Unlock the future of healthcare innovation as we sit down with Linda Van Horn, CEO of iShare Medical, and journey through her remarkable transition from IT consulting to revolutionizing medical data exchange. Get ready to be enlightened on how Linda's platform is reshaping care coordination through the power of secure digital identities and cryptographic keys, ensuring HIPAA compliance and fostering trust within the healthcare industry. Her candid insights into the complexities of developing a robust healthcare data model and the significance of Federated Identity illuminate the path to a more interconnected and efficient healthcare system.
Experience a deep dive into the transformative role of artificial intelligence in healthcare with Linda's expertise guiding the way. Discover how iShare Medical is leveraging AI to enhance clinical decision-making, automate workflows, and pioneer strategic growth. Linda's dedication to agile development and her pursuit of meaningful collaborations reveal how iShare Medical is not only targeting data integrity and privacy concerns but also setting a new standard for security measures in the healthcare sector. Tune in for an exploration that promises to leave you inspired and informed about the advances propelling healthcare into a new era of digital excellence.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
Hey everyone, welcome back to the growing Lean
podcast sponsored by LeanDiscovery Group, an
award-winning software and appdevelopment firm based out of
Virginia.
This is your host, dylan Burke,also known as Teage, and I'm
very happy to be here today withLinda Van Horn, ceo at iShare
Medical.
Welcome, linda.
Speaker 2 (00:22):
Thank you, dylan, it's great to be here.
Speaker 1 (00:25):
Yeah, I appreciate you joining us today.
To get us started, could yougive us a little bit about your
history and background and whatled you to iShare Medical?
Speaker 2 (00:37):
Sure, it'd be great.
My background I have a BS incomputer science and an MBA from
Rockhurst University in KansasCity, missouri, when I first got
out of school and I always tellthis part of the story because
I think it goes to what broughtme to be here.
But I started out in nuclearand structural engineering
applications.
The company that I worked fordid things like nuclear power
(00:58):
plants and nuclear weapons.
I learned how to secure a datacenter.
I think that's really animportant we're kind of the sum
of our past.
I learned how do we get reallytight security.
We're in the iShare Medical asa medical communications
platform and it's very importantto be secure.
That's kind of first piece.
(01:19):
After I left that company, I wasa senior manager in IT
consulting at Deloitte.
While I was there I had theopportunity to work on a number
of different projects, but oneof them was writing a claims
identification system forinsurance companies.
I learned all about pricingpremium and adjudicating claims.
I left Deloitte to go on andfound co-found the Payne
(01:39):
Institute.
We were anesthesia-basedinterventional pain practice, so
we're basically a doctor'soffice.
We opened 22 locations in twostates in five years, including
an ambulatory surgery center andthe rehab institute, which is
physical therapy.
So here in my background I'vesecured a data center.
I know how to do a big softwaredevelopment project.
Now I'm running a doctor'soffice, but I was frustrated by
(02:04):
the fact that we don't havereally great medical records in
healthcare.
They weren't really helpingproviders to become more
efficient.
I sold my interest in the PayneInstitute and started 21st
Century Edge because I reallywanted to help get the right
information on the right patientto the right provider so that
they could be more efficient inperforming medical care.
Speaker 1 (02:28):
Okay, that's awesome.
That's amazing and, yeah, I'mimpressed with your resume, if
we could call it that.
So what does I-Share Medical doexactly and what is your
overall business strategy?
Speaker 2 (02:44):
Sure, so I-Share Medical is the trusted online
platform for communicatingbetween patients, providers and
payers and devices, so we're aninteroperability, integration
and automation platformnationwide.
We're also a direct trust,accredited trust anchor there's
only a handful of those and weprovide the bi-directional
(03:06):
sharing of information toimprove care coordination and a
reduced cost.
Speaker 1 (03:12):
Okay, awesome, and tell me about your scaling
journey, or your journey ofgrowth.
I see you started around 12years ago.
Is that correct?
Speaker 2 (03:24):
Yes, we started the company in the fall of 2011, but
our first commercial productwas launched in 2015.
So we've been accredited trustanchors since the inception of
the accredited trust anchorbundle and we're really focusing
on three health IT pillars.
The first pillar is digitalidentity.
(03:44):
So it's very important tounderstand who you're
communicating with to establishtrust.
So if I know that this personhas been ID proofed, that they
really are a patient or theyreally are a provider or they're
a payer, that gives themcertain rights under HIPAA for
what that person can and cannotdo.
So we ID proof patients,providers, payers and devices
(04:07):
and assign two pairs ofcryptographic keys.
One key pair is used fordigital signature of the
transaction.
The other one's used forencryption and decryption and
that way we know who we'retalking to.
That's the trust in directtrust really is knowing known
digital identity, the security,privacy and things like that.
We are E-NAC accredited forHIPAA, privacy and security.
(04:30):
So when we do ourinteroperability, we take the
senders cryptographic keys, thereceiver's cryptographic keys,
we bind the transaction suchthat only the sender and
receiver can decrypt them andread them.
