Erkan Akyuz, MS, MBA is president and CEO of Lyniate of Boston, MA.
Inform me about your self and the corporate.
I’m a software program developer by commerce. I began within the PACS world, the imaging world, at a small firm known as Mitra Imaging in Ontario, Canada. I used to be a developer on a product known as Mitra Dealer, then did some show work, and from there I went into administration.
We began Lyniate as a carve-out of Rhapsody, our flagship product from Orion Well being in New Zealand, in November 2018. Shortly after that, six months or so, a possibility got here to merge Rhapsody with Corepoint Well being out of Frisco, Texas, and we did that merger. A major driver behind the merger was having the ability to present a extra full resolution to the market in all of the segments, with the benefit of use of Corepoint and the extensibility and the a number of platform power of Rhapsody.
We’ve been operating the corporate in that mode for some time. Earlier this 12 months, we additionally merged NextGate’s enterprise grasp affected person index options into the portfolio. In late July, we additionally merged CareCom, which is a terminology companies supplier out of Copenhagen, Denmark, into Lyniate.
What’s the present state of interoperability and what challenges stay?
After I began as a developer on Dealer within the late Nineteen Nineties and early 2000s, we had an interoperability problem. As builders, we used BizTalk from Microsoft. Then Orion got here up with Rhapsody. So even 22 or 23 years in the past, there was a core expertise subject about interoperability and having the ability to alternate messages between EMR and the PACS methods and the modalities.
Within the years that adopted, I might say that due to corporations like Corepoint after which Orion Well being, the issue of interoperability has virtually gone away. Regardless that HL7 normal adoption, or its implementation in a typical method, by healthcare was difficult, corporations like Corepoint corporations and Orion Well being offered options to make integration and interoperability extra environment friendly.
Quick ahead 20 or 25 years. We nonetheless have interoperability challenges. They’re much less in technical nature and extra semantic in having the ability to assist folks interoperate with one another. Not solely to ship the correct model of HL7 after which obtain the correct model of HL7 again, however to assist a physician prescribe a prescription precisely. Then on the pharmacist aspect, to obtain that prescription and administer the correct capsules in order that we reduce errors and we enhance effectivity.
Interoperability points are a lot, a lot much less technical in nature. I don’t assume that we have now the problems of having the ability to alternate information now, It’s extra of a multi-organizational workflow. We hear about information blocking or a website that doesn’t wish to share information, however that’s a straightforward method out by blaming the seller, blaming the EMR vendor, blaming the hospitals, and many others. And at occasions, our healthcare ecosystems — from payers to suppliers, a number of payers to a number of suppliers — introduce such complexity that one vendor, one supplier, can’t actually clear up it.
For my part, we’d like, as a nation or as a globally, higher motivation to make information obtainable to the methods with none trouble, with none wrestle, in order that it may be utilized in care settings the place the information isn’t produced. If the information is produced in an acute care setting however now must be accessed in a social care setting, that must be simple, with out many bottlenecks.
Sadly as we speak, we generally see authorized, generally affiliation-related, bottlenecks. A social care employee won’t be able to get entry and even determine the place the information that they want for the affected person, for the newborn or the particular person they’re offering take care of, is offered, how they will discover it, and the way they will entry it. We have to do higher from each angle, each stakeholder on this image – distributors, suppliers, and payers — to create a federated atmosphere by offering our information, making it obtainable to everybody who needs to entry it. From the buyer aspect, we have to make it simpler to eat this information from federated, primary information suppliers.
What interoperability wants are coming from payers and life sciences corporations?
Relating to technical connectivity, they can entry the information. However they don’t perceive how the information is saved and structured in addition to a supplier. Should you’re a supplier, you developed your EMR construction and made choices about how one can retailer affected person information, so you have got an excellent thought of the way it’s finished. Once you entry a distinct supplier, you may’t work out how one can navigate by way of it. If you’re coming in as an outsider, if in case you have by no means been a hospital, should you by no means seen an EMR, understanding this information construction isn’t that simple.
You have an interest in a single bit of data. Let’s say you have got a scientific surveillance system. You wish to monitor sure illnesses, and they’re unfold within the hospital. Let’s say you have an interest in getting a notification each time a affected person is identified with sepsis. In as we speak’s world, so as to get that notification, an exterior celebration — let’s say on this case, life sciences or gadget corporations — must have good understanding of how one can discover the information and create an alert to allow them to get a notification. Our EMR methods weren’t designed to create these alerts. They don’t perceive it as a lot.
We have to make accessing and consuming information a lot simpler than it’s as we speak. We use cash alternate, like ATMs, as our purpose internally. Lyniate will likely be finished when exchanging healthcare information is like paying an electrical or fuel firm invoice, using in an Uber, or utilizing Venmo. There are not any limitations. You may pay somebody impartial from what that somebody does, in a number of codecs — examine, money, Venmo, PayPal, Wires, Zelle, or no matter. These completely different protocols and mediators are capable of transfer forex. It’s really easy that we don’t even understand how fuel firm accesses that cash, however they do it. Sadly in healthcare, when a life sciences firm is making an attempt to get a imaging information, sepsis information, or scientific trials information, they should have a deeper understanding of the place that information is and the way they will get it.
