Vince Albanese, CEO of Haven Health Solutions and Scott Stuewe, President of DirectTrust at Converge2Xcelerate Conference (Boston, MA)
- Haven Health Solutions uses blockchain to add layer of security and trust between pharmacies, doctors and patients
- DirectTrust is a non-profit association of 121 health IT & health providers to support secure health info exchange
- DirectTrust has trusted framework of over 106,000 healthcare organizations
Vince Albanese – CEO/Founder, Haven Health Solutions: 00:00
If we are going to experience the benefits of 2025, as Mckinsey defined it or address the issues that we heard today in the last session. We wanted to have a practical, pragmatic way of getting to what the barriers are in order to be able to achieve that. And so my name is Vince Albanese, I’m the CEO of Haven Health, which is in the blockchain notifications and just thinks business. And I’m joined with my colleague Scott Stewie, the president of DirectTrust to talk about seamless saved notifications and what that means and we’re calling that a new modality. So if you ask this, what should be a relatively simple question here how can you remind the patient that they need to take their AIDS medications? There is complexity built into that all over the place. And so what we’d like to talk about the grand scheme of what could and should happen, the subject that we is a problem.
Vince Albanese – CEO/Founder, Haven Health Solutions: 01:06
So there isn’t a problem if everybody buys into the Amazon model and they all do one thing, right? But the definition of “we” is all of us working together around us as we should have these conferences and things are important. The other thing is as soon as you start to give you the aides and behavioral health and the other things that really impact us as human beings, as things go, this information is being restricted in all kinds of ways. So this problem is extraordinarily different color to tackle. So why is that? So what we have here is not the problem with under-representation by IT or technical staff or it’s not a problem. People volunteering or working together. We have a major logistics problem with healthcare and that is the problem that Haven, Direct trust and all of the entities working together are attempting to solve.
Vince Albanese – CEO/Founder, Haven Health Solutions: 02:00
The issue has to do with local optimization versus global optimization here. So until we begin to look at the entire problem from end to end, does this describe and do the work for the logistics, they were really never going to get to a solution that’s meaningful. What local optimization means is that if you’re a payer and you develop the world’s best healthcare portal for handling prior authorizations, but the doctor has 6 of them they have to deal with, then you are locally optimizing, right? If you are at the American medical association working on mechanisms to reduce prior authorization, let’s stick with that example for a second and you come back with something that is biased toward the doctors, then you are locally optimizing. So we’re working on solving this kind of a problem. What is the definition of why? If we don’t do that, it’s an issue.
Vince Albanese – CEO/Founder, Haven Health Solutions: 02:53
It’s because you generate waste in assistance. So I’m a student of LA gold rat, indicates my age, I guess on throughput theory of constraints and those types of things. So fundamentally, global optimization is what we should be after in a healthcare setting and it’s our mission here. So I’m joined about Scott’s Stuewe the president of DirectTrust and we are working together. The point that it has, this has to be solved with an industry consortium perspective is absolutely critical and it’s got my opinion. Managing one’s learn the best in the country in that area. So the question that Scott asks is the kind of the dirty secret and how do we operate, which is, it’s really the friction that comes from us not wanting to share pie that is preventing PHI from being distributed here. Competitors, political pressure, all kinds of things, stop us from wanting to talk about who those patients really are. So that’s the problem that you’re working together on. And Scott, I’ll turn turned over to for a market summary.
Scott Stuewe – President, DirectTrust: 04:15
Well, so I’ve been roughly 30 years in the industry. I’ve worked as the have operability expert. That means early on time starting in the interface realm, system communication, all the way through today where, you know, regional and national efforts are starting to play a huge role. And as we’ve gone through this exercise from the very beginning of my work in the days when I installed my first masture index system in 1999, just about the same place as where we are with regard to patient matching, which is to say in in in a patient, national members is the problem of you trying to get the artifacts of care to match up so that the data that is produced in two different settings getting us to match likewise, documents that are in tagging punches, demographics, those to associate, that’s the mission passion problem.
