Episode 19: The Ongoing Quest for Interoperability

One of the biggest barriers to innovation in healthcare today is the inability to easily use and exchange data among healthcare organizations and the software solutions they use. This presents a disconnect between health systems and the health tech world. Paige Goodhew, product marketer for Redox, shares the goal of enabling technologies in the hands of patients that meet them where they are, so that they can participate in their own healthcare.

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Full Transcript

Announcer: It’s time to think differently about healthcare, but how do we keep up? The days of yesterday’s medicine are long gone, and we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans, and many of those humans have unbelievable stories to tell. Here, we leave the policy debates to the other guys and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together, and here’s some amazing stories along the way.

Ready for a breath of fresh air? It’s time for your paradigm shift.

Michael: Welcome to the “Paradigm Shift of Healthcare,” and thank you for listening. I’m Michael Roberts with my co-host Scott Zeitzer. On today’s episode, we’re talking to Paige Goodhew, and she’s a product marketer for Redox, which is a company focused on creating more interoperability and healthcare. Paige, thank you so much for being on the show today.

Paige: Yeah, I’m excited to be here and to chat with you all.

Michael: Absolutely. So, I’d like to just jump into a few quick questions to kind of talk about what you do at Redox and what Redox does, and so kind of give everybody an overview of the company itself and then we can kind of jump into some of the bigger questions of healthcare. But as a product marketer for Redox, can you tell me about what your daily responsibilities look like?

Paige: Yeah. So, that’s a great question because product marketing tends to vary pretty widely across companies in terms of what does that mean, and what does the role entail? Here at Redox, my main focus is making sure that we are effectively articulating the major differences with our product and our company and how that allows us to approach interoperability from a different and novel angle.

To do this, I work closely with our product management team to understand what’s new, what the impact will be for our customers, and then making sure that our customer-facing teams such as our sales teams, our customer support focuses and our implementation teams know how to talk about this with our customers appropriately to make sure that we can get them excited about new things that will help them and also set the right expectations about what our product is doing so that they know where we fit into their offering.

I also spend time reviewing feedback from our customers and keeping up with industry news to keep an eye out for trends that can provide additional data to consider as our product management team is looking at new and upcoming development.

Scott: Paige, let’s take a step back. Why don’t you explain to us a little bit about what Redox is, like an elevator speech, so to speak?

Paige: Yeah. Redox is an interoperability platform that provides a consistent integration experience for software vendors and for healthcare organizations. What we see is we work with software vendors across the spectrum and we work with anyone from a one or two-person startup in the garage to large Fortune 100 companies, and they are how innovative and interesting products that they want to use to make healthcare better, but oftentimes these companies are getting stuck with figuring out, well, how do I get the data I need for my product to work or how can I get the data from my product back to the healthcare system that I’m supporting?

And to do that means that you need to be able to integrate with a variety of different health data sources. The most common one are EHR vendors like Epic, and Athena, eClinicalWorks, Cerner, and Allscripts. But there also are other types of health data sources such as health information exchanges, interoperability networks like Carequality or CommonWell, and even more so, we’re starting to see an increase in wanting to integrate with CRMs like Salesforce.

So, Redox fits in between those systems to help make sure that they are able to get the data across in a way that is easy, efficient and is something that will scale for those software vendor companies as they’re working with more and more health systems. Ultimately what we do is we essentially build a network of these different connections that is completely reusable. So, if you are a health system that has 10 different products that you want to purchase, you can use one connection with Redox, and if you authorize the same data feeds to connect with those 10 different applications instead of of having to stand up all of those different connections on your own.

So, it really helps simplify and streamline that integration process for both healthcare providers as well as for the software vendors that need to integrate with this variety of systems that are in use in healthcare today.

Scott: Yeah, it sounds like it’s a really great tool that could be made available to help translate between really disparate systems that are out there.

Michael: Yeah, I’m thinking about, you know, just all the different…Getting into the marketing parlance very quickly as you know, what’s your tech stack look like? You know, all the different systems that you have to use and it’s a challenge that all industries are facing made all of them more complicated by the fact that its healthcare and all the regulations and all the HIPAA and all of that fun stuff that you have to use to make all those things work.