And I know that maybe soundslike a lot of jargon.
I know this is also the ITplatform, but it's basically
secured.
For those that may not befamiliar with this, it's X509
(04:52):
certificates.
When you go to any website yousee that HTTPS but it's assigned
to the digital identityassigned to the patient.
We can interrogate that digitalidentity and know how they were
ID proofed.
So there's a bunch of standardsfrom NIST, the National
Institute of Standards andTechnology, that tell us about
identity proofing and encryptionand all that stuff.
So we're a very heavilystandards based.
(05:13):
So those three health ITpillars are digital identity,
interoperability and then thethird one is a learning health
system which is automatingworkflow so that using those
tools of secure communicationbut then using them for real
world use cases.
I'll use an example of eventnotifications.
(05:34):
So CMS, which is the Center forMedicare and Medicaid Services,
one of the largest payers inthe United States or for a
government payer in the UnitedStates, they passed a law that
said you had to send thehospitals had to send an event
notification whenever a patientwas admitted, discharged or
(05:56):
transferred from the hospital.
So when the hospital sends,first of all we can take that
event notification, which isvery cryptic, in a format known
as HL7251.
We decode it and make it humanreadable.
We can also route that messagedirectly to the patient's chart,
to the provider inside theirEHR, regardless of the EHR
(06:19):
system, because we work withevery certified EHR.
So it's a wonderful way to getthe information to them.
But it also triggers activity onthe end of the provider.
So, for example, if a patientgoes to the emergency department
, it's three o'clock in themorning, the doctor's office is
closed.
The hospital sends an eventnotification.
(06:40):
We can trigger the electronichealth record system to respond
with the patient's medicalrecords.
So now the provider and thedoctor or caregiver in the
emergency department can seethat patient's medical records
in real time within seconds oftheir admission.
Even if it's three o'clock inthe morning, it's 247365.
(07:02):
So that provides a reallyhelpful way to do care
coordination, because aphysician might make a different
decision.
Knowing the patient's medicalhistory, maybe their allergies,
you know.
To prevent, you knowpreventable medical errors.
If we know they're allergic topenicillin, for example, we're
not going to give thempenicillin.
(07:23):
So if we have the medicalrecord, we know that.
And that's really what sharingmedical records are about
getting that right informationon the right provider, on the
right patient to the rightprovider.
Speaker 1 (07:34):
Okay, amazing, amazing.
So, to summarize, it'sBasically an encrypted
communications channel betweencaregiver and care receiver, as
well as an encrypted method ofsharing their personal data.
Speaker 2 (07:49):
Right and routing it right.
So routing it you know, in theUnited States we have 333
million People.
In the United States we haveAbout six million Providers,
about 1 million of them aredoctors, about 6500 our
hospitals, and then we haveabout 7,000 insurance companies.
(08:10):
So we're trying to create acommunications Among the people
that get the care of thepatients, the people that
provide the care, the providers,like the doctor, harm, pharmacy
, lab, hospital and the peoplethat pay for the care, the
payers, which are Called payersbecause they're both insurance
companies like at none you knowI did health care and things
(08:32):
like that but also governmentpayers like Medicare and
Medicaid, the Indian HealthServices and the Veterans Health
Administration.
So those are examples of we'retrying to facilitate the
communication but routing it.
So what happens sometimes todayis it doesn't get routed to the
patient's chart.
It gets like faxed to theprovider.
Then they have to scan it or,if it's electronic fax, they
(08:54):
have to read it and attach it tothe chart.
We want to go directly to, anddo go directly to the patient,
and so in order to do that, wehave a mechanism for routing the
Messages into the provider.
So it doesn't matter what theHR system is, we can route it
right directly to the patient'schart and that's phenomenal
(09:14):
because it saves a tremendousamount of time.
I'll give an example one of ourrecent products which we just
launched, and it's a way toAutomate the intake process.
So patients oftentimes when theygo to the doctor they have to
ask, answer, a bunch ofquestions.
This particular client of oursask their patients 248 questions
they want answered.
(09:35):
So we send those questions tothe patient in a form that's you
know web form that they canfill out everything.
They can type it in.
They're going to use patientlanguage in that.
So they're going to say I'mallergic to penicillin, I have
hives.
We see that and say hives isnot a medical term, the term for
hives is eutica area andthere's an rx norm code that has
(09:58):
to be coded in so the HRinterprets it.
So we translate that into theright coding system and Deliver
it to the patient's chart insidethe EHR so that the staff no
longer has to type it.
So in their case we're savingthe staff, you know, 40 minutes
of typing time of putting thatintake form in because there's
(10:19):
so many fields on it.
The data is more accuratebecause it's completed by the
patient and and the provider canreview it, reconcile the
medications in their chart.
So it's just reallystreamlining that workflow and
providers aren't waiting for thepatient to fill something out
(10:39):
in the waiting room, so it'sspeeding up the time that the
providers have in workflow sothey can see more patients in a
day.
