Newly installed DirectTrust CEO Scott Stuewe has been in the health IT industry for more than two decades, and he’s burnt out on one particular buzzword: interoperability.
“I think the notion of interoperability leaves providers cold,” he told FierceHealthcare during a recent interview. “They don’t understand what that means.”
Now, Stuewe is leading an organization dedicated to solving that very problem. Founded in 2012 by recently departed CEO David Kibbe, DirectTrust is a nonprofit association helping 121 health IT and provider organizations securely exchange health records through a bidirectional “trust framework.” Stuewe, who spent 24 years at Cerner, replaced Kibbe as CEO in July.
In an interview with FierceHealthcare, Stuewe talked about his goals for the organization, why he thinks the “panacea” of interoperability is impossible to fulfill, and how blockchain factors into DirectTrust’s future.
FierceHealthcare: You’re taking over for David Kibbe, who founded DirectTrust in 2012. What made you take the job?
Scott Stuewe: David is obviously a hard act to follow. He is a brilliant guy with a long history in this industry. But I also have a long history in this industry and I have a real passion for this interoperability problem.
There’s so much opportunity and we’re so close in a lot of ways to interoperability. So I’m really eager to be a part of running the last 10 yards. We’re not at the halfway mark. Even though people feel like there’s a lot of work left to do—and there is. But there is but so much behind us. It’s going to be really exciting to move from the track being laid to really seeing some cars on the track.
FH: That sounds optimistic. Do you think it’s really that close?
SS: I think it’s going to creep forward. Some things will happen fast and somethings will happen slow. I do think we’re pretty close to being at a point where there is basically no one you can’t talk to. What isn’t quite there yet is the usability of how you talk to them.
But I think the word “interoperability” has stopped meaning anything at all. A better term might be “automated healthcare communications.” Healthcare communication is not something that’s new. We’ve been doing it an doing it mostly by fax and phone. But being able to do it so the things you need are present right away—that’s the part of interoperability people believe can happen.
The other kind of nirvana is the organizations I want to talk to are easily available to me. And I can communicate with them in the same ways I did before but highly efficiently and in the same workflow.
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Wife and two daughters who are both out of college and the house. Down to one dog that forgets who I am daily. I call her my “50 first dates dog.” She’s not old, just strange.
Fairway, Kansas, Kansas City’s very first suburb
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Meditation always starts my day—it clears out the cobwebs. Then I make a list while I drink my French-press.
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FH: Is that what you hear from people in the industry? That they are burnt out on interoperability?
SS: I’ve been in it and I’m burnt out on it. It doesn’t mean anything. To some people it’s this panacea where all of the EHR companies in the world are going to act as one system and the fact that I have FHIR, it will all behave like one system.
I don’t believe that. I don’t think that will ever happen.
The reason why we have this stage is because HITECH pushed the envelope around the adoption of EHRs and it happened faster than the other things could get into place. If everything happened on its natural course, an iTunes would have popped up at the same time as the iPhone. Now what we have is iPhones but we don’t have iTunes.
Now it’s a deeper chasm because everyone is digitized faster. And, look, I’m not complaining. I was at Cerner and no one was complaining there was an incentive to adopt. But we got that cart pushed pretty far ahead of the horse.
The industry was absolutely adopting [before HITECH]. I was inside of Cerner seeing the adoption curve. It was growing and fast. When HITECH came along it grew really fast. It shortened what would have been a 10-year process to a three-year process.
I’m not saying it isn’t a good thing. But frankly, we need that benefit of lower cost now. Once we get all your productivity tools accessible from the EHR, it will be cheaper. Healthcare will be cheaper when that happens. It will be lower cost once it’s all connected, it’s just going to take some time.
FH: How do you plan to continue what David has done, and what do you plan to do differently?
SS: My background and what I think I can bring is a real strong set of relationships with EHR community. It’s not just Cerner, where I worked for 24 years, but also through my work with both CommonWell Health Alliance and CareQuality, I’ve interacted with virtually all of the EHR suppliers. And I have a desire to use DirectTrust as a place to convene conversations about improving the workflow of our network.
In general, we want our trust framework to be utilized in other contexts. When you think about what 1.7 million identity-proofed individuals and organizations means, there’s an opportunity to use that same set of players as well as certificates that make those transactions completely secure, and use that in other technical contexts.
And really generalizing this notion of automated healthcare communication. Not that we’re leaving the idea of interoperability, which is still word everyone is using. But we’re talking about a media effort to try and move data from place to place and make it usable on the ends. That’s the goal of interoperability and I feel like we have the ability to bring our trust framework to make a secure and trusted quadrant of the internet safe for healthcare.
FH: What are your goals for the company? Are you going to continue focusing on building up your membership?
SS: We want to move into areas where we are making real tangible benefits for all members regardless of what it is they believe about what it is we do.
Being able to convene a conversation of EHR vendors to improve the use cases we’re already supporting would be very useful to a lot of our provider organization members. Likewise, there are blockchain members that seek to utilize their tech in various context to healthcare so we want to bring those technologies to bear on the on interoperability challenges we see. Basically, we want to be indispensable to our members—all of them.
FH: You brought up blockchain, so I’ll bite—how can that technology help DirectTrust and its members?
SS: I would offer that blockchain’s best opportunity immediately in healthcare is where its good everywhere else, which is contracts.
We’re already actively working with some of our blockchain-based members to create use cases that could basically solve some of ugliest problems in healthcare that are fundamentally about how the contract between the payer and provided is adjudicated in a simple way. And then provide Direct as a mechanism to communicate about that contract with the personal health information being secured.
That’s the 1+1=3 thought around blockchain. It is clearly early in the game of blockchain generally, but we do have members that are blockchain companies and have multiple uses cases that they are pursuing utilizing DirectTrust as a communication vehicle.
FH: What obstacles will DirectTrust face over the next five years and how does that compare to what the organization faced over the last five years?
SS: I think it’s the obstacle we all have in the EHR space. I like to think of the era we’re in is the space between the digitization of our industry and its full connection.
[Former Cerner CEO] Neal Patterson used to say: When an industry digitizes, it can be radically transformed. Think of the music business and how it has changed so completely after digitization. But the real change took a while because the infrastructure had to be in place. iTunes wasn’t immediately available. In fact, there was a period of time where everyone was carrying a toolbelt with different devices: a pager, an mp3 player, a phone and a personal digital assistant (PDA).
Today you can carry one device that does all that stuff. But it took that device and the network to be built. It’s an ecosystem of applications that need to function together, and it’s the network that supports smooth communication.
That’s the big challenge right now: Each enterprise is carrying a big toolbelt with multiple answers to every aspect of the problem. What they are looking for is the one thing they can use for their productivity. And they want to use the EHR because that is their productivity tool.