So, that’s huge to have that connection. Paige, we talked a little bit before the show just about, you know, how does this work for different sizes of organizations in terms of healthcare providers? And you mentioned some of the software companies. So, thinking about something that just is simple as a practice, just trying to understand how they get appointments booked with them, it sounds like Redox can help kind of connect the dots there as well.

Paige: Yeah, we definitely can. We work with a large number of applications that provide some type of scheduling product and that can be anywhere from self-scheduling products to waitlist if you want to make sure that you’re filling up your waitlist and you don’t have holes in your schedule to even ones that are doing things like appointment reminders or post-appointment sending patient education. As technology has become such a bigger part of all of our lives, we’re seeing that patients want more of these technologies. They want to be able to interact with their healthcare providers that way.

And for a practice or a healthcare organization, if you have a few different programs that you want to implement to provide scheduling support for patients in any of those forms, that’s where using Redox would mean that you can connect with us once, and our team can hook you up with the different programs that you want to use in order to make it easier for your patients to get in or to make sure that your schedules stay as full as you need to have them filled to meet your cost requirements. And because you do this in a reusable way, ultimately, what that means is that you can get that return on investment for those products that you’ve implemented much more quickly.

Obviously, anytime that you buy a product, the time between when you purchase it and when you start using it, that’s kind of dead time where you’re not actually seeing the benefits. So, the more that we can decrease that dead time and make it as fast and easy as possible to start using it, the more value healthcare providers can achieve from those for both their practice and their patients.

Scott: Kinda shifting gears here a bit, health systems and health tech companies both have very specific languages that they use to communicate complicated ideas. How do you try to create a shared language for these two disparate groups?

Paige: That’s always a fun topic. I’ll focus on this mostly on the technical side, obviously. We have a very technical product. One of our developers at Redox actually recently shared a really good internal blog post. That’s how we communicate a lot of our ideas across the company. And he talked about the challenges of creating a shared language. And what stuck with me with what he shared is that there’s really three components to any type of language, whether you’re talking about math or you’re talking about Spanish. Those are all types of language.

The three components are words, syntax, and semantics. And if you think about this in terms of spoken language, English is a really good example where one of the reasons why English is difficult for non-native speakers is not necessarily the vocabulary or the sentence structure, but it’s really that nuance of how meaning and that those semantics can change even if the word itself doesn’t. So, for example, think about the word “right.” You can say, “You were right.” “Make a right turn at the light.” And, “Access to clean water is a basic human right.” And in all of those sentences, they have, you know, the same word that’s used, the syntax matches, but that meaning is very different for that word. And healthcare integration has similar challenges where the big problem is not the structure, but it’s really understanding what’s the meaning of what you’re asking for to be able to get the information you need or to interpret that information correctly.

One of the things that we say at Redox that is one of our big lofty goals is we want to make healthcare data meaningful. And many healthcare specifications when it comes to integrations, focus on the words and the syntax. So, what’s the structure? But they don’t really tackle how to use that specification in a way that’s meaningful. And so, to think about it, to use our scheduling example, one of the key things, when you are doing scheduling data, is you need to have a shared understanding of who is this patient that we’re talking about?

Most often, you’re going to use some sort of an ID or an identifier. So, in human speak, we would say something simple like, “We need the patient ID.” That’s what a software vendor might say to a healthcare organization they’re setting up, so they put integration with. But what that really means is we need the patient identifier that can be used to share information about the same patient across systems so that both of our systems know who we’re talking about.

Now, when you peel back the curtain on healthcare integration specifications, you could see that you can get patient IDs using the PID segment in HL7. You can use that patient resource and fire, and then as soon as you get into the world of EHR vendor APIs, there’s a myriad of different API calls that might be used. You might use a get, you might use a poll, and you might get data pushed towards you. However, when you use any of these, essentially this is the syntax that we’re talking about here, the word in the syntax, you’re likely going to get a whole list of patient IDs, and that’s because, across these systems, patient ID has a variety of meanings.

