Interoperability Without the Theater: With Brendan Keeler

Therasa Bell (: 00:02

Welcome back everybody. I am super excited to be back on the Kno2fy podcast after a little bit of a hiatus. Everybody knows there's a lot going on in the industry. I've been excited to reconvene. I am honored to be next to some of the coolest people. If there is such a thing in interoperability, are there cool people in interoperability? But I'm honored. No, I don't think so either.

Honored to be surrounded by two co-hosts that live, breathe, are closest to the beats, I'd say, of interoperability. course, Brendan Keeler. I feel like I need about five minutes for his introduction. So bear with me as I go through some of the great things that he's done in his past and what he's doing to really lead the charge. Definitely a change maker, I would say, in interoperability. And we are super honored to have you here, Brendan. So thank you for that. But as everybody knows he leads the interoperability practice at HTD Health.

where he provides both executive partnership and subject matter expertise for all projects that within HTD Health that relate to health information exchange and everything interoperability. Prior to that, as you guys know, he's been in some really cool companies, including Flexpa, Zeus Health, Redox, Epic. In fact, these are all partners of Kno2, so really honored to have him here. He's also been a changemaker for virtual care and digital health startups such as Elion Health, Revero Health, RevelAi Health.

Am I saying that right? Revel AI health. Let me get that right. And vitalized care. and he writes the Health API Guide newsletter with everything around data standards and regulatory changes, which I think, basically everybody in healthcare follows. So welcome Brendan and love having you here. Thank you for joining us. And then of course I am, have my cohost here, Matt Becker, who is the senior vice president for no two. We are honored to have him for, interoperability and public policy.

and be able to share some of his background and experience. He has a long history now, is it about 50 years, in interoperability? Is that roughly what you're at? Yeah, about 50 years, no, 20 years in interoperability. Comes from a payer before us and of course spent a long stint at Epic and today leads on a national stage level for interoperability policy across multiple national networks. So honored to have you also, Matt, as my co-host.

Matt Becker (: 01:59

It seems like it.

Therasa Bell (: 02:19

And then I am Therasa Bell. I am the president and founder of Kno2 and thrilled to be here. So thank you. And with that, Whitney, I will hand this to you.

Whitney (: 02:26

All right. We got a lot to cover today. so Brendan, I'm going to come to you first and we'll start off with a question. and we'll see where this conversation goes. You have written extensively in the past about the gap between what vendors claim is interoperability and what actually works in production. So a lot of us, I think almost everybody in this podcast today are about to walk into HIMSS and there's going be a whole lot of solutions there that are claiming that they have solved interoperability.

Where should we be skeptical? What can we believe? Like, just give us your take.

Brendan Keeler (: 02:59

My take, and even though my title literally has interoperability in it, is that interoperability is bull**** Like it is a superset of twelve or a hundred different problems that have varying levels of solvedness, right? Clinical data exchange between providers is different than clinical data exchange between payer and provider is different than EHR integration is different than e-prescribing is different than claim submission. And if you think about every workflow between entities,

How digital is it? it ubiquitously digital or are we still doing SMS, fax, phone call, carrier pigeon? Like that is the measure. And when you break it apart, you look at each of those vendors, say, which sliver are you trying to solve? And is it actually being solved? Because networks are hard to build. Building network based product, which most interoperability products play into either existing networks or purport to create new networks.

Creating that to ubiquity is the hardest tech problem because it's not a tech problem. It's a B2B building brick by brick, the connection between different businesses and establishing the favorite word of the Interoperability Community Trust. And I think that that's challenging. And so it gets very cluttered. When people come to HTD, say, does Kno2 compete with Redox, compete with DrFirst? And I'm like, wow, you got to...

You got to disentangle it think about the problems to be solved before you can figure out the right tools and whether they're actually truthful in what they're promising or it is ,you know, snake oil.

Whitney (: 04:39

think that's a really great point, Matt, Therasa, any reactions?

You're muted, Trace.

