David Whitlinger, Executive Director of the New York e-Health Collaborative

Mark Masselli: This is conversations on healthcare, I am Mark Masselli.

Margaret Flinter: And I am Margaret Flinter.

Mark Masselli: Well, Margaret the rollercoaster ride continues, we’ve gone from
the up in the air presidential campaign to the further falling off a physical cliff. It’s
quite amazing in such a short time.

Margaret Flinter: It is since President Obama was reelected the rhetoric has
shifted to the physical cliff and what might happen on January 1st, that’s when
existing tax breaks expire and the funding for a number of programs including
Medicaid and Medicare begin to fall off.

Mark Masselli: And listeners may disagree on what might happen but they all
agree, this is a stern warning to congress to start compromising.

Margaret Flinter: Somehow I have the feeling people have learned from the
experience of past years, we’re in this situation because congress couldn’t agree
on a solution in the last legislative session so they kicked this rather large and
complicated can down the road now it’s come to roost.

Mark Masselli: The good news it seems to both sides of the aisle are attentively
testing the waters of compromising, coming to the table to discuss ways to avert
falling off this physical cliff.

Margaret Flinter: Which is a term that we may want to forget about at some point
soon but although we’re far from agreement Mark, that house minority leader
Nancy Pelosi said she is confident that a disaster can be averted though many of
the Tea Party Republicans are still vowing to block all efforts to raise taxes on the
wealthiest Americans.

Mark Masselli: And they’re still demanding cuts to the so-called entitlement
programs like Medicaid and Medicare. I anticipate a lot more noise pontification
before the matter is settled probably on both sides.

Margaret Flinter: Well, it may be noisy but at least they’re talking and that’s a
step in the right direction. It’s also something our guest today is something of an
expert about David Whitlinger is the Executive Director of the New York eHealth
Collaborative.

Mark Masselli: It’s a consortium of health policy experts, health care
stakeholders, medical professionals and IT experts, all coming together for the
goal of making New York State’s many electronic health systems, communicate
easily with each other.

Margaret Flinter: And Mr. Whitlinger has a lengthy career in creating those
interoperable systems, a real challenge in health care right now. So we’re
looking forward to that conversation and there’s a lot of states around the country
that could learn by the example of the (2:05 inaudible) in New York over these
past years.

Mark Masselli: And we’ve Lori Robertson, Managing Editor of FactCheck.org
who will give us another analysis of perhaps misrepresented claims about the
health care law.

Margaret Flinter: Well, we hope she took a bit of a vacation after all those
presidential debates and no matter what the topic you can hear all of our shows
by googling CHC Radio.

Mark Masselli: As always if you have comments email us at chcradio.com or find
us on Facebook or Twitter, we’d love to hear from you.

Margaret Flinter: And we’ll get to our interview with David Whitlinger in just a
moment.

Mark Masselli: But first, here’s our Producer, Marianne O'Hare with this week’s
headline news.

(2:38-2:41 Music)

Marianne O'Hare: I’m Marianne O'Hare with this headline news. The Obama
administration and the Department of Health and Human Services released the
latest set of rules governing insurance coverage and the Health Care Law. At a
briefing this week, HHS Secretary Kathleen Sebelius released the latest rules
concerning insurance company practices. The rules bar insurance companies
from charging higher rates to women, canceling insurance policies for customers
who are sicker and denying coverage to people with pre-existing conditions. The
rules also outlined what the so-called essential benefits should be, they include
ambulatory patient services, emergency services, hospitalization, maternity and
newborn care as well as mental health and substance abuse services, rehab and
lab, currently close to 50 million Americans are without insurance, they will be
required to carry insurance by 2014 under the Affordable Care Act. As for the
State’s Insurance Exchanges, online marketplaces where customers will be able
to purchase that insurance, 18 states are now saying they won't set up their own
exchanges and they’re going to let the federal government provide insurance
exchanges, 18 states have set them up or are in the process of doing so while
the rest of the states are taking advantage of the extra month a lot of them by the
Obama administration to state their intentions. And if you have the privilege of
utilizing indoor sanitation this week, you may not realize just how lucky you are.
This week marks World Toilet Day, a day to reflect on just how many in the world
go without in fact they have to go outside everyday. 2.5 billion people live in the

world without access to sanitation or plumbing and it’s a leading cause of death
and disease in communities dwelling in poverty. World Toilet Day aims to raise
awareness and support to bring sanitation solutions to the third of the world’s
population that goes without.

