Interoperability is a key challenge both industry and Government are working to solve. One Atlanta-based health technology company is working to redefine how Healthcare information is shared among organizations and agencies. By developing and implementing cutting-edge, HIPAA-compliant technologies and optimal workflow at a massive scale, Ciox Health is streamlining the supply chain of medical records, health information and clinical documentation with a goal of advancing the industry by solving some of its most complex interoperability challenges.
Reaching across the U.S. Healthcare ecosystem, Ciox sources, acquires, enhances and delivers medical records and discrete clinical data from virtually anywhere in the country, touching more than 100 million patient records annually and managing clients with millions of annual requests for clinical data across a fragmented system.
Recently, FedHealthIT’s Executive Vice President, Susan Sharer, had the opportunity to sit down with Paul Roma, CEO of Ciox, and Mitch Mitchell, Senior Vice President, Government Solutions at Ciox, to discuss the challenges and the opportunities for solving for the last mile of interoperability.
Positive Disruption in Healthcare
The Healthcare business is changing rapidly including in the focus by Government and commercial providers on improving the way information is stored and shared across a fragmented health IT landscape.
Despite the widespread adoption of EMRs, Ciox CEO Paul Roma says there hasn’t been significant improvement over the past decade in our collective ability to source and acquire clinical content and pull insights from structured and unstructured data. Currently, data about patients is created and locked in silos, where it can’t be easily accessed and used by the patient or by those who serve that patient. It remains a challenge for stakeholders to share information, and intervention is required to facilitate that exchange. This can have a material impact across the ecosystem.
Because EMR incentives (HITECH, Meaningful Use/Promoting Interoperability, etc.) were designed to promote technology adoption, EMR technologies are foundationally designed to support intra-provider clinical and reimbursement workflows. While an explosion of digital clinical data followed EMR adoption, most of the rich clinical context of the patient-provider encounter remains trapped in unstructured free text and notes. Interoperability requirements have emerged but largely promote point-to-point data sharing or “passive interoperability.” This misalignment of objectives has created a “last mile” challenge preventing access to the benefits and true system interoperability.
“We aren’t sitting around waiting to see what the next technology is going to be to create the disruption needed, and we aren’t waiting for all things to be connected so that information flows without friction,” said Roma. “Instead, we’re stepping into the void to provide immediate access to critical, relevant information. What the industry needs right now is a true technology-enabled service that combines the best of technology and people.”
The Federal Connection
The Federal Government maintains an insatiable appetite for clinical information across numerous agencies and departments to serve a variety of use cases, according to Mitch Mitchell, Senior Vice President, Government Solutions. Ciox presents the opportunity for these Government stakeholders to leverage the pervasive access to rich clinical information that Ciox has established and optimized over many years working with the majority of U.S. hospitals, clinics and health IT vendors. Through the development and ongoing enhancement of a secure and complex technical infrastructure, coupled with proven workflow and processes, Ciox supports a massively scalable data acquisition and exchange capability that goes a long way to address the growing requirements that represent the last mile challenge of systemic clinical interoperability.
“There have been many achievements across the industry in leveraging IT and industry standards for health information exchange (HIE), but we’re not there yet and gaps remain. These are especially pronounced when it comes to unlocking the valuable clinical insights from unstructured data such as provider notes, subjective assessments and narratives within the chart. These insights are largely unavailable at scale through the current implementation of HIE methodologies, and are critical to meeting the current and future needs of patients and their families.”
Filling the gap and beginning to solve for the last mile of clinical interoperability, Ciox gains access to the larger network of care settings and accesses a more comprehensive clinical payload of information that may not be connected within an HIE infrastructure.
Tackling Complexity
The Defense Health Agency and Veterans Health Administration are examples of complex Healthcare systems relying on internal direct care resources and a large network of commercial hospitals, clinics and external providers to deliver care to beneficiaries. Roughly 60 percent of care delivered within the military health system is provided within the commercially-purchased care network. Maintaining seamless access to rich clinical content from those encounters can improve the overall patient experience and delivery of care while reducing costs.
While the Patient-Centered Community Care (PC3)/Veterans Choice programs have improved access and augment the care Veterans receive in VA facilities, the same needs exist to provide timely access to clinical data from those encounters around various use cases, including quality reporting, continuity of care and data validation and coding. Within the Veterans Benefits Administration, the initial determination of disability or eligibility for benefits is driven largely by the ability to access detailed clinical records and documentation from across the Healthcare ecosystem.
Beyond the DoD and VA
Many other departments and agencies within the Federal Government, including the Centers for Medicare & Medicaid Services (CMS), National Institutes of Health (NIH), Centers for Disease Control (CDC), Food and Drug Administration (FDA) and Social Security Administration (SSA), are also large consumers of comprehensive clinical information for a host of different use cases, including risk adjustment, data validation, fraud, waste and abuse prevention, quality reporting, clinical data abstraction, retrospective sentinel event analysis, clinical and basic research and disability benefit determination.
The SSA, for example, has a need for detailed medical record and clinical documentation to support the determination of impairments related to critical disability benefits. Ciox satisfies nearly 20 percent of the Agency’s total demand of 16-20 million records per year for related clinical data. The SSA is an example of a complex and distributed Government agency benefiting from access to comprehensive clinical information and unstructured data embedded within a clinical record.
“When we look at the NIH and its clinical research initiatives, we see an obvious opportunity to bring value by helping to unlock those hidden gems and insights within the record, perhaps from a note or observation that could lead a researcher to a faster conclusion or light the way in a new direction,” says Mitchell.