SWIFT’s [Society for Worldwide International Financial Telecommunications] forex alternate protocol is an instance. We want to have the ability to present companies like SWIFT to the a number of suppliers of that forex — with healthcare information because the forex, and a number of customers of that forex — with out being held to know an excessive amount of within the intrinsics of how I hold the money, how you retain the money, and the way we’re going to use it. We have to carry it to the constancy of the healthcare information and make that simply accessible, impartial from the affiliations between organizations. We have to implement a SWIFT-like atmosphere to handle these transactions. I don’t assume we’re very near it but.
Who would lead the cost for a SWIFT-type alternate in healthcare?
I believe it needs to be a shared effort, however bringing a gaggle collectively round that resolution goes to be troublesome. For example, I actually admire how RSNA succeeded as a corporation in offering management, after which got here DICOM. I began my profession as a developer within the DICOM world. RSNA got here up with the IHE [Integrating the Healthcare Enterprise] thought. Their factor was, we aren’t going to reinvent DICOM. We aren’t going to reinvent HIE. However we’re going to carry the events collectively who’re stakeholders to make use of requirements on the subject of exchanging information.
I used to be a technical consultant of my firm. I might go to Chicago every year, the place we might spend every week across the desk with completely different distributors and completely different suppliers. We might focus on, how are we going to do affected person info reconciliation? Let’s say the modality acquired this examine after which affected person info modifications. Which bits and bytes of the requirements are going for use? How we’re going to populate it?
IHE and RSNA led this effort to create these integration profiles, saying that if it is a workflow, then all of the EMR participant actors are going to do that and all of the modalities are going to try this. Representatives from distributors, suppliers, and requirements labored collectively to outline how that integration profile will do the job. We modified our code in Connectathons, we examined all that stuff, and it labored.
As we speak, while you look between the modalities, PACS, RIS, and no matter methods are doing their job, then exchanging information and who’s going to do what, fairly actually, we don’t. However now it’s a system. Yearly we have now Connectathons. Yearly we’re testing integration profiles.
They want one thing comparable on the EMR aspect. Let’s say HIMSS can take this management since they’re a robust participant. They should carry life sciences gamers, gadget producer gamers, EMR distributors, payers, and anybody and everybody who’s interacting with affected person info. How will we do that? What’s the integration profile? Are we going to make use of HL7, FHIR, or DICOM?
Let’s say there’s an integration profile known as Accessing Affected person Info for Medical Trials. The life sciences gamers ought to outline what they want, how they wish to use it, and what format they wish to eat. The EMR distributors can describe how they will entry the information. Suppliers will supply the authorized construction they require.
It must be a joint effort and group. HIMSS could also be an excellent one, or it may very well be the American Hospital Affiliation. A corporation must take the result in pull these gamers from the completely different corners and produce them collectively for a typical trigger. IHE is a stellar instance of how it may be finished, and proper now, IHE profiles are working like SWIFT.
I did a bit little bit of analysis about SWIFT, asking why these competing banks don’t fear about shedding – or let’s say “leaking” – prospects to a distinct financial institution. We all the time hear that affected person leakage makes suppliers not wish to share their information to guard their buyer base. I discovered that SWIFT is a authorized entity and all its shareholders are the member banks who’re utilizing SWIFT for cash alternate. Each time then there’s a SWIFT alternate, banks pay a transaction payment, and on the finish of the 12 months, they principally obtain a proportion as dividends. The financial institution that contributes probably the most funds into SWIFT receives probably the most funds from SWIFT on the finish of the 12 months.
So within the financial institution world, they created the SWIFT group and so they personal it. There are not any third events. In healthcare, TEFCA could also be an excellent instance. Perhaps we create a corporation like that and mandate it collectively by a membership, a paying membership by the life sciences, payers, and saying that we would like this group to be the SWIFT of healthcare.
The place do you see the corporate going within the subsequent three or 4 years?
We put a imaginative and prescient in entrance of us to implement an infrastructure layer that helps not solely information alternate, but in addition helps handle the identification of information. That’s why we merged with NextGate. Then additionally to assist translate the content material of the information in order that the buyer of the information doesn’t want to fret concerning the format the information was saved in and the information itself will likely be translated for them within the unit that they wish to eat it. We additionally wish to develop it much more than having the ability to retailer that information in order that our customers and different healthcare IT suppliers just like the distributors can entry this infrastructure as a platform that they will use to alternate information. Then ensure that the information that they’re exchanging is trusted — coming from a trusted celebration and belonging to the person who they consider that it belongs to — after which deciphering it to the format that they want. In the event that they wish to additionally retailer it extra in perpetuity, they will additionally retailer it.
Our imaginative and prescient is staying as an infrastructure supplier for healthcare interoperability to offer a extra multifaceted options, reminiscent of what we did with Rhapsody and Corepoint in information alternate, identification administration and identification assurance with NextGate, and terminology mapping companies in and increasing that even to the coding companies with CareCom. We are going to proceed to spend money on them and develop the infrastructure based mostly on what we’re listening to from our prospects.