I’m Marianne O'Hare with this headline news.

(4:26-4:32 Music)

Mark Masselli: We’re speaking today with David Whitlinger, Executive Director of
the New York eHealth Collaborative, a non-profit organization founded by a
consortium of health care leaders working to improve health care for all New York
residents through health information technology. Mr. Whitlinger is the former
Director of Healthcare Device Standards in Interoperability for Intel Corporation.
He holds leadership roles in many standards organizations throughout the world
including Health Level Seven and Bluetooth. Mr. Whitlinger welcome to
Conversations on Healthcare.

David Whitlinger: Oh, thank you very much for having me this afternoon.

Mark Masselli: David, your organization the eHealth alliance recently brought
together close to a thousand health IT professionals for the Digital Health
Conference in New York City where many thought leaders and technical
innovators in the health were in attendance. And we are always, it seems to me,
at a cross roads in American Healthcare System but certainly we are the cross
roads on technology, can you give us a sense of the big picture of where we
stand today with the use of electronic health records?

David Whitlinger: Sure. I will tie it back to one of the key note speakers that we
had at our conference Dr. David Brailer who is the father of this current
movement. He was appointed as the first National Coordinator for Healthcare IT
back when George Bush was in office and laid down the challenge of that have
every provider have an electronic health record system and every patient has the
records stored as such by 2014. And he brought to light a lot of the differences
between the marketplace as well as the regulatory and policy frame that was
(6:08 inaudible) in that era as oppose to today and this explosion of electronic
health record innovation come from two things. One, the federal government in
the Obama administration put together a stimulus package of $50 billion in order
to help the provider community get on electronic health records. And then the
other is health care reform itself whether or not you’re democrat or republican it
seems that all parties and all policies agree that our payment system has to
change for health care or it will go from 16%, 18%, 20% of GDP and keep
climbing. We have to stop paying for additional service, paying for more and
more service in a fee for service healthcare setting we have to now start pay for
managed care, where clinicians and physicians collaborate together on a given
patient for better outcomes, higher quality and greater efficiency. And that one of

driving that collaboration naturally lengths itself the usage of common internet
tools that every industry over has figured that how to use in order to become
more efficient.

Margaret Flinter: David, one of the states, it’s really been I would say among the
most proactive in setting up systems to facilitate not only the adoption of
electronic health records but also the integration of records within regions, the
Regional Health Information Organizations or the RHIOS that have been set up.
Help us to understand what is this relationship between individual practices and
their electronic health records and then the RHIOS and then the State Health
Information Network, how do they support one another and with all the innovation
that’s happening? Is that the right infrastructure at the state level to really
advance this?

David Whitlinger: Oh, yeah. Just to (7:50 inaudible) the acronym its State
Health Information Network of New York or we affectionately refer to it as the
SHINY and just to build it as the layers as you described obviously a lot of
clinicians now are getting electronic health record systems thanks to the federal
stimulus and that’s just over the last two or three years. All the non-hospital
practices are really getting engaged, hospitals to a large degree is embraced
electronic health records five or seven years back. So those institutions are now
getting their electronic health record systems in place and figuring out how to
improve their workflow and then where we build from there is each of the
communities in the state of New York have put together a RHIO or Health
Information Exchange and each of those RHIOS are in the space of getting
everyone of this electronic health record systems, each of those provider
communities to connected to the network and there’s two things that we’re
looking forward to that set of connections to provide. One is the ability for the
patient records available across the whole community and eventually the whole
state of providers and so that’s the network, that’s the network effect and so
having at the fingertips of every clinician in the state the records that their fellow
clinicians have created to a given patient at any given time has an immense
amount of power and being able to improve the quality of care and the efficiency
of that delivery. The other major capability that we look towards in that network is
the ability to just use the network as a transactional network following the
national (9:27 direct) model and that is being able to send the records from one
clinician to another in a very secured email like fashion and providing those
through the statewide network those are the two big capabilities that we are
looking for at SHINY to give all clinicians and eventually all patients.

