Open Solutions to Healthcare Challenges
IEEE Pulse talks with Michael Wasser, co-founder of HealthSherpa and CEO of BloomAPI, about the changing landscape for electronic medical records, and the future of healthcare interoperability and innovation.
IEEE Pulse: You have founded at least four companies already, correct? How did you get in the business of start-ups?
Michael Wasser: After college I worked for Microsoft and then moved to Boston for a year where I joined someone else’s start-up. I formed my first company soon after, which did okay, but the second one I ended up selling. That company was in what I would call technology for technologists—helping people better understand where they’re spending money, especially as it relates to cloud computing technology.
Then the third company was HealthSherpa, which is still in business. HealthSherpa received a lot of attention just by launching at the right time—during the first open enrollment season for the new health insurance plans—and ended up becoming a major health insurance broker. I left at that point to focus on patient provider technologies but my partners continued and they’re doing a really great job. They sold a large percentage of the health insurance this past season, in fact.
Pulse: Do you think starting HealthSherpa provided an impetus for moving into the healthcare technology field?
MW: Actually, when I first started in healthcare technology it was with Vista, an open source EMR [electronic medical record]. At that time there were a lot of people considering adopting Epic and I mentioned to a few friends that I had got Vista running on my laptop and was just starting to learn how it worked. They mentioned it to some other friends who knew some CIOs (chief information officers) who were looking at Epic. The CIO would say ‘Come in, I want to see Vista because no one else can demo it to me.’
At that point I got access to a lot of really intelligent people who had been in this space for years and years. During our interactions, they would also mention a long list of technology problems they were facing that they didn’t necessarily have good solutions for, so that’s what I drew from in terms of finding a set of technology to work on. In health care, I would say that I’ve had a sequence of experiments. HealthSherpa was probably the seventh of those experiments. BloomAPI was actually one of the earlier experiments.
Pulse: What was the motivation behind BloomAPI?
MW: BloomAPI started as an open source project, which I began because I was talking with a hospital system that had a directory of physicians that was out of date and they wanted to know where they could find reliable information. So I used the NPI (National Provider Identifier) as a way to get them started. The NPI doesn’t have great data quality but it was a good learning experience—I put it on a small server, let people access it, left it alone while I did HealthSherpa, and when I came back to it, I saw it was getting about 1.5 million queries every month.
Initially, I didn’t think this would get used and I had no idea why people were using it because, again, I was still relatively new to healthcare technology. So I started talking to as many people as I could who were using the tech and that took me everywhere from start-ups on one end to hospitals, to payers, to malpractice insurance companies—so many different spaces in health care touch on the NPI somehow. That experience helped me learn quickly and focus on more problems and that’s what eventually led to the IT/EMR integration issue because it was something that we kept hearing over and over again in all different applications of EMR interoperability and integration. Across institutions, people were all very consistent in saying that they needed access to clinical data; and that’s what brought me to BloomAPI today as a company that I’m currently spending my time on.
Pulse: So where do you see this effort going? Do you see the use of open source technology growing in the healthcare context?
MW: We’re technologists at heart and we significantly benefit from open source ourselves so everything that we do, if it’s something that is clearly reusable in some way, we put it out there for other people to use. And a lot of the time these are small components as opposed to the full picture but those smaller components themselves can help further the industry in various ways, too, whether it’s the NPI look up tool or a it’s a way to easily remote access various specific technical components or technology that will help do some of the automation we’re working on.
In the context of our larger company, at this point we’re just trying to find as many ways to get out and connect to as many different healthcare practices as we can. There are so many practices that still have little or no technology staff—it may be a practice of one to 20 clinicians, who might have a part-time IT individual or they have somebody’s brother’s friend who comes in on Tuesdays—and those are the practices that we are trying to help the most with this type of interoperability solution because they get the least support from the existing vendors out there.
Pulse: Interoperability seems to be a hot button issue right now, and it seems particularly important for those patients who have multiple providers who currently aren’t able to easily share information across platforms, which ultimately impacts the patient’s health care. Do you see interoperability solutions changing this situation?
MW: Absolutely. Especially when you are undergoing treatment for some significant acute event or a chronic issue, you might go to one specialist and then you go to another specialist and you do the same tests again and again because they can’t access the medical records. It’s still a really common story and it shouldn’t be. This was supposed to be what we were getting when we moved to electronic medical records and that’s not what we got at the end of the day.
Emerging interoperability solutions will help remedy this. For example, one of our customers does exactly this, they collate health records for an individual across EMRs regardless of where the records originate, so as an individual is going through treatment for a chronic condition they’re able to bring their own records with them, including things like imaging and test results. The hope is that even if the provider doesn’t feel comfortable with the tests that were done at least they have the context of what the other clinicians looked at and thought of and tried and so it’s more of a collaboration instead of it being a situation where they start from scratch again.