Some systems will use the term medical record number or MRN, which seems straightforward and is usually what you want, but it can get more challenging if it’s a healthcare organization that has potentially merged various systems and they now might actually manage three, four or five different patient MRNs that are going to come across to you when you ask for that patient ID. Some systems will talk about an internal and external identifier. Some will use a unit record. So, there’s all these different ways that these healthcare, these systems that are used for health data, think about an identifier, and usually, the healthcare specifications just tackle how do you get anything that’s defined as a patient identifier? And not how do you get the patient identifier that is meaningful to be able to make sure that we can exchange the specific set of data? And that’s just one example of many in which…There’s a big need to understand the nuances of how to identify and communicate what’s the data that you need for what you’re trying to accomplish.

What Redox does is, and we’re a little bit unique, is we do hundreds of integration projects every year, which is a really high volume. We’ve integrated with 30 or 40 different of those healthcare data sources that I’ve mentioned, and over that, we’ve figured out, and we’ve learned the semantics of what these different systems think of when they’re talking about their patient identifier. And the output from that is we have an API that we’ve built that is designed to, as much as we can think about, what’s the human speak? What is it that you’re going to ask? What do you want from the data? And then we will do that work of translating whatever it is that we’re getting from the health data source into what it is that you want from that into our API.

Michael: That’s fantastic stuff. So, obviously, you know, your company, you’re like you’ve got all of the technical knowledge and the technical information that you guys need to be able to interact with this information. But, you know, just looking through your profile before we talked and even listen to some other podcasts where you had appeared, you know, I know that you have a background that comes from healthcare. I know that Redox is very steeped in healthcare, and so these aren’t just programmers hopping in and saying, like, “Hey, we can figure this out.” But it comes from this sort of rich engagement with the healthcare ecosystem as a whole. So, talk to us a little bit…and we have some other questions for you, but I want to just dig into a little bit of your past and how you’re able to kind of speak with some of these organizations. I know that you had worked with a hospital before and even with Epic, if I recall correctly.

Paige: Yeah, yeah. I’ve been in healthcare for almost 20 years now in some form or another. I’ve said this before, but I always like to say that I’m a healthcare nerd who ended up in tech. So, I very much come from the healthcare side. I’ve spent the past 10 years on the tech end of it, which has been really interesting. But I think that some of my perspective has been a little bit different is I like to say that my career grew up with health IT. I remember using a DOS-based system at the first hospital that I worked at. So, that was really entertaining.

And I remember when HIPAA started to become this huge thing, we had to really think about and worry about in terms of how data is moving electronically. I’ve had the chance to be on the side of working to provide healthcare to patients, mostly in administrative style capacities. I wasn’t a clinician myself, but I supported clinicians and supported making sure that patients were able to get the care that they needed, and I watched health IT come in and just expand and really explode into where it is today.

And that’s part of why I ended up on this side of…I found it very fascinating to recognize this huge opportunity for technology to really help with some major inefficiencies and gaps in how healthcare is provided. And one example I like to use is I’ve moved around a little bit in my life and when I think about my medical record…I have medical information in Indiana, I have it in Washington DC, I have it in Washington state, and now in Wisconsin, and it still is really fragmented. If you think about people that have been born in just the past 15 years as health IT and the move towards electronic health records, they have a much more comprehensive set of their medical records, and they have that information that will exist with them and persist throughout their lives.

And when I think about the opportunity for the research and the things that we can learn about figuring out indicators of early disease or how to treat it or how to handle it, there’s so much power that exists in health technology. And that’s part of why I ended up on this side is that it felt like an opportunity to participate in something that can really enhance and expedite some of the things that we’re learning about healthcare today.

Scott: That whole interoperability…That’s a hard word. That whole interoperability ideal, you know, to me, is so critical to all of our own healthcare. I mean, we’ve all walked into the doctor’s office where the doctor actually works for the hospital, and you’re thinking, “Why would I fill out this information over and over again?” All the way up to, you know, something truly emergent. You know, like I’m going into an ER and why wouldn’t they know if my name is Scott Zeitzer that I have, you know, I don’t know, a medical history of X and don’t give them this. You know, that kind of stuff. Like, why would that be more easy to get ahold of and access?