Scott Stuewe – President, DirectTrust: 05:15
Additionally, you have this problem of what I’d call duplication, where in an individual institution, frequently up to 20% of the of the records are duplicates, which is to say there’s more than one me in the system and 20% of the records are on faculty. We can set others. That’s actually a pretty typical, in fact, in some large ITNS that’s a smaller so that’s not actually a patient this problem. I think of that as an identity problem. So these are the four big problems that we haven’t had to solve fundamentally. So I was involved in the Commonwealth effort when it first launched. Identity was at the center of what it is Commonwealth wanted to do in Commonwealth. Hasn’t really quite gotten there and no one has yet. So the question of identity is actually a still issue. Next is consent. So consent, Vince talked a little bit about that.
Scott Stuewe – President, DirectTrust: 06:09
Consent straight forward for treatment between providers as long as the data is not sensitive in any way. So if it says is there any way, if it’s substance abuse treatment day, it’s behavioral health data, it’s all of that data actually needs to have a different things. Consents in middle States, which is a complex problem. If you got explicit consent on everything that work in all States, but in the absence of that rules are very different. The fourth is what I call this tension between a mass centralization on the one hand and mass a synchronization. So if I’m going to centralize it, one system that everybody’s on one plot, I only have to get that system to work together. If, on the other hand I’ve got lots and lots of systems, partly I want to have to get all of those systems to synchronize. And the more of those systems that are in the harder synchronization problem is this tension is, it remains in in our world and is actually codified in tech.
Scott Stuewe – President, DirectTrust: 07:15
So if your reader of tech ed appreciate that telecom, I basically set up the tension, great, great dynamic device saying that there will be a relatively small number of highly decentralized organizations that will nonetheless synchronize between each other for the person, the purpose of the patient identification records themselves, but for the patients. So this is the challenge that we have. So if we’re going to get past this fundamental issue is to grapple with a solution that might actually start with the identity problem. So if we actually build a system that was built on the notion that identity was at the source of what it is we needed first, that identity could basically solve the patient management problem. And by identity, I mean, let’s get right to start. Let’s identity proof. People when they show up, wherever they show up, but then also gives you a credential that can be utilized in various settings.
Scott Stuewe – President, DirectTrust: 08:13
So that’s what kind of, what the solution might look like. And then if in the process of doing that, we actually also involve the patient in the process and could capture their consent in the process of enrolling them in such a, an activity, enrolling them in a pair portal. For example, have a parent portal represents any proofing event that could be brought up to a certain level that would be adequate for the purposes of issuing a credential, which by the way, they do already. And they issue credentials to get access to your job as HR. So I mean, so you’re getting access to Phi with the credential that you get in an identity proofing. This is probably not quite up to the standard of IL200 under this expectation, but it’s pretty good. So could it be too enough?
Scott Stuewe – President, DirectTrust: 09:03
Is it good? And if we’re any capture the patient’s identity and their consent at the same moment and then issue them a visual credential at that moment, you could get a lot done and a lot of them were better. So that’s the fundamental thought. Now, notifications as a legality is a little different than we in push. So pushes what? So we run the DirectTrust network, which is to say we are the operators of the our members are the operators of the network that run basically a billion transactions a year at this point through being pushed back and forth by people know that they’re sending to because of our press record that’s different than priority, which is, you know, the patients in front of him or in their records. And it’s also different from this notification side.
Scott Stuewe – President, DirectTrust: 09:56
Yet notifications is different because it involves all this interest in communications. So notifications are really a Grayson of interest to the payer. The parent would like to have notifications on virtually anything that happens to a patient, but they’d also have to have the ability to communicate to the patient and the provider or you know, aggressive attention care. So that’s the kind of the subtext of what a federated subscription-based notifications model would do from a value proposition standpoint starting will be the, the notion of identity first, finding the problem of NPI as NPI is frankly a costly aspect. How would you then our operability today. So skipping over the technical world to a role in the future where everyone’s communicating by fire or having this instead are point to point without necessarily any of the areas. How does that look and world where I’ve got this sort of mass summarization as an expectation?