Therasa Bell (: 04:48

I could jump on many things that Brendan just said and totally agree. It's funny when people use the word one healthcare, I always say which part of healthcare because healthcare is a really wide definition and thus you have a wide set of needs that need to be covered. And when people say interoperability, I say which part. And interoperability in itself, there's multiple aspects to it. And I'll say for our company, when we started it,

What we took on was one part of the formula for interoperability, which was connectivity at scale. I mean, Brendan hit on our key to our value prop is we have all of these different ways in which information can be exchanged. So if it's from, I always say from fax to fire or carrier pigeon to fire, whatever you want to call it, it's you have a unique set of different ways that information can be exchanged. And we have to tackle that and digit, digitize that.

and then you have all the other parts of the formula of interoperability to get to it at scale and it's hard. So I sit in these panels and I sit in conversations. And if I hear the ATM analogy one more time, I'm probably going to throw something, because it's not even close to the same analogy of what we're trying to accomplish, within healthcare. And I mean, you take the ATM analogy, not to minimize it, but you have a data set of zero to nine. That's what you're dealing with. And.

interoperability in itself in healthcare, with healthcare being so wide, it's a very, very hard equation, and there's lots to solve still. So when we go into things like interoperability without the theater, for me, that was a very important name, because that's what it's been historically is these grandiose statements of we've solved it, when it's factually incorrect on multiple levels, and we have to be really careful with that. So

It was really important for us for what we're doing here upcoming, which I know you're going to get into Whitney, to make sure that what we're presenting at the HIMSS Showcase is real and it's real and available and on the street. Is it perfect? No. And we're going to be the first one to say it, but perfection can't override the need for progress and interoperability. And that's really what we're focused to.

Whitney (: 07:05

So let's go back for a minute. You mentioned when you found a no-to back in 2014, do I have the right year? What problem, so you were trying to solve connectivity. How were you trying to solve it? How did you approach it differently? Cause I think you took a little bit different angle and I think that plays into the conversation today. Like how does it look, how does Kno2 look today versus like maybe what other definitions of interoperability are.

Therasa Bell (: 07:11

You do?

Therasa Bell (: 07:29

Well, I'd say there's multiple parts to what we did differently. And that's why it's probably been such a long haul for us for, you know, 2014, because many of the interoperability companies have started in 2018, 2019, maybe something that came out of the emergence of COVID. They saw this opportunity. We started a long time ago with a very specific path. Like I said, we narrowed our scope to connectivity being what we would solve for at least initially.

fundamentally in the product set. So connecting everywhere, taking on that heavy lift of connecting everywhere, instead of trying to hitch our way into one standard or one protocol or one network, made, I say we made network of networks a thing before networks of networks was the, you know, the buzzword five years, almost six years before it was the kind of the buzz phrase. And now that's kind of dying too, but we made network of networks a thing, adding in all the connectivity and all the common ways in which

clinical information could be exchanged. We would make that available. Simplicity was the name of the game. So keeping our focus simple, keeping our layer of an API, single API layer for all forms of exchange so a technology vendor could connect once and communicate everywhere. That vision has never changed and we've never steered course from that. And then the last part was the business side. So when we went after...

I always say everybody was going after the deep pockets of healthcare. So they were going after the health systems. They were going after the physician offices where all the money from meaningful use was being pushed into. actually chose to go to the other direction. you know, imagine having that conversation with your board. It's like, no, we're not going to actually go where the money's at. We're going to go the other direction and you know, hope we make it. We went the other direction because I knew to solve the connectivity part of the formula of interoperability, it was going to require the parties that couldn't

they weren't on the internet. always say we're bringing healthcare on the internet. They weren't on the internet at the time that our business development methods had to go after those parts of the market and get them connected to the platform and get connected to the rest of healthcare. What that demanded is that we kept again, simplicity in how they connected because they couldn't even spell the word interoperability at the time. They had no interoperability practice. didn't exist. It didn't matter to them. They didn't have the stimulus for it.