So there's a tremendous amountof benefit of just automating
this workflow and that's kind ofthe thing we focus on.
We look at workflow and say youknow what, how can we
(10:59):
streamline that?
And so, being in that uniquePrecision that I've been in
about securing a data center,you know doing large software
development projects, one for aninsurance company Running a
doctor's office I understand theworkflow of the insurance
company, of the providers.
It's really a unique positionto be in just be able to look at
that whole picture and how itall interact, interact and then
(11:22):
build software around, how theworld really works.
Speaker 1 (11:26):
That's.
That's crazy.
That's awesome.
I can definitely speak to thebenefits of workflow automation
because that's what we do forsmall businesses, so I can
imagine the benefits in thehealthcare space having
everything flow seamlessly.
But that's really awesome.
And Tell me, over your 12-yearjourney, what have been the
(11:48):
notable accomplishments, if wewere to go on a timeline basis.
Speaker 2 (11:54):
Sure, I'd have to start with the creditations,
because those are hard to get.
There's a whole lot oftechnology and I jokingly say
our rules have rules.
We have so many rules becauseit's highly regulated If you see
healthcare on the surface.
The reason why it's so complexis there's so many data elements
(12:17):
being able to.
The first thing we did wascreate a data model in third
normal form.
It took us a year to identifyevery piece of data that was
used in the healthcare systemand then structure it in third
normal form, which is organizingthe data so that we recognize
the relationships or cardinality.
(12:37):
If you're a technical person, Ican use an example of that, but
I'll just take a simple exampleof phone number.
In the old days we would put afield in their phone number, but
patients can have zero to manyor providers can have zero to
many phone numbers.
You might have a home, work,school, whatever phone number.
Being able to look at that datamodel and say, okay, there's a
(13:01):
one to many relationship or zeroto many relationship between
the person and their phonenumber.
That's normalization Organizethe data so it's not redundant,
the data exists in one and onlyone place and it's easily
accessible.
That's a big accomplishment ofbecoming a direct trust
accredited trust anchor andE-NAC accredited for HIPAA,
privacy and security.
That allows us to communicateacross our nationwide network of
(13:24):
2.8 million healthcareproviders.
To put that in perspective,there's only 6 million MPIs or
national provider identifiers inthe United States.
We've got a very wide and wehave a directory of those direct
addresses so that you candiscover that electronic
endpoint.
If I am in a doctor's officeand I know there's a famous
(13:47):
nephrologist which is a kidneydoctor at the Mayo Clinic and I
want to refer a patient to thembecause I don't know anything
about this rare kidney disease,I can go into Isher Medical
Directory, look that up and thensend off a message to that
doctor.
Being a part of FederatedIdentity Trust Network, that is
(14:08):
huge because and I'll talk alittle bit about Federated
Identity and I'll use theexample in the United States of
Driver's License A driver'slicense issued by any state in
the United States is trusted byall states.
If I live in Kansas CityMissouri, if I am flying out of
Los Angeles, california, Ipresent my Kansas City Missouri
(14:31):
or my Missouri driver's licenseand TSA is going to look at that
, of course.
Make sure it's valid, make sureI'm me, I'm not on any kind of
no-fly list and then they'regoing to let me through security
.
That's a Federated Identity.
We have a Federated Identitythat's trusted throughout the
healthcare system and a Identityissued by any trust anchor is
trusted by all trust anchors.
(14:51):
Trust anchors include theVeterans Health Administration,
the Indian Health Services, sothose are two federal agencies
that are trust anchors.
They include big EHRs likeCERNR, athena Health, e-clinical
and NextGen.
Those are trust anchors.
Then there's also organizationsthat become a trust anchor as
well, but mostly it's aboutpeople that have really large
(15:14):
volume become a trust anchor.
Our customers are the EHRs andHIEs and individual practice
doctors, practices and patientsand payers that need to
communicate that through thehealthcare system.
But having the FederatedIdentity means that we can share
that information and we trustthe identity of each person in
(15:38):
the network.
I think that's a really hugecomponent of what we do.
I think those things are makingyou proud of what we're done.
We also have had some wins inthe investment space, where we
won LaunchKC, which severalyears ago, which was a
recognition and a grant that wegot.
(16:00):
We also got investment fromMissouri Technology Corporation,
which is a public-privatepartnership.
We've got a number of angelinvestors, but we've mostly been
self-funded and just reallybootstrapping it together for
what we're doing and just tryingto do the right thing all the
(16:21):
time.
Speaker 1 (16:22):
That's awesome and definitely sounds like you're on
the right track.
Where are you Let me think howto phrase this.
Where are you on the journey ofwhere you want to be, like from
when you started to where youwant to be?
Where about are you now?
Speaker 2 (16:41):
What's taken far longer than we ever expected.
It's been far more complex forthat.
You know.
We have just you know hundreds,thousands of data elements in
healthcare.
