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: [00:00:01] Welcome to the Outcomes Rocket podcast where we inspire collaborative thinking, improved outcomes and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez
Saul Marquez: [00:00:18] Outcomes Rocket listeners welcome back once again to the Outcomes Rocket where we chat with today’s most successful and inspiring healthcare leaders. I really want to thank you for tuning in and I invite you to go to outcomesrocket.com/reviews. So let us know what you thought about today’s episode. I want to introduce our outstanding guest. Her name is Tina Joros. She is the general manager open business unit and vice president at allscripts the open business unit. All Scripps is responsible for supporting developers using their API eyes for connectivity with all scripts solutions. They support fire and enable APIs along with proprietary API is built and supported by scripts and have enabled billions of data shares using their API alone over just the past few years. They’re really moving and shaking transforming health care with connectivity and improving outcomes and that’s why we wanted to have Tina. So, Tina welcome to the podcast and maybe you could fill in the gaps there in the intro.
Tina Joros: [00:01:21] Thanks, Saul. It’s a pleasure to be here and I appreciate you asking us to come here and talk a little bit about the program and what we’re doing. Just a couple of things to add. Full disclosure I’m a licensed attorney so it definitely helps with the regulatory issues but I do like to mention that just in case anyone is wondering where some of the legal background comes from. So just adding that.
Saul Marquez: [00:01:40] No. Absolutely it’s a beautiful skill and over in Indiana right.
Tina Joros: [00:01:45] I originally went to Indiana University for undergrad and law school and now I’m in South Florida so I know you spent a little time in South Florida as well. So I’m happy to be here.
Saul Marquez: [00:01:56] It’s so nice over there. Did you escape the hurricane madness.
Tina Joros: [00:02:01] We did alright. We did alright. Not too bad this season. So every year we get a little bit of a scare and we make it through. So.
Saul Marquez: [00:02:09] Awesome. I’m glad to hear you guys made it without any major issues so an hour here so Tina tell me a little bit about what got you into health care.
Tina Joros: [00:02:18] Sure. So in terms of the medical sector in 2000 2002 I was still practicing in private practice as an attorney and looking for in-house work. So when you’re looking for that kind of transition into private or into the corporate world you’re looking for businesses that are growing and there was no better time for growth for electronic health records vendors than in the early 2000s. That was before meaningful use. So it was just a software development company that had roadmaps and enhancements based on customer requests and everyone was in the mode of you know who can build it faster. Full functionality get something to market. So at that time they were looking for more attorneys and I got my chance and couldn’t be happier with how that worked out. But you know this is still a growth sector although I think in a little different way. But for our vendors I feel like I’ve been in this industry since before regulatory requirements dictated our our futures. And now throughout this entire transition. So.
Saul Marquez: [00:03:20] Yeah that’s pretty cool. So your specialty took you into this industry you got in before it started booming and and here you are still so committed to the cause. What do you think Tina after all these years of being in it is a hot topic should be on every medical leaders agenda.
Tina Joros: [00:03:37] Well for me my hot topic is always about interoperability connectivity open platforms. It is all that we think about in the developer program and the open business unit that I run. So for me my hot topic is always interoperability.
Saul Marquez: [00:03:51] You know. And how do we do that Tina just feels like it’s just such a challenge to all align on common language or platform like how do you approach it at all scripts. How do you get to that end goal and what do you recommend to the listeners to get there.