Therasa Bell (: 09:49

But we needed it to matter to them in the future. So making sure we met them where they were at and then brought them forward. But then also our economics. So maintaining and this still drives the company today, maintaining a business where we have operating margins that allow us to keep our costs at a point price point that they can afford. So when I when we go after that, you know, therapists, physical therapists that works part time in the strip mall and needs to pay $12 a month for interoperability are

Matt Becker (: 10:10

Hmm

Therasa Bell (: 10:19

structure, operational structure and our costs allow us to do that all the way up to the health systems and now the payers. But that model has proved to be some of the best choices we made. It was very, very hard as a company to do that. I would say there are many years where I questioned myself. I questioned what we were doing. Was it the right thing? But we did it. And it's the right, it was absolutely proving to be the right thing today where these markets trying to get patients out of the most acute, most expensive parts of the healthcare.

and get them into these post acute settings, getting them back to home, getting them virtual care. All of that has been a precursor to what we did here as we built the company. So super excited about where we sit today and again about the conversation today.

Brendan Keeler (: 11:04

And I just want to jump in here. Like the reason I like Kno2 and is the promise of this type of company, the on-ramp to Carequality, TEFCA, these networks was to extend to the non-certified EHRs, the EHRs where it was sticky and challenging that lacked resources and to understand and parse both the technology of connected to networks, also the

governance and things like that. Like they still don't have any resources, right? They're like a 10 man company or something. Like that is who you've gone after to say, hey, we're going to extend to this long tail. And that was kind of the initial intent of CommonWell connectors and other of these roles to allow to on ramp and find innovative ways to meet the rules of the network, make it, you know, tailor it for particular niches that would otherwise never join.

Matt Becker (: 11:47

Mm-hmm.

Brendan Keeler (: 11:59

and contribute to the longitudinal record. And many other groups targeted business associates within already saturated organizations. think there's nothing wrong with that per se, but the value to the overall longitudinal record to extending to parts of the care journey that are under addressed and actually probably need interoperability most, but have less and less financial resources or reason to do it. Like that's the cool thing. And you're not alone. You're not the only on ramp that said that, but one of the few.

one the most successful in relentlessly pursuing that pattern. So pat yourself, you guys on the back, I'll pat you on the back. it's, it is what was intended. And that's why I find it very exciting to see you continue to do EMS, do assisted living, do these care settings that, you know, otherwise might just sit out of the loop.

Therasa Bell (: 12:36

Ha

Matt Becker (: 12:50

Yeah, and you have to have that focus. And I appreciate the fact that Therasa and Kno2's vision has had that focus from the very beginning, to your point, Brendan. And it really is because of the fact that it's not just the long tail, and these folks just don't have the money to do

Matt Becker (: 13:05

It's the fact that this entire system wasn't built for these folks. It was built out of a need for major hospital systems and major health systems to connect to each other. And then we kind of got the, I don't want to say the scraps, but we got the results of that without thinking of what happens when your parent goes to a nursing home and that becomes their address for three months and things like that. So it has been a challenge, but I think the focus.

of making sure that everybody's included has permeated thanks to Therasa's leadership and some of the Kno2 vision to make sure that these folks are included and it's just kind of reflected in policy today, which I have appreciated being on board here.

Therasa Bell (: 13:50

I'd say one of the, I spent a lot of time reflecting on the impact of making these decisions. In fact, it's a daily exercise for me of making the decisions to stay the course, even in some of the most difficult times, especially during COVID, I would say that the impact it's had on the company. And I would say one of the,

Whitney (: 13:50

So Matt, go ahead, Trace, I'll come back to you Matt in a second.

Therasa Bell (: 14:17

strongest impacts is the humility it's let us maintain. Because we have these organizations that while Epic, and this is, you'll hear me say it a lot, Epic has had two decades to build out their interoperability practice. it's, Brendan started out with saying, this is less about technology. Technology is the easy part of interoperability. But they've had two decades to build out their interoperability practice, including all their privacy.

including the technology, including the workflows, including educating their users, including legal, all of these things that take a lot of time. Now we get to ride the wave of that and a lot of the learnings, but bringing that to an industry or a series of industries, whether it's post-acute therapies, behavioral, dental, vision, EMS, virtual care, mean, there's...

