We had such an interesting conversation with Interop Hero, Dan Kazzaz, CEO of Secure Exchange Solutions. We traveled through time to understand where interoperability came from, how we got here today, and what future opportunities lie ahead for secure solutions in the healthcare IT market.
Dan has a long history with interoperability, having first started programming in 1968. Then about a decade later, in 1977, he began working with startups (both in and outside his own company). But it wasn’t until the early 1990s when Dan honed in his focus on B2B e-commerce. Throughout his years working in this space, he’s participated in various standards development organizations, including DirectTrustTM.
Today, he has an incredible team that has helped create highly successful secure exchange solutions. Dan says they roughly handle an impressive 50 million messages each month and lead the market in many areas. For example, they’ve integrated into more than 100 electronic medical record systems, 1,500 clinics and hospitals, 400,000 providers, and the list goes on.
Secure Exchange Solutions offers robust health information service provider (HISP) services, sophisticated message routing and conversion. This includes routing admission, discharge, transfer (ADT) notifications and continuity of care (CCD) documents based on patient demographics and other criteria, as well as automated chart retrieval. And what’s more, their products use Direct Secure Messaging.
Dan’s perspective on the importance of cross-industry interoperability helps us get a glimpse into the mind of someone who has helped shape such a crucial component of the healthcare system we know (and rely on) today.
“People think of healthcare as just one industry, but it’s really several industries. For example, health insurance companies are one industry, hospitals and clinic are another industry; pharmacies are yet another industry.”
Take insurance companies, for example. What do they have to do? They need to verify that the right item is paid for at the right amount. To do that effectively, the insurance company and clinician must work together and speak the same language. But because they’re separate industries, they often join different standards organizations. As a result, the interoperability between payers and providers around verification of clinical payment information is an obstacle. It’s known as the “prior authorization problem” or “claim payment problem,” if you will.
At its core, this problem exists because there are multiple standards and each industry group is represented by their own standard — making it hard for them to communicate. Each standard has their own value-add, so the industry challenge is to get standards development organizations (SDO) to efficiently share their intellectual property. If we can solve for that, Dan believes industry as a whole would benefit.
As we move on, Dan broadly breaks down the two components of interoperability that he feels are most important — content (metadata) and transport. To simplify, he uses a webpage as an example.
“The ability to serve up that visually pleasing [webpage] is really a combination of two standards…HTTP…and HTML, which you all know and love, right? But that’s really just basically a tag standard for how things are presented. So again, it’s back to metadata and transport.”
Dan goes on to explain how metadata is simply tags and lists, and that each standard has its own way for tagging or listing information. Tags (like a patient or doctor name) are delineated and presented in a certain way, depending on the type of standard that’s used. Lists, on the other hand, rely on metadata standards that allow a user to select a value (like gender, for example). So that metadata is how patient and doctor information shows up.
“Now, as far as transport protocols…DirectTrust is the only standards development organization that has created a secure messaging standard. If you combine secure messaging and data content, you can get a very, very wide adoption.”
Knowing this, the industry combined the HL7 CCD standard with Direct messaging to push clinical information from point A to point B, and that’s where we’re at today.
Taking a step back, Dan gives us a brief history lesson on how electronic medical records were first used in the 1990s. Getting patient information into the hands of doctors and hospitals was a success, but what about exchanging health information between providers?
It was around this time when people saw the opportunity to push information out, in addition to collecting it. And it’s that lightbulb moment when the National Coordinator for Health Information Technology (ONC) started a group to create a standard for push messaging.
“To date, DirectTrust is really the only organization that has developed a secure push standard so that you can get information out to the appropriate party at the appropriate time.”
We wrap up our journey through time by looking at the 21st century and beyond. Dan believes there are two things that will help address some of the key components of the 21st Century Cures Act: the ability to do effective patient messaging via Direct exchange (both one and two-way communication) and the ability for insurance companies to easily exchange information.
Dan and his team have been particularly successful in this area, as they’ve been helping insurance companies communicate with providers that are serving their members.
“So, if we can help insurance companies communicate with their members directly; if we can help providers communicate with their members directly, that will save everybody a ton of money…Right now, if you’re not using Direct [messaging], getting a secure communication path between any two points is a real pain in the neck.”
To have easy connectivity that is secure, companies need a mechanism like DirectTrust to get the certificates established for a secure connection.
In summary, the two areas where DirectTrust can help support the 21st Century Cures Act is patient-member communication and payer-payer communication. If the industry would focus on those areas, Dan thinks we would see some real progress.
At DirectTrust, we’re on a mission to strengthen trust in the healthcare space. Dan weighs in on areas we can explore to continue to deliver on that, like identity-proofing and certificate signing.
A big issue for everyone on the provider side is that every doctor has to sign all sorts of charts and documents for the patient in order for people to get reimbursed (like the ambulance driver or another doctor). It becomes a long process. If there’s a one-click way for doctors to sign charts and apply that verified signature to other documentation, that would help minimize the amount of work doctors have to do for signing. It would really simplify that whole process while retaining a high level of trust and security. Plus, it would cut down on fraud, waste and abuse.
To close our conversation, Dan offers final thoughts around the necessary adaptation of standards over time.
“Standards have to evolve. [They] need to be living, breathing things just like everything else.”
Dan says standards have to evolve because not everyone is at the table when they’re created, so there may be things people aren’t aware of going into those conversations. There are also times when people have different ideas for standards that were not yet thought of.
We have quite the history of adapting standards (we’ve come a long way from Morse Code). As our knowledge of the world changes, our standards also have to change to match the needs of today.
Thank you to Dan Kazzaz at Secure Exchange Solutions for sharing his experience and perspective with us!
Learn more about the Interoperability Hero Initiative and check out our first class of Interoperability Heroes.
This post was contributed by Alyssa Foggia-Hamm.