So if I use the analogy of abank and I apologize for anybody
who knows banking because I'mnot a banking expert but if I
want to send a transaction inbanking, I need to have a
(17:01):
routing number, an accountnumber, maybe a person's name, I
need to know whether this is adebit or credit, I need to know
the dollar amount.
There's just a handful of dataelements.
When I am talking in healthcare, I've got past family, social
history, medications, allergies,surgeries, encounters where
I've had doctor offices orprocedures, and it goes on and
(17:24):
on and on all these dataelements.
So that's where it becomes moreand more complex.
And Because our legacy systemsweren't built on that structured
data, every EHR created theirown data.
So one person called a bloodpressure, or somebody called it
systolic and diastolic, becausethat's what blood pressure is
about.
There's actually eightdifferent ways to measure blood
(17:46):
pressure.
So, figuring out all of thesesystems, the healthcare system
has been going through a processof codifying what we do.
But it's super complex to dothat stuff.
So we are, you know we areScaling.
We have more things that wewant to do.
We have our ice-share medicaldirectory, our ice-share medical
(18:10):
messaging.
We integrate with the EHR's, wedo that bidirectional exchange.
We have that federated identity.
But there's more that we have onour roadmap of how we want to
automate more of the processes,bring in more uses of I Machine
learning and train neuralnetworks.
So we're really beginning toleverage some of the AI
(18:33):
capabilities for probabilisticdecision-making and Clinical
decision support.
But we have we're just on apath, right you know, to get
there and it just we just comein every day and take one day at
a time and keep our eye onwhere we're headed out there and
and Keep charting a course.
I jokingly say you know there'sit's very easy to see something
(18:58):
, the new shiny thing.
You know.
I'll use the example of a dogwith a squirrel.
You know it's like you.
The dog comes out, there's asquirrel and it's like they're
gone.
They're absolutely gone to thatsquirrel and that that's chasing
something that is not on thepath right.
So, you know, I always say andI think of the Star Wars stay on
target, stay on.
(19:19):
So we, we consciously thinkevery day.
So we do.
You know, lean, agiledevelopment.
We have Chrome meetings everyday.
Sometimes they're five minutes,sometimes they're 30 minutes,
but we, we get together everyday as a team to talk about
where we are, the status of whatwe're working on, where
somebody needs help, and stayingon that path to get to where we
(19:41):
want to go.
Speaker 1 (19:43):
Okay, awesome, I love it.
I love it.
And what have been, if any,what have been the biggest
collaborations or partnershipsthat have helped you get to
where you are?
Speaker 2 (19:55):
Yeah.
So we've had the opportunity toparticipate in some interesting
and fun things.
Some of them I can't disclosebecause of, you know,
non-disclosure agreements.
But you know, I think the youknow the automation of workflow
to get the data into the HR.
(20:15):
I think that's really kind of ahuge thing.
We're working with a bigcompany.
We're working with one practicewithin a company that has a
bunch of practices, withoutnaming, being very specific on
that.
So we're looking to helphopefully roll that out to the
rest of their practices and, Ithink, becoming the trust anchor
(20:36):
you know that, connecting with2.8 million healthcare providers
I mean that's a huge, you knowaccomplishment to have become a
credit trust anchor and that'ssomething we go through
reaccreditation, which is a verytedious tedious is the wrong
word it's a very thoroughprocess.
We have to prove how we doeverything and we have to prove
(20:58):
it.
We also became a part of theDepartment of Homeland Security
Critical Access Infrastructure.
So we have 2 data centers, cisa, which is that cyber security
from Homeland Security.
They do our vulnerabilityassessments.
They determine how frequentlythey run those.
(21:19):
So they could be running themmany times a day or they could
run them every couple weeks.
Two weeks is the longest periodthat they run on the
vulnerability scans but be goingthrough that process to get on
the Homeland Security.
Our data center is a tier threedata center, which means that
for every piece of equipment wehave on the floor we've got one,
at least one more piece ofequipment that's idled, that is
(21:42):
ready to be deployed.
We have like seven internetcompanies coming through that.
We have two power stationscoming into our data center, one
from Kansas City, one from StJoe, so that if Kansas City,
which is a big city, if theylost power, we could flip over
to St Joe.
We have a second data center inDes Moines that is married in
real time with our data centerin Kansas City.
(22:02):
So there's a lot of redundancyand infrastructure that had to
be built.
That is expensive and timeconsuming.
We store the private keys onhardware security modules.
We have them married betweenKansas City and Des Moines.
Hardware security modules arevery interesting in that if they
(22:23):
detect a hardware or softwareattack they erase everything on
the machine.
They destroy themselves.
So you have to be carefulreally working with them,
because they can destroythemselves and they're very
expensive and also the privatekeys are the only way to encrypt
the information so if theybecome corrupted or somehow
(22:44):
damaged you can't get that back.
I mean, that's the sameinfrastructure that's behind
blockchain of having PKI thepublic key infrastructure.