There's a lot of humility that's required by both parties to go into it and say, hey, this is what things look like today. And we're to have to lock arms here and push forward to get to the other side quickly. And a lot of trust that, to use the word trust, that's way overused right now. A lot of trust that these vendors have placed in Kno2 to say, we're going to trust you to kind of guide our future here and take us to that other side because...

They finally have all the market headwinds and tailwinds saying you have to do this. And they've got to get there fast. So it's really changed who the company is and how we operate changed or kept us probably pretty different than the rest of the industry. And I think it stands out a lot in the rest of the industry. We're a little bit of a mystery to I'd say the rest of the industry. I felt I'm proud of that. But I think often we are a little bit of a mystery on who we are and what we do. We're going off course there, aren't we, You weren't expecting all these topics.

Whitney (: 16:00

I'll bring us back. So Matt, my question for you is, like Therasa had mentioned at the beginning, you've worked in interoperability for 50 years. I think that's what she said. That's what I'm going with. 50 years. And you've worked at different companies who have been trying to make interoperability work. So walk us through what it looks like when, what separates vendors who are doing the work, the actual work of connecting providers and patients.

Matt Becker (: 16:01

You

Therasa Bell (: 16:04

Right.

Matt Becker (: 16:12

Yeah, it's about that.

Therasa Bell (: 16:13

Close, give or take.

Whitney (: 16:29

um, from the vendors who are just doing the marketing. And I'm curious on Brendan's perspective too, but Matt, we'll come to you first and then Brendan, you can answer this question too.

Matt Becker (: 16:37

Yeah, I think the separation is just in the details of what's happening. The actual work is not glamorous. I remember we did the first Carequality connection at Epic. was from Sutter Health to eClinicalWorks was the first exchange that actually happened. I remember sitting in the basement of the barn at Epic with a couple of experts on the phone with eClinicalWorks for hours. I think it was a Friday night, the barn, the basement of the barn, know, just pure Epic style.

Therasa Bell (: 16:59

The barn, Matt? The basement of the barn, okay.

Matt Becker (: 17:06

with a couple of experts and essentially eClinicalWorks on the phone until eight at night on a Friday trying to get this thing to work. And it's not easy. It's not something that just turns on by a switch at the end of the day, especially when you're in the early stages of the thing. And I think the companies that really separate themselves are the ones that are really the dive in, get dirty, get in the details, and actually drive outcomes.

Matt Becker (: 17:28

At the end of the day, it's about making sure that not only is the patient data getting from place to place, that it's doing it at scale, that it's doing it in a place in a way that providers can easily act on it. All of the things that we talk about are really hard to do, and it takes a concentration of doing the next thing and doing it really well. And at the end of the day, there's the companies that can...

can bite off more than they can chew in terms of saying, we're going to connect everybody and we have the technology to do that. To Therasa's point, the technology is only maybe 10% of it. It really is the grit and the grime of making sure that you're doing the work and you're engaging folks and getting that data where it needs to be in the right format or else you're going to fail. And it's building on top of your successes too. And so...

One thing leads to another in terms of, we got this data to go. Now we have to make sure the data is usable. Now we have to make sure it's in the right workflow. All of those things are incremental steps and they're not glamorous. And so making sure that you have a company and just a focus on the things that actually matter are what I think have been the keys to actually making this successful over the last decade or two.

Brendan Keeler (: 18:44

I'll jump in here. mean, totally, totally. It's not sexy. It's not, it's never been sexy. It's slow, right? Like network building and things like that take time where you can go build now, even, even in the tech enabled care business boom, you can go build that and then like raise a bunch of money in like two years and like, great building these things, building relationships between entities is inherently not a tech problem. It's a social.

parasocial problem. And that means the time horizon is like maybe not even venture capital, you know, sized. It just takes time to build networks, to build, to try and do the hard stuff. And so in this, especially now in this AI era where there's so much capital and so much interest towards solutions that can go skyrocket, like network-based businesses don't, and AI doesn't actually solve for them. And so

What I find super interesting is it's actually getting harder, not easier to go and do that, that work because there's so much capital and interest towards the skyrocket point solutions that really don't have legs long-term versus network based built businesses that need to be built brick by brick have more long-term value by doing so, but may struggle to find capital and things like that because, because of the comparisons, the relative comparisons in

the very short site of venture capital firms. so like for the businesses that choose to do that, it is very sustainable long-term and is hard and not sexy, but you know, you're building capabilities that just weren't there before referrals between counterparties, know, clinical data exchange between new entity types. That is awesome. And AI solutions can't go knock down the door to make a network.