And then, you know, you start thinking about, just like you said, “Wow, wouldn’t it be great to take all this information in a HIPAA compliant manner, scrub the data, etc., etc.” And then go, “Wow, we’ve got all these people with Apple watches intermittently taking how much they stand, what their heart rates are like.” I believe that Tim Cook if I’m not mistaken, he said that he’s diabetic and so he’s very interested in trying to get some better data around that. We work with some companies that have platforms for patients. Have you seen some tangible results, like, just from your experience at the company in terms of getting somewhere on these fronts?

Paige: That’s a great question. Research has been a little challenging, mostly because, as you mentioned, obviously, it’s critical that information is scrubbed and de-identified when it’s appropriate. There are a few barriers and blockers when it comes to some of the traditional integration paths that make that more challenging. I would say that what we have the opportunity to support a fair number of patient-reported outcomes programs where post-surgery, for example, if a patient has had a total knee replacement, they can be enrolled in a program where the healthcare organization is able to collect the patient’s feedback on how are they doing post-surgery, are they recovering?

And they are able to start to collect the data and figure out, you know, what’s the baseline for our patients? And they could even, you know, figure out what are the baselines for specific surgeons in terms of coming out of the surgeries and be able to understand now how is this patient performing comparative to those baselines? So they can now intervene earlier than maybe they would have if they hadn’t been able to collect that information in such an easy manner previously before.

And, you know, we still sometimes see these…If you had surgery like that, they maybe are going to mail you a survey that then you are filling out on paper, and you have to mail back, and being able to provide that in an electronic format where it’s sent directly to your phone or directly to your email using the appropriate secure methods, it makes it a lot more accessible and easier for patients to provide the data that these healthcare organizations need to make sure that this patient is getting healthy at the rate and the pace that they expect them to.

Scott: Yeah. And then just, you know, even the potential to be proactive. As I mentioned about being able to track, say, a diabetics’ sugar levels and inferring knowledge from that. I know that if there was a way to get clean data, say, into Watson, you know, the IBM system and seeing if they could come up with some ways to be proactive about it. We work with a company that has a robotic system for lung biopsies, and one of their goals is to say like, “Well, if you find a tumor, you know, in this particular portion of the lung, what are chances that another tumor are in another portion of the lung?” You know, that would be based on data points obviously. This stuff just always genuinely, you know, excites me.

Paige: I’ll jump in really quickly. One of the other things that I think is everybody wants to figure out how can we use AI in healthcare, and how can we make sure that, you know, we’re building good models? And as a woman, one of the things that I’ve gotten concerned as I read about this is so much of our medical research is actually based more often on largely male populations. And so, when you think about building AI models, if what we’re putting into the AI is research that’s based on men, you know, inherently, there may be some bias that we’re putting into this research.

And so, thinking about the ability to increase the breadth of data that can be collected in addition to the ease means that there are so many greater opportunities to make sure that we are creating medical models that are based around specific populations whether that’s being a female or whether that’s being a minority or other types of things rather than kind of the dataset that’s been used historically, which has gotten us really far. But, you know, I think we’re now starting to see and realize there are all these differences that come from inherent differences and biologies. And being able to collect that data more quickly I think will actually be a huge improvement when we think about, “How do we apply AI in medicine?”

Scott: I couldn’t agree more. I mean, I can’t tell you how many different conversations I’ve had both on this podcast and just in simple conversation where we’ve literally, over the past hundred years, just said, “Oh, wow, hormones, that’s hard to figure out. Would you stick with guys?” And it’s Like, “You know, population has a bit more estrogen, guys. Can we think of this all out?” And it’s like, “Well…” So, I am always excited about that as well.

Michael: I think one of the themes that we’ve seen from doing this show and one of the things I was excited to kind of expand this conversation around Redox and the systems that are kind of accompanying it, we had a chance to talk with some different healthcare networks where they could talk about that initial engagement with the patient in the primary care space, and then because the healthcare network is large enough, that healthcare system is large enough, they can own every stage of the patient journey.

