Focusing on health care data interoperability
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Intro:
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Saul Marquez:
Welcome back to the podcast. Today I have the privilege of having Dr. Tom Giannulli on the podcast. He’s the CMIO for IHMI at the American Medical Association he’s a practicing physician and chief medical information officer at a number of innovative and successful organizations over the past 20 years. He’s a fan of health care technology and innovation in the medical arena and has served as a strategic leader to guide several EHR and related software solutions and evangelize advanced technology and products within the health care setting. With over 15 years of deep experience and mobile tech and medical software, he helped shape companies businesses and clinical strategy. Previously he was chief medical information officer at Kareo, Epocrates, the founder and chief executive officer of CareTools which developed the first iPhone based EHR and he’s also been the V.P. of advanced research for clinical data critical and the founder and CEO of Physix. He loves working with small and independent practices to help them use technology to improve the patient experience. Practicing what he calls heads up medicine so that’s a brief snippet of Dr. Giannulli but what I want to do is welcome him to the podcast and have him fill in any of the gaps of the introduction. Tom, welcome.
Tom Giannulli:
Well thank you so much I appreciate it. I was a really good introduction and I think you covered the bases really well there so I really don’t have anything to add. And I look forward to talking further about the topic today.
Saul Marquez:
Now thanks a lot Dr. Giannulli and we’re excited to have you on as well. So to begin with, I want to ask what got you into the medical sector?
Tom Giannulli:
Well it’s interesting. As a child we had some friends that were physicians and my family really respected that role in society and it kind of motivated me to be a good student. And one day go to med school in then once I reach med school I realize that though I love medical practice I really like technology as much and want to blend the two. So I started working towards getting a master’s in engineering related to health care and worked on the artificial heart project at Utah which was very exciting and kind of blended those two disciplines well. Then from that point to started looking at problems to solve and most those problems today tend to be solved through software and innovation along those lines so that’s where I naturally gravitate.
Saul Marquez:
I love it and it’s so great that you’re able to envelope you know tech into your passion of medicine. So now you’ve been doing it for quite some time. What do you think is a hot topic that needs to be on every health leaders agenda and how are you guys approaching it?
Tom Giannulli:
Well there’s several things we’re involved in. The most important that’s on mission to the AMA is our focus on health care data interoperability and how we can contribute to the problems that contribute solutions to the problem around moving data from point A to Point B in a way that can be understood and is complete with respect to what’s needed to solve the problem at hand. And today there are several issues with data interoperability and health care. Most notably the first problem would be liquidity. There seems to be a lot of resistance to moving data from silo to silo and some of that’s based on competitive advantage of the players involved. But that problem seems to be being addressed by Congress and through some technology move advances some through throughout the Cures Act. And so while we’re focused on AMA is the data portability standards that would sit on top of those liquidity solutions which we feel will be in the market soon because what happens when you start moving data you realize that this data doesn’t make sense and I can’t really use it. And so we’re at we’re trying to focus on the data standards and formats that make that data highly useful when it starts moving.
Saul Marquez:
Yeah for sure in a lot of companies are trying to come up with their own solutions on the back end trying to form some sort of standardize way. As you mentioned liquefying the data and making it useful for third party providers or just other companies making software to help providers. Can you give an example of how the AMA or maybe a company you’ve seen or a hospital you’ve seen has created results by doing things differently?