Therasa Bell (: 20:39

Thanks

Brendan Keeler (: 20:40

So they will be drawn towards existing networks, send a lot more volume towards existing networks and network-based products. But, you know, like we're not, it's not gonna get necessarily any easier in this next era. It only might get harder. And so the utmost respect and support for you and for everyone that pursues that relentlessly, rather than being drawn like a moth to the flame of the easy ways, the easy patterns out to make a buck.

Therasa Bell (: 21:09

I'd say it's like Brendan has either wrote our book or read our book in terms of the definition of who this company has become to come back to the statements around interoperability is hard. The industry in many cases justified the industry is kind of over it. Like why haven't we made more progress? Where are at? And we hear that all the time. And a lot of that's driven just by consumerism and now AI is that we have like the attention span of a guppy.

And we can't push fast enough. But we know in this network build, like I won't let our company be called a software company. I won't. For a long time, I wouldn't let us actually become a network because unless you're two-sided, you're not really one. We were a network aggregator. But we were going through these evolutions of the company. It is brick by brick. And we have maintained that. And it's been hard. And like you said, finding even capital for it. Yeah, I'd be the first one to say.

for a number of years that was really, really difficult because people didn't see the vision. They didn't understand. It's like, well, how hard is it? How hard is it to solve interoperability? And what do you do semantic interoperability? Or do you do this, you do that, and you try to tell them what you're focused to. You couldn't keep their attention, but now all of sudden, those tides have changed. And infrastructure play, which is what we've always been, we are infrastructure. Nothing succeeds without infrastructure.

And it's the least sexy part of the equation. Nobody wants to be the plumber. Well, now everybody wants to be a plumber and electrician, but nobody wants to be that. Right. And I've always said, Hey guys, we're, we're the blue collar. Just deal with it. It's good. Stay, stay the course because it will happen. And here we are. We sit there and it's happening for sure.

Whitney (: 22:53

So I want to shift the conversation a bit to focus on HIMSS Matt, I'm coming to you. At HIMSS, we are going to be demonstrating a patient journey starting at the PCP, moving to specialist, hospital, post-acute care therapies, walk us through what it looks like when the data flows seamlessly.

Matt Becker (: 23:15

When the data flows seamlessly in an ideal state, it's invisible to the provider, but the provider sees the benefit of it. And so understanding from beginning to end the fact that you can go from a major health system, you can go to the emergency department, to a specialist, to long-term post-acute care, to home health, to all these things. And the fact that the patient will not have to deal with the adage of carrying a stack of records with them.

But at the same time, having those providers be able to do their job in a way that is meaningful right from the get go, right when they open their application, they understand everything they need to know about this patient, they can actually take care of the patient no matter what kind of provider they are and what kind of, what part of the journey they're serving in. And at the end of the day, making sure that all of that data, not just some of it, not just from the hospital system makes it back to the patient.

years now since: 2014

piece by piece to make sure that all of this is working and the fact that it can work and it can work at scale and it can work where you don't have to look up a phone number to dial for a fax or something like that is going to be critical to the future of healthcare in this country. And I'm really excited to show people the promise of it working and trying to get folks on board with make sure you're connected, make sure you're doing this because it's going to only serve our providers and patients going forward.

