This article is part of a series powered by HLTH and CHIME to highlight key insights and perspectives from leading executives speaking at ViVE.

The ViVE conference in Miami Beach last week offered a useful roadmap for the  progress made towards interoperability, health equity and value-based care and what remains to be done.

Micky Tripathi, national coordinator for health information technology at the U.S. Department of Health and Human Services, pointed out the sea change in EHR adoption that’s transpired over the past decade, due mainly to the HITECH Act which sought to incentivize hospitals to convert to electronic health records. He noted that in 2010,  about 10% of hospitals were using EHRs compared to 95% at present.

His presence at the conference served to set the stage for the next chapter of interoperability, illustrated by the Trusted Exchange Framework and Common Agreement (TEFCA) and the drive to connect the networks of providers, payers, labs and others with each other, from CommonWell and Carequality, to EHR-centered networks such as Epic and Cerner, and  public and private health information exchanges.

Maturing of digital health implementation, less futurism

ViVE offered a great stage for healthcare executives and their collaboration partners to discuss the impact of the widespread adoption and scaling of virtual health and other forms of health tech over the past couple of years since the onset of the Covid-19 pandemic. We’ve moved far past the point where these were simply abstract concepts or insights gained from a series of pilots limited to large academic medical centers. There was also widespread commitment to health equity in many forms from UnitedHealthcare and Providence’s work to improve healthy outcomes for pregnant women to RubiconMD’s efforts to address access to specialists in underserved rural communities.

Digital health pilots: Getting to “no” faster

Part of the goal in drug development is to find out as early as possible whether a drug will work or not. The earlier a drug can be identified as a failure for a particular indication, the better it is for the company, from the money saved to the insight of knowing what doesn’t work and, if possible, why. It seems that health systems have gone down a similar path when it comes to evaluating the value of digital health tools. For pilot studies to be successful, they have to have a baseline of expectations. Neal Patel, Chief Informatics Officer with Vanderbilt University Medical Center, said on a panel on ROI that he focuses on “scalability and adoption: did the pilot fix the problem?” He also noted that because Nashville where Vanderbilt is based is a relatively small ecosystem, people will let you know if you’re doing well or if you suck.

Big Tech and retail health continue to ramp up healthcare ambitions

Bloomberg’s scoop last week that Aaron Martin, the outspoken Digital Officer for health system Providence who played a leading role in building its venture fund would be moving back to Amazon was a striking development that underscores not only the tech giant’s continued expansion into healthcare. But it also illustrates a trend on display at ViVE — the influence Amazon, CVS Health as well as Google are flexing as part of the push to transform healthcare. Prior to Martin, Amazon tapped Providence innovation executive, Sunita Mishra, M.D., in 2020 to serve as medical director of Amazon Care Medical, Amazon’s clinical delivery team [You can check out her interview with MedCity editor in chief Arundhati Parmar here]. There’s an increasingly well-worn path between the big health systems and big tech companies such as Google and Apple and that seems set to continue as providers seek to improve the patient experience and the user interface for tasks such as scheduling appointments, checking in for appointments and getting patient data between appointments while tech and retail health companies seek to/continue to deepen their healthcare knowledge base.

Specialists and value-based care: Incremental progress

Although primary care physicians are on the front lines of the shift to value-based care, specialist medicine has lagged behind in making the shift from fee for service which, as one one speaker observed, represents 90% of specialist care costs. “At the end of the day, there has to be an incentive for specialists to make the switch to value-based care,” he said.

In a panel discussion, a group of medtech companies shared some insights on how they work with specialists and were addressing the challenge of bringing down healthcare costs while improving outcomes for patients.

Octave Bioscience focuses on quantitatively measuring subclinical disease activity for Multiple Sclerosis and detect relapses to identify suboptimal responses to current interventions through a combination of patients responding to regular health queries and through imaging analysis, according to its website. 