Tom Giannulli:
Yeah. So a good example would be around say something as simple as blood pressure. So blood pressure devices today are used in the hospital, in the ambulatory clinic and they’re used at home. However these signals are all different. They all format the data differently. So taking blood pressures from multiple sources and aggregating them this is quite a chore. They tend to conform to the same set of standards. So what we’ve done in AMA is propose a set of standards that are universal that can be applied to any device. And we actually include data elements that discuss what type of device it is, things like whether the patient was in the right position with the cough was placed in the right brachial artery or left whether the patient was at rest for 15 minutes prior to the measurement and all of these factors come into play when you try to compare the raw data so the raw data from one device that was taking the wrong body with the wrong preparations is not going to be a valid signally compared to one that was taken with all those parameters in the correct slot. So what we do is create the data standard that allows you then communicates information and then the physician can then filter out the signal from the noise and then make decisions based on qualified data. Now without having this protocol that we’ve developed which was clinically validated and included the right information for the right reasons you couldn’t do that. So you can take that same example and broadened it across the board other issues that we’re focused on are social determinants of health which have to do with the patient’s environment that they live in, their access to health care, their insecurity around food their knowledge of their disease. All these are very very important to determining your outcome as a patient and also how can we intervene as health care professionals to get you to a better outcome and these determinants have been ignored for a long, long time. But there’s data that shows these determinants are very very important but we can’t really act on these determinants and understand their impact if we can’t discuss them in a uniform way. Right. So is very focused on working with very several large partners to figure out how do we how do we describe these determinants in a way that everyone can understand and that’s standardised and codified. And so we’re working on that currently we’ll be announcing some of our progress at the HIMMS conference coming up in February 11.
Saul Marquez:
Very soon. Now this is this is very insightful Tom and you guys are doing some great work proposing standards to standard sets to allow interoperability is huge is the vision to try to come up with more of these and then hand them off and make them requirements for device companies and things like that to make it easier?
Tom Giannulli:
Yeah. So our role in AMA, we’re mission driven and so we have focused on those data standards liquidity or data portability standards that are significant that impact health care in a very big way. And our are not yet standardized so there’s a lot of unmet needs with respect to these data portability standards. That’s what we focus on the data elements like medications and diagnosis. We’re not really concerned with those things they’re well described and well accepted. We’re looking for areas where there are gaps and blood pressures one social determinants another. Other areas that we’re looking at and working with our partners in academic healthcare and industry relate to say provenance or data governance. Well how do you know that has to do with how does data move from so that patients download their own information to third parties. How is that data protected, how the patient rights protected, how is that information tracked? So those are all areas that we’re focused in on. And there’s other areas as well that include other IOT devices and signals from different types of new devices around health care and how do those devices transmit their information away that could be compared to other devices in the same category. So there’s there’s a lot of work we’re doing in different domains but all focus on what the market needs what is aligned with our mission at the AMA to solve these problems and where there’s unmet needs in general.
Saul Marquez:
I think that’s brilliant. And one quick opportunity that I wanted to take Dr. Giannulli is for the listeners to better understand IHMI and for you to give a little synopsis on what the focus there is within the within the AMA.
Tom Giannulli:
So IHMI took my stands for Integrated Health model initiative. So that’s the whole idea there is to build a set of data standards that kind of describe universally certain domains within healthcare so that you can take this information and move it from point A to point B with complete computerized transmission and understanding of that information. Fancy word that’s often used semantic interoperability. So if we can do that then this information can be moved across the globe essentially with complete description and common understanding and then made maybe useful by aggregation. Generally around populations and then analytics around that information to determine which information or which parameters have the most weight with respect to patient outcome and risk and then use that information help guide treatments such that you minimize risk and improve outcome and decrease costs. So in a very data driven world where people tend to think data is the new oil, the data is only as good as it is it’s us formatting or it’s descriptive modeling and we’re trying to create really crisp clean and universally accepted modeling to describe the data so that it becomes much more valuable when used as discussed. So that’s really our intent and we do that to impact health care for the patients and providers which is our mission. We also will deliver these sophisticated models to the ecosystem. Free of charge as what they call fire profiles. So if you wanted to take advantage of moving data from point A to B using these standards you simply plug in our fire profile into your fire services and it should then format that information and move it across to the other endpoints so they can understand it completely using the same technology.
Saul Marquez:
It’s brilliant, that’s brilliant work and definitely a great vision that you guys are working on over there, Tom. So I love what you’re up to. Seriously, like pioneering work putting the portability back in the HIPAA right.
Tom Giannulli:
Right.