So we mirror that.
Unlike blockchain, we keep anaudit trail of everything.
We know everything that'shappening, but the private keys
are kept private and so insecuring those.
So that's a part of thatbackground of having that
(23:07):
nuclear data center kind ofbackground of locking down the
data center, protecting people'sprivacy and security of the
people and the providers thathave the data, the insurance
companies that have the data.
It's a very important part ofwhat we do and something we take
(23:27):
really seriously is protectingthat data and having the
infrastructure in place to dothat.
So I think those kinds ofthings you just kind of do them
and you kind of move through,but they are major
accomplishments when you lookback and say, wow, we did that,
we were part of that.
I participate in four ANSIstandards development
(23:49):
organizations, so it's reallyfun and interesting to be a part
of developing the standardsthat we use in health care.
Speaker 1 (23:59):
Yeah, 100%.
I couldn't imagine what wouldhappen if you had to lose your
your data and start over wouldbe disastrous.
Speaker 2 (24:09):
So we're not going to do that.
We back them up and we haveredundancy and yeah, that's why
you have we Kansas City to DesMoines about three and a half
hour drive down the highway.
So we used to have Kansas Cityin Dallas.
We decided to move the seconddata center to Des Moines On the
thought process, if we everneeded to go there when we
deployed the HSM's, we thought,well, it'll be right there.
(24:30):
We've merely never needed to,you know, go there to in person
to do stuff we're.
You know, it's pretty, prettyawesome.
Speaker 1 (24:40):
Yeah, so all sounds amazing and Unfortunately we
have come to the end of our time.
But what?
What advice would you like togive to other business owners
who may be listening, that arelooking to succeed in this crazy
world?
Speaker 2 (24:58):
Sure, I actually have several little nuggets, but one
of them would be Figure outwhat you want to do, not what
somebody else wants you to do.
You know it's your passion,it's your vision.
If you are, you know,passionate about what you do and
you love what you're doing,you'll never work a day in your
life.
That's.
That's a quote from somebodyelse, but it's really true and I
(25:20):
think in the beginning I mademistakes, listening to other
people what they thought Ishould be doing and I didn't
agree with them, but I thought,well, they, they know more than
me or whatever.
You know more about yourbusiness than anybody else and
you know, not that, you know, Iknow everything.
But stay true to your heart andand your, your culture, your
(25:43):
ballet values to do good thingsto help people.
In our case, that's what wewant to do.
We do this to help providersand patients and payers get the
data they need and To use thatdata to improve care and
outcomes and to reduce costs,and that's really our passion
and we look at everythingthrough that lens.
(26:04):
So if I was advising anybody, Iwould say Follow your heart and
never give up if you, if youare on your path, you're gonna
have.
You know it's a roller coaster.
You're gonna have high momentsand low moments and sometimes
really low.
To be true.
If you want to know that theentrepreneurs journey it.
There can be some really hardtimes where you think, how am I
(26:25):
gonna make payroll, or how am Igonna do Whatever, or how am I
gonna, how am I gonna createthat federated identity, how am
I going to design the softwareto achieve what I wanted to do?
But if you, if you areCommitted to it and you just
never give up, just keep going.
Too many people I think theythrow in the towel, they give up
(26:46):
.
You know we're never giving up.
I tell that to my team all thetime.
We're never gonna give up,we're gonna.
We will figure this out, nomatter how hard it is, we will
figure this out and we will getthrough it and and you know you
just then then you look back andsay, wow, you know, we did that
, you know yeah, and that's,that's the reward right and
(27:08):
helping people hearing thestories of people were getting
their medical records were madeof change In their health and
their health care In their lives.
Speaker 1 (27:20):
Amazing.
Thank you so much for that andyeah, I really love your passion
and energy in the business andI'm excited to see what the
future holds for you.
What is the best way for peopleto get in touch with Linda Van
Horn if You've got any offersfor them or if they're looking
to follow your entrepreneurialjourney?
Speaker 2 (27:41):
Absolutely Well.
One of the things that we doand you can go to our website,
which is I share medical calm wedo monthly webinars and we we
cord them and we put them up onour website.
So if people are interested inlearning more About what we do
and in interoperability, that'sa good place to go.
Also, obviously, give us a call.
(28:02):
We're available at 816-249-2555.
My extension is 101 and so Ithink the website and that and
and that, and then you know alsoyou can reach out to us at info
at I share medical calm,through email.
Amazing Well, thank you so muchagain, linda.
I've really enjoyed this timeWe've had together.
Speaker 1 (28:24):
Well, thank you, dylan, it was really good.
I appreciate your effort.
Thank you so much for that.
Speaker 2 (28:29):
Thank you, dylan, it was really good.
I appreciate your interviewvery much.
Hey everyone, welcome back to the growing Lean
podcast sponsored by LeanDiscovery Group, an
award-winning software and appdevelopment firm based out of
Virginia.
