0:1:13.590 –> 0:1:37.830
Chaudry, Zafar
Well, I think the standards we use are defined overall nationally by healthcare as a community and also driven sometimes in collaboration with vendor partnerships. So there are some big vendors in the electronic medical record space and the data interchange space. And so traditionally those standards have been built on HL 7 recently while over the last.

0:1:38.660 –> 0:2:7.220
Chaudry, Zafar
Two years or so, we’ve moved to the fire based a standards on data interchange and exchange and some vendors we work with are able to exchange data within their own systems across not only the nation but also the world. So it really depends on what type of information you want to exchange with who, who your partner is and how amenable and open the vendor partner is in terms of that interchange. But it’s.

0:2:7.860 –> 0:2:13.440
Chaudry, Zafar
It it’s possible it’s doable. The question is what information do you need to exchange and how?

0:2:14.810 –> 0:2:21.250
Jordan Cooper
I see. And what information? Uh, have you found any unusual use cases at Seattle Children’s?

0:2:22.320 –> 0:2:52.590
Chaudry, Zafar
I mean, we do get more international patients that seems to be opening back up post pandemic and yes we our primary electronic medical record system is Epic and we can see information if the patient comes from an epic site no matter where they are in the world. So we’ve seen some of that. We do some work for the military and able to see some information for the patients that are sent from the military services as well.

0:2:53.380 –> 0:3:11.900
Chaudry, Zafar
But it really depends on why the patient is coming to us and for what type of care. Of course, there are other challenges is if you’re seeing a physician, how long do you actually get with the physician and how much time does that physician have to look at that data during the visit or previsit?

0:3:13.490 –> 0:3:14.710
Jordan Cooper
And so.

0:3:15.520 –> 0:3:36.700
Jordan Cooper
When uh provider is looking to coordinate care for a child who comes to Seattle to receive this specialized care, how do you overcome the challenges of not only getting them the information as you just spoke to, but actually having the physician review and account for the information that is available to him or her?

0:3:37.530 –> 0:4:8.100
Chaudry, Zafar
So that’s the the physician workflow process is defined by the clinical community that we have. So they have processes and workflows in place based on specialty as to what information needs to be seen and how that is seen. In many cases, if you’re referred to children’s, there is a triage step that happens and we’re using nurses, nurse practitioners, physician assistants to help us triage.

0:4:8.480 –> 0:4:13.210
Chaudry, Zafar
And collect that information in preparation for the actual physician visit.

0:4:13.880 –> 0:4:21.130
Chaudry, Zafar
And a lot of that information now is electronically available, whether it comes through the EMR, whether it comes through a health information exchange.

0:4:22.730 –> 0:4:50.980
Chaudry, Zafar
Unfortunately, some information still comes through the the dreaded fax machine as well, but that seems to be on the decline. There’s a lot more electronic data interchange and for us that shifted about two years ago when we moved from a dysfunctional EMR to a single standard. EMR is when we started to see more interchange of data than ever before prior to that.

0:4:51.420 –> 0:5:21.370
Chaudry, Zafar
We didn’t have a lot, a lot of electronic data in our patients. We were still using paper and lots of facts services, but we don’t do that as much now because most organizations will provide the data electronically and it really doesn’t matter what system they’re on. The challenge is usually do arise though from smaller practices that refer to us. So if you’re a small pediatric practice, you probably are running an antiquated.

0:5:21.740 –> 0:5:36.70
Chaudry, Zafar
Paper slash electronic electronic medical record system and they tend to fax over information, but if you’re coming from a standard practice that’s run by a big health system, it’s either interchange through Epic or Cerner directly to us.

0:5:36.770 –> 0:5:37.230
Jordan Cooper
I see.

0:5:38.360 –> 0:5:43.50
Jordan Cooper
Now you have previously spoken so on the topic of OK we’ve covered.

0:5:44.170 –> 0:6:15.240
Jordan Cooper
How do you gain access to information and then how once you have access to information, how do you actually utilize it? So you’ve previously spoken about application rationalization, whereas Children’s Hospital has gone from 840? Do I believe 788 digital applications and you had to determine in a rationalization of each application which are valid, which should be archived, which should be decommissioned? Could you speak more about?

0:6:15.400 –> 0:6:20.270
Jordan Cooper
Uh. Determining how you maintain your digital portfolio?

0:6:21.290 –> 0:6:52.20
Chaudry, Zafar
So I think application and application sprawl is a challenge for any healthcare organization. We certainly gone through that cycle multiple times. I think rationalization of applications for us is an ongoing piece of work which never seems to end because as we add new applications, we have to deprecate old ones. We’ve tried to identify subject matter expert slash owners for each one of the applications that we have.

0:7:21.660 –> 0:7:21.980
Jordan Cooper
Mm-hmm.