Scott Stuewe – President, DirectTrust: 11:03
So this is, I think the context we’re looking at kind of way. Interesting thing about working with Vince. So this is a blockchain company now. So this works for a blockchain of any blockchain has a potential role to play around undermining this fundamental tension between centralization and synchronization for the purposes of something that would be manageable. So if you start with something like the subscriptions on a patient, you could have a subscription school tame the who, what, where, why about this particular this particular subscription would be the what identity proof individualism about what identity proof individual is interested in receiving information about this. And then what do I want to know about and as consent obtained.
Scott Stuewe – President, DirectTrust: 11:54
So all of that could be managed in distributed ledger. So this is, I think what makes distributed ledgers most useful is that they have this ability for different authorities to manage a single asset. This is again, the challenge. If payers don’t want to share 300 million records or privately whether they want to show them or not, it’s just challenging to provide 300 million references and then update 20% of them or whatever. Right here on a day rolling includes, and this is the challenge of how they can manage that in their own environment, in their own of a distributed ledger. That’s the thinking about how this might work. So I’ll turn back over to Vince, he’s getting considerably more tactical than at my on his past stuff.
Vince Albanese – CEO/Founder, Haven Health Solutions: 13:13
So let’s see. And so there would be practical here, the ability to inherit over a decade worth of work by over a hundred organizations and the ability to work with the nation’s security infrastructure for the transport of healthcare messaging today and with a group of people who already understand what Federation is lends itself to partnership with blockchain. So the practical side of what we’re doing here is the, the truth of the matter is on the progression of where, what happens with a blockchain. There is the newness and gee-whiz, cool stuff side of this. But the truth of the matter is we’re watching is none for us in the beginning was he caused people to get together and talk about what that means in our case that our get to market strategy has been the medical doctors and medical societies in various States. Delaware has been on the first use case. So the interesting thing is that we’re finding that small States are taking a progressive posture and we want to be first a blockchain. Delaware was the first state to put their hand up and do some things with blockchain. And now it’s crossing the country that way.
Vince Albanese – CEO/Founder, Haven Health Solutions: 14:04
So the medical doctors in those States as part of that expansion had adopted this strategy and understand that that the goal here really is to reduce uncertainty and what happens, the problem with uncertainty is that it causes waste. So when a patient doesn’t know what’s about to happen next, are they, do they pick up the phone, call your primary care physician who doesn’t have anybody to answer the phone, who calls back in a site and just starts over and over again? It works the same way we prepare. It works its way through, right through this full of waste. Uncertainty we believe is the root cause of wasted healthcare. The way to alleviate that problem is do something that sits over the top that opens up free communication and we believe for way to facilitate and not worry about all that infrastructure.
Vince Albanese – CEO/Founder, Haven Health Solutions: 14:53
But who would you trust with that? What company? You can put their hand up and said that they want to own, that it has to be done through the industry and our opinion, that organization already exists. It’s run by run by this gentleman. So in the state of Delaware we have managed, and I believe this is historic you have the hospital association, veteran society, the Delaware health information network, the state government all sit around one table and talk about one set of problems and their particular cases, it’s focused on prior authorization. So with this group sitting together actually working, talking as human beings with the technology being what Scott, the challenge to me was can you federate the source of truth out there? So that’s what the blockchain is going to do and it’s going to let all the rest of the pieces operating flow like they used to.