This is your host, dylan Burke,also known as Teage, and I'm
very happy to be here today withLinda Van Horn, ceo at iShare
Medical.
Welcome, linda.
Speaker 2 (00:22):
Thank you, dylan, it's great to be here.
Speaker 1 (00:25):
Yeah, I appreciate you joining us today.
To get us started, could yougive us a little bit about your
history and background and whatled you to iShare Medical?
Speaker 2 (00:37):
Sure, it'd be great.
My background I have a BS incomputer science and an MBA from
Rockhurst University in KansasCity, missouri, when I first got
out of school and I always tellthis part of the story because
I think it goes to what broughtme to be here.
But I started out in nuclearand structural engineering
applications.
The company that I worked fordid things like nuclear power
(00:58):
plants and nuclear weapons.
I learned how to secure a datacenter.
I think that's really animportant we're kind of the sum
of our past.
I learned how do we get reallytight security.
We're in the iShare Medical asa medical communications
platform and it's very importantto be secure.
That's kind of first piece.
(01:19):
After I left that company, I wasa senior manager in IT
consulting at Deloitte.
While I was there I had theopportunity to work on a number
of different projects, but oneof them was writing a claims
identification system forinsurance companies.
I learned all about pricingpremium and adjudicating claims.
I left Deloitte to go on andfound co-found the Payne
(01:39):
Institute.
We were anesthesia-basedinterventional pain practice, so
we're basically a doctor'soffice.
We opened 22 locations in twostates in five years, including
an ambulatory surgery center andthe rehab institute, which is
physical therapy.
So here in my background I'vesecured a data center.
I know how to do a big softwaredevelopment project.
Now I'm running a doctor'soffice, but I was frustrated by
(02:04):
the fact that we don't havereally great medical records in
healthcare.
They weren't really helpingproviders to become more
efficient.
I sold my interest in the PayneInstitute and started 21st
Century Edge because I reallywanted to help get the right
information on the right patientto the right provider so that
they could be more efficient inperforming medical care.
Speaker 1 (02:28):
Okay, that's awesome.
That's amazing and, yeah, I'mimpressed with your resume, if
we could call it that.
So what does I-Share Medical doexactly and what is your
overall business strategy?
Speaker 2 (02:44):
Sure, so I-Share Medical is the trusted online
platform for communicatingbetween patients, providers and
payers and devices, so we're aninteroperability, integration
and automation platformnationwide.
We're also a direct trust,accredited trust anchor there's
only a handful of those and weprovide the bi-directional
(03:06):
sharing of information toimprove care coordination and a
reduced cost.
Speaker 1 (03:12):
Okay, awesome, and tell me about your scaling
journey, or your journey ofgrowth.
I see you started around 12years ago.
Is that correct?
Speaker 2 (03:24):
Yes, we started the company in the fall of 2011, but
our first commercial productwas launched in 2015.
So we've been accredited trustanchors since the inception of
the accredited trust anchorbundle and we're really focusing
on three health IT pillars.
The first pillar is digitalidentity.
(03:44):
So it's very important tounderstand who you're
communicating with to establishtrust.
So if I know that this personhas been ID proofed, that they
really are a patient or theyreally are a provider or they're
a payer, that gives themcertain rights under HIPAA for
what that person can and cannotdo.
So we ID proof patients,providers, payers and devices
(04:07):
and assign two pairs ofcryptographic keys.
One key pair is used fordigital signature of the
transaction.
The other one's used forencryption and decryption and
that way we know who we'retalking to.
That's the trust in directtrust really is knowing known
digital identity, the security,privacy and things like that.
We are E-NAC accredited forHIPAA, privacy and security.
(04:30):
So when we do ourinteroperability, we take the
senders cryptographic keys, thereceiver's cryptographic keys,
we bind the transaction suchthat only the sender and
receiver can decrypt them andread them.
And I know that maybe soundslike a lot of jargon.
I know this is also the ITplatform, but it's basically
secured.
For those that may not befamiliar with this, it's X509
(04:52):
certificates.
When you go to any website yousee that HTTPS but it's assigned
to the digital identityassigned to the patient.
We can interrogate that digitalidentity and know how they were
ID proofed.
So there's a bunch of standardsfrom NIST, the National
Institute of Standards andTechnology, that tell us about
identity proofing and encryptionand all that stuff.
So we're a very heavilystandards based.
(05:13):
So those three health ITpillars are digital identity,
interoperability and then thethird one is a learning health
system which is automatingworkflow so that using those
tools of secure communicationbut then using them for real
world use cases.
I'll use an example of eventnotifications.
(05:34):
So CMS, which is the Center forMedicare and Medicaid Services,
one of the largest payers inthe United States or for a
government payer in the UnitedStates, they passed a law that
said you had to send thehospitals had to send an event
notification whenever a patientwas admitted, discharged or
(05:56):
transferred from the hospital.
So when the hospital sends,first of all we can take that
event notification, which isvery cryptic, in a format known
as HL7251.
