We recently sat down with Interop Hero, Lou Galterio, Founder of SunCoast RHIO, to discuss the role of architecture in the world of interoperability, and how the people who interact with that world experience it. (After all, his motto is: it’s all about people.)
Lou has been around for quite some time, having worked in three different industries throughout his life. Each with lessons that can be applied to his current field of healthcare. He started his professional path in New York City as an electrical engineer (now Verizon), then found his way into the banking industry before finally ending up in healthcare.
SunCoast RHIO is a regional health information organization with an interesting history. Back in New York, Lou was a chief information officer (CIO) for a hospital where he automated their public hospital system. (No small task.) When he moved to Florida, he knew few people would be ready for what he experienced in New York — a significant change in how things are done. So, in 2012 he started his non-profit company as a way to train doctors and consumers of healthcare on how the medical world was shifting to an electronic medium.
By being non-profit, Lou was able to build a level of trust with hospitals and the medical community. (They didn’t see him as having an ulterior motive.) In fact, hospitals used to have him sit in on vendor meetings as a way to help them assess whether or not they were getting a straight story. Then, when the National Coordinator for Health Information Technology (ONC) was established, it created organizations that funded the health information exchange, certification of electronic health records, and training for doctors on how to use these things.
As a result, it seemed his business model had become redundant. Just as he was considering going out of business, many of his clients told him not to. Instead, they recommended he shift his company to a for-profit model and sell his services. (Talk about a dedicated clientele.)
Lou finally spills the beans on what he thinks makes his company so uniquely qualified in the interoperability space.
“Primarily, our delivery to our customer base is the ability to electronically transmit certified and very secure information. If a doctor or hospital needs to report quality measures to the government, they could use us. The government sees it’s from us and they say, ‘OK, it’s good.’”
Lou’s company had to go through a lot of certifications and testing to get to that level of credibility. Another scenario in which Lou and his team provides their services is if a hospital gets audited and needs to respond. Hospitals can either respond with paper or respond electronically. There are only 15 companies in the country that the government will accept electronic responses from — and SunCoast RHIO is one of those 15.
“We still do consulting. We help our hospitals and doctors with meaningful use and that kind of technology, so we use Direct messaging [for a lot of things].”
Because Lou has relationships with different standards and organizations, we asked if they merged together in some capacity, and what that looks like. Lou leaned into his experience in the financial industry to recall how there are systems all over the place. There are systems in different countries being used by different people, and serving different people as well. So, Lou brings to light the idea of viewing this large web of information exchange in an architectural way.
“When you’re talking about an architecture, there are pieces of that one thing that never change, and then there are the pieces around it that do. So, if you think of it like that, there’s always going to be change. You have to plan for change. And if the architecture is well-built, and if the people and the systems that interact with it are well-done and follow standards, you’ll have your one system.”
Being a people-focused guy, Lou goes on to explain how all people touched by the healthcare industry (both working for and served by) fit into this healthcare IT architecture.
“If you think of healthcare itself, it is about people. It’s about people who are well, the people who are sick, the people who care for them. And it’s about the people who are trying to serve this market…We’re all touched by [the healthcare system].”
As we all know, everyone has a personal story about their own healthcare experience. It’s why one could argue that people are the key component in which the technology within this architecture must adapt to support.
We dive into one example where this idea holds true. SunCoast RHIO worked with Centers for Medicare & Medicaid Services (CMS) on an Electronic Medical Documentation Interoperability Initiative (EMDI) project. It looked at a patient who was being transferred to a different hospital, and after being admitted, made various stops along their care journey.
The patient ended up in a skilled nursing facility and then eventually in home health care. That care journey touched more than 60 systems and SunCoast RHIO was able to show CMS how they could track that patient through a legal, secure record. That record showed what happened throughout the entire care journey, including who was involved.
So, without the patient, we have no architecture. It’s clear how important this technology is when you’re dealing with someone’s well-being.