Vince Albanese – CEO/Founder, Haven Health Solutions: 15:45
So that is how things are moving at a specific level. It is a subscription based, a federated notification system running over the back of the nation’s existing healthcare infrastructure as the employee by the hips and the work for DirectTrust. So subject of practicality, you know, so there’s a modality. What is it fixing it. So there are four takeaways and I will credit another thought leader for me getting Dr. Greenspan. So we’re coming down this path and there are four legitimate takeaways that that come out of this. First is let’s acknowledge that there is risks with blockchain and the projects you need to start, we have run head on into where are you doing that a thousand times, right? So that is not the place to go. Some entity or institution that already isn’t trusted, intermediary is not the place to be displaced right out of the gate.
Vince Albanese – CEO/Founder, Haven Health Solutions: 16:50
So we’re working to look for new applications out there, lesson number one. Lesson number two is the blockchain will always be slower or less scalable and more complex because deploying more nodes. However, there is an ROI to be determined that ROI comes from commercial industries. Afraid to have too much power. We want to hand regulatory costs was an audit. Compliance sometimes exceeds the cost of deployment, political factors. No one wants to host that data in one, one place because of the risks. So you look for those kinds of things and it lends itself to watching. I have, we believe that we are at that stage in the curve on adoption for blockchain, kind of lighter scale. Number three is that this to us is really a data play. What that means is it is different than an asset-based transaction on a blockchain.
Vince Albanese – CEO/Founder, Haven Health Solutions: 17:45
When you’re replicating data, everybody’s getting copied to point or did a copy of that. So we are not doing any, there’s no smart contracts. So we know cryptocurrency, none of those things play because in this case all we’re doing is really making sure that we are replicating data and reliable, safe and beautiful in there. Number four is that it isn’t really so much about transformation and revolution. We’re talking about where we’re going to be in 2025. I think that’s the appropriate timeframe. So this is slow adoption by risk versus petitions. Where the privacy of our data as patients comes together, we want to be able to answer that question and we ask that at the beginning that the AIDS patient should be able to get from any institution. So if you’re having, and you can go in and you have to problem solve, you’re willing to meet any of this, but we believe the world is always going to have institutions that give you an interrupt rate.
Vince Albanese – CEO/Founder, Haven Health Solutions: 18:39
They need to be able to communicate with each other. And as such the need to federate that we think is paramount critical launching plays an important role there. So I will say that when I first approached Scott with the idea of a blockchain a year ago, that this is a long-term employee excerpt lawyer. And I was skeptical even at the beginning. Have you seen a lot of technology come and go? But this idea has really germinated in a way that I mean truthfully getting Scott up to a blockchain conferences it’s a big deal. That take people but it’s indicative of the adoption of these kinds of technologies as a technology, not as it takes the dust or something. Your best friend deliver something to do. So we’re doing practical pioneering work, excited to be here. And Scott, thank you for the efforts of you and your entire organization supporting this idea of federating.
Scott Stuewe – President, DirectTrust: 19:50
I think the notion that it’s the things we already have lying around. So there are lots and lots of organizations that today deployed notification systems. There are hundreds of platforms. So the question of could you actually maintain those existing connections, kind of allow for them to share a source of truth. So the combination of a of a block chain based subscription database and a trust framework that enables exchange across that hall that is in existence today is I think a powerful opportunity we have. So, using the existing trust framework and the existing infrastructure of the 20 to 40 audience that might just fate in that it’s such an activity basically could be a platform, the federated platform, the collaborative platform that enables this kind of nationwide notifications model as opposed to one that could be based on a single platform or on the idea that the platforms that are there and have to actually duplicate everything in their system constantly. One another. So that’s the thinking about why blockchain.
Vince Albanese – CEO/Founder, Haven Health Solutions: 21:17
I would like to close with this thought here is that I’m active volunteer with DirectTrust. We’re working on national standards and trust, instant messaging and the important things in a healthcare setting. Scott and I also serve on the board of the discover Alliance, which is another that is working to enable discovery across the healthcare ecosystem. That has some very important players participating in that also. And we encourage you to look at both of those consortium’s as individuals work to help with Federation and have us work together instead of this idea of as you can tell, I’m solemnly against local optimization. We’re trying to fix us. So thank you.