Mike Edgeworth, Chief Population Health Officer with Octave and a neurologist by training, noted that a lot of the MS therapies are referred to as disease modifying therapies (DMTs)– which drive the cost of MS. It works out to be about $5 million per patient. Of the $80 billion spent on MS in 2019, 70% was for DMTs.

“We know that in the treatment of MS getting the patient on the right drug fast is the best way we can prevent relapses. Half of MS patients will be disabled in 12 years [after diagnosis],” said Edgeworth. “Although pharma companies are developing some sophisticated drugs to treat the disease, it can take 12-18 months before physicians determine whether a drug is working for a patient or not.”

The company helps patients share feedback and self assessments on symptoms of the disease and side effects of the medication between appointments that span a variety of sensitive issues that patients may be uncomfortable sharing with their physicians in person such as bladder dysfunction and sexual dysfunction. These are summarized in reports that are shared with neurologists right before their appointments.

He noted that if neurologists had the data insights to determine from the outset what the phenotype of their patient’s disease is — whether it’s a mild or severe case —and inform them earlier if a drug is effective for the patient or does it need to be switched with another — it could potentially improve outcomes for patients.

Cardiovascular direct care costs amounted to $320 billion in 2016. That’s projected to more than double to $800 billion in 2023, according to Dan Blumental, Novocardia Founder. His company is focused on developing a heart failure program that straddles remote patient monitoring, algorithmic approaches to directed medical therapy and moving care out of what Blumenthal describes as high cost settings like hospitals. It’s seen interest from risk-bearing entities, particularly payers and primary care groups.

Sema4, a spinout of Mount Sinai Health System that went public via SPAC and led by CEO Eric Schadt, also took part in the discussion. It generates and aggregates big data centered on patients to provide insights into medical conditions and interventions that could help prevent or treat them. The company combines genomic and clinical information and applies analytics to gain insights for precision health. In its quarterly earnings summary this week, Sema4 revealed it has signed three new health system partnerships with NorthShore University HealthSystem, AdventHealth, and Avera Health. Its acquisition of GeneDx at the start of the year will help it develop one of the largest data generation engines in clinical genomics.

Schadt said at ViVE  that its platform can be used to do virtual clinical trials.

“Ultimately that’s what the data is going to drive – testing and patient engagement. It is a growth hack engine for how can we get to the right scales of data to build the best models.”

Trusted Exchange Framework and Common Agreement

New buzzwords

There were plenty of buzzwords to match the hype of some aspects of health tech, as Politico’s health tech reporter pointed out. Although AI was not one of them in the discussions I heard, “seamless integration” definitely was.

Qualified health information networks or QHIN will be finding its way into more conversations this year if TEFCA gets the traction the ONC hopes it does. QHINs agree to the governance framework principles espoused by the Trusted Exchange Framework and Common Agreement. In return, QHINs get the technical certificates to enable them to communicate with each other and access to a directory of endpoints. Carequality is managing the QHIN application and onboarding process. Health Gorilla is positioned to be the first QHIN.

Challenges that remain

For all the obstacles in the journey towards increasing data sharing and data usability, there remains a ginormous amount of unstructured patient data that cannot be shared in a productive way beyond any one clinical setting.

Accurately matching patient records across organizational boundaries is another challenge. In an interview ahead of her appearance at ViVE, The Sequoia Project CEO Mariann Yeager shared some of the inherent challenges of accomplishing this.

“It’s one of those core capabilities you need to have really, across the board, whether it’s treatment or research or if you’re requesting information, you have got to make sure you’re marrying the patient record the provider is requesting info for with the exact same person in your system before you release it. So these are pretty universal concerns. That’s something that’s on our radar. We did a white paper a couple of years ago. It’s one of those long-range issues.

“We talk a lot about the unique health ID that’s been a big focus. If you have a secondary identifier, like a social security number or some other member ID, you can get metrics up to 99.9% of the time. And then there are other approaches as well. We improve the definition of identity trades and have consistency there to raise the bar.”