The Key to Scalable Healthcare is Interoperability

Interoperability. It’s an industry buzzword that you’ve probably heard thrown around a time or two. It means, in its simplest definition, the ability of technology and platforms to communicate seamlessly. However, the successful adoption of interoperable software is anything but simple. 

Currently, the healthcare industry is built on siloed, outdated technology that’s left it years, even decades, behind other verticals. For example, banking, another highly regulated industry, has embraced and successfully transitioned to more digital systems. Fierce healthcare even likened the struggles of healthcare’s transition to value-based-care to the early days of credit cards.

Dr. Jon Lensing, the CEO and Co-Founder of OpenLoop Health, sees the writing on the wall and the key role interoperability will play in the future of healthcare delivery. We sat down with Jon to talk about some of healthcare’s biggest bottlenecks, where interoperability fits in and how OpenLoop is pioneering this change. 

What made you want to get into the digital health space?

I think for the longest time, even throughout my childhood, I loved the sciences, math and STEM subjects. But I also had this passion for wanting to help people and serve them, always putting myself second.

When thinking about my career and where I wanted to be, I wanted to blend the two and I think that’s what really pushed me into wanting to become a physician.

Once I was there, I started to realize all of the problems within traditional healthcare. You have a finite pool of clinicians like physicians, nurses and therapists with an ever-growing patient population. It’s very difficult to get the sector as a whole to adopt new technologies and to evolve with demand.

I saw telehealth and healthtech as a solution to addressing this finite pool of clinicians and making them much more efficient at delivering care. One of the positive things to come out of COVID-19 is it forced healthcare to adapt and evolve in utilizing new technologies in order to continue serving their patients. I wanted to be a part of that conversation, and I think it has the potential to have an incredibly large impact on how healthcare is perceived, received and delivered. 

Multiple experts have stated publicly that healthcare is years, in some cases decades, behind other industries. In your opinion, what are some of healthcare’s biggest bottlenecks to scalability? 

There are so many bottlenecks to healthcare right now that it’s difficult to know where to start. I think, like banking, healthcare is riddled with various legalities, right? You’re dealing with people’s lives. So, there’s a lot of rules, regulations and stipulations put on the industry as a whole and that can slow down innovation at times. It’s meant to be a good thing that protects people, but at the same time, it can cripple innovation.

‘...it’s like building a car but all the parts are different models.’

Secondarily, there’s areas of healthcare where, as far as technology is concerned, people have built point solutions that don’t communicate with point solutions and with other systems across the board. So, for those not in healthcare, I liken it to a bunch of people building a car with all these parts but all the car parts are different models. These systems don’t talk together and that’s because people have viewed building technology from the ground up rather than the top down.

They’re not looking at the industry as a whole and how care is delivered or how their solutions fit into that matrix of care delivery. They're looking at a problem first and only thinking about the immediate solution to that—not thinking about how that interacts with all the other steps in the healthcare journey. Now you’ve spent years building this solution and you're then going to spend years trying to figure out how it fits into the greater scheme of healthcare. 

Instead, you have to think first about, yes here’s my problem but here’s how it fits into that greater scheme of care delivery. Now, what’s going to be the most seamless way to fix this problem? Once they have that idea then it’s actually time to build the product.

‘...there were a lot of home grown solutions.’

Then I think the third and last bottleneck that comes to mind is when people transferred from paper records to electronic records, there were a lot of home grown solutions. There wasn’t an immediate group of EHRs that popped up. So a lot of these companies are sitting on legacy technology they tried to build, they don’t want to rip it out because it’s a pain for the physician and for the administration—but because you have thousands of these home grown solutions they, again, don’t communicate with each other. 

Banking institutions now have the ability to communicate with each other. They can send payments very quickly. Players like Venmo have integrated via Plaid. Everyone is so protective over their healthcare information and so protective of the small proprietary technology they built that it makes it very difficult to share information. 

What do you believe is the key to sustainable, scalable healthcare and why?

I think in much the same way you try to build a new product for an industry, the same things apply here on the macro level. To be scalable and sustainable, you have to look at these bottlenecks we just talked about. What’s actually driving this slow innovation within the sector?

For me, if I were building another company, I would look at all these different point solutions and how I can get them to seamlessly fit into this beautiful mosaic that is healthcare.

For example, if you were thinking about e-prescribing technology, I would be thinking, okay, here are all the major EHRs. What are the top EHRs that account for 80% of patient visits? How do I integrate seamlessly into those? And how do I make a physician’s, nurse practitioner’s or PA’s workflow a lot more efficient with my integrations? 