We decode it and make it humanreadable.
We can also route that messagedirectly to the patient's chart,
to the provider inside theirEHR, regardless of the EHR
(06:19):
system, because we work withevery certified EHR.
So it's a wonderful way to getthe information to them.
But it also triggers activity onthe end of the provider.
So, for example, if a patientgoes to the emergency department
, it's three o'clock in themorning, the doctor's office is
closed.
The hospital sends an eventnotification.
(06:40):
We can trigger the electronichealth record system to respond
with the patient's medicalrecords.
So now the provider and thedoctor or caregiver in the
emergency department can seethat patient's medical records
in real time within seconds oftheir admission.
Even if it's three o'clock inthe morning, it's 247365.
(07:02):
So that provides a reallyhelpful way to do care
coordination, because aphysician might make a different
decision.
Knowing the patient's medicalhistory, maybe their allergies,
you know.
To prevent, you knowpreventable medical errors.
If we know they're allergic topenicillin, for example, we're
not going to give thempenicillin.
(07:23):
So if we have the medicalrecord, we know that.
And that's really what sharingmedical records are about
getting that right informationon the right provider, on the
right patient to the rightprovider.
Speaker 1 (07:34):
Okay, amazing, amazing.
So, to summarize, it'sBasically an encrypted
communications channel betweencaregiver and care receiver, as
well as an encrypted method ofsharing their personal data.
Speaker 2 (07:49):
Right and routing it right.
So routing it you know, in theUnited States we have 333
million People.
In the United States we haveAbout six million Providers,
about 1 million of them aredoctors, about 6500 our
hospitals, and then we haveabout 7,000 insurance companies.
(08:10):
So we're trying to create acommunications Among the people
that get the care of thepatients, the people that
provide the care, the providers,like the doctor, harm, pharmacy
, lab, hospital and the peoplethat pay for the care, the
payers, which are Called payersbecause they're both insurance
companies like at none you knowI did health care and things
(08:32):
like that but also governmentpayers like Medicare and
Medicaid, the Indian HealthServices and the Veterans Health
Administration.
So those are examples of we'retrying to facilitate the
communication but routing it.
So what happens sometimes todayis it doesn't get routed to the
patient's chart.
It gets like faxed to theprovider.
Then they have to scan it or,if it's electronic fax, they
(08:54):
have to read it and attach it tothe chart.
We want to go directly to, anddo go directly to the patient,
and so in order to do that, wehave a mechanism for routing the
Messages into the provider.
So it doesn't matter what theHR system is, we can route it
right directly to the patient'schart and that's phenomenal
(09:14):
because it saves a tremendousamount of time.
I'll give an example one of ourrecent products which we just
launched, and it's a way toAutomate the intake process.
So patients oftentimes when theygo to the doctor they have to
ask, answer, a bunch ofquestions.
This particular client of oursask their patients 248 questions
they want answered.
(09:35):
So we send those questions tothe patient in a form that's you
know web form that they canfill out everything.
They can type it in.
They're going to use patientlanguage in that.
So they're going to say I'mallergic to penicillin, I have
hives.
We see that and say hives isnot a medical term, the term for
hives is eutica area andthere's an rx norm code that has
(09:58):
to be coded in so the HRinterprets it.
So we translate that into theright coding system and Deliver
it to the patient's chart insidethe EHR so that the staff no
longer has to type it.
So in their case we're savingthe staff, you know, 40 minutes
of typing time of putting thatintake form in because there's
(10:19):
so many fields on it.
The data is more accuratebecause it's completed by the
patient and and the provider canreview it, reconcile the
medications in their chart.
So it's just reallystreamlining that workflow and
providers aren't waiting for thepatient to fill something out
(10:39):
in the waiting room, so it'sspeeding up the time that the
providers have in workflow sothey can see more patients in a
day.
So there's a tremendous amountof benefit of just automating
this workflow and that's kind ofthe thing we focus on.
We look at workflow and say youknow what, how can we
(10:59):
streamline that?
And so, being in that uniquePrecision that I've been in
about securing a data center,you know doing large software
development projects, one for aninsurance company Running a
doctor's office I understand theworkflow of the insurance
company, of the providers.
It's really a unique positionto be in just be able to look at
that whole picture and how itall interact, interact and then
(11:22):
build software around, how theworld really works.
Speaker 1 (11:26):
That's.
That's crazy.
That's awesome.
I can definitely speak to thebenefits of workflow automation
because that's what we do forsmall businesses, so I can
imagine the benefits in thehealthcare space having
everything flow seamlessly.
But that's really awesome.
And Tell me, over your 12-yearjourney, what have been the
(11:48):
notable accomplishments, if wewere to go on a timeline basis.
Speaker 2 (11:54):
Sure, I'd have to start with the creditations,
because those are hard to get.
There's a whole lot oftechnology and I jokingly say
our rules have rules.
We have so many rules becauseit's highly regulated If you see
healthcare on the surface.