Saul Marquez:
So all these things that you’re doing don’t come without any any hitches. Right. So maybe you could chat with us about a set that you guys had that you learn from that’s made you guys better.
Tom Giannulli:
Well there is a whole ecosystem of partners in the environment around interoperability and so we want to play with those initiatives that are receiving traction and are well accepted. So one of them is the HL7 standard called FHIR and we welcome that as well as any other standards that will help get data moving from point A to Point B and provide liquidity. There are other standards that are being discussed. It’s a fairly robust area of innovation. So we look forward to others but we think that fire may be the standard of choice for a period and are complying with that in ways it’s not competitive to other efforts in this space. And you know health care interoperability has a lot of problems to solve. One of the issues is some of the standard development organizations tend to focus on the exact same issues where we’re trying to focus on areas that there are gaps in other people are not paying full attention or giving that their full effort so that we are noncompetitive to other efforts in the space. Sometimes that’s not always the case. And there’s a bit of our standards better than yours so use ours and we’re trying to avoid that by collaborating with everybody and making it an open process. So we’ve learned that you can’t develop these standards in a vacuum. You’ve got to go out see who’s done what already in the space, invite them in to have a conversation and figure out what’s the best way to advance as a group versus advance as AMA alone. And so they may is known as a as a convener and that’s what we’re we’re doing with itemize is opening up discussion across the board to anyone who’s interested in taking their input and feedback and then developing a set of universal standards against that in a way that most people will agree that this is the right direction to be going in.
Saul Marquez:
And what would you say to date is one of your proudest leadership experience is.
Tom Giannulli:
Well we have a great team at the AMA in Chicago and when I came on board about four months ago I realized what kind of strengths we have and so it’s been a very positive experience to understand kind of the best in class staff that they may have selected for I to my. We have folks that have been in the terminology interoperability space for over 20 years. One of them actually helped co-found snowmelt as a standard as well as others who have done tremendous work in academic medicine or in industry. So we have a pretty pretty good team that I’m happy to have had in place and added a handful of new employees in the last four months to help augment the team. So we’re ready to start delivering solutions in the market. One will be announced at hims and another that’s in process will be announced as well. So we are definitely making progress.
Saul Marquez:
That’s huge and congratulations to getting this ship off the runway. It’s definitely taking off and excited to hear about the releases at HIMMS. What would you say is I mean what you guys are doing is an exciting project right. But if you had to hone in on anything in particular what would you say is keeping you up at night in a positive way that’s an exciting project?
Tom Giannulli:
Well I think that the there’s several areas in health care that have been somewhat ignored and now that information is can be structured and described in a way that you can take this information and aggregate it, analyze it, and use it and sophisticated A.I. based models like predictive modeling. That’s pretty pretty exciting stuff and is really the future of managing risk in healthcare for the betterment of the system and the patient. So that core fundamental requirement of good analytics and A.I. is data and if we can get to those technology companies who are investing in this area you know a high volume of rich well-structured information or data then they can perform in the system as a whole benefit. So that’s what I would say is the most exciting part of the mission here at the IHMI.
Saul Marquez:
That’s huge and it’s the beginning. I mean you guys this is sort of one of those things like anything else it’s the compound effect: the longer you guys are at it the better and better but the good thing is that you’re starting.
Tom Giannulli:
Yeah I agree. There’s we’re trying to skate where the puck is going to be with respect information and data. We believe that liquidity solutions that have been in place for almost 20 years now are starting to be to solidify. And so the second order problem is really the one we’re focused on and it is it is not a short term effort. The AMA is very long term views of this problem and I to my will be here for a long period until this problem has been resolved which should take a fair bit of time.
Saul Marquez:
For sure. Thanks for sharing that, Dr. Giannulli and so and getting to the end of the interview here and a lot of times these are way too short to cover everything but I think it’s still really, really meaningful conversation that we’re having here. This part of the podcast we have a lightning round so I’m gonna ask you some questions you give me some short responses. I’ve got five of those questions for you followed by a book that you recommend to the listeners. So you ready for that.
