 Hi, everybody, we're back. This is Dave Vellante of Wikibon, and this is theCUBE. We're here at the MIT Information Quality Symposium. What we do at theCUBE is we drop into events like this. We try to extract the signal from the noise. I'm here with my co-host today, Paul Gillan, who will be with me all day today. Michael Nix is here. He's the Director of Analytics at the James M. Jeffords Institute for Quality and Operational Effectiveness at the Fletcher Allen Healthcare Organization. Michael, welcome to theCUBE. Thank you very much, Dave. Appreciate being here. So, we were talking a little bit before you came on and sharing with us your role as the Director of Analytics. But talk about the role that healthcare plays in analytics and start with really what your role is within Fletcher Allen. Well, thank you. First of all, Fletcher Allen Healthcare is what's called an integrated delivery system in Northern Vermont. We're based out of Burlington. And we deliver care in both a hospital setting as well as physician practices and a number of outreach activities. So we're involved in virtually every aspect of healthcare delivery in the Northern portion of New England. And what we are passionate about as a healthcare provider is providing good care. For our organization, because we are servicing a relatively rural activity or rural area, the people that we're dealing with as patients are friends, family, neighbors. So it's very personal in terms of how we are delivering care. And it's very important that the care that we deliver is the best possible care because it's up close and personal for us. So healthcare is probably one of the most information dependent industries. In order to deliver good care, you have to have accurate information. It has to be complete. It has to be timely in order for physicians and other practitioners to make good decisions. What we are as healthcare industry facing is the technology boom that we are experiencing through the rollout of expanded electronic health records or EHRs is an incredible increase in both the span of information as well as the absolute volume of information that is flooding into our provider environments. So give us the healthcare 101 and what's happening with electronic medical records. I mean, healthcare affects everyone. Everybody can relate to it, but it's a complicated situation for a lot of people. They really understand the plumbing behind the wall. So give us the brief overview of what's happening in the industry generally, but specifically with EMR. Well, with the advent of what's called Obamacare, there has been a massive increase in the amount of resources that are being put into the electronic capture and distribution of information, the EHRs. In the past, many of the healthcare delivery, even in relatively sophisticated, excuse me, care settings was done with a mixture of paper and electronics. So there were missing elements. When you went on to an electronic system, there were critical piece of information that just simply were not there. The physician, the practitioner, the therapist, were not seeing the whole picture. With the infusion of the incentive dollars under the Obamacare, as I'll generically call it. Even he calls it that. Even he does it that. It's not a disparaging term. It's basically what we refer to it. There has been a concerted effort to move healthcare forward in terms of a much higher level of electronic integration of basic information. And that is the sort of game changer. It's a paradigm shift. It's also a technology challenge. It's also an incredible opportunity because every time patient care is delivered, you are taking a very high risk of incomplete or inaccurate information causing a provider to make the wrong decision. And when you're talking about your own healthcare, we want to make sure that the right decisions and the right care is delivered in every setting. I've heard some astonishing numbers about the number of deaths that occur in the US each year because of poor quality data, 180,000 or something like that. Are those numbers real? They are very real. And every organization that delivers healthcare is acutely interested in trying to overcome these structural obstacles to the delivery of good care. If you, for example, are allergic to a particular medication and a provider does not know that and they administer that medication to you, you could go into like an anaphylactic shock or leading to death. So as we think of data quality, we're really thinking about it in terms of the delivery of care to you, the patient, or to Dave here as the patient. What is the implication of not knowing or having the wrong information in terms of making crucial decisions? We all think about what happens if I show up in an emergency department, when I'm unconscious, no one knows me, you are at a disadvantage. But even in routine care settings, if there's not complete information, you can't depend on someone remembering your own doctor, for example. Do they remember everything about you when they have thousands of patients? Of course not. And we have to remember this about ourselves because I'm sure everybody who's watching has had the experience of going into the doctor. Every time you go into the doctor, you fill out another form and you're asked about the same allergies, the same medications. And so the patient themselves, patients themselves can make mistakes that cause data quality problems, but also just why is there a need to do that? How close are we to a world where people will carry a single medical record with them that is accessible to anyone they want to give it to and where this information only lives in one place? That is a policy level question that as we generically say is well above my pay grade, but what we are struggling with here in the United States is the fundamental issue of the technology increases and the technology innovations that we have available to us are somewhat constrained by the policy decisions and the medical legal structures that we must operate under within both the US statutes as well as guidelines from various federal agencies. And that is not a criticism. I think it's just the realization that we as healthcare delivery systems must learn to push back into these policy areas and say look, these policies are not resulting in the best possible care. Are there ways we can approach privacy policies? Are we ways that we can approach payer issues of proprietary information in such a way that care is delivered at the best possible level of quality by sharing of information now that we are capturing more of it. Are you saying that HIPAA and Obamacare are at odds with each other? They are fundamentally trying to achieve objectives that do have conflicting outcomes. And as with any public policy, it takes time to work through all the implications of these broad policies. So I believe what we're really talking about is the technology is going to push the policy envelope as well as pushing the public perception once they