How Interoperability Supports Healthcare Operations and Learning | A Conversation with Kevin O'Hara

Welcome everyone to today's webinar: How Interoperability Supports Healthcare Operations and Learning. Today, you'll hear from Kevin O'Hara, HealthStream's Senior Vice President of Platform Solutions, as he discusses how HealthStream is leading the way towards improved interoperability in healthcare. So without further ado, let's hear from Kevin. Kevin, thanks so much for joining us today.

All right, sounds exciting. I've heard this term interoperability, so I want you to break it down for me and whoever is watching our conversation. What is it and why is it so important? Sure, yeah, great question. And it really comes out of that platform notion. There are really two ways we think about interoperability. One is interoperability between systems. So if you think about our own applications, partner applications, and third-party applications that exist in the hospital, it's enabling those systems to talk to each other. Lots of standards have developed over time that have made that easier. Otherwise, you have translation issues: what my system thinks about a person and what a person's identity is might be different in another system, so you have to have ways for these systems to talk to each other. The way they do that in a more modern way today is via APIs, which are Application Programming Interfaces. Even though you have these APIs and standard methods for APIs, you still have to have the taxonomy, the language underneath that, to work together. That's the second layer: systems talking to each other and what they're talking about. One of the things we're really focused on is talking about the same person no matter what system they're in. We think about interoperability at the person level. Within HealthStream, we have 10 or more applications that we own, and each of those applications has an idea about who Dan is for instance, and we need all of that to be consistent. We want to know that that Dan Paulus in one system is the same Dan Paulus in another system. Getting to a unique identifier for everyone in all of our systems, and ultimately for everyone who works in healthcare, is a key focus of ours. That way, we can exchange data about those individuals and make it much easier for them to be doing what they're meant to do: deliver care, and not have to spend as much time dealing with paperwork or re-entering data. You'll see that manifest in that individual having a portfolio that covers everything they've done across our entire ecosystem. But fundamentally, the interoperability element is knowing that that Dan is Dan no matter what system they're in, and extending that to partners and others so they can talk to us about the same Dan and we know it's him, and we can pull all that data together.

In reality, if I'm a CEO or a healthcare leader and I come in on any given day, am I trying to figure out what a dashboard is and how they do or don't connect? That feels like a big pain point. Am I? Yeah, it's really kind of amazing how low the state of the art is and how many of these problems have yet to be solved. On the physician side, for some advanced practice practitioners, there is what's called the NPI, a National Provider Identifier. That exists to try to tie all these people together, and most systems will talk about someone's NPI, whether it's insurance systems or HR systems. But that doesn't cover everyone who works in healthcare; it only covers a portion. There's been a longtime effort to create a Universal Nursing Identifier, but for some reason it's never really caught fire. It's something we're very interested in. Even with that, you still have large numbers of people who work in allied health professions and other areas that are still not covered. So as you're indicating, if I'm a CEO coming in, I've got multiple systems. I want these systems to talk to each other. There are lots of layers of interoperability. They want to be able to talk to each other about the same patient, to have machines talk to each other so diagnostic equipment and lab equipment can talk to your EHR. There are just layers and layers of these interoperability problems. We at HealthStream are primarily focused first on this identity because we're in the business of supporting the people that deliver care, so that's core to what we do. But there are many other layers of interoperability. One other area where we support interoperability is with certain medical devices you need to be trained on and cleared on before you can use them. We have systems that are interoperable with our Learning Management System that allow people to be trained on those devices with a course in our system, and then we automatically communicate with systems that allow those devices to be turned on for that user. That's a different layer of interoperability, but one we're very excited about. It's very healthcare-specific; you're not going to find that in a generic LMS, and it takes advantage of our breadth of knowledge across the healthcare continuum.

Is that like an auto-credentialing almost happening, because they need to be trained, validated, and then they have access? Right. Yeah, it's one of the things we're very excited about because it's actually in the workflow of what's going on in the hospital and ties back to training and education. To unlock that device, you've got to have taken that course. All of that requires communication about who that individual is and what they're credentialled to do. So yes, we're here to improve the quality of healthcare, and we focus on developing the people who deliver the care.