Tina Joros: [00:04:09] Yeah I think there’s two ways that we think about approaching interoperability. There are the things that we can wholly control within all scripts connectivity and interoperability in and out of our own systems which I can tell you how how we’ve built that kind of functionality which is very different from the other type of interoperability that we’re talking about today which is industry wide. How do we all start speaking the same language. And I think there are very different methods for impacting success and progress in that field. So inside all scripts I think the best way to get started is just to start our API have grown organically based on client need partner requests. We didn’t start off with a roadmap that said to be interoperable we need to be doing these 200 things started with a very simple Hi I’m a device integrator and I need to get this resolved over into the patient record. Okay let’s build an API that does that and over the years we’ve taken these requests from our developers and from our clients and we’ve built out a very robust set of API. I think at last count over 900 different actions across four different solutions and three and API sets. So you know when you’re controlling all of the environment and you’re working with your own solutions I think the best thing to do is just to get started and to keep building and enhancing and growing on top of that which is what we’ve done with our proprietary API. But over the last couple of years the focus has shifted and a very exciting way to looking outside of what you can control and thinking about interoperability from an industry wide standpoint and that is also very exciting but comes with its own set of challenges and own kind of dialogue and decision making process. So you know I can talk about all the different ways that we participate in industry wide events to kind of influence the standards that are being set to have her voice heard. But it is a very different process because for interoperability at an industry wide scale you also need consensus and collaboration and agreement on definitions and things in order to move forward. You can’t just plow ahead and start building.
Saul Marquez: [00:06:17] That’s for sure and it’s a balanced approach. And listeners as we listen to this topic maybe you find yourself going to another conference where they’re talking about interoperability again and maybe some of you guys and gals roll your eyes and think oh here we go again. But think big with Tina’s doing here is thinking about interoperability from a company perspective and what they’re doing. And then more broadly. But you’ve got to start working on it. So Tina maybe you could give us an example of how all scrips has improved outcomes by taking steps toward making things more interoperable.
Tina Joros: [00:06:50] Yeah and I think improving outcomes means something different whether youre a hospital health system or provider. So the outcomes are different based on the solutions that our clients are using and the goals that they have with implementing that solution to begin with. But for me one of the metrics that we use to measure progress is just data shares and that is based on our proprietary API. How many times is that being used. You know every single day every single week to get data where it needs to go and we count data shares weve been counting since 2013 the data shares that were enabling through our program. And to me the best outcome is that those numbers keep going up they keep increasing. For example in October of 2017 we had a hundred and eleven million data shares in one month which is one month’s worth of data. But you compare that to an entire year’s worth of data in 2013 which was 122 million data shares the very first year we started counting. And you think about the progress in a relatively short period of time. We’re now doing in five weeks what it used to take us a whole year to accomplish in terms of exchanging data and the numbers are just exponentially growing. So that makes me happy. That tells me that our API is being used that clients are using the partner solutions we’re enabling and building their own things and they’re seeing value out of it. If they were not seeing value if they were not getting the outcomes that they want when they connect these things then we would see those numbers go down or stay stagnant and they’re growing and growing and that is to me fantastic so there’s tons of individual metrics and things we can look at. But to me data shares is one of those that we should all be looking at to decide if interoperability is really happening and if it’s really working.
Saul Marquez: [00:08:40] And that’s a great call out Tina and so how would you define data share.
Tina Joros: [00:08:44] So for us again with our proprietary API we’re talking about either a call that allows someone to get data out of our system whether it’s a big call like a get the CDA or whether it’s a very discrete call like get med’s we can count every single time one of those transactions is happening. Same thing with putting data back into the system. So most of our API are by directional so have we read information from the system through the API that someone didn’t have before. Are we putting data back into what we consider the source of truth in the electronic health record associated with that patient. Either way an exchange of information is happening that helps improve healthcare.
Saul Marquez: [00:09:24] Yeah totally. Thank you for that definition. I think that will help a lot. And congratulations to you and your team. It just sounds like you guys are rocking and rolling over there with these data shares going through the roof.
Tina Joros: [00:09:36] Well it’s true and our technical teams have done a great job of building a great platform. But I’m going to say for a moment that the technology is not the only answer so for us what we’ve realized over the years is that the technology working is great. That’s one thing but all the business side processes and the things that have to happen in order for those transactions to even take place is something that we focus on all day every day to make sure that the companies that want to use our API both have access to them and that the pricing and distribution model is right so that they can actually get them out into the clients hands.