Tom Giannulli:
Yes I’m ready.
Saul Marquez:
All right. What’s the best way to improve health care outcomes?
Tom Giannulli:
I believe the best way to improve outcomes is to take a holistic approach to the patient which includes the medical, behavioral, and social determinants and analyze those on a patient by patient basis as well as through population analytics and then determine you know how to best intervene based on on that information.
Saul Marquez:
What’s the biggest mistake or pitfall to avoid?
Tom Giannulli:
I think narrowly viewing the patient a non holistic view the patient is been the problem traditionally and we found that trying to manage patients with the out considering all the parameters that affects health and wellness won’t really shape or move the needle much. And so we’re learning from that process and I think we’re going to see some big strides in the next several years.
Saul Marquez:
Love that. How do you stay relevant as an organization despite constant change?
Tom Giannulli:
Well I think you have to be aware you have to have your sensors up and paying attention to the market. Aimé is very good at understanding macro and micro trends. We have quite a few people who are experts who are in our D.C. office looking at the political landscape and the policy changes as well as technology and health care. So all three need to be part of your analysis on almost day to day basis.
Saul Marquez:
Really insightful. What’s one area of focus that drives everything in your organization?
Tom Giannulli:
On a mission. AMA is a mission driven organization. They have a very top level mission which is the betterment of health care for all. Through working with providers and patients there is a lot of breakdown of specific missions. Below that having to do with interoperability improving outcomes reducing patient physician burnout improving patient experience all those are related the mission really drives us on a day to day basis.
Saul Marquez:
And the last one here Tom is a two part question. I would say number one is what is your number one success habit? What is your number one health habit?
Tom Giannulli:
I’d say my success habit is maintaining enthusiasm and passion for the problem. Fall in love with the problem and stay in love with the problem is important to driving you to to solve it and you can’t look at it as an occupation or a job it’s got to be more of a passion. For me that’s what keeps me going every day and allows me to enjoy my work.
Saul Marquez:
Love it. And how about your number one health habit?
Tom Giannulli:
My number one health habit is to make sure I have adequate time for family and my own physical workouts things that I do to maintain my own health and mentally as well as physically and I think we have to separate work from life. And if you do that well I think you’ll have a very successful career and a happy home life.
Saul Marquez:
Love it. Some great advice there Tom. And what book would you recommend to the listeners?
Tom Giannulli:
There’s lots of books that I would recommend. The one I think is probably the most important would be Inspired by Marty Cagan. The Bible on product management and any good technology companies today including I to my which is not a company it’s an organization with AMA. But we focus on what is the problem you’re trying to solve? How do you solve that problem? Keeping in mind at all times the end users needs. And how do you test that theory and move forward iteratively with better and better product and solution design and Marty Cagan’s book is really that Bible that is used by all major tech companies who are solving the same types of problems.
Saul Marquez:
Love it. What a great recommendation. Listeners., you could go get all of these tidbits as well as a full transcript of our conversation with Dr. Tom Giannulli. Just go to outcomesrocket.health and type in Dr. Tom Giannulli in the search bar or type in AMA for the American Medical Association you’ll see the interview pop up right there with everything that we’ve discussed. Tom this has been a tremendous pleasure, I’d love if you could just leave us all with a closing thought and then the best place for the listeners can get in touch with you or continue to follow the work that you’re up to.
Tom Giannulli:
Well thanks so much for today I really appreciate the opportunity to talk to you about IHMI and AMA’s mission. I’m very hopeful that as a patient myself and others that are listening can benefit from the expertise and technology we’re developing and I really feel like there’s some important changes on the horizon for everybody. So if you have any questions you like to hear more about IHMI contact us through our website address which is ama-ihmi.org.
Saul Marquez:
Outstanding, Tom. This has been a true pleasure and really I really appreciate the insights you’ve shared and looking forward to staying in touch. Thanks again.
Tom Giannulli:
Thank you. Take care.
Outro:
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