How does this impact the day-to-day of nurses and nursing life? There's obviously an impact in terms of staffing here. So speak to that a little bit, because I know everybody's thinking about that. Sure. Recruiting and retaining top talent is incredibly important, very hard today. At multiple levels, understanding someone's experience, where they've worked, their competency, the training they've had, their credentials, all of that is necessary to identify and retain top talent, and to bring in new talent. Our goal, in the shorthand I use, is to be healthcare's people platform: anything you need to know about someone who works in healthcare you should be able to find out from our platform. That takes a lot of the friction out of all those hiring, retention, and promotion processes. This data should be known once and used many times. You went to the University of Illinois once; you've always gone to the University of Illinois. The number of times people need to reenter information about their education history, work history, and credentials is staggering. It's like calling a support line, being asked to put in your account number, then having the operator ask for your account number. That happens constantly. It adds cognitive overhead to your day-to-day job. Anything we can do to take that out makes the life of a clinician easier, makes the life of those recruiting and retaining clinicians easier, and ultimately allows you to identify top talent and figure out how to help them move to the next level. So we're addressing the efficiency of the process for HR folks, CNOs, everyone, to look at one record rather than aggregating from all different places.

Basically what you're saying, correct. Okay. And then how does this make the nursing staff feel, do you think? Having to enter something 14 times is frustrating, and they have a full-time job to do. Have we gotten anecdotal feedback about what this opportunity is and how it makes people feel better? Oh yeah. Anything you can do to make someone's day-to-day easier is important. What we see is that if you provide this information to end users, you also have an opportunity to congratulate them, provide praise, give them kudos for the work they're doing. Rather than having to go find that information, if it's brought to you automatically, which is what we're focused on, it's very different. If we can automatically surface that for you because of the network and ecosystem we've built, then not only do you not have to go do it, but it automatically shows up to your managers and executives, and they have an opportunity to react to that. At multiple levels: taking that load off you and saying we as an employer care about you, care about your long-term history, care about helping you develop your own portfolio which showcases the work you've done and extra effort. That's something we hear positive feedback on all the time. It also gives the employer an opportunity to make sure employees are getting what they need: the credentials, certifications. You can identify gaps and bring opportunities to staff to meet those needs.

So I'm thinking in my head, LinkedIn comes to mind as a point of truth for most people's careers. Is that kind of what you're alluding to? And when we think about big data, cloud technology, or AI, is this what we're talking about? There is definitely the concept of a portfolio being like LinkedIn for healthcare, except imagine if LinkedIn was automatically populated rather than you needing to put that information in. That's what we're doing. We're providing a lot of the plumbing in the background to automatically populate your portfolio, which would be akin to LinkedIn but covers a much broader expanse because it includes certifications, licenses, credentials, competencies. It's pulling all of that together for you automatically. Imagine logging into LinkedIn and it already knows all that about you without you having to add it.

Talk about this from a healthcare perspective specifically. We only work in healthcare. How is interoperability and what you're trying to do with the platform? I saw you give a presentation to our investors and we talked about the different lanes for our different divisions and the benefits coming out of that. Unpack that a little bit so we can see the roadmap moving forward. Sure. Just in our own corner of the universe, we have ten applications. We cover Learning and Development, Credentialing and Privileging, Scheduling. All those applications should be talking to each other automatically so our customers have this healthcare-specific people stack of applications that all work together. Information about someone's learning history and competencies can be used in the scheduling process. We're building this platform, this fabric underneath all of them, that allows our applications to communicate with each other and makes them all better. Rather than just basic scheduling, we're doing competency-based scheduling. Then you extend that to other applications to add information into the system and make those systems smarter, and also get information out to make their own systems smarter.

Okay. And I know we've just introduced a developer portal. Part of this is that part of the API plugin piece you're talking about? Yes. In order to tap into the entire ecosystem, you want to make your APIs publicly available so developers of other applications and customer systems can come and see what they need to do to integrate with your system. This changes the model from point-to-point integrations, where you'd have to meet, have handshakes, discuss, build special endpoints, to something that can be many-to-many. As long as a developer looks at our documentation, they can write to our application and integrate. We build the APIs once and have them work with many applications. The developer portal is a key part of that and a real key advance for HealthStream to get our APIs out into the hands of our customer developers, partner developers, and third parties who want to build applications on top of our network.

Super quick. HealthStream ID is the identifier, right? For a HealthStream customer, that's going to allow you to be on the platform and have this interoperability. Yes, your HealthStream ID is essentially your passport. It's a single identifier that exists in our system, ties you together. We want every individual human who works in healthcare to have one and only one HealthStream ID that follows them across their entire career and across all these applications.

Okay. And challenges? What are you up against to make this happen? There's a lot of infrastructure in healthcare. Just quickly, top three challenges you're wrestling with. The top challenge is very basic: you're Dan Paulus, you're Daniel Paulus, you're Daniel W. Paulus, you move around. Getting that nailed down to identify how we get one of you in the system. We have tens of millions of records in our system, have been at this for nearly 30 years, so we have a lot of that to do. Just basic data matching, blocking and tackling. Second is user experience: how do you as Dan understand what the HealthStream ID is and how it works across the entire system, the value, to get you bought into it. Finally, having all these systems adjust to recognize that standard ID and begin to use it and take advantage of it rather than staying in their own silos. Those are the top three challenges we're seeing.