Saul Marquez: [00:10:12] And Tina a lot certainly goes into that and you said something that really struck a chord is like aims are different for everybody and for you all it’s those data shares for clinicians it’s improving those outcomes for payers it’s something different for employers. It’s something completely different so be clear on your outcomes. Friends and you will be able to achieve them much easier. Just like Tina and her team has gotten together as an organization to achieve theirs. You know it’s not always been rainbows and Sunshine’s. There’s been some difficulties maybe you could shine some light on a setback that you guys had and what you learned from it.
Tina Joros: [00:10:48] Absolutely. So in terms of setbacks again on the business side which is where I focus this is where I dive into when you’re getting a program started. You start with where you can start. You start somewhere and then take a look at what’s working and you take a look at what’s not working. After about five years of running the program we had the opportunity to take a look back at all the companies who had expressed interest in joining the developer program and how many of them were actually translating into full partners that had solutions available for our clients. And looking back at that data I was fairly disappointed to see that we were only signing about 9 percent of the companies that wanted to work with us that had taken time to fill out a form and say all scripts I want to be a part of this. There are various reasons for that. In some cases people were just kind of exploring so they weren’t really ready to sign up. In other cases we might have applied our own internal analysis and said This is not a good fit for our partnership program and in other cases we had said yes this is a good fit but the company that we approved said no not for me. So we started digging into why why we were not having a higher rate of success with companies that had expressed interest in working with us and that got us into the legal contract that got us into the pricing that it got us into the marketing opportunities that we were offering and guaranteeing in our contracts. And so it took us about 14 months to really unravel what was most important in some of these areas. But to me that analysis was amazing and it helped us produce an opportunity to change our program and to make it even better and more accessible and priced at a different in a different way. So in January of 2017 we rolled out what we call ATP evolution which of course is an evolution of what we had been doing before but taking all those lessons learned and some of the painful lessons and saying okay let’s push forward into some new territory and do this a little differently. And one of the things we introduced were some click through legal agreements which as an attorney I am so super proud of the mistake this agreement that goes through this old school email of yes you’ve been approved here’s a PTF version of it and someone says oh I want to make red lines. Can I have a word version and then you go back and forth and you talk. And that brings us back in take weeks that can take months to me. All too slow. I took all of the information we were getting. Where were people redlining our agreement. Where were we having discussions that were just terms that were not a good fit for these developers. And how can we make a contract that is so fair that people can feel comfortable clicking through it. And to me the work we did to get to a clickthrough agreement for our ADP evolution and our new integrator category is a big success. We’ve had 225 companies sign up in the first 10 months of the program and that is with a boom agreement which is super. So to me that’s a big win. It is actually huge. Changing that dynamic and saying okay we don’t have to do this old school partnership model anymore we can figure out these terms and make them fair and protective of all scripts and and good for the company signing up. So that’s one area we looked at. Yeah. The other area that we really focused on was pricing. So back in 2010 2011 when we were starting our program the only types of developer program models we had were the apple and you know the Google markets with a revenue share percentage and that was a good starting place. But today we actually have taken a look at all of our API has organized them into different tiers and now we charge a usage based pricing for API usage. So we have taken all the upfront cost out of connecting with us and we have pushed that all to just charging companies and clients for what they use based on how they design their integration they can control the costs in large part. So to me the legal side of it the pricing side of it that’s huge to opening up opportunities for companies to actually work with us in a way that makes sense with their own business models.
Saul Marquez: [00:14:46] Wow Tina that’s super interesting and congratulations.
Tina Joros: [00:14:50] That’s exciting. It’s exciting when finance could be so exciting right. You our game changers right now. It’s really amazing.
Saul Marquez: [00:14:58] That is so interesting you know and health care where you know the fax machine is still alive and pagers as innovators. It’s our job to make the process easier to implement. And what Tina and her team have done here listeners is they’ve made it easier to implement. They took what was hard and time consuming with red lines and they just made it a clickthrough agreement. They figured out what it was that was making these companies tick and made the pricing a better model they made it easier to implement. And in healthcare innovation is implementation and Tina. I just want to say you guys are doing an amazing job at it.