“My message to [technicians] is make sure you’re doing it as well as you can; as perfect as you can because peoples’ lives could be hanging in the decisions you make — but don’t let that scare you.”
On the topic of members and patients, Lou takes a deeper dive into what it truly means to be unified, and what we should focus on to achieve that.
The real key to unification, Lou explains, is to make an intentional approach to speak a language that everyone can understand — especially the people who use the technology and are impacted by it. To do that, the industry needs to stop talking to itself with so much jargon and make sure the people they’re essentially creating all this technology for understand what they’re doing.
“I think there has to be a very proactive approach to making sure what we’re doing is known by the people we’re doing it for.”
Technology and people work together in all sorts of ways to make interoperability come to life. So, how does Lou see both those components working into the overall architecture we’ve been talking about?
“Back to my early days…when I was trying to get people to use computer technology to check their healthcare, in the day I’m from, the feeling was, ‘If the doctor says to do it, I’m going to do it. I’m not a doctor, I don’t need to understand it.”
To Lou’s point, years ago, patients would do whatever their doctors told them. They didn’t bother to expose themselves to the technology or the “how.” Now, however, younger generations are not afraid of technology. In fact, they embrace it. Many don’t and will never know a world without it.
People are more involved in their healthcare than ever before. And we’ve got the gross domestic product (GDP) to prove it. In the U.S., healthcare costs make up just under 20% of our overall GPD — and it’s growing.1 Health is something that affects not only an individual, but their loved ones as well. On a personal level, Lou explains that the work of interoperability in the healthcare space is going to touch people in the pocket book. It will impact everything (and everyone) they care most about — where their hearts are, he says.
So, how can we bridge this gap between healthcare technology and the people who use it? After all, interoperability is meant to make the healthcare experience as seamless and efficient as possible, for not only providers, but consumers as well.
One specific solution, Lou described, is to embrace a secure blockchain technology and crypto technology as the architecture moving into the future. He says these solutions will help to greatly reduce ransomware and hackers, and can keep historical records.That said, Lou expects to see more of what we’re doing today in the years to come, but perhaps through the lens of youthful and forward-thinking generations. He praises future generations with confidence that they’ll continue to help move the industry forward through innovative contributions and perspectives.
“People embrace messaging…that’s just the way everybody lives today. By making [Direct Secure Messaging] usable, as if people think of it like an email, and doctors think of it the same way, and it’s secure…the payload that can be carried by a DirectTrustTM message takes in all the different standards that we’re all starting to see take place.”
It’s hard to think about the future without acknowledging how much change we’ve already seen in such a short amount of time. Lou looks back on a book that helped him understand the idea of change happening at an increased rate. Change is happening so quickly, he describes, that people struggle to manage it. Lou reflects on the times when he would sit and watch the ocean waves near the Long Island Sound, where he grew up. He paints a beautiful picture of nature’s order.
I would watch how smooth the waves were when they came into land…and then it would crash on the sand. So, you would have this order, this very smooth order of the water…and all of a sudden it hits the sand and you have this chaos. What happened to the order? The order was still there, it’s just that we couldn’t see it. When the wave finished doing it’s thing and it went back out again, all that crazy foam and chaos went away.”
His point being, we shouldn’t look at the way we’ve done things in the past as the way it has to be. The people who are going to inherit this world have new ideas and those ideas will work.
Lou’s final message is to the technicians who work to support and improve interoperability. He says to not lose faith and to believe in the people who dedicate their lives to this work. The people in the healthcare IT field are committed. Lou’s passion for the industry is clear when he shares that he wanted to be a doctor, but says he wasn’t smart enough. So instead, he applied to be a CIO. (Lou, we think you’re pretty smart.) And since then, Lou has been serving the field he loves through IT. Now that’s a level of dedication to be admired.
Thank you to Lou Galterio at SunCoast RHIO 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.
1 statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/