0:6:52.180 –> 0:7:23.510
Chaudry, Zafar
Whether they’re clinical or not, and then we consult with them to see whether the application is valid, whether that application still needs to remain on and if that application is to be turned off, what happens to that data shows that data be archived or can that data be deleted in Pediatrics? What we find is you tend to have to keep the data for a really long time up to 30 years and therefore, any system you deprecate the data has to be archived, but it’s a consistent Q&A.

0:7:52.740 –> 0:7:53.80
Jordan Cooper
Hmm.

0:7:23.970 –> 0:7:54.560
Chaudry, Zafar
Of the validity of each application. Now by putting in a single integrated EMR, we were able to deprecate some applications, but at the same time as needs and wants and demands change for for the clinician, new applications have to be installed or applications are revised or changed from 1 vendor to another in the clinical space. So we might have an EMR at the core, but there are about 40 other systems bolted into that that require refresh upgrade.

0:7:54.650 –> 0:8:14.940
Chaudry, Zafar
Potential change. And then there’s the whole interoperability between all of the systems which we have a platform that we use, which happens to be intersystems, so we also have to maintain, run and reconfigure that system as well as part of the application rationalization process.

0:8:15.880 –> 0:8:22.860
Jordan Cooper
I see. So you use uh intersystems to promote interoperability between different systems?

0:8:23.980 –> 0:8:43.890
Jordan Cooper
You are constantly evaluating which applications are necessary and and you said you’ve moved to a single integrated EHR which is epic. And previously I mentioned that you have been in the United Kingdom. What do you think? Are there any lessons learned from your time, any knighted Kingdom where there’s a single payer?

0:8:45.90 –> 0:8:47.130
Jordan Cooper
National Health Service system.

0:8:47.550 –> 0:8:57.920
Jordan Cooper
Uh, and that you leverage it also leverages intersystems is, are there any lessons that you learn from your time in the UK that you think could benefit American healthcare delivery systems?

0:8:59.170 –> 0:9:22.80
Chaudry, Zafar
Well, I think in the UK the government made interoperability a lot simpler because as part of the process of being a vendor on the approved list by the government, you had to comply with standards of information interchange. You didn’t have a choice if you didn’t agree to the national standards, which were.

0:9:23.920 –> 0:9:53.900
Chaudry, Zafar
Not difficult to meet. You couldn’t be a preferred supplier to the government, therefore couldn’t provide systems to the independent hospitals across the country. So and the UK’s health model is based on a national spine of information so similar to having one major health information exchange for the entire country, and they call it the national spine. And all clinical systems are required.

0:9:53.990 –> 0:10:6.820
Chaudry, Zafar
To send data to the national spine and then that national spine can be accessed from any health care facility using a smart card and that will have all the patients information.

0:10:8.880 –> 0:10:18.180
Chaudry, Zafar
Doesn’t matter where you live, and that was a requirement that the government placed on every vendor doing business in the country. Of course we don’t have.

0:10:18.990 –> 0:10:31.560
Chaudry, Zafar
I’ll have reached the ability where the federal government has said if you want to play in the healthcare space, you must meet these certain standards. I think CMS has been trying to do some of that.

0:10:33.210 –> 0:10:44.930
Chaudry, Zafar
I may have put some of that into action, but then some of it has been delayed, so it’s taking a lot longer to get to that. You know, how do we interchange the information? I think the lessons learned is.

0:10:45.600 –> 0:10:51.650
Chaudry, Zafar
They still needs to be some legislation that says people must do the right thing.

0:10:52.290 –> 0:10:57.80
Chaudry, Zafar
We’re using the standards which most vendors can support. Sometimes choose not to.

0:10:58.940 –> 0:10:59.180
Jordan Cooper
Hmm.

0:10:59.80 –> 0:11:12.50
Chaudry, Zafar
Comes proprietary, right? But the end of the day, if I open my system up to you and you open your system up to me, then I can’t necessarily charge you for all of those interfaces that I would.

0:11:13.100 –> 0:11:14.520
Chaudry, Zafar
In general, charge you for.

0:11:16.0 –> 0:11:19.10
Jordan Cooper
I see so, but you’ve mentioned.

0:11:19.90 –> 0:11:33.390
Jordan Cooper
Umm. Well, you mentioned that moving Seattle Children’s to 1 instance of EPIC has been helpful, but that you’ve still required the use of inter systems to.

0:11:33.470 –> 0:11:46.750
Jordan Cooper
Uh promote, enter the the successful interchange of information, especially when integrating different information from individual pediatric clinics. Can you speak more about?

0:11:47.120 –> 0:11:50.210
Jordan Cooper
Uh, that particular need.