Mark Masselli: So you’ve laid out very nicely for our listeners there’s enormous
opportunity and yet challenge that the federal government has undertaken. You
talked about the stimulus bill which put $50 billion in to trying to encourage
private providers to engage in and participate in electronic health records and
then you noted in the Affordable Care Act to the sort of pushed towards the
Health Information Exchanges in that states and regions are putting this together

so you have the provider gathering the information and now so they can share it
with the hospital or share with another provider and you’re at the heart of this
trying to pull them all together right? So tell us a little bit about the consortium
that you’ve been working on to try to pull these health information exchanges
together sort of the new interstate highway system that you’re building here in
trying to help design. So tell our listeners a little more about how that design is
going.

David Whitlinger: You know early on we looked at the usage of Health
Information Exchange in New York and the usage of Health and Information
Exchange was really being impeded because of the lack of integration with the
electronic health record systems themselves. And so it was a broken workflow if
you will. So a clinician might have to use their electronic health record system in
the user interface for that in certain situations and predominantly for most of their
workflow. There have been another cases when they wanted to see records
from across the community to had a jump over to a different system and it was
really clumsy. So what we thought is you know the best of both worlds here is for
these electronic health record systems to embrace and integrate their Health
Information Exchange over an extension of itself and that’s what we tested out
with the clinicians in our state and we found that that was quite the case that they
would find that it would be much more useful than a separate user interface for
their HIE or RHIOS that was something that we tested with other states that
we’re also running into the same adoption barriers and broken workflow. And
when we talked to electronic health record software vendors and the HIE
vendors, they also agreed that a deep integration between their product lines
would ultimately end up in a better experience where the provider trying to use
their system as well as ultimately the patient.

So we sat down formed the workgroup with the states, 15 states as you
mentioned, 37 vendors and a couple of dozen of the health information
exchanges and said lets solve this problem with the technology, lets put some
engineers to work on it hammer out the technical standards so that we can have
plug and play interoperability between the EHR product in the health information
networks. So what we announced two weeks ago is our partnership with CCHIT
one of the major testing bodies in the electronic health records marketplace. And
that testing body is now opening up in stores to certify against our specifications
that become certified will be plug in play with the others that are also certified.

Margaret Flinter: Well that is incredibly exciting and I think consumers who are
listening recognize that as the holy grail may be from a consumer perspective.
I’d like to stay with the consumer perspective for a minute around the meaningful
use of electronic health records, I thought that phrase meaningfully used was so
well named, you recently wrote a black post about the arrival of meaningful use
2.0 so tell us what does that mean to consumers and maybe some good
examples of that for our listeners.

David Whitlinger: Sure, so the meaningful use program is how the federal
government is determined how its going to allocate the resources, the financial
resources and reimburse the physician community for the purchase and usage of
electronic health record systems. And it comes in three stages and those stages
they don’t just give the clinical community money or purchasing an electronic
health record system. The clinical community has “use it meaningfully” or
meaningful use and there are some dozens of measures that prove that the
clinician is using the system to improve quality, to improve the efficiency and
overall health care experience. What’s notable and meaningful use stage two
that’s the federal government thankfully included a lot of measures that have to
do with patient engagements and being able to provide the patient with their
record in an electronic form, and being able to start to interact in a much more
useful way with the patient and their health information. Largely promoting
transparency you’re starting to promote more transparency in the health care
system in a whole. You can may be roll back what’s been a dozen years to when
the digital photography era was just starting to do be on the cusp of a consumer
engagement and the publishing of different file format standards, and different
standards for exchanging digital photographs really made that explode with low
price cameras and the ability to share photos on collaborative website with all
based on standards that exist in the consumer experience that was enabled
because of it. We are looking at the edge of that right now.

