Tell us a little bit about yourself and Audacious Inquiry.
I’ve been writing software professionally for more than three decades, and like many software geeks, I spent more than a decade before that “playing” with computers. The first computer I owned was a Tandy Color Computer. Before I got involved in Health IT standards, I worked on linguistic software, including spelling correction, hyphenation, electronic reference works (dictionaries and encyclopedias) and search enhancement tools, and eventually moved into XML content management. Some of the software I wrote (or rewrote) still lives on in the spelling correction algorithms used today in Microsoft Word.
I’ve been working with standards for decades. My big start was in implementing SGML based electronic references, and later I moved on to W3C XML standards. I had the privilege of working with several of the editors and cochairs in W3C XML, Schema, XSLT, XPath and XPointer standards workgroups at a company that built an XML and SGML content management solutions. After the dot-com bust in 2001 I moved into healthcare IT, and about a year and a half later was nominated by my employer to make them leader in Health IT standards. We joined IHE and HL7, demonstrated some really cool stuff with CDA and the precursor to XDS at a HIMSS demonstration in 2004, and later that year I became the editor of the first HL7 CDA implementation guide, the Care Record Summary (which eventually led to CCD and C-CDA over the next decade), and started work on IHE Cross Enterprise Document Sharing (XDS). XDS was to become the foundation for document exchange standards used in Carequality, eHealth Exchange, and CommonWell. Within two years of developing the CRS and XDS, the local hospital implemented them in my community (in the South Shore region of Massachusetts). I think that is what changed my career in standards into a calling. I cannot think of anywhere else software developer would work that could have such a positive impact on so many lives.
I joined Audacious Inquiry a little over two years ago. Audacious Inquiry is a thought leader in the Health Information Exchange space, providing a connected care platform that uses industry leading standards like HL7® FHIR®, C-CDA, and Version 2, and IHE Cross Enterprise Sharing standards to securely exchange critical data during the most important moments of care. This helps providers and payers working towards value-based care to improve patient outcomes and reduce costs. Working at Audacious Inquiry has been a really good fit for me personally: I get to design and develop HIE software solutions, work on Health IT standards, and advise federal agencies and state HIEs on both.
Ai is a B Corp, and before I worked there, I did not know what a B Corp was. Today, I am thrilled to be working for one and seeing a real commitment towards social good. The company has been growing rapidly for quite some time, and we have several new open positions.
Ai builds products that support health plans, providers, public health, and HIE customers. Those products include our Encounter Notification Service® (ENS), which enables better care coordination and supports the new CMS conditions of participation; and the Patient Unified Lookup System for Emergencies™ (PULSE), which helps providers or first responders access critical health data during emergencies. Most recently, we announced a partnership with SureScripts to include Medication History data into PULSE™, which solves a major problem during disasters when people get displaced and do not have access to their medication. I worked on standards developed for the Emergency Responder use case back in the early days of ONC and ANSI/HITSP which are now implemented in PULSE™. It is cool to see something that I worked on a few years ago in standards be implemented and used.
Give us an update to the SANER Project (see our previous coverage). Where’s it at? What did it accomplish? What still needs to be done?
The Situational Awareness for Novel Epidemic Response (SANER) Project is an industry-wide collaboration that aims to revolutionize outdated and unreliable data-sharing processes to improve real-time situational awareness of health care system capacity in the COVID-19 pandemic and future public health emergencies. The SANER Project took the HL7 FHIR Situational Awareness for Novel Epidemic Response (the SANER IG) to ballot a couple of months ago. The SANER IG passed ballot and we are presently working on reconciling the feedback. We’ve received support from HIMSS EHRA, IT companies like Microsoft and AWS, and GIS vendors such as ESRI, who have all been working on communicating this data to public health and emergency response agencies over the last nine months without a standard. ONC and CDC have also both been contributing. With the feedback we have received, we’re headed into our third HL7 FHIR Connectathon in January with some new capabilities.
Pilots are our next big step for The SANER Project. In late September, we were honored to see ONC award the Texas Health Services Authority (THSA) funding for SANER through the STAR HIE Program. Audacious Inquiry is working alongside THSA and HASA to develop a pilot demonstrating SANER, and we just kicked off the technical and policy advisory groups last week to get that moving forward.
What were your big takeaways or lessons learned from rolling out the SANER project so quickly?
Maintaining momentum during COVID-19 has been tough. Hospitals and other health organizations rightly have been entirely focused on treating patients and keeping staff safe, which makes engaging them on a project like SANER more challenging. However, it has helped us focus on demonstrating the value of the project — really identifying pain points and showing how we can ease burdens and reporting requirements.
Where do you still see major holes in healthcare interoperability? What needs to be done to help fill those holes?
If there is one thing that COVID-19 has illustrated for the Health IT community, it is that you cannot just pay attention to one side of Health IT interoperability (the EHR systems). Public health agencies need incentives and funding to improve their interoperability solutions as well. Meaningful Use and other policy changes on the EHR side are a good start, but so much more is needed for true interoperability. We need to do more to enable situational awareness for public health uses and to understand the availability of critical resources, such as ICU capacity, across our health care system.
We also need more education on standards. I am working on a book that will soon be published soon by IHE and funded through ONC on IHE Standards for Health Information Exchange.
What’s the coolest healthcare interoperability project you’ve worked on (besides SANER)? What made it your favorite?
SANER is my current favorite, but it’s a toss-up between two others for second place: National network standards (XCA/C-CDA), and FHIR enabling an EHR system for a former employer, because I measure cool on two levels. The first is the number of lives impacted, and for that, the national network standards win hands down, and extends beyond the US boundaries. The second is how fun the project is. Implementing a FHIR Server in an EHR was probably the most fun I have had in any sort of implementation effort. Watching the APIs “light up” was fantastic as customers implemented them and coming back to it a couple years later working with that vendor on a recent pilot while at Ai was also very enjoyable.
What should the role of government be when it comes to healthcare interoperability?
Outside the US, most national governments fund a lot of the Health IT standards work directly through national initiatives from HL7 affiliates and IHE national implementation organizations. The U.S. does not have a single national health IT standards initiative. Having AHRQ, CDC, ONC, ASPR, and CMS all separately involved may give us more funding for these efforts, but it also brings more complexity. I would like to see more coordination at the federal level in the future.
What’s your favorite kind of motorcycle? (Side Note: In case you missed the connection, Keith is @motorcycle_guy on Twitter and his blog and may be more well known as Motorcycle Guy than Keith in some circles.)
I love cruisers. My first bike as a young adult was a Honda CB 100 that I learned on, but then took a 20 year hiatus after college. These days I am riding a V-Star 1100, that is, when I have somewhere to go. I have been so busy with COVID-19 related initiatives, and not had anywhere safe to ride to, that I barely got out on my bike at all this year.
What can the health IT community do to help you and Audacious Inquiry?
Get involved in Health IT standards efforts, and if you are working in a hospital that is having challenges with reporting situational awareness data, and want to learn how SANER can help, contact me!
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