Sameer Desai emphasizes that Verana Health’s primary focus is to provide the best customer satisfaction for its registry members. To achieve this, they meet their customers where they are. For practices using Epic, Verana Health has an FHIR injection API that allows them to easily ingest the data. This minimizes the burden on hospitals or practices. However, for practices using smaller, specialized HR systems that may not have similar integration capabilities, Verana Health is responsible for directly obtaining data from their databases.
They then work closely with the HR vendors to understand data mappings and ensure compatibility. Alternatively, if the HR systems have standardized data extracts, Verana Health works with those extracts and maps them to their common data model. This approach provides multiple options to customers, allowing them to participate in the registry and benefit from insights into the quality of care while receiving suggestions for improvement.
Additionally, Mr. Sameer Desai highlights that Verana Health considers patients’ well-being. They offer practice opportunities to participate in clinical trials, ultimately benefiting patients. While certain regions may have limited access to breakthrough treatments and trial participation, Verana Health strives to solve data-related problems for them. They facilitate connectivity to platforms and ensure that these regions are included, enabling them to be part of the larger healthcare ecosystem.
Furthermore, Verana Health leverages artificial intelligence (AI) to go beyond structured data. They analyze unstructured data such as notes and employ AI models to identify additional information. Verana Health excels not only in identification but also in converting this unstructured data into a structured format. By doing so, they can provide valuable structured data to research organizations and clinical trials, aiding in research advancements.
Achieving Effective Problem Solving and Execution in Product Development: Verana Health’s Collaborative Model and Success Stories
“I build the platform, I get the data, and then my outbound product managers are building experiences based on which customer they are serving.”Sameer Desai – Senior Director of Engineering & Product Management at Verana Health
Mr. Sameer Desai discusses the collaborative structure and roles within Verana Health’s product management team. He explains that the structure resembles a common model seen in Silicon Valley, known as inbound or outbound product managers or technical product managers versus traditional product managers. Regardless of the terminology, Mr. Sameer Desai’s focus at Verana Health is on building the platform.
“So I am more technically oriented in terms of setting up the platform and looking at how we can scale this.”Sameer Desai – Senior Director of Engineering & Product Management at Verana Health
As a technical product manager, Mr. Sameer Desai is primarily responsible for platform development and scalability. He considers the developers and individuals who will create additional applications on top of the platform as his customers. He focuses on the technical aspects of platform setup and operational scalability rather than direct customer interaction.
On the other hand, the outbound product managers work with the data and insights generated by the platform. They use this information to create tailored experiences for different customer segments. Verana Health serves various customer bases, including societies, doctors/providers, and clinical trial sponsors. Each customer base has specific needs, and the outbound product managers build experiences and applications to address those needs.
Mr. Sameer Desai emphasizes that the platform he develops remains agnostic to the specific customer bases. He acts as a layer between the data insights and the engineers, ensuring they clearly understand how the data is used without burdening them with customer-specific details. This structure allows for effective collaboration and streamlines the product development process.
Verana Health’s Resourceful Approach to Ensuring Smooth and Efficient Scaling
According to Mr. Sameer Desai, operational scaling at Verana Health involves several key aspects. Firstly, connecting with different electronic health record (EHR) systems is challenging, some of which are cloud-hosted while others are on-premises. With over 1,500 connections to individual practices, the goal is to make the setup process as easy as possible, particularly for small practices with limited IT resources. Verana Health focuses on building user-friendly and remotely manageable solutions to alleviate the burden on these practices.
In addition to the operational challenges, there is a focus on reducing data latency. In contrast to the traditional approach of working with claims data that may have a lag of 90 days, their goal is to shorten the lag to weeks. Maintaining connections and ensuring stability is crucial in achieving this objective. The company takes responsibility for ensuring the smooth running and uptime of these connections, focusing on maintaining low latency for data refreshes.
Another aspect of scaling involves the staggered implementation of different EHRs. Each EHR system may be adopted by practices at different times, which requires careful planning and program management. Resources on their side and the EHR partners’ side are limited, so efficient planning is necessary to make the implementation process feasible. Verana Health has dedicated mapping and clinical data transformation resources available for this purpose.
Once the data is received, another scaling layer comes into play, addressing data curation and organization for specific disease areas. Verana Health focuses on understanding market needs and the requirements of research organizations to effectively curate and transform the data for analysis and research purposes.
While these aspects are important, Mr. Sameer Desai emphasizes that the first two aspects, which are external-facing and involve operational scaling, hold greater significance. Meeting their partners’ needs is a priority, and achieving it requires a combination of art and induction in the planning process. It is not solely a scientific endeavor but also involves carefully considering various factors to ensure successful scaling and operational efficiency.
The Future of Interoperability: Navigating Integrations and Data Streams for Smaller Startups and Niche Practices
“We are moving towards data set marketplaces, where startups can leverage pre-cleaned data sets and build experiences that other competitors are not focused on.”Sameer Desai – Senior Director of Engineering & Product Management at Verana Health
According to Mr. Sameer Desai, the healthcare industry lags behind other sectors in effectively leveraging data. He acknowledges that there are reasons for this discrepancy, noting that healthcare cannot acquire data in the same way as consumer industries.
However, Mr. Sameer Desai points out an emerging trend in the overall data landscape: the rise of data set marketplaces. He cites AWS as an example of a company that has recently introduced its marketplace, and he believes that other vendors are pursuing similar initiatives. This development will make the data space more interesting as organizations undertake the initial groundwork. They’ll be responsible for the data cleaning and preparation processes, making curated data sets available in these marketplaces.
Mr. Sameer Desai highlights the potential benefits for startups in this evolving landscape. By leveraging these curated data sets, startups can explore developing new AI models to address challenges that other industries and competitors may not be focusing on. Alternatively, they can utilize the data to build unique experiences that competitors have not yet explored or may not be interested in pursuing.
He emphasizes exhaustively exploring these options before resorting to expensive data acquisition methods. Mr. Sameer Desai acknowledges that establishing numerous connections and acquiring data through traditional means can be a capital-intensive process.
Let’s Sum it Up
Here are five key takeaways from our discussion with Mr. Sameer Desai:
- Data standardization challenges persist in healthcare, hindering interoperability and AI’s full potential.
- Although still in its early stages, adopting the FHIR standard is essential for achieving data interoperability in healthcare.
- Technical and operational obstacles must be addressed, including reconciling different data entry methods and addressing variations in data organization across different systems.
- Verana Health employs unique strategies to tackle data standardization challenges. They also offer multiple options for practices of different sizes and capabilities to participate and benefit from insights into care quality.
- Operational scaling, reducing data latency, and effective data curation are crucial for successful healthcare data management.
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