If we’re talking RCM type stuff, like eligibility checks, again, how are we going to integrate into these EHR platforms very seamlessly to make checking a patient visit or surgery against their insurance as quick as possible?

Or if I’m using video visits, how do I think about what patients are booking? How do I think about what schedulers are booking? And how do I fit into their workflows as seamlessly as possible?

On a more granular level, it’s like, okay, if I have an eligibility check but I also have an automated claims filing solution for RCM, how do I get those two pieces to communicate together? Then how do I get those two to communicate with the broader EHR or system?

So I think [the key] is this intercommunication, this connectivity between different point solutions that’s really going to drive sustainable, scalable healthcare. 

How might we see interoperability tackle the continued rise of healthcare costs, provider shortages and accessibility issues?

The problem with the reimbursement side of healthcare is it likely needs to be built from the ground up. Fee-for-service, even though it’s been an industry standard for the longest time, is perversely incentivized. It [consists of] clinicians who need to maintain and manage their overhead, seeing decreasing reimbursement rates, needing to then bill more to keep up with past years. More tests, more surgeries, more imagining, longer stays—but then the insurers aren’t wanting to pay out as much. Those two stakeholders are then misaligned. 

‘I’m a huge proponent of value-based care. I think it aligns all stakeholders.’

The group that suffers the most are the patients. They’re getting put through the ringer more, they’re having to pay more out of pocket but they’re also having to get more health treatments that probably aren't aligned with what they actually need.  

I am a huge proponent of value-based care. I think it aligns all stakeholders. I’m an even bigger fan of fully baked capitation. Clinicians getting paid x amount of dollars per year to manage a patient and try to keep them healthy. Then that means the clinicians are trying their hardest to put patients into preventative care to keep them from getting sick rather than reactive medicine when they’re already sick. From an insurance standpoint, they know exactly how much they’re paying out per patient life, so it's easy to go back to employers.

These building blocks are just a way to enable more preventative and data driven decisions within healthcare. I think even on a patient by patient level, a lot of these solutions that are coming out allow us to specifically tailor healthcare choices to a particular patient. 

A lot of healthcare is algorithmic. But with data driven tools, we can say, okay, this patient is a young female with a lot of recurrent UTIs. And we know she has allergies to x, y, z and these medications haven’t worked in the past. So, we’re going to take a different personalized pathway for her.

I think these solutions [interoperability] enables efficient healthcare, specific healthcare and cost savings. 

How is OpenLoop pioneering innovation in seamless care delivery?

OpenLoop, when first started, took a top down approach. We looked at the telehealth industry as a whole, saw all the problems that were occurring and broadly classified the majority of them as clinical operations problems. 

Then we went back to the drawing board and said, okay, what are the pieces that a telehealth company, or any company that wants to offer telehealth services, need in order to deliver care virtually? Then we built that stack of solutions necessary to do that.

We wanted a system that all talked together and communicated easily. That’s when we went to a client to say “hey, we can help you deliver care virtually”. We didn't need to pull in x, y, z point solutions, then try to build that tech around them to get them communicating. 

‘We came to the table with this full-stack solution that enabled clients to hit the ground running.’ 

They can see more patients right off the bat. Better address them, get the data they want, the outcomes these patients need-all because the solution was scalable. It was sustainable and built on these interoperable building blocks. 

OpenLoop really prioritized top down thinking and built in the same fashion. 

What might the future of OpenLoop and its services look like?

OpenLoop is relatively unknown, I feel like a lot of people don’t want to hear that from founders and CEOs, but it’s true. We listen to what the market is telling us, we listen to what the client is telling us. So, if the market takes a shift and demands something slightly different from what we’re offering, we follow that. We listen to our customers.

As of right now, what the market is telling us and what the clients are telling us is they love what we’re building.

So the future of OpenLoop for the time being is to double down on what we’ve built. Make our processes more efficient, make our tech more robust, add on all these additional feature sets that clients are requiring to be their go-to solutions. 

We kind of view ourselves being the go-to infrastructure for digital health, much like Shopify is the go-to infrastructure for e-commerce. We want to become that dominant engine that powers all these patient visits. In 20 years from now when you look at telehealth and all these telehealth visits being conducted virtually, I would like to have had OpenLoop have some hand in powering these patients. 

It’s our personal belief here that the majority of healthcare will be delivered virtually in the next ten years, and so we’re really positioning ourselves to take on that market and help transition the industry to a more virtual-first environment.