Okay, plenty of work ahead for you and your team. Always plenty of work. What about bring us home, Kevin, with the opportunity you see on the horizon? I could guess some things, but making life easier for so many people with this singular sign-on. What do you think as you're telling people why we're investing in this and how it's going to make their lives and business better? Sure. It has incredible upside for everybody. All of our systems working together makes all of them more powerful. Our ability to extend that to customers and partners makes their systems more valuable as well. What we really want to do is provide this foundation for many other applications to develop without having to do the 30 years of hard work we've done to get plugged into 70% of U.S. hospitals, get their data feeds, and build on top of that. There is no reason to rebuild what we've built over the last 30 years. The most exciting opportunity is to enable innovation across the entire ecosystem and not have this tax people have to pay of all the basic work that needs to get done. We've already done that, invested 30 years, and we want others to take advantage of that.

Fascinating stuff. Thank you so much for spending time explaining this for us. We appreciate all the work you're doing, Kevin. Great, thank you.

Okay, Kevin, I want to drill down a little bit on this singular use case kind of thing. The analogy that comes to mind is LinkedIn as a profile. Is that relevant to what we're talking about? Similar, but maybe a little different. That's more job-hunting behavior, but we're trying to do something a little different, right? Yeah. If you think about wanting to pull together a portfolio of everything you've done over time and tell a story about it, which is a lot of what LinkedIn is about, we're doing that. The key is starting with this unique identifier and plugging into many systems. The difference with LinkedIn is if you imagine LinkedIn automatically did that for you, plugged into your HR system, competency system, and other systems, and pulled all that data together. That's what we're doing. In healthcare it's a little different. Most people who work in healthcare have a professional license that needs to be kept up to date with continuing education. The records around those are maintained by state boards, and we can collect primary source verification data about those licenses. That's different from LinkedIn, which is my story about myself. What we're doing is pulling together a fully validated story about you, which is important because of the regulatory environment in healthcare. It's different to say I have a license or certification, and then people want to know those are accurate. There are people in hospitals whose entire job is calling state boards of nursing or occupational therapy and verifying licenses. We've heard from them that the automation we bring frees them up to do higher-level work. We do that automatically with APIs that go call on that data and offer it to our customers. In systems like a Learning Management System, that allows someone in the hospital, who is already doing four jobs, to move up the ladder. I was talking to someone at a hospital the other day who spent half their day doing this work and the other half on talent development. We're able to shift the mundane work and move it to organizational and talent development. That's really powerful.

Yeah. So I'm hearing automated, validated profile in some ways, right? If that's a really short way to say it. Exactly. That's super helpful and I can see how that would make so many people's lives easier. Talk a little more about an anecdotal story of what this looks like when it's working well. Do we have a customer we've partnered with, or are starting to partner with through our developer portal, that is seeing these systems talk to each other and making the CEO's life and leadership's lives easier because they have the data in front of them and are connecting the dots? Yeah. We have started to see some great work using our APIs to integrate into the regular workflow in a hospital. One example: a new hire is made. In the past, you'd have to do a file upload to get that person into our system, or someone would need to key them in. Now the HR system can automatically call our system and create that user, so they're up and running right away. Often as part of onboarding, that person is automatically assigned courses they need to take to use the badging system. Customers will not allow someone to get their badge until they've taken that training. More critically, they often won't let them get on a shift until they're trained on the EHR. We have integrations that automatically call our system to check if Dan has completed his time and attendance training. If yes, activate his badge. If he has completed his EHR training, activate his ability to be put on a shift. Those things would have required someone in the hospital to make phone calls and run reports. Now it all just churns along in the background. That is real interoperability between systems, with three or four systems all talking to each other, and it doesn't require anyone to type in information or pull reports. It makes it much more efficient for someone to get up and running at a facility. Some of the largest health systems in the country have had those challenges and resolved them working with us and our APIs, accessing them through the developer portal. That's very exciting for everyone involved.

Yeah, and there's safety and compliance issues at the core of this too, right? People need to be trained before they get access to be on the floor. Exactly.

Correct. All right, okay. Thanks a lot, Kevin. Appreciate it. Thanks, Dan.

That is all the time we have for today. I would like to thank Kevin for sharing his insights and thank you to HealthStream for sponsoring today's webinar.