Tina Joros: [00:15:38] Thank you. Well we have a long way to go because there’s so many areas of friction in this whole process. And my goal is to eliminate that friction to streamline every process that we can so that we can get to the point where these apps and devices can be connected in a very a very enjoyable way. Not even. Let’s not make it not not about making it less painful it’s about making it enjoyable. Hey I got a new app today and we’re starting to use it and it’s fantastic. So to us that’s a pretty high bar. But I think it’s achievable.
Saul Marquez: [00:16:10] Love it. And you guys have the vision and you’re cranking out the numbers. Tina I think it’s wonderful. And at the end of it all it’s being able to make these applications in such a way that enable our providers to give patients the best. And I think that’s super cool. What would you say. One of your most proud moments to date.
Tina Joros: [00:16:32] I have a lot of proud moments. I was really happy with that big October that we had in terms of data shares. I’m always happy when the companies we’re working with win awards and when a client walk up to me at an event and say I have found out about this the scripts application store and we installed it and we’re using it and it was a great experience. I’m happy when people are pleasantly surprised. So my proudest moments are a series of small moments that add up to really changing the way we do things. For the most part so we’ve got a great team. We’ve got great clients we’ve got great companies working with us. And honestly those little moments we try to take the time to appreciate the fact that an application got installed is working people are getting value out of it. That in and of itself is winning in this industry.
Saul Marquez: [00:17:16] Love it. Nice. I love that and big thing here is making those small wins you appreciate them. You know you take the man you smell the roses and you don’t have to do these big you know you don’t have to achieve these huge momentous things. You got to appreciate the small things too and you guys sounds like you guys do a really good job of that.
Tina Joros: [00:17:35] We try. We try.
Saul Marquez: [00:17:36] So how do you implement this into the culture right. I feel like a lot of times you could just speak to it. But how do you make this part of the culture of the organization.
Tina Joros: [00:17:45] Yes that’s one of my biggest opportunities in the company. So in addition to just being an evangelist outside of our company for open and for connectivity with all scripts I do the same work inside of our company Allscripts has over 7000 people all of whom have very busy day jobs and they hear about the developer programmer API AIs and there’s a learning curve that takes place inside our company as well. So I spend a lot of time with our sales services support marketing even our finance people. Everyone in the company to make sure that they’re educated on how we work how we provide value how they can play a part in making this experience a great one for Allscripts clients. And so over the years we’ve done a lot of training. We’ve done a lot of making sure that especially client facing resources that are going to come across these applications in their day to day job. Understand how we work how these companies are working with us and we can take a look at our own internal processes and apply that same lens of trying to streamline to the same internal processes as well. So there’s a lot of work to do internally and externally and we do both. So we spend a lot of time making sure that our own employees know the value that we’re creating through this program and how they fit into the overall big picture as well.
Saul Marquez: [00:19:02] Yeah for sure. Now that’s great advice. Tina what would you say an exciting project that you’re working on today.
Tina Joros: [00:19:08] So there’s a couple of things within our own developer program. I am really excited about continuing to streamline the business side for all the companies we’re working with. So in conjunction with the usage based fees we’re working on some automated payment processing through our developer portal which sounds easy. We go to websites to do e-commerce transactions all the time but yet in this industry when we’re charging people for API usage we’re still going to 30 days after the fact. Send him an invoice and give him another 30 or 45 days to pay it and it’s a very disconnected experience where someone wires you money or sends you a check at the end of the day. And to me that is just not good enough. So inside our own developer portal to help our own partners and companies that we’re working with streamlined their process we’re working on automated payments so that they can pay the credit card the day after their transactions post and to me helping those improvements helped reduce the overall cost of maintaining this integration. If you need less business side resources to facilitate your integration with Allscripts then that is good because it helps bring down the overall total cost of your Shen so that I’m excited about industry wide I’m really excited about a couple of initiatives that are happening. We joined recently the Charron alliance. And this is a group of individuals that I think are doing some fantastic work on patient access. And we’re working with them on what does that mean for a patient to access their medical records. What are the most important things that need to be in place to facilitate that exchange. I think they’re doing a fantastic job and I’m also really excited about some work that the ANC is doing to define interoperability and determine how we’re all going to start measuring it. You know I talked a little bit earlier about how we measure our data shares but I’m interested to see how as an industry we’re going to start measuring did this actually happen. What is data blocking what does it mean to be interoperable is that different than just being connected. I think those are all really exciting things that are coming that were participating in those discussions. We want to make our voices and our opinion heard that ultimately you know we’re going to get some guidance on that that I think will change how all of us operate in this industry and how we determine our next steps in the world of interoperability.
