Health data interoperability was never designed for insurance risk assessment. Adapting the system took decades of persistence and innovation—and a guy like Chris.
Chris Fierer began his career developing health data infrastructure and interoperability technology from scratch, so he hasn’t just observed the evolution of electronic health records, he’s contributed to the current state of the art. Today, as Director of Product and Design for our Irix® suite of interpreted data tools—which now includes Irix EHR—Chris is one of the people most responsible for bringing the promise of electronic health records to fruition for individual insurance carriers.
Considering that George W. Bush created the Office of the National Coordinator for Health Information Technology over 20 years ago, some would dare say that Irix EHR is finally bringing that promise to fruition. But developing the national infrastructure that enables health information interoperability first required an array of rules and standards—the 21st Century Cures Act, TECFA, the HITECH Act, the HHS Health IT Alignment policy, and others—that outsiders find utterly bewildering.
Luckily for us and our Irix EHR customers, Chris enjoys navigating this complex landscape—perhaps because his personal product management mantra is, “Fall in love with the problem, not the solution.” In this Q&A interview, he shares how that perspective has helped us to ultimately deliver the EHR solution insurers have been asking for.
One challenge that recurs across tech sectors arises when technology develops ahead of regulations or standards. Inevitably, existing tech either has to be shoehorned into new standards, or standards have to codify existing tech, whether that would be the first choice or not. What did that look like in the early days of health IT?
One of my first jobs was at a healthcare startup near my home in the Research Triangle region of North Carolina. Our team built out the API layer integrating their portal into different EHR and practice management (PM) systems. It was a great job for me because I was that engineer who loved to talk to customers and really understand the problem. I was a year out of college and was given the opportunity to work with most PM and EHR companies around the country, telling them, “This is going to be how we exchange data with patients, and part of the future of healthcare.”
It was very much in its infancy, so there were limited standards. As standards developed, I had to write code from scratch. We didn’t even call it “interoperability”; we were just trying to exchange data efficiently and make our customers’ days better by improving workflows and adding automation. We didn’t realize it, but we were indirectly setting the standards for health data interoperability.
From the perspective of individual insurance underwriters, EHR has been a sort of “holy grail” that has been “two or three years away” for a decade or more. Irix EHR is finally delivering on that promise now, but what makes health data interoperability so hard?
Healthcare is a big, complex system with lots of inertia, so achieving meaningful interoperability is not a hot, Silicon Valley-startup story; it’s a generational story. There are a lot of people who are invested and entrenched in this multi-trillion-dollar industry, many of whom you never hear about, that don’t make the headlines. In the 20 years I’ve been working in it, there have been many public and private initiatives, using lots of carrots and sticks. So yes, change comes slowly, but we have made a lot of headway.
It’s worth remembering that the main goal of people trying to improve health data interoperability has been to improve the treatment use case. Other uses—whether they may be operations, billing, clinical trials, research, or in our case, life insurance—are not as far along from a regulatory and framework standpoint.
Are there hurdles or political impediments that, if removed, would improve health data interoperability?
Oddly enough, across the last several administrations, health data interoperability has been one thing that Democrats and Republicans have agreed on. Administrations come and go, but the FHIR standard, the HITECH Act, the Cures Act, the Cares Act—everyone’s continued to push for improvements. But it’s strategically hard for EHR vendors who’ve built their whole business on serving doctors to now open up everything to whoever wants it.
And from a change management perspective, opening up that data exchange is challenging. If a health system wants to turn on data through an API, it’s virtually operating as a software vendor. They’re not really staffed to be a software company. How do they support it? How do they sustain it? How do they know who is who? Honestly, it’s less a technical lift at this point; it’s getting the incentives, and the access aligned to make new markets like ours work as well as possible.
Irix EHR is unique in that it’s a claims-driven electronic health records tool that also uses Irix Prescription Data and Medical Data. How does layering in other independently sourced data improve an EHR solution?
The idea of a complete, longitudinal picture of the individual’s health has always been the dream. As a patient, if you touch the healthcare system, what are the byproducts of that one appointment? It’s scheduling the appointment, it’s insurance, billing, pre-approval; it’s showing up for the care, receiving the care; it’s a prescription; it’s follow-up and physiotherapy, and on and on. There’s an enormous ripple effect, and all of those things generate their own data. They should all talk to each other, but we’re not quite there yet.
By building an EHR tool that takes advantage of the other Irix Data Sets, which have higher hit rates and collate data from numerous sites, we’re able to get much closer to that complete picture. This is a good example of the advantage of being problem-focused instead of solution-focused. If we were just looking for an all-EHR solution, we might not have realized it’s the whole picture that matters, and missed an opportunity to best serve our customers and the market.
When you first started working on this stuff, did you imagine you’d make it your entire career?
No! When my boss at that startup told me to code an API, I thought, “Great, I’ll be done in three months.” Here I am, 20 years later, still doing very much the same stuff.
Sometimes the right people and the right technology and the right problem and the right incentives all come together to turn that thing people have been dreaming about into reality. I might be biased, but this is where I think Milliman IntelliScript is. We’re uniquely positioned to help make some of that happen with the individual insurance market in EHR.