Therasa Bell (: 25:07

say when as Matt and Whitney has been the I'll say victim probably victim of T Bell saying you know what and no offense to HIMSS i said i'm not doing another him's interoperability showcase it is like i can't do it i cannot bring my soul to do it unless it's going to be my way and and so i said no we're going to decline it not to sound like i'm being bossy here but i said we're going to decline it we had the opportunity to negotiate with HIMSS, thank goodness, and do it our way

Right. So they came back and said, okay, tell us your way. What is your way? And I said, we're going to, there's a series of requirements that, that we have for a kind of a mini showcase within a showcase is first of all, it's not, it's going to be a, a common use case, one that we see everywhere. So a patient with, you know, a couple of comorbidities diabetes has to be one baseline, Two: an age, so somebody over 65. So let's deal with, with a real situation here. it has to be every care setting.

as Matt touched on, that's outside of acute. And of course we need acute in there, but every care setting outside of acute, again, represent a person over 65 in an assisted living facility that has these conditions, but also sees other providers. And they have to use standards-based communication, multiple standards that have already been established. That has to be a requirement. So these vendors can't be doing some jerry-rigged thing behind the scenes. It has to be in product.

live in production using, I don't care if it's direct messaging, if it's 360x, Carequality, TEFCA, combination of all, which it ends up being a combination of all to accomplish exchange at scale. If a vendor couldn't support that, they couldn't participate. That was a fundamental requirement. And to get to that is exactly where we've landed and it was awesome.

And it's been hard, right? So we're working through this. Matt had said it's not, you know, it's not a light switch. It's a dimmer switch for sure. But these vendors all attested to that and Epic threw their name in the hat, eCW threw their name in the hat. We have NextGen, some of the leaders saying, this is really cool. Let's do it and let's bring it together. And we're super excited about that. And it's real. These vendors have come forward with production live ready systems.

Therasa Bell (: 27:25

that we're bringing together and showing interoperability in the different use cases of both push-based, 360x being able to close the loop on transactions, query-based, population health management, a patient, individual access, a payer participating. We have a big announcement as we know related to a payer. It is what has been 12 years of effort to show it, but those were our kind of rules of the road. And if you couldn't meet it, sorry, you couldn't participate.

And here we sit, so really excited about it and what we're doing.

Whitney (: 28:00

Brendan, you have evaluated a lot of solutions when you see a demo either at HIMSS or elsewhere like this data flowing across the continuum. How do you tell whether it's real or staged? Kind of what's your evaluation criteria?

Brendan Keeler (: 28:13

man, it's like trying to read AI now and be like, "is this real?" I mean, look, I take most demos at face value of like, they made something. I care about ubiquity and everything. So I see- one, I trust Kno2, but I've been looking at 360X for a long time and I, since 2017 or something like that. And I'm like, when are we going to scale this puppy up? And so I'm excited by the participants in this.

I'm excited by the interest in referrals and I think there's appetite for it now as we've, as we move between interoperability problems. And I'm like, let's get everybody on board. Let's get school nurses on board. Let's get, you know, behavioral health, like simple practice over here. Let's have some regulatory backing for 360X, even though it truly is one of the most gross standards of all time when you stare deeply at its innards. but that's why.

It's so impressive that there's this demo that is going to really show between not the same vendor being like, "Oh look, we sent to ourselves" or, "Oh look us in a counterparty" but multiple counterparties doing it deeply embedded in their software. I hope there's mistakes because that's a good sign of a real demo. I hope there's like a little oopsie or something because when there's no oopsies, that's when you know it's fake.

Therasa Bell (: 29:37

Put that voodoo on us, Brendan. What is that? What is that?

Matt Becker (: 29:38

I know. I agree with you and hate it at the same time.

Brendan Keeler (: 29:38

I... well then everyone will love it! Recovery from the oopsie. That is the sign of true demo.

Therasa Bell (: 29:43

Yeah.

Whitney (: 29:51

Alright, as folks are walking the HIMSS floor, let's give them a toolkit then for how to evaluate what they're looking at. So I want you this is a question for all three of you. You can answer. Well, I'll start with Brendan and then we'll go to Matt and Trace it. So what are three and if you don't have 3, 5, 1, I don't care. But what are some questions that a person should ask every vendor that's claiming they do interoperability?