And so, they can connect that data very, very easily because it’s all in the same system. It’s all…I say easily because I don’t have to do it and so we’re figuring out. But to have other people that are in this space because one of the things that so many people are worried about is we’re going to go down to consolidation and all of the little guys, so to speak, all of the smaller companies or smaller practices or smaller healthcare groups are just going to get eliminated. And it seems like Redox is really a chance for other groups to fight back, to start to contribute in a way that they couldn’t in the past, which is exciting to me.

Paige: Yeah. Well, I think the other piece is that, you know, when we think about healthcare and when we talk about healthcare organizations, most often people are so focused on what’s happening within the four walls of the healthcare system, but the vast majority of healthcare that any of us receives or does for ourselves happens at home. It doesn’t happen just within those walls of the health system. And that’s part of why I feel really passionately about figuring out how do we enable these technologies that are in the hands of the patients that meet them where they are so that they can participate in their healthcare and so that we can start to think about not only what’s happening to the patient when they’re here at our facility like in our clinic or in our hospital, but what’s happening to them at home that might actually give more insights as to how we need to care for them and treat them? You know, you’ve mentioned Apple Watch as a really powerful opportunity for people to start collecting data and provide that to their clinicians.

Now, kind of the same thing as we talked about early there, we need to make sure that data is being provided meaningfully. Just dumping rows and rows and rows of data collected from your Apple Watch isn’t going to be helpful and meaningful, but just the start of being able to collect that data and get it where it needs to go has a huge potential to make sure that even if you’re a smaller system that there are ways that you might be able to provide better care and enhanced care that can, you know, overall help long-term with your viability as an organization.

Michael: This is super fascinating stuff. I really appreciate your time today, Paige, because this is something that if you’re involved in healthcare, if you’re sticking with healthcare for as long as, you know, as people are, like, obviously, this is something that people are passionate about. We are all patients. We have family members that are patients. This is something we all care about, and to see that there is room for progress, there’s room for evolvement in this space, and it’s not just I go back to the hospital when I’m sick. I go back to the doctor when I’m sick, but I can participate in my health instead of just when things go wrong is really incredibly encouraging. So, Paige, I’m going to throw one more question out there. Is there anything else that we haven’t had a chance to talk about today that you’re really excited about in terms of just where you’re seeing this industry go?

Paige: Yeah, I think the last thing that I would love to squeeze in is that, as much of a proponent as I am for technology, I do always want to make sure it’s clear that technology in no way replaces the amazing work done by physicians and nurses and other clinicians. And what I’m most excited about and what I think is coming is a new wave of technology as we continue to break down very technical barriers, which that’s what integration is.

It’s a very technical barrier that prevents the people that are using these technologies from being able to participate in the design. Being able to remove those issues, I think, is going to help open up a wave of not more technology, but technology that’s more thoughtful and technology that’s designed much more around the experience of our physicians and our nurses, and the experience of the patient. I’m excited about that and I think that that’s a wave that’s coming and I’m excited that Redox is helping to participate and removing a technical burden that is a very challenging one if you are not a tech person, and especially if you’re not a health tech person, to be able to pave the way for the people that are using these technologies to start to have a much bigger voice in what they need from the technologies to really augment what they’re doing and help them provide better care.

Scott: I couldn’t agree more. This type of technology and healthcare technology overall, but this specifically will help empower medical professionals to take better care of their patients. And that is going to be a major change in the next decade. Technology used to be just like this paint write. Now, instead of writing on a paper, I need to just stick it in this system. And it’s evolved to the point now where it’s like, “Yeah, of course, you need to put it into the system in some matter, but look what we can do with this data, how we can help you take better care of your patients. We can help you take better care of the population as a whole.” Just really looking forward to it. So excited about it, absolutely. Absolutely.

Michael: Thank you again, Paige, and thanks everybody for listening.

Announcer: Thanks again for tuning in to the “Paradigm Shift of Healthcare.” This program is brought to you by P3 Inbound, marketing for ortho, spine, and neuro practices. Subscribe on iTunes, Google Play, or anywhere you listen to podcasts.