Pulse: So eventually we could actually realize the concept of patient-owned data where individuals carry their health information with them?
MW: I honestly have no idea why we haven’t done something like that already. France does, for example. They have a single card that can be used to grant access to your health records; you go into any practice for the first time, you give them your card, they put it into a standard reader and the information transfers into whatever EMR product they’re using and they can see your whole health record. Then, when the clinician writes notes at the end [of the visit] these are written back. The information is encrypted so if you lose your card it’s not a big deal and it’s generally accepted that this is a secure, safe way to keep your health records. It’s convenient, it makes sense, and there are so many entities in the United States who are capable of making this happen. The payers are extremely well positioned to do it, Medicare is incredibly well positioned, even Medicaid now has more of a federal presence and they’re capable of doing it, too.
The standards are all there, as well as the practices. We can look at other countries like France, learn from them, and do the exact same thing or something similar here. France, for example, is already on their second or third generation of that technology at this point. I think that this would be such a big win for everybody. Consider interoperability; now we’re going and building these big, very expensive HL7 pipes between places, when it could just be that the patient walks in with their health record and each party that treats them for something then gets access to that full health record as a result.
Pulse: It does seem as if we have been approaching interoperability in a very complicated way.
MW: Yes, it’s like we’re building pyramids in a sense. We’re building these HL7 pipelines that cost approximately US$10,000 each; beginning by connecting only the major hospitals first and then we can start to fill in the gaps. This is partly because we have the budget to build just as much as we can and we have these HIEs (health information exchanges) that were massively expensive to construct and are massively expensive to interact with and now payers are starting to pay the HIEs for data as well, when all along this could have been a rather cheap implementation. But it wasn’t, so the payers now have to foot the bill of these expensive HIEs. It’s almost like we took on a lot of debt up front and now everything is just more expensive as a result.
It’s possible EMR vendors could have come up with simple solutions here, but, they are not necessarily incentivized to promote that kind of technology. That said, high-level federal organizations, like Medicare, are really well positioned to promote these sorts of solutions.
Pulse: Can you talk a little more about BloomAPI and where you see APIs changing the healthcare landscape?
MW: We see BloomAPI as a way to democratize access to clinical information—to make it as easy and as cheap to get to it as is possible so that anybody who will realistically benefit from having the health data can get access to it. Whether it’s another health system, whether it’s a vendor, whether it’s another entity trying to move someone from one EMR to another EMR, or a patient-facing portal or patient-facing technology, they can do it without asking if it’s possible.
What I heard in the past and what brought me to what we’re currently working on is the constant question, ‘Can you integrate with my EMR?’ I don’t even think that this should be a question; it should just be ‘Well, clearly as a technologist you can connect to my EMR so let’s move on’ with your solution. What I would like to see happen is that we can get to a place where we can give any healthcare practice access to interoperability by offering a solution where you can go to a website, download a technology, and then you’re done. That’s all you have to do and all of a sudden you have a website that you can go to and when Vendor X wants access to an EMR, you don’t even need to think about it, and it doesn’t cost that much. That’s where we want to be as a service provider.
I think there is the potential, even if it’s not through us, for things like interoperability to change the economics of technology in health care, to change the type of organization that is doing the innovation in the first place and to change the way that we’re enabling people to leverage their skills. Today there’s a barrier. You might have developed a really good solution that might be for clinical care, or it might be some particular type of user interface, but the companies that win the bid aren’t necessarily the people who are really good at these specific problem areas—they are the people that have a passable solution but they can interoperate.
It’s almost as if interoperability is this big wall that you have to be able to surmount. But when interoperability isn’t even a question any more, then we can focus on the things that are actually hard—the things that are actually important—and solve those problems a lot better than we are solving them today.
Pulse: Yes, more options provide more opportunities for innovation. So what’s your next project?
MW: I don’t know what happens next but everything right now is concentrated on BloomAPI and it’s entirely focused on these EMR integrations. I think this by itself presents such a long road ahead of us. I hope it’s not as long as some might think but there’s so much that you can do once this world opens up and I think the effects will cascade and will continue to multiply. And I don’t think it’s going to be just one small facet that changes. lnteroperability is almost like the bottleneck in innovation right now and if we remove this barrier it’s just going to be a flood of innovation with various technologies and types of solutions we haven’t seen before.
Michael M. Wasser is the CEO of BloomAPI, located in San Francisco, CA. He was a keynote speaker at the 2016 Pulse On Stage event held prior to HIMSS16 in Las Vegas, NV. You can find more on the event here.