Saul Marquez: [00:21:25] Yeah that is so interesting you touched on so many hot topics there. Tina and it sounds you guys are involved in a lot of them. Maybe we have to do a part two to this because it’s pretty interesting. Ok let’s pretend by the way I think it’s so cool you’re doing very applicable. It sounds like you’re doing some pretty amazing things just to make business easy which is what a lot of companies need. So you’re an asset over there. Tina I hope you know that.
Tina Joros: [00:21:48] Thank you.
Saul Marquez: [00:21:50] Let’s pretend you and I are building a medical leadership course on what it takes to be successful in medicine today. It is the 101 or the ABC of Tina Joros. This is the syllabus we’re constructing right now for the listeners for questions lightning round style and then a book for the listeners. You ready.
Tina Joros: [00:22:07] I’m ready.
Saul Marquez: [00:22:08] All right. What is the best way to improve healthcare outcomes.
Tina Joros: [00:22:12] Make data available where it needs to be to treat a patient.
Saul Marquez: [00:22:15] What is the biggest mistake or pitfall to avoid.
Tina Joros: [00:22:17] Over thinking and over architecting API.
Saul Marquez: [00:22:20] How do you stay relevant as an organization. Despite constant change.
Tina Joros: [00:22:24] Expect change you have to be flexible and adaptable. This industry is going to continue to change for many many years you should not expect it to stay the same.
Saul Marquez: [00:22:32] What is one area of focus that should drive everything else in your organization.
Tina Joros: [00:22:37] Quality and just the concept of being open. It’s a big word but we live it we are the open business unit and being open means that you are creating possibilities and creating potential and that is really important.
Saul Marquez: [00:22:51] And finally Tina what book would you recommend to the listeners as part of the syllabus.
Tina Joros: [00:22:55] So my favorite book of all time is Jonathan Livingston Seagull by Richard Bach. I think it’s a great reminder not to be afraid of the unknown to stay true to yourself and your instinct and that it’s okay to be different and we’re doing things differently here at all scripts so it’s a challenge that I like to live by.
Saul Marquez: [00:23:11] That is so awesome. Tina listeners visit outcomesrocket.health/Tina TINA. You’re going to get all the lists of Q&A that we had here as well as the syllabus that we put together. Links to all scripts links to the projects that are going on and also a link to the book that Tina recommended. Before we conclude Tina this has been a lot of fun. I want you to just share a closing thought for the listeners and then the best place where they could get ahold of you.
Tina Joros: [00:23:40] Excellent. Thank you so much, Saul. And again I really appreciate the opportunity to share what we’re doing here. We are not the only vendor out there but to the extent that you want to get connected with someone and have a great experience please go to developer.allscripts.com and we’re happy to help you with our process and get you started. Joining the AllScripts developer program. So thank you to everyone. My final thoughts are just to take that first step forward. It’s not as hard as you think it might be and it can even be a great experience.
Saul Marquez: [00:24:06] That’s outstanding Tina and sage advice again just want to say thank you so much for joining us. Super excited to keep up with what you guys are up to.
Tina Joros: [00:24:15] All right. Excellent. Thank you.
: [00:24:20] Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration and so much more.
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