Mark Masselli: We’re speaking today with David Whitlinger, executive director of
the New York eHealth Collaborative, a non profit organization founded by a
consortium of health care leaders working to improve health care for all New York
residents through health information technology. He holds leadership roles in
many standards organization throughout the world including Bluetooth. David
let’s pull the thread a little on standards and you’ve worked a lot in that field tell
us why they’re so important from the consumer point of view. How do consumers
translate the standards that you all are setting up?

David Whitlinger: You know the work that we’re doing right now is deeper into
the industry and it’s really based on trying to get the software systems to be
interoperable to enable the clinical community to exchange records. Now we’re
really seeing some deep engagement both in the vendor community and in the
provider community that are driving the necessity for interoperability and
therefore the ability for these different software, hardware systems to really work
well with each other in a plug and play. So that’s great. You know we’re seeing
that market drivers are now aligning for us to drive on interoperability and
fortunately this isn’t rocket science so to speak, these kinds of data
interoperability problems have been solved countless industries over health care
has some other twists and nuances but its not completely (16:08 inaudible) to
be able to do this kind of interoperability. And where we see this heading though
is very rapidly being able to arrive on a set of data standards as well as protocols
where interoperability that’s ultimately will bleed over to consumer products,
consumer services and enabling patient engagement at a much, much greater

level. We’re looking forward to all of these smartphones having apps, all of the
social networking sites, that have platforms and app communities being able to
really engage, they have already in the consumer side now with the health care
side and solving some really complex health care issues that haven’t really been
able to tackled in the past.

Margaret Flinter: Well David we’ve had this sort of real time opportunity very
recently here on the Eastern seaboard of hurricane Sandy and I was struck
during some of the news footage of the images of neonatal intensive care unit
nurses carrying primary newborns down the dark stairs to ambulances and
relocating them to other hospitals and I would imagine as the leader of your non-
profit organization devoted to improving health care through technology that
doing your own analysis of where the state of electronic health technology is
working and where its falling short as we look at our ability to manage during
disasters like this is and I wonder if you’d like to comment on what you’re thinking
is as you analyze this most recent natural disaster and the impact its had on
people’s health records.

David Whitlinger: You know I did have opportunity a couple of years ago to be
also involved in the Katrina crisis and just in context for the most part new
Orleans wasn’t different than any other U.S city in that most of the health records
were on paper. And they were physical located in the physician practices or
hospitals. And but unfortunately millions and millions of records were destroyed
just by the natural disaster itself. And on the other side of that patients who many
had many complex conditions diabetics with congestive heart diseases and on
top of that dozens of medications. Physicians in the clinical community had to
start from scratch with those patient, it was very hard on the patient community of
course. Now here we are several years later we have the ability to look at 78%
of the hospitals in New York are connected to the state-wide network and
therefore naturally through that connection have an amount of redundancy in the
patients’ data that they, they’re stored.

Mark Masselli: David we would like to ask all of our guests this final question
when you look around the country in the world what do you see in terms of
innovation in health care technology that our listeners at Conversation should be
keeping an eye on?

David Whitlinger: You know I really think that at this stage we’re seeing that the
health care industry itself is going to braze health care IT for a number of reasons
and we’re going to see it go through the traditional adoption curve as an industry
and that’s all going to as remarkable efficiencies in quality of care improvement.
But where I think the innovation is going to really start to occur in patient
engagement is that as we now have the ability to engage with patients through
smart phones and social media and other actions. Those kinds of things are now
going to merge and marry to the health care community and the clinical
community. And I am very, very hopeful that between personal consumer

devices and that health care community we’re really going to start to get on top of
which is sort of the next major crisis, the chronic disease way. The chronic
disease at its heart is about behavioral change and people taking better care of
themselves being able to make the behavioral adjustments in your lifestyle that,
support a healthier life, and I am really starting to see signs of that engagements
through smartphones and social media and health care community responding.

