Interview with DirectTrust Interop Hero: Dan Wilson

We sat down with Dan Wilson, co-founder and CEO of Moxe Health, to hear about his experience with interoperability through a different lens, and how that unique perspective uncovers gaps around privacy and preference. He humanizes data exchange in a way that reminds us what our end goal is — to help people better understand and share information the way they want.

Dan has been working in healthcare for about 15 years. He started his journey in the employer wellness segment and moved over to Epic where he spent many years implementing health records with health systems around the country. He then co-founded Moxe Health in 2012.

His company focuses on data interoperability on the non-treatment side (payment and operations). Moxe Health often sits among health systems, insurance companies and other vendors to see how they can use clinical data and information exchange to make the operating side of healthcare more efficient.

Their broader goal is figuring out ways to make healthcare more affordable and available, using the infrastructure that’s been built over the last 30 years around digitizing data to unlock the most value for society.

We agree with Dan that there are so many factors impacting the patient experience, as well as the quality and affordability of healthcare. Many conversations with our Interop Heroes are rooted in perspectives from the treatment side that focus on connecting providers. Knowing Dan represents a different side to data exchange that’s more patient-focused, we wanted to get his thoughts on whether or not the industry has all the tools necessary, or if there are perhaps more in-depth conversations that need to happen to further advance the payment and operations side of the work.

Dan recognizes and credits all the progress up to this point, but still believes there’s a fair amount of room for improvement and growth. He attributes that belief to his point of view on interoperability.

“Interoperability isn’t a thing. It isn’t even a point in time that we will have arrived at. It is a philosophy and we are all allowed to have a slightly different interpretation of what interoperability means.”

Dan explains how the industry has historically had a technology-centric view of interoperability. It operated with the goal of connecting data bases to move semantic information back and forth. And while the industry has succeeded in reaching that goal (and others) to certain degrees, that doesn’t mean the work is done.

There are now different points of view coming to the table that go beyond technology. For example, when a payer approaches the idea of interoperability, they aren’t thinking about the technology behind it. They’re focused on things like needing a medical record so they can understand what happened during a visit, or getting information to determine a prior authorization.

“When you look at a patient…they’re not thinking about technology either. They’re thinking about, ‘Why do I have to fill out those forms again? Why doesn’t this doctor understand my medication history?’ So, we all come at this from a slightly different point of view and we’re looking for something different out of the interoperability experience.”

Dan thinks the industry has done great work building and investing in the core foundation of interoperability as it stands today. And now, it’s time to take that foundation and those tools to help solve a new set of problems. By pinpointing specific obstacles, Dan believes there will be significant progress in the areas that need the most attention.

According to Dan, the body of work around data exchange should be an ongoing effort to further improve the interoperability experience for all users.

“I don’t think there’s a destination we’re going to get to where we say, ‘Great job, it’s done.’ We will just have uncovered the next problem set that we want to try and solve.”

We enjoyed hearing Dan describe the vision of where we’ve been, and we wanted to learn more about his perspective on what he thinks the next challenge is.

From where Dan sits in the payment and operations space, he’s most focused on incorporating more privacy-centric principles into data exchange. He believes privacy issues have held a lot of the non-treatment data exchange back.

To his point, a health system or provider are both meant to be a steward of their patient’s data. So, when they’re asked to share patient information with somebody outside their trusted environment, and with whom they may have an adversarial relationship, that could deter them from doing so. Sharing more information with the payer triggers a concern that the payer could use that data to pay less, use it against the provider in some way, or that the payer has another bad intent. To combat that concern, the industry has to think about what minimum necessary data exchange looks like.

The question then becomes: how can you enable the exchange of data without oversharing? That gets in to access control and principles around privacy. If a patient doesn’t want their data shared at all, or only in certain situations, there needs to be a way to capture and honor that request.

Dan goes back to his point about the industry viewing interoperability as mainly a technology, and therefore not often thinking about those patient-focused principles as they relate to data exchange. He believes the focus over the next few years will be around how to get more specific in understanding the content of the data they’re moving around and the purpose of use.

“From a technology perspective, how do we maintain accordance with business preferences, patient preferences and legal requirements to say what data can and cannot be shared in a variety of different circumstances…That is the area we are primarily focused [on].”

Dan brings up lots of interesting ways to think about some of the important gaps that need attention, and brings to light how a one-size-fits-all approach just doesn’t work when it comes to patient experience. We wanted to dive deeper into Dan’s thoughts around finding solutions to meet the unique needs of each patient.

He’s seen evolution in legislation that leans into some of the flexibility in the Health Insurance Portability and Accountability Act (HIPAA) guidelines. However, even today it’s still common to find an organization that believes they can’t email a patient record because of HIPAA. This could be due to the complexity of HIPAA guidelines and various interpretations of them.

After all, HIPAA is intended to protect the individual and their wishes for how their data is used. That said, this isn’t a global concept because each person has their own perception around what data is sensitive to them and what isn’t. You can imagine how challenging it may be to solve for that level of individualized nuance at scale.

Dan believes the solution is to focus on getting better at understanding how an individual views their health data, and wants it used (or not used) for their benefit. And then, discovering how technologists can support that.

If that sounds like a big lift, you’re spot on. Dan reiterates the importance of a diverse ecosystem of people and perspectives coming together to help solve for this, and we learn some of that work is happening now.

For example, Dan’s team is collaborating with the American Health Information Management Association (AHIMA), a national association focused on health records management. He mentions they’ve been getting more involved in the interoperability space and looking at privacy-centric data exchange. As part of their involvement, AHIMA is also focused on educating their membership on these topics and bringing more privacy-centric discussion into the interoperability space.

“We were fortunate to partner with [AHIMA] this year on rolling out…AHIMA dHealth^TM, which is really a program to help applications looking to leverage [the 21st Century Cures Act] to be able to better serve their users…getting patient data into those tools to help them understand various privacy considerations and make sure they’re incorporating them into their tool set.”

In addition to AHIMA, Dan is also involved with the Protecting Privacy to Promote Interoperability workgroup, which has formed recently. These groups are just two of many working together to help the industry recognize and honor an individual’s preference around their personal information. There’s plenty to talk about, like how to make sure the framework works for everyone and not just pockets of people.

Today, when a person needs to buy in to the current one-size-fits all model, the people who are most disadvantaged and not factored in to decision making will likely opt out. So, when it comes to discussion on topics like data, machine learning and bias in models, it’s important that every disadvantaged individual opt in to have data shared so those models can be built and trained in ways that don’t continue to have bias.

To get to that point though, we need to give people power around how their data is shared on a granular level. Dan is hopeful there will be real progress in the near future on that front. He tells us there are lots of organizations focusing on this work, and leading the way for the industry-wide approach he feels so strongly about.

As we wrap up our conversation, Dan expresses his excitement around the dynamic problem-solving that’s going on now and expects the momentum to keep growing year after year. He’s looking forward to the continued collaboration in problem solving and building bridges across organizations to leverage lots of expertise that will help improve outcomes for real people.

Thank you to Dan Wilson at Moxe Health for sharing his experience and unique perspective with us!

Learn more about the Interoperability Hero Initiative and check out our second class of Interoperability Heroes.