0:11:51.730 –> 0:12:2.640
Jordan Cooper
What value the integration engine provides to healthcare delivery systems or hospitals that have moved to one individual instance of any ajar?

0:12:3.710 –> 0:12:25.50
Chaudry, Zafar
So an integrated EHR EMR isn’t going to solve all of your clinical needs. There are still some ancillary systems that that require interconnectivity, that the beauty of working with an interface engine specialist such as intersystems is they will support any standard.

0:12:26.130 –> 0:12:32.200
Chaudry, Zafar
And don’t block standards, but support them all and therefore you can use that tool to connect from.

0:12:33.420 –> 0:13:4.390
Chaudry, Zafar
Smaller vendor systems to larger vendor systems, and that’s what we’ve done. So Epic or Cerner or any of those don’t necessarily solve all the use cases that you need clinically. Sometimes you have to buy other systems like a document management system, workflow systems, etcetera. And they then have to be even radiology systems. And therefore they have to be bolted in to the EMR and most health care organizations will use an interface engine system.

0:13:5.110 –> 0:13:9.200
Chaudry, Zafar
That that will support all the standards. So we’ve been using the intersystems.

0:13:9.890 –> 0:13:13.220
Chaudry, Zafar
I’m sort of healthcare platform for a really long time.

0:13:14.80 –> 0:13:26.200
Chaudry, Zafar
Once the information is flowing through Intersystems health share, you can actually take a feed of the data from that system and then use that.

0:13:27.50 –> 0:13:56.340
Chaudry, Zafar
To to provide information in the in the form of analytics. If you choose to do that, and so you can actually do that and we do that, we feel all of our data into a data warehouse as well and all of our reporting that gives us our clinical outcomes data, our performance data, etcetera comes through dashboards which we display on Microsoft Power BI. So there’s value to the data that you’re interchanging between systems.

0:13:57.80 –> 0:13:57.280
Jordan Cooper
Umm.

0:14:6.140 –> 0:14:6.400
Jordan Cooper
Hmm.

0:13:57.40 –> 0:14:7.230
Chaudry, Zafar
I’m in the sense that you can improve clinical outcomes. Look at how you’re treating patients and most health care organizations have some form of that, some more advanced than others.

0:14:8.230 –> 0:14:26.790
Jordan Cooper
So in United King, back to the United Kingdom, you said that all vendors working with NHS are required to adhere to certain data interoperability interchange standards, I believe is what you referred to. What would be the need for having an integration engine if every?

0:14:27.210 –> 0:14:31.60
Jordan Cooper
Uh, if every service already here is to the same standards?

0:14:44.480 –> 0:14:44.810
Jordan Cooper
Umm.

0:14:31.910 –> 0:14:53.20
Chaudry, Zafar
Well, if you did, if you if you were able to get people to sign up to to a standards based model, then yes, you wouldn’t need the interface engine because each vendor would be signing up to the same pledge in effect. And so the NHS use of interface engines does exist but isn’t to the magnitude that let’s say we do it children’s.

0:14:53.890 –> 0:14:54.190
Jordan Cooper
Hmm.

0:14:53.870 –> 0:14:56.640
Chaudry, Zafar
So there is some reduction in cost from doing that?

0:14:57.480 –> 0:15:20.610
Chaudry, Zafar
Uh, but at the same time, you have to then get everybody to agree to a particular standard, and it’s easier to do in a publicly funded health system such as the NHS because they can mandate that as a way of doing business. Of course, in the US, we do not run a system where we force people to do anything.

0:15:21.520 –> 0:15:33.710
Chaudry, Zafar
And that’s why that’s going to be very difficult to implement here. It’s gonna be more of a does it become a federal guideline which then people try to follow versus how do you enforce that?

0:15:41.210 –> 0:15:41.490
Jordan Cooper
Mm-hmm.

0:15:34.410 –> 0:15:56.400
Chaudry, Zafar
Because in an open, competitive environments such as the US, you can’t force people not to do business, right? You have to encourage them to do the right thing, but at the same time you can’t block them from doing business, which is different in publicly funded health systems. They can tell you that you can’t do business in a particular country if you don’t follow a particular standard.

0:15:57.700 –> 0:15:58.250
Jordan Cooper
So.

0:15:59.40 –> 0:16:4.100
Jordan Cooper
We’ve covered a big ground speaking about the NHS, different interoperability standards.

0:16:5.280 –> 0:16:32.200
Jordan Cooper
I’d like to ask you, so far as we move towards the end of this podcast episode, if what sort of projects are is Seattle Children’s working on that you find to be exciting that are leveraging some of these standards that may be exchange exchanging data with with other other entities. What sort of interesting projects are you excited about that you’d like to share with our listeners?

0:16:33.170 –> 0:16:34.180
Chaudry, Zafar
So our most.