understand what the implications to them as individuals in terms of care delivery are. Absolutely. And my understanding is from an adoption standpoint that Obamacare, they're stages, right? So stage one was to adopt the software and whatever technical infrastructure and stage two gets into meaningful use. Is that correct? Can you clarify that and what implications does that have from a data quality standpoint? Well, meaningful use is a three-stage program that was designed as a set of incentive programs to both provide seed funding for the technology movement into more advanced platforms. In other words, to pay for the software and the hardware to really allow organizations who are lagging behind the technology to acquire significant and quantifiable increases in capabilities. Now, once you have a platform, you actually have to use it in a meaningful way, ergo the term meaningful use. What that means is that just having a system where people capture information on paper and then maybe somebody scans it into a scanned document into a electronic file, that isn't really information capture within the scope of it. So it means having tools that are friendly and useful to the providers where it has to be part of the clinical workflow. It has to be things that support the good and timely delivery of care. And it cannot be tasks that are just added on to an otherwise chaotic and busy schedule for these providers. So designing effective tools is really what meaningful use is about. Getting the right tool in front of a provider. And that's what at Fletcher Allen from the very top on down, we have spent an awful lot of time and energy and I can truthfully say millions of dollars trying to achieve those goals because it is the right thing to do. It is what is needed to deliver good care although the achievement of meaningful use has to do with meeting certain guidelines for funding. It really comes back to achieving meaningful use is achieving better care for your patient. Yeah, but there's a business case implication as well. Exactly. Can you talk about that a little bit? I mean, it means saving lives. As Paul was saying, you're going to, whatever the number is, it's going to improve that. It's going to cut costs. I would presume, do you have visibility on that yet? As I say, there's an implication that that will occur and there's a carrot and a stick with the funding and so forth, but do you have, is there light at the end of that tunnel? I think there is light, although it is a very long tunnel and it is a very dark tunnel because when you are talking about redesigning the incredibly complex care delivery systems that have evolved over literally hundreds of years in terms of how care is delivered and the technology innovation is resulting in significant paradigm shifts. For some of the practitioners, the more senior and older practitioners, as in any case that you have major change, it means relearning. For the younger practitioners, it means more facilities, you might say, in terms of acceptance of new technology. But healthcare delivery is one of the most complex industries that exist within the whole world because when you think of healthcare, it is not just getting a shot, it's things like surgery, it's like therapies, it is diagnostics. You have CT scans, you have lab reports or lab studies. In other words, when you look at it, it's about 14 or 15 distinctly different business operations within a delivery system just to do acute care, the traditional hospital setting. So getting all of those pieces and parts to work together in both a synergistic as well as a effective way is really the challenge that every healthcare organization is trying to undertake. So the key for us is can we deliver better care? The answer is yes, we are making incremental movements toward better care. We're catching more things earlier, like my earlier example, having a drug allergy and making sure that that system knows about it and sends a flag that says, oh, you can't give this patient this antibiotic because they're allergic to it or some other type of thing. Yes, we are achieving better care, but it is also a very long journey because of the complexity of the medical environment. I wanna ask you before we run out of time about what's going on, you talk about complexity, that's just within the hospital or the on-site care provider. You have all the complexity of the supply chain, there are different, there are insurance companies, there are pharmacies involved, there are all kinds of players outside of your direct control who have to exchange data and data formats, consisting, making sure the data is in a consistent format that the right fields are being used, there's a whole model underlying that so that the data that's being exchanged is meaningful to each player in the supply chain. What is going on currently to solve that complexity? I'm a great question. Along with the Obamacare, you might say the meaningful use aspect, there's a new approach that is being rolled out across the nation, it's called Accountable Care Organizations, or ACOs for short. The idea around an ACO is to have a network that is not a single provider, but basically linking the care delivery systems in multiple organizations where you as a patient might be involved. Ed Fletcher Allen, we are involved in the only statewide ACO, we have an ACO that we are standing up, or stood up in January of this year, where we have established a network across the entire 14 hospitals that exist within the state of Vermont, as well as approximately another 65 to 70 other provider organizations. The idea is to bring together those different care delivery systems and capabilities into a single stream of information so that we can make sure that we do know as much as possible to deliver good care. But that again is a monumental task. One- Just in Vermont. Just in Vermont, which is a relatively small population base. Inside an organization, the complexities of getting the multiple systems to talk to one another is enormous. When you start talking about going inter-organizational, as well as creating infrastructure, it's not sexy, it's not easy to understand, but these infrastructure projects that have to take place are absolutely critical to the long-term success of integrated healthcare across the whole continuum. Michael, thanks very much. We're pretty out of time, but really appreciate you coming on and sharing your perspectives in this important topic, and it was a pleasure meeting you, and good luck with getting to that end of the tunnel. And as Dat Tran said, it's not a project, never ends. Never ends. All right, thanks again. Thank you, Paul. All right, keep it right there, everybody. Peter Akin is up next. We're going to talk about data management and double-click on that topic. This is theCUBE. I'm Dave Vellante with Paul Gillum. We'll be right back. We looked at all the programs out there and identified a gap in tech news coverage. 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