In this episode we discuss the promise and reality of Interoperability and Precision Medicine and whether these are just the latest buzz words or something we can really begin to leverage to impact the treatment and care of our patients.  We talk with a 25 year veteran of Health IT, Alan Portela, about this important topic.


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00:00:03From the studios of health care tech talk it's your host terry baker hello welcome this episode a health care tech talk i'm terry baker Well as you listen to this you may be boarding planes or just landing in sunny orlando getting ready for him Seventeen an exciting time
00:00:30with a chance to see amazing technology that's impact in health care as well as reconnect with friends and colleagues from around the country maybe even around the world Today we're going to talk about a couple of those topics that are probably going to be hot this week and
00:00:43that is a precision medicine and cyber security More importantly what is the promise of those two topics And are we as an industry poised to take advantage and fulfill those promises today I have a great guest to talk with me about it With more than twenty five years
00:00:58of health care industry experience and a passion to lead via disruptive and continuous innovation alan portela is the ceo of air strip a position he has held for more than four years Before joining the airstrip mr portela was thie president of clinique op international and previously led an
00:01:16implementation of high acuity hr systems for the u s military health system veterans health administration and a number of prestigious healthcare organizations in the private sector Mr portela has held senior executive rules with a number of innovative health care technology vendors and was among the leaders who pioneered
00:01:34global care quest and m health company that emerged from u c l a medical center department of neurosurgery more than a decade ago Welcome to show allen thanks for joining us today Thank you alan I just read that you've been in the health care industry for more than
00:01:50twenty five years Do you have a special passion for it or just a glutton for punishment If it is the combination I think that the passion is what i do every day to to make a difference on the management side is is going to ruins everything Yes it's
00:02:11a great show but it is a long week and another thing that heiress to me looking into aa looking at your bio there was the fact that you've implemented hayek unity e h r systems for the united states military health system as well as the veterans health administration
00:02:24Being a veteran myself i found that kind of interesting about that was a bit of a challenge Well i'd have to say that experience was one of the most rewarding experiences i had in the last twenty four years on because we were dealing with the area of high
00:02:38acuity at the time these are areas that we were the already on duty the match off what could be done for those wounded warriors so there was not a lot off that day there was not a lot of competition at the time because the traditional legacy systems off
00:02:56today didn't have decayed thedailybeast colder in those areas though it wass definitely best time were tendon technology you introduced in high security meaning that emergency departments i see use ours everything we did had an immediate impact on the point of injury in the battlefield to the transport areas
00:03:19into the use of the theft enable hospital book to read son diego naval hospital prepare armenian and many other places it has been a great experience and once you do that you would never need it Sure yeah i found one of the reasons i have a passion for
00:03:35health care and delivering technology inside to health care myself is that feeling of making an impact on people's lives and i can imagine the opportunity to make that direct impact on wounded warriors and veterans is was especially inspiring and beautiful and actually and they stop pick me i
00:03:49want to make reference sometimes to some of the things that we used to do in the department of the sense healthcare infrastructure when it comes to security another sounds great so you know cyber security and interoperability i have been hot topics in the industry for a long time
00:04:05why is it so important for you right now so i will actually turn that around Ok that is ok because the way i see it is that these are two topics that have been talked about in health care for a long time but we have done absolutely nothing
00:04:19about it has bean is a big topic for me personally for more than a decade on i have done a lot of things about god that i want to share with the rest off the market So we all take this the more since i mean when you talk
00:04:35about interoperability well if you look at what happened starting with meaningful use program where we provided incentives to accelerate the adoption on victimization of electronic health records that requirement and incentive he was really centered around just adoption but not about how those instinctive acted with partners Sure there
00:04:59was a result of that there was no emphasis on how we can go beyond the very limited detail after the standers off the d a h r seven knowledge off seven inspire the standards that today cover about ten percent off the data that is needed from the electronic
00:05:20health records and it only addresses that then it's running off breakfast doesn't address that the data that is needed from medical devices on other data sources said the reality is that if you look at them previous world not from the the office of the national coordinator and i
00:05:39think it was two thousand fourteen to two thousand twenty four was a ten year growth matt we're very much everything is centered around the data and that are available to their nature statement to the a and fire which are not really sufficient on our limited just to your
00:05:59child area just just in on the area of interoperability everything that what happened the last decade it has been just talk right in the area of cybersecurity it's even if it wants to taste in mary because this is the person example when i tell you what i was