0:16:35.390 –> 0:17:7.480
Chaudry, Zafar
Our biggest focus at children’s right now, using the data that we sit on and it’s a lot of data, is around equity diversity and inclusion. We’re putting a huge focus that children’s and we have done over the last 12 months in taking all the data that we have around the patient’s around the demographics of the patient, they’re outcomes, their ethnicity to figure out whether we are being equitable and diverse in how we treat patients equally.

0:17:8.60 –> 0:17:40.370
Chaudry, Zafar
And the data has allowed us to do that. So we’re able to see how we treat white patients worse versus Asian patients versus African American patients by race, by sex, by age. And we’re able to modify our clinical procedures and workflows to bring a level of equality that wouldn’t have happened if we didn’t have the data that showed us areas where they may be discrepancy. So the real value for us with the integrated EMR.

0:17:40.450 –> 0:18:8.60
Chaudry, Zafar
And interchanging data between the systems that we have and receiving data from other partners systems is we can now tell you how long it takes to give patient X of a particular race of a particular sex pain medication what the outcomes are post operatively, what the outcomes are when they go home and whether the outcomes are the same. So if you were to take a 6 year old child.

0:18:8.850 –> 0:18:38.460
Chaudry, Zafar
Of multiple races female who just had a tonsillectomy. Do they get the same petition pain medication? Do they get the same doses? Do is our outcomes the same? Do they recover within the same time frames and it’s allowed us to adjust the way in which we practice medicine for the better and better outcome for the clinical patient. So that’s the most exciting thing we’ve been working on in the last 12 months. I believe using the data that we have.

0:18:39.840 –> 0:18:41.810
Jordan Cooper
With that particular use case, you just.

0:18:43.130 –> 0:19:2.300
Jordan Cooper
Elaborated upon and in that particular example of the the patient who’s getting a tonsillectomy. If you did find a difference in the outcomes or the time of getting the pain medication, could you just give a quick example of how you how you have in the past modified a clinical workflow?

0:19:3.830 –> 0:19:10.230
Chaudry, Zafar
So give me the example of tonsillectomy. What we learned with tonsillectomy was if you have a tonsillectomy, it children’s.

0:19:10.870 –> 0:19:14.700
Chaudry, Zafar
All the patients that had tonsillectomies were getting opioids.

0:19:15.860 –> 0:19:16.200
Jordan Cooper
Umm.

0:19:15.410 –> 0:19:22.790
Chaudry, Zafar
For pain control, which isn’t, which isn’t unusual, but of course you don’t really want to give opioids to kids.

0:19:23.510 –> 0:19:23.930
Jordan Cooper
Mm-hmm.

0:19:23.560 –> 0:19:40.550
Chaudry, Zafar
So what we did is we looked at the data and said how how many medical, how many pills do we give for pain? How long does the child have pain after surgery and can we change the cocktail of pain medication and move it away from opioids?

0:19:41.180 –> 0:20:11.670
Chaudry, Zafar
So we changed the the different types of medication we give postoperatively and we’ve reached a point that we do not give opioids at all now for post tonsillectomy patients, which is a lot safer for the patient, right, because of the levels of addiction to pain medication. So we’ve made that change, but that’s been a collaboration between the surgical teams and the post operative teams and close monitoring of the patient. So talking to the patient on a daily basis.

0:20:11.730 –> 0:20:41.840
Chaudry, Zafar
Feeding that information into our data pools and then saying actually we’ve found a new way of treating pain with zero opioid usage. And so that’s how you change it by collaboration between teams looking at the data, working with the patients and that’s huge. If you have opioid free post tonsillectomy pain medication, there’s zero risk then of any form of addiction to to an opioid. In that case scenario.

0:20:43.30 –> 0:21:14.200
Jordan Cooper
So, Zafar, I’d like to thank you for for joining us today. I think we’ve had an interesting conversation that in in one way metaphorically has mirrored actually kind of the rollout of EHR across the United States. You’ll notice that the American Recovery and Reinvestment Act 1008, there was an incentive to get every single American life covered by an EHR in a way that we measured an incentivized that use with something called meaningful use. I think over the course of this discussion we’ve spoken about.

0:21:14.300 –> 0:21:45.610
Jordan Cooper
How hospitals and providers can access various different forms of data and the standards required in order to enable the access of that data. But then on top of that, our conversation moved to how can providers meaningfully leverage that data in order to improve clinical outcomes, reduce disparities of care and generally improve the value and quality of care that is provided? I think that’s a very interesting narrative, and I appreciate your willingness to share that with me and our listeners on Healthy Data podcast today.

0:21:46.450 –> 0:21:49.430
Chaudry, Zafar
Thank you for having me. Thank you for the conversation. It’s been a pleasure.

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