Brendan Keeler (: 30:16

First, I would just say like, okay, but which part? Like which problem are you solving or problems, right? Maybe they're doing multiple, but are you doing clinical data exchange? Are you doing EHR integration? Are you doing e-prescribing? Are you doing clinical trials exchange, know, surface it in workflow or something? There are infinite problems. As soon as we solve clinical data exchange, we move to referrals. As soon as we solve referrals, we're gonna move to diagnostic image exchange like that RFI that the government has out now.

And on and on, there are infinite workflows that are analog that need to be digitized that are in this superset. So the critical question is like, okay, but what are you actually doing? Go one level deeper and then you can ask them, well, can you do it with everybody? Is it already set up? Is it ubiquitous? Does it take, is it point to point? Like you need, you need to know the ubiquity of what they're promising when it's a network based.

you know, a network based exchange, because if you have to go set up with your counterparties, that's a very different equation than this is ready to rock via an existing network, existing connectivity, existing trust frameworks, things like that. So it's just important to, neither is wrong, right? Like it can be very valuable to set up point to point with your counterparties for referrals or something like that, or whatever it might be. But you should know the work ahead of you and you should know the implementation effort.

that stands between you and the promise of the outcome, just like any product. This is not unique to interoperability or connectivity. It's a functional question you should ask any SaaS vendor when you're buying their cool SMS patient outreach solution or something. Those are my two, right? What are you actually doing and is it ubiquitous? And then you can get details around like, what is the modalities, an API, is it UI, what's the cost, all of the actual buying inputs. And if you ever need

assistance, there's probably consultancies that can help you distill between those things. But not to hype anything, all to say that those buying decisions are downstream of is the problem actually gonna be solved and what's in between me and the value proposition that's promised.

Therasa Bell (: 32:18

Thank

Whitney (: 32:29

Yeah, great answer, Matt. Anything to add? Any questions you would add?

Matt Becker (: 32:33

So I think for me it starts with what are your outcomes? You mean you're gonna advertise so many different things at the end of the day like what have you actually done and what have you actually proven to improve patient care? That's it for me and if they start talking about technology, I'm probably already out of the conversation. It really is how do you bring people together to solve a real-world problem and if they don't have exact answers to those questions and they've been around for a while I immediately become

suspicious. The second piece for me is just what are you doing next? What are the next two or three things that you're focused on? And the reason I asked that question is to extract where their their mind is business-wise. If they're working on the really hard problems that they say things like, "Hey we're working on making sure data quality from from the groups that are contributing is is peak and we're making sure that it's

entirely formatted and ingestible by systems" that's fantastic. If they're focused on, "we're going to solve prior authorization" that is a little bit of a yellow red flag for me in terms of, we're trying to attack the thing that's going to make us money next. And so there's definitely room for gray in between all of that. And definitely solving prior authorization would be really incredible for healthcare. But at the same time, I don't...

I would want to make sure that they're not focused on the golden apples of what's new and shiny and can drive marketing and sales kind of going forward, but actually solving real world problems. If they have a great answer for how they're solving prior authorization and scale, that's one thing. But at the same time, trying to attack the really hard problems that I've been trying to solve for ages and claiming they have an easy answer to it would be a really big red flag for me in that process. So those would be my two.

Brendan Keeler (: 34:26

I think scale is ubiquity. Have you solved it at scale is implicitly that aspect of ubiquity. They can have a very novel Da Vinci powered tool that they've built, but they haven't actually wired it up to all the payers or used a validity or something like that. They haven't actually done the work to reach network scale and ubiquity. That is why it's so important to understand is this a...

Matt Becker (: 34:31

Good point, yeah.

Brendan Keeler (: 34:55

Is this something that's point to point that I could do with counterparties versus have you scaled this puppy up? And so totally agree with you there, Matt.