00:06:17doing in the department of the stands when we were doing all the automation off health care records in the department of defense we had to at the time there was gold force of dedication that he was appalled at the time by a cop defense information assurance certification of
00:06:34her detention process which is basically hit pound steroids not only looks at the detail audit trails and angry self replication but he really looks at body tells from the operating systems which is were hackers are going to come in on where you will detect for them abilities way
00:06:54in a dance off an incident happening so what we had to do is several months the department of defense they used to publish vulnerability undescribed the category levels depending on how which they were massive event we needed people security patches in place for those that were considered the
00:07:15highest category off bottom of the hill this happen on a weekly basis so we have to have that certification i can't obey commands upside on I was very surprised that there is nothing in place although now we're starting to see that even the department of the stones that
00:07:34we place the diet that with with management plan work phone miss on its very similar that it's going too much people look so there are now standard sports is security but they're not being enforced My view everybody should be the ability to take to comply with security stand
00:07:54so on nightside i decided to take an approach People actively go after those securities certifications and i even go there if we were not doing business in the With the exception of some pilots at the department after stands even for diet up certification again we want for the
00:08:12arts are a mess and now we're going for ladies I think it's called clear and they security certification it then decided to have our approach to always people acted to those requirements And you look at what we do on the sensation off the real time world confrontation wantedto
00:08:30we actually decided to watch three five twenty trust to fifty eight years Even one of the fda was not making this requirement depending on on the intended hills and we always said if you're going to have a shortage of care givers and an influx of stations you always
00:08:48need to have that not because it is so we want for way are always on the position that you have to be proactive and aggressive when it comes to regulatory in compliance sure think is ah a person that has maintained a lot of technology and house inside of
00:09:05hospitals often it is what's the vendor let us do what does the vendor you know almost having to dumb down your securities dumbed down your patches sometimes dumbed down your security to actually meet the limitations of the various technologies that we bring into the organization That could be
00:09:21a pretty frustrating situation Yeah yeah andi if you if you see what is happening today everybody's looking at the cyber attacks for packers coming on they take your th i defer the personal health information workers on dh that's how you see all these settlements on people really concentrating
00:09:44on that aspect the real bad guys that you want to stay away from are the potential terrorists that want to come in into the community on disconnect haitians are our own piers and parts right or patients there are in an intensive care unit so so those are the
00:10:03things that in my view are much be important that a personal health information the record i mean although that it's important that i have seen health care providers that basically what they need to do today is get a good insurance so every time they get back they can
00:10:18take the helmet right But when it comes to saving lives it's it's something that you cannot buy that's a great point that's i think we've had those discussions relative to ransom where you know and why health care is one of the groups that keeps tends to get hit
00:10:32the most is because there has been some challenges around keeping systems patched updated secured and such and to your point you know you pay a ransom or maybe you have insurance or you deal with a fine but when you start talking about actually impacting patient care because somebody
00:10:47does hack a medical device ah that's a whole different ball game and in the scary scary concept yeah and i i have testified in congress for the past six years on these two specific topics i have to send it to the white house in the past and my
00:11:04position on cyber security wass that responders success way to protect aid of with encryption doing transform the client device from the server without storing data on declined device Do you allow authentication like the beauty wanted antonin in my position to the government wass standards exist to fix the
00:11:26problem of security in health will not be that difficult but the gordon will have to provide funding to the health care providers to start complying with those standards on then on the local agility side every time i testified i always mentioned that standards were not enough but decayed
00:11:48abilities to extracting the data that it's clinically relevant the capabilities exist because each of those systems out there that we know very well they have very robust architectures that seems the government didn't and force there the ability to share the data then they keeping in silence because it's
00:12:11to their gas interests what i don't want to take a political stand off here but every time there is change i see that there is an opportunity and it's very unfortunate that nothing has been done at least in the last twelve years and i stayed twelve sort please
00:12:28the i go beyond what happened under the obama administration and it includes what was deemed un or not being done even under yeah you know kind of back to the interoperability piece what are the hurdles you're seeing in terms of interoperability and the massive adoption of interoperability they
00:12:46have also so what happens is that i live in in in a different world which is i work with my doctors and nurses are leading data so much to be able to pull the quality of care from intensive care units operating rooms what we call high acuity data