The reason why it's so complexis there's so many data elements
(12:17):
being able to.
The first thing we did wascreate a data model in third
normal form.
It took us a year to identifyevery piece of data that was
used in the healthcare systemand then structure it in third
normal form, which is organizingthe data so that we recognize
the relationships or cardinality.
(12:37):
If you're a technical person, Ican use an example of that, but
I'll just take a simple exampleof phone number.
In the old days we would put afield in their phone number, but
patients can have zero to manyor providers can have zero to
many phone numbers.
You might have a home, work,school, whatever phone number.
Being able to look at that datamodel and say, okay, there's a
(13:01):
one to many relationship or zeroto many relationship between
the person and their phonenumber.
That's normalization Organizethe data so it's not redundant,
the data exists in one and onlyone place and it's easily
accessible.
That's a big accomplishment ofbecoming a direct trust
accredited trust anchor andE-NAC accredited for HIPAA,
privacy and security.
That allows us to communicateacross our nationwide network of
(13:24):
2.8 million healthcareproviders.
To put that in perspective,there's only 6 million MPIs or
national provider identifiers inthe United States.
We've got a very wide and wehave a directory of those direct
addresses so that you candiscover that electronic
endpoint.
If I am in a doctor's officeand I know there's a famous
(13:47):
nephrologist which is a kidneydoctor at the Mayo Clinic and I
want to refer a patient to thembecause I don't know anything
about this rare kidney disease,I can go into Isher Medical
Directory, look that up and thensend off a message to that
doctor.
Being a part of FederatedIdentity Trust Network, that is
(14:08):
huge because and I'll talk alittle bit about Federated
Identity and I'll use theexample in the United States of
Driver's License A driver'slicense issued by any state in
the United States is trusted byall states.
If I live in Kansas CityMissouri, if I am flying out of
Los Angeles, california, Ipresent my Kansas City Missouri
(14:31):
or my Missouri driver's licenseand TSA is going to look at that
, of course.
Make sure it's valid, make sureI'm me, I'm not on any kind of
no-fly list and then they'regoing to let me through security
.
That's a Federated Identity.
We have a Federated Identitythat's trusted throughout the
healthcare system and a Identityissued by any trust anchor is
trusted by all trust anchors.
(14:51):
Trust anchors include theVeterans Health Administration,
the Indian Health Services, sothose are two federal agencies
that are trust anchors.
They include big EHRs likeCERNR, athena Health, e-clinical
and NextGen.
Those are trust anchors.
Then there's also organizationsthat become a trust anchor as
well, but mostly it's aboutpeople that have really large
(15:14):
volume become a trust anchor.
Our customers are the EHRs andHIEs and individual practice
doctors, practices and patientsand payers that need to
communicate that through thehealthcare system.
But having the FederatedIdentity means that we can share
that information and we trustthe identity of each person in
(15:38):
the network.
I think that's a really hugecomponent of what we do.
I think those things are makingyou proud of what we're done.
We also have had some wins inthe investment space, where we
won LaunchKC, which severalyears ago, which was a
recognition and a grant that wegot.
(16:00):
We also got investment fromMissouri Technology Corporation,
which is a public-privatepartnership.
We've got a number of angelinvestors, but we've mostly been
self-funded and just reallybootstrapping it together for
what we're doing and just tryingto do the right thing all the
(16:21):
time.
Speaker 1 (16:22):
That's awesome and definitely sounds like you're on
the right track.
Where are you Let me think howto phrase this.
Where are you on the journey ofwhere you want to be, like from
when you started to where youwant to be?
Where about are you now?
Speaker 2 (16:41):
What's taken far longer than we ever expected.
It's been far more complex forthat.
You know.
We have just you know hundreds,thousands of data elements in
healthcare.
So if I use the analogy of abank and I apologize for anybody
who knows banking because I'mnot a banking expert but if I
want to send a transaction inbanking, I need to have a
(17:01):
routing number, an accountnumber, maybe a person's name, I
need to know whether this is adebit or credit, I need to know
the dollar amount.
There's just a handful of dataelements.
When I am talking in healthcare, I've got past family, social
history, medications, allergies,surgeries, encounters where
I've had doctor offices orprocedures, and it goes on and
(17:24):
on and on all these dataelements.
So that's where it becomes moreand more complex.
And Because our legacy systemsweren't built on that structured
data, every EHR created theirown data.
So one person called a bloodpressure, or somebody called it
systolic and diastolic, becausethat's what blood pressure is
about.
There's actually eightdifferent ways to measure blood
(17:46):
pressure.
So, figuring out all of thesesystems, the healthcare system
has been going through a processof codifying what we do.
But it's super complex to dothat stuff.
So we are, you know we areScaling.
We have more things that wewant to do.
We have our ice-share medicaldirectory, our ice-share medical
(18:10):
messaging.
We integrate with the EHR's, wedo that bidirectional exchange.
We have that federated identity.
But there's more that we have onour roadmap of how