Margaret Flinter: We’d been speaking today with David Whitlinger, Executive
Director of the New York eHealth Collaborative, a non profit organization of
health care leader seeking to improve health care through health information
technology. You can learn more about the organization and Mr. Whitlinger’s work
by going to www.nyehealth.org . David, thank you so much for joining us on
Conversations on Health Care today.

David Whitlinger: Thank you very much for your time

Mark Masselli: At Conversations on Health Care, we want our audience to be
truly in the know when it comes to the facts about health care reform and policy.
Lori Robertson is an award-winning journalist and managing editor of
FactCheck.org, a non-partisan, non-profit consumer advocate for voters that aim
to reduce the level of deception in US politics. Lori, what have you got for us this
week?

Lori Robertson: Well Mark and Margaret, as you know the supreme court said
that the mandate penalty in the Affordable Care Act with a tax and that has
sparked a few misleading claims about the law. We noticed a new republican
talking point from several GOP law makers who claim that the congressional
budget office said 75% of the law’s taxes would be paid by families earning less
than a $120,000 a year. But that's not what the CBO said at all, instead it said
that 76% of those who would pay the penalty or tax for not having health
insurance would earn under that amount. They wouldn’t be paying 75% of all the
taxes in the law in fact they’re not even going to pay 75% of the mandate
penalties. That’s because the penalty increases with higher incomes. The CBO
estimated in the 2010 report that 3 million taxpayers who earn less than 500% of
the poverty level and that's a $120,000 for a family of four would pay an average
of $667 a year as a penalty for not having insurance. 900,000 taxpayers who
earn more than now would pay the penalty but they would pay an average of
$2,556. So don’t believe it if you hear this talking point about lower income
earners paying 75% of the large taxes. I am Lori Robertson, Managing Editor of
FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the
country’s major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you would like
checked email us at www.chcradio.com. We will have FactCheck.org’s Lori
Robertson check it out for you here on Conversations on Health Care.

Mark Masselli: Each week Conversations highlights a bright idea about how to
make wellness a part of our communities and everyday lives. America is aging
and along with that fact managing more and more chronic diseases. Well many
of these illnesses are manageable outside the clinical setting. Some put patients
at higher risk for medical emergencies while conducting the business of their
lives, inventor sees our Camacho thought why not make a bracelet that can be
comfortably worn with a portable software program and USB plug that can be
used to input all the essential medical data into any computer. He developed the
care of medical history bracelet on which a patient’s medical data is stored,
things like blood type chronic illness descriptions medications, emergency
contacts even copies of x-ray images or CAT scans.

David Whitlinger: So you have a general information about yourself like
insurance policies your telephone numbers and addresses for all your doctors
emergency contacts all your surgeries your immunizations any medical devices
that you may use.

Mark Masselli: The care medical history bracelet can also store other vital
information if the patient is having a medical crisis or can’t speak for themselves.

David Whitlinger: You know its important to have the right information at the right
time and you know nowadays as you know we’ve got the best doctors in the
world the best physicians but they are only as good as the information that you
provide them.

Mark Masselli: And there is added benefit for those with disabling diseases like
essential tremors where it can be difficult for a patient to write on medical forms
or speak about their conditions to a medical professional. The care medical
bracelet also has been programmed to process data from brail text and currently
comes in bi-lingual versions both in English and Spanish, a simple variable USB
device that can offer critical medical information for patients who are unable to
speak for themselves assisting medical professionals coming to their aid in a
crisis. Now that's a bright idea.

Margaret Flinter: This is Conversations on Health Care, I am Margaret Flinter.

Mark Masselli: And I am Mark Masselli, peace and health.

Conversations on Health Care, broadcast from the campus of WESU at
Wesleyan University, streaming live at www.wesufm.org, and brought to you by
the Community Health Center.