00:13:07this is what you see data that comes from medical devices patient morning to spend later situation pants on a real time data system At the same time the data that comes from the electronic health records the data that is charged that the doctors and the nurses depending on
00:13:25the high security in some cases everything in amendments So if you know god the standards that exist for interoperability like ccd a which is primarily on the the ambulatory side on their nature seven on fire for the high security areas there's the realities if you look at the
00:13:47top spenders the children this they don't make today the data that i am describing available through those standards they have a both not to do that over the next three to five years That didn't make it available to the standard pretty negative a tale to their propriety toe
00:14:07data So the reality is with collaboration from providers than this on government those vendors will make available that data So they talked it that is definitely now exposed in this challenge that nose yes as we start talking out about precision medicine because position medicine or personalized medicine it's
00:14:33what you really have to start looking beyond just data that comes from the charge all right and of course the first one you need to do is to say ok i'm going to consider that the charges are one of those data sources the first question i have to
00:14:49ask myself this amite getting all the data that i need from those years charged today or am i just getting the data that is available to rachel seven seats eva and fire so if the answer is i'm not getting all the data you already have the first hurdle
00:15:05to be able to support position that second question is are we addressed in standards like a j another's for the medical device it's medical devices from the high security every expectation morning there's mentioned thank you date a stipulation plants but are we addressed that same standard to be
00:15:25able to extract data for patients that are on a group post morninto at home or with attached the measure stare uk g's waves when they're at home or any other specific condition that is being monitored with the medical device including an implantable device so is that data it's
00:15:45all on proprietary protocols and not made available now you don't have that next data sort so far out of the two that i gave you yes maybe there was some data on the body centers at home because that's more anything and people are more into the opera want
00:16:02but i already told you that on the other side you're only getting a percentage of the data that and then of course in going to economics we go into stina types another other types of data sources that you mean that are going to become more available convenience future
00:16:19they've been important thing and precision medicine it's the berries static data that you need inches with countryman decisions offices it comes from the anti air systems like laboratory radiology dissolves etcetera but one attention goes into the emergency department and then they did transport to the o r and
00:16:39then to the intensity Kerry what happens doing that event Were you're collecting hundreds off thousands of records throughout the length of stay how the body reacted to medications want your sis geologic pena types where when you were admitted to the hospital it's not only important for the doctors
00:17:02and nurses estimate decisions at that moment of care but also as you get this charge on go home what happened to you in that event is something that cannot be ignored and how your body reacted to different things cannot be door and that's the only way we're going
00:17:18to be able to move into position sure but this is one garment needs to take a very strong position and basically say we're going to take a fresh look at interoperability we're going to go beyond the charges were going to force which our vendors to expose all the
00:17:36data we're going to go into medical devices and now we're going to start looking to genomics and other data sources on dh that's when one when really you can make me think I was very pleased when i saw about the twenty first century cures act on the funding
00:17:53that will go into position medicine because i know that people i want to start realize how limited data it's today and also i like how this bipartisan more to support in macro be moving into a true value days Windows more is going to also exposed the fact that
00:18:15now decisions are basically saying you're changing the way you incentivize me around improving the quality of care But you're not helping me to get the data that i need to make the right fish So i think that there is the implosion There is a revolution that is taking
00:18:34place and there is no other option than taking a very serious look no more Oh talking about things that a lot of great points there I know i had a meeting earlier today where i was You know something was brought up is a big new concept we needed
00:18:49to think about and i remember talking about it for the first time eight years ago and had they'll chuckle a little and other great points there in that people want that precision personalized medicine and to do that you're going to be taken inputs from a number of different
00:19:02medical devices with you know different vendors as well as impatient outpatient at the home so many different data inputs and devices is that kind of where airstrip comes in can you talk a little bit about your mission with airstrip pond what you provide to help facilitate this yes
00:19:17as you can see i have so much fashion but what i feel here i have him talked about us but that we on i would like to continue on on that boat but basically i wanted to mention that we started connecting to hospitals you know step picks for
00:19:34decisions to be in in the morning of months a dealing labor especially high risk pregnancies so now the doctor on the normal guys i did see the fetal heartbeat and maternal complexions as well as what the nurses are charging when the months are admitted and they've seen that
00:19:51on on a mobile device with that knost equality we were one of the first applications to receive fda a surveillance on actually we also received the tactics on methodology patent or how to view there we rendered wave forms on mobile device it's nejedly on each operating system yes