Therasa Bell (: 35:05

think Whitney from, I wouldn't say much different than what Matt and Brendan had said, other than I'd probably ask what the business model is. So tell me what your business model is, because I can discern a lot. If they're- Kno2 is a very simple subscription, communication subscription model, right? So much like the mobile industry, I get all my goods in one, right? One, I pay one fee for unlimited data. Many of them will be, you know, either by connection, by...

per member per month, right? There's just different models and it tells me what they're focused on, what they care about. And then I know what kind of company they are. So interoperability is such a wide word as we started out the conversation. Then I know exactly the next series of questions to ask, including scale, including longevity. And then the last one I'd probably end with is how does AI factor into the equation for you?

because we get asked that all the time and because most people don't know what they're saying when they asked about it. But how does AI factor into either into alongside adjacent into what you guys are doing? And it tells me what I need to know about who the vendor is, their longevity and what's happening. And you know, probably how long they'll be here or, and maybe they made the- Well, not to be arrogant, but maybe, maybe not based upon those, those answers that they give.

Brendan Keeler (: 36:23

I don't think it's arrogant. I said it facetiously, but we help with lot of bake-offs for interoperability, health information exchange, for EHR integration. have 11 factors that funnel into that decision-making process. and reputation is one of them. The perceived reputation, which is actually derivative of how long have been around, how many people do they have, are they involved in active lawsuits. There's inputs into that that are weighted differently by different buyers.

You know, people imagine there's one right solution for any, or- one right tool for any problem that is false because every business is different. So they're buying inputs are different and something that is very valuable or very important to one buyer is completely different. And so, but you're a hundred percent right. Like we hear that all the time. And sometimes people go, "that doesn't really matter that much" But when I know, and sometimes people say "our reputation matters a ton" or "We need this business to be around in 10 years. It is our number one priority" Like those.

those are sometimes buying prerogatives and sometimes they're not. And so you're right to highlight it that brand reputation, risk tolerance and bendiness with rules, like those are actually real things to measure and understand about, you know, based on what you're looking for.

Therasa Bell (: 37:42

Yeah, I agree.

Whitney (: 37:45

All right, moving into a little game. I don't know if you can call it a game, but we're gonna do a lightning round. So I'm gonna ask each one of you a different question and then you have to answer in one sentence each. That might be hard. You can't expound on it one sentence and then we'll wrap up this episode for today. So Brendan, coming to you right away. What is one thing that tells you immediately that a vendor is doing theater or it feels staged?

Brendan Keeler (: 38:15

If I ask them about that ubiquity question and they say, "Oh yeah, it works with everyone." You're full of **** Like, that's it.

Therasa Bell (: 38:26

you

Whitney (: 38:26

Good one, good one. Okay, Matt, what's one thing you're excited to show people at our HIMSS demo?

Matt Becker (: 38:33

that it all works together, that no matter where you go, the patient can be taken care of and can be taken care of with their full data set and their full chart.

Whitney (: 38:44

and then Therasa, what is one thing you want listeners to remember about real interoperability?

Therasa Bell (: 38:51

reset your expectations, it's really hard.

Whitney (: 38:55

Good answers, everyone. Those were all good. All right, so if you're going to HIMSS, come by booth 12720 and see for yourself. It's going to be a who's who of interoperability demonstrating real data exchange. There's not going to be theater. There's not going to be vaporware. It's just the complete care continuum connected. You can schedule a meeting ahead of time with us on site, and we'll show you exactly where your data flow breaks down and how to fix it. We'll see you next week.

Whitney (: 39:24

All right.

Whitney (: 39:28

The last little ending are the questions.

Whitney (: 39:34

Okay, I will record that. Can I record that at the end? Yeah.

Whitney (: 39:44

Yeah. No.

Therasa Bell (: 39:47

Okay.

Sure.

Whitney (: 39:50

Sure, everybody say bye.

Matt Becker (: 39:52

Yeah, give me 30 seconds here. I'm going to reset my entire internet just because I was worried about Justice.

Brendan Keeler (: 40:07

Hey, I'll be at HIMSS too, so reach out. We'd love to see people.

Therasa Bell (: 40:09

Hahaha

Whitney (: 40:09

you

Therasa Bell (: 40:13

Tip your waitresses.

Brendan Keeler (: 40:14

Thank you so much for having me on everyone. It was great to chat.

Therasa Bell (: 40:18

Thank you, Brendan.

Whitney (: 40:19

Thanks for being here.