For the third part of this “Voices of Greenway Health” series, we spoke with Scott Fannin, Vice President of Product Management and Rob Newman, Vice President of Interoperability Services. Our conversation centered upon the topic of interoperability, however, the core of our talk was Greenway Health’s second mission pillar: connect.
(Editor’s note: To hear audio excerpts of this interview, click on the media player buttons that run throughout this article.)
Free: Today’s Greenway Health is the product of multiple mergers occurring over the course of many years. How has the company benefited from its evolution from many separate companies into a single entity?
Fannin: I’m glad you asked that question because we embrace our past. We fully appreciate how the goals and mindsets of our previous iterations have provided us with the strong foundation that is required to perform our work today.
By combining our talents, experience and visions of the future, we have created what I genuinely believe is a model organization that is ideally suited for the future challenges in the healthcare industry.
From my perspective, we really gained a lot of discipline with the Tampa team. They really brought a lot of discipline with processes and procedures that can help us from the perspective of what you really need as you start to you go from a small to a medium to a large-sized company. I think that helped a lot and then we have been able to really marry that with the innovation we were known for in Carrollton [GA] as well as a lot of the specialized areas from Success[EHS] in Birmingham [AL], like public health and other areas of focus, to really bring three different companies who had strengths together. In the process, I feel like we are a much stronger company today because of that.
Free: The second pillar of Greenway Health’s new mission is “connect.” Beyond the obvious issue of interoperability which we will address later, what are the connections that must occur in today’s current healthcare environments? Which ones are either not made or all together ignored?
Newman: The connections that we do make – one of the things, I guess, playing on the merger of the companies a little bit, and maybe a little bit of how we built our connectivity strategy here at Greenway – is more of a hub-type connectivity with our Greenway Exchange model. One of the things, as you know, we are required to connect a lot of our providers to for Meaningful Use is immunization registries, so we had connectivity to 40+ immunization registries through Greenway Exchange. And, not quite that many at the time for the Success[EHS] and the Vitera product lines, so what we have done there is connected those product lines, connected Energy and success[EHS] through the Greenway Exchange hub, and then give them access to all of the registries that they didn’t have access to before. So, there’s a little play on the merger aspect of it there, too.
Free: Continuing with the theme of connections, in terms of clinical connections, what isGreenway Health’s plan to overcome the many interoperability struggles that exist in healthcare?
Newman: One of the major hurdles is patient identity, or identifying patients across enterprises. Pretty much everybody can identify a person within their own systems and understand who that is. But, what we are trying to do now, obviously, is exchange data with systems that have different internal identifiers. There is no national patient identifier, so that is a struggle that we are having across the industry. Greenway is a member of eHealth Exchange, Surescripts and CommonWell Health Alliance which are all three different methodologies, or different groups, that are trying to solve the patient identity problem. Greenway is, I think, the only member of all three of those still at this time. It was the case the last time I checked.
That is one of the biggest things we are trying to do. Again, going back to the Greenway Exchange hub, the thought there is build it once and reuse it. We are really trying to cut cost, cut efforts and make things a lot more efficient with trying to reuse connectivity that we established not only across the same platform and across many customers, but even across different platforms Greenway has now.
Fannin: Some other challenges we have had in the industry is some of the governances of the legal aspects in termd of the connections between entities. We aim to make sure you have all the ducks in a row from a legal security standpoint and governance, especially with large organizations, is an important part of that. That oftentimes is when we start getting the attorneys involved and it can really prolong the ability to connect and exchange data.
Another thing I think is critical that though we use a lot of standards within this industry, there is not really standard implementations across the country. Every time you want to connect two entities together, there is always a conversation around what kinds of data is to be exchanged and how we are going to fill the standards, if you will, and with which data elements and what data we are going to exchange. There is still a conversation around that point instead of having just being able to turn on a system and they are live. That is where we want to get and that is where we need to get.
Historically, interoperability has been very much a case-by-case, vendor-to-vendor, implementation-to-implementation, which really prolongs it. It is exasperated by the fact that interoperability is as hot now as it has ever been from a demand standpoint. More customers and more people in this industry need and want the data exchanged, and so it basically takes that same problem and start exponentially adding to that scale and makes it more of a challenge.
Free: Some studies suggest that technologies like patient portals actually push away many patients who are in the most need of care. How does Greenway create its solutions in a manner that does not isolate the patient?
Fannin: Absolutely. The key thing is, and I am glad you asked that question because this one has always been kind of near and dear to my heart, is that the portal is no different than anything out there on the internet. If it is not useful, if it doesn’t deliver a value to you as the consumer, you will not use it. So, how do we deliver value to the consumer? Well, save my time. Save me money. Allow me not to have to drive into the office to talk, or exchange information, with the provider. Those are the sort of things that we have to have as far as a portal and oftentimes people lose sight of that. They think, okay well, if I provide the clinical information, for example, to the patient that’s going to deliver value. Well, to some patients it will, to many it won’t. However, if I tell you that you you don’t have to call into make an appointment, or you don’t have to write a check to pay your bill, that gets a little bit more attractive. Or how about this one? How about if the doctor is running late, we send you a text and let you know your appointment has been pushed back 30 minutes? Those are the sorts of things that really deliver value to the consumer. Those are the things that we all want as patients and, I think, that has been key because I think in the past there have been solutions and features that deliver maybe value, but to very small subset of patients.
Free: As an attempt to create more positive outcomes for patients, Meaningful Use was meant to help physicians make better connections with their patients via technology. How can Greenway Health assist providers in terms of meeting Meaningful Use standards?
Fannin: We have seen great success from our customers on, of course, Stage 1, which, I think, across the board, Stage 1 has been a great thing and really met the objective they had which was: “let’s get all the providers using electronic health record and let’s get them off paper.” I think that has been a huge success. Stage 2, a bit more of a challenge for a lot of the customers, not just ours, but across the board in the industry. Attestation numbers for ambulatory providers on Stage 2 is still relatively low. On the acute side it is much higher, but on the ambulatory side it is lower. It’s been more of a challenge. There are things in Stage 2 that are more of a challenge and I think providers are starting to ask the question: “is this all worth it? Is it worth it for the reimbursements?”
All of our systems can fully support Stage 1 and Stage 2. We are working towards Stage 3 that has just come out, and it raises the bar even higher. Not just for the vendors, of course, but for the providers and the practices themselves. They have a lot more burden to bear on it. There is a lot more knowledge they have to have and a lot more they have to provide.
It is going to be very interesting to see how Stage 3 shakes out, but, of course Greenway Health, will be right there at the front, leading the charge on having all of our capabilities in place for our customers to be able safely and completely attest for Stage 3.
But, from a personal standpoint, I think it is going to be an industry challenge. There is a lot of interoperability in Stage 3 and it is going to require a lot of success, not just in the EHR vendor business, but in a lot of other business that have interoperability, for instance the registries, the public health organizations that we have to exchange data with.
I really see some challenges for the industry as a whole, but from Greenway’s perspective, we look at Meaningful Use as an opportunity to assist our partners to achieve our common goals of serving, connecting and caring for patients.