00:20:13we were going into the operating system side and realize that we need to leverage from the incredible tools that exist the mobile devices we started moving into cardiology intensive kerrigan impatient monitoring on this is where we were in mind dad we need to work very closely with the
00:20:33companies like are full of go go so us we were looking at a way form coming in real time from a monitor on the doctor wanted to zoom in into an intensity willing to be able to keep the medical aspiration to preserve that agnostic equality for women in
00:20:53and we have to work it up or with google for them to be able to modified their operating assistance to be able to support thiss type off off diagnostic quality visually station so we realized very quickly that now if you look at the way things were done in
00:21:12the past or still today at eighty percent of the hospitals in the country the patient goes into an ambulance with just pain on that station now gets put on a regulator for twelve or fifteen leads monitored they go into the emergency department and at that point they need
00:21:31to provide that ecology too especially if it's what they call the golden hour and now it cardiologists needs to look at the data that they're not usually at the department so that's why is there a way Is a diagnosed that you have the full blockage of the artery
00:21:47Maya carded in part Now they basically the standard is ninety minutes on Dog toe balloons are ninety minutes from the emergency department to the gods Love to hear that argument code Stemming Yeah exactly Standing s t elevation Maya prizes infarction So basically what happens here is that now
00:22:08invitation is in the ambulance We can send that the a g to the cardiology on a near real time basis within seconds And now the cardiologists can make that determination that this is stanley and activate the custom and have everything ready for that station So instead of being
00:22:27ninety minutes from the emergency department to the castle that now you can do thirty minutes from the event when the ambulance takes you out to the castle and every second that you accelerate the time to intervention it's more healthy heart muscle you would have the last time they
00:22:48would spend intensive care unit and the better quality oflife that you would have moving forward on potentially it's his life saving So what happens is we moved through the whole aspect ofthe medical device connectivity and dishing sensation on what we have done recently it seems we're teaching dicing
00:23:11those wave forms Now we are taking that data and we're normalizing it on streaming it to analytics third party on the lyrics tools that are doing wonders with the data that we are providing being able to start now looking at impatience in the intensive care units that are
00:23:30either with traumatic brain injury or or or or order conditions and now we can beaded ice that data sent it to this analytics engines or algorithms to be able to start providing early detection off possible station the compensation so we're about we're experiencing a ton of other customers
00:23:54the things that are just things that you couldn't imagine it's three or five years ago on the deity off now the integration that were doing deeper into the electronic health record they're not using the standards But it's working with those vendors on their proprietary product off is that
00:24:15nothing can be better than validating the data that comes from the medical device and it's analyzed with an algorithm that old city to combine the data that's what the nurse and doctors are charging every fifteen minutes on that station that has provided brain injuries and it's in the
00:24:34mural intensive care unit and at the same time display data in context with diagnosed where the demon she's looking at studio to be able to support other the communities there are do not have didn't the level of text of peace or especially at the central hearts do so
00:24:53we need In essence we are providing the in context an agnostic seamless in bash board that access data from multiple data sources for multiple environments team and put it all into one deal in context with singles and mourn it separated so it's it's an exciting time but but
00:25:17we don't want to be the only ones in doing this because there is a lot to be done on we need to create tech assistance off share value systems off then there's providers and goldman you need that that can really accelerate the transformation again great points ah time
00:25:37is of essence whether it's strokes or heart attacks or sepsis detecting sepsis is a patient declines as well as being able to kind of force multiply by by you know being able to take a centralized diagnostic physician group or something like that and extending them to remote sites
00:25:53So all kind of like you said need an exciting exciting things yeah that may be an example here because unlike to bring experience from video so we're working with the university of michigan under a number of grants from the army they have been thieving creating algo reasons to
00:26:14be away from interpretation the same patient monitors that hospitals had been using for the last twenty years now with a grant from the army they're looking at a twenty seconds national away form one lead looking at the next twenty seconds and within forty seconds Now they can tell
00:26:35you that this particular station has the science off hyperbole and which is the loss of blood or plasma that could be caused from trauma or similar conditions to be caused by the priest signs off a septic shot This world was done for kids in afghanistan that are close
00:26:58enough to be an ied explosion God they're shot ways kids them like if you're on a car accident on since they are eighteen years old facing two b healthy the after that even happens but hours later they start bleeding internally on they die on this side Both algorithms
00:27:24now are being tested in places like university of michigan to be able to use god for trauma for patients coming in in ambulances from a car accident or for flotation that are in the isis is that could potentially develop in sepsis and now you can do early science