Connectivity and the Last Mile
Programs on the Federal side have come a long way in defining what they need to get done. Now that they know what is needed, partners are required to support them over the next few years in finishing that last mile.
“The network we have established took many years to build. Our presence at a vast number of clinics and hospitals was a slow and gradual process and that foot in the door is not the end. There is always a challenge regarding behavioral change; you have to get people to use the solutions and services,” says Roma.
The second challenge is achieving true IT integration in the absence of detailed standards regarding IT infrastructure which may require large logistical efforts to ensure connectivity.
According to Mitchell: “To achieve this high level of interoperability, we’re connecting hospitals and clinics through a digital grid that will enable information exchange and unlock insights beyond what current health information exchanges can do. This will allow for significant increases in the capacity and variability of clinical information access that can be supported.”
Beyond simply sourcing and acquiring a record, the ability, technology and experience to programmatically review and abstract relevant clinical information is a critical facet of the value chain that Ciox has refined and honed to scale.
Roma says the company’s approach leverages an “access first” mentality. “We now have the presence, the portals and the connectivity, so the access is there. The next stage will be driving deeper into electronic integration. The average hospital has seven EMRs. We’re now working to ensure we aren’t just connected to one or a few, but to all of them.”
The Technology
Building on its mission to help patients, clinicians and other stakeholders source information and unlock clinical insights quickly and securely, Ciox has introduced a highly scalable clinical data platform to improve and streamline how Healthcare information is interpreted. Ciox HealthSource™ uses artificial intelligence and natural language processing technologies to enable access to a richer clinical dataset, while reducing administrative burdens and improving financial performance for a broad array of stakeholders.
Designed and developed from the ground up, HealthSource vastly improves clinical data exchange by unlocking previously inaccessible and unstructured data and incorporating it into the workflow of Healthcare information. The platform transforms and optimizes how records are acquired and how relevant clinical information is abstracted.
The Human Element
With approximately 9,000 employees, Ciox Health is a critical ingredient in achieving pervasive access to rich clinical content and the exchange of that data across the Healthcare ecosystem. Trained in executing HIPAA compliant exchange of data, this workforce is skilled in ensuring the optimal approach to sourcing and acquiring clinical data is utilized, that the best approach to systemic interoperability is established, and that what is being exchanged meets the requirements of the organization. The process is intensely people driven but leverages complex technology to satisfy the spectrum of requirements for clinical information.
In many cases, complicated rules that limit what can be shared require redactions. Until now, there hasn’t been a technology that can do this effectively at scale. However, this year Ciox introduced the HealthSource platform, now commercially available, and has been installing the software in organizations around the country, modernizing and standardizing the release of clinical data to authorized requestors. Roma says that, for Ciox, this component is a no fail mission. “We are invested in ensuring our platform and people meet the stringent requirements for privacy and security.”
Trends: Where We’re Headed
Mitchell says his team is seeing more collaboration across organizations, combining for a unique value proposition for the Government stakeholder. “The content from clinical documentation and records we are able to source and acquire is needed by a combination of agencies, some with similar requirements for continuity of care, research, registries or safety. The trend of collaboration among vendor partners, leveraging a combination of products, services and domain expertise, is positive and will serve the agency or department in a constructive and thoughtful way.”
“At Ciox, we are passionate about giving our customers the ability to abstract and interpret unstructured clinical information and consume the large volume of information required to fulfill their mission,” adds Roma. “If we’re going to collectively address the interoperability challenge, developing and integrating tools that automate the digestion of information across the Healthcare ecosystem must remain a top focus of our industry.”
About Paul J. Roma
Paul J. Roma is Chief Executive Officer of Ciox Health. He brings 20 years of executive management experience in Healthcare companies, enabling organizational transformation and significant performance improvements. Paul is an experienced executive with a proven record 
of leading successful mission-critical transformations for Fortune 500 companies in the Healthcare and life sciences industry. He specializes in growth/innovation strategies and applying disruptive technologies to drive performance. Prior to joining Ciox Health, Paul was a senior partner and Chief Analytics Officer of Deloitte LLP, where he led global analytics and new product offerings and was the National Technology Leader for Healthcare and Life Sciences for eight years.
About W.B. “Mitch” Mitchell
W.B. “Mitch” Mitchell is Senior Vice President, Government Solutions with Ciox. Mitch is a senior strategy and management professional with over 25 years passionately building businesses in 
Healthcare and information technology. He combines expertise in Military and Veteran’s Health, and Federal Health Programs, Health Information Exchange, Patient Engagement and Clinical eHealth Strategy Development, Cyber Security and Technology Implementations for Health Systems, Medical Groups, Federal, State and Local Stakeholders. For 15 years prior to joining Ciox, Mitch led teams across McKesson/RelayHealth and Change Healthcare, supporting complex commercial and Federal Health IT and HIE engagements.
About Ciox
Reaching across the U.S. Healthcare ecosystem, Ciox sources, acquires, enhances and delivers medical records and discrete clinical data from virtually anywhere in the country, touching more than 100 million patient records annually and managing clients with millions of annual requests for clinical data across a fragmented system.
Ciox is the trusted partner of three out of fi ve U.S. hospitals, more than 16,000 clinics, more than 140 health insurance companies and a growing number of marquee clients in the life science, Government, and legal industries. The company has experience connecting to more than 400 EMR vendor systems and serves a critical role with respect to information aggregation and delivery.