00:27:44off the compensation so so there is a lot that word comes from what we're doing on the stage at the department of his fans but again the key is medical device companies need to expose the data and then the hr continents need to go way beyond standard Very
00:28:01interesting that i think we could probably go on and talk about a lot of these subjects all day Very interesting and i appreciate you I kind of you know giving us a primer and giving us some insights into where interoperability is helping move us forward with precision medicine
00:28:15Um so i guess coming up this week you're going to be going to him seventeen what you expected to see there where you think i'll be the hot topics So you know they very fortunate that since we're doing things that are ahead off many others in the areas
00:28:30that have been discussed for the last ten years just about anything a cyber security related i'm very fortunate that i have in partners like the h e a the dignity health in tal foundation the on on many others dodd that ball go there all go to him so
00:28:55always not my my my the best thing that happens at hands from unis to always running to mind my friends my customers my partners on ben as far as the top that you know it's very interesting because every year there is the new topic and it doesn't really
00:29:14mean that anybody has anything for those topics but everybody knows but those are the buzz words or boots reflect that before he wa cyber security was being their probability at some point it was all about i see ten the other times he was all about live interviews the
00:29:34i predict i predict all the signs are going to be they're going to say precision medicine right it's going to be so much fun to go to everybody and ask the questions on topics of we're discussing on on these things of you andi i always have so much
00:29:50fun it's him that's the fun part of him to put fenders on this part andrea lies how little they're doing about the signs that well you've been going to hymns for twenty four years how's the experience been over time we've talked about the exciting things we think are
00:30:05coming up in health care what have you seen happen over these last twenty four years house it's how has it changed over time so if you look at my my first one was in ninety three in nineteen nineteen on diego and i think that health care i t
00:30:18was always the small girl off innovative people people in the medical device side you saw the shift from denied it to the two thousands were in the past medical device companies were ruling dangerous i mean they ended deadly off two thousand after y two k it made a
00:30:39huge switch to the car companies and i started seeing the last three years is all about the analytics companies that are strong in analytics companies that are sworn on the workflow optimization tools care collaboration tools so our unexcited that the industry got much bigger there is a lot
00:31:03of attention andi it regardless off all those signs that then there's food out there there is a group of about five percent off the people on the floor that we know who they are we got to an incredible job on the medical device side they do an incredible
00:31:21job chronic health record side incredible job now on the new wave off the analytics and care collaboration tools in cognitive computing which is it's also the next generation we're going to see signs for machine learning but you know the good ones are so does things i know that
00:31:43i just like to go on walk and go to that five percent and their west doesn't exist maybe i have not been getting so much exercise so i like that a tense i walked probably five miles a day yeah i always tell people wear comfortable shoes yeah some
00:32:00of my favorite places to walk around the hymns floor is actually around the edges and you find some interesting small booths where people are you know presenting some interesting interest ting technology or solutions but now i told you agree and i think yes decision medics and russians are
00:32:15unimportant its computing all those things are it's things that definitely dead coal companies out there And it's The last thing that i am to mention which is very exciting for me is what i have seen in the last four months In the area of political It could be
00:32:33a good clinical condition oriented body sensors What it's coming out on patches for glucose monitoring for diabetic patients Patches that have to be diligent transmitted through a mobile home You know companies like ours with electronic are doing a great job in that area Dan in also catches another
00:32:56sensors quotations at home to deal to the continues You can t monotone the many other body sensors that now combined with the deeply mourning just blood pressure Part scales You were looking at a whole new generation off morning during the outside of the four wars and tossed it
00:33:18so that's that's exciting too Yeah sounds like it Do you have any official duties at hymns this year You pretty much just attending and enjoying the show and meeting up with the colleagues and customers I'm planning on planning to go with the patch that i would put a
00:33:33different card I want to work sunglasses on I'm just going to go undercover there you go yeah appreciate you for joining That's today allan Any final thoughts you'd like to share with the listeners day any kind I know you have a lot of passion a lot of different
00:33:48things going on but any kind of final thoughts is late to the topic today Well i think that i wanted to say that i like to approach of doing saying spire to the show on on i would be more than happy to close the loop after this show
00:34:06on on deceive our expectations working right well it sounds good I appreciate it again Thank you for joining us today and hope to talk with you soon Thank you take and i want to thank you our listener for joining us today I hope you've enjoyed this episode and
00:34:23gained some new insights into precision medicine for everybody It's traveled to orlando for the him seventeen conference I hope you have a great week and safe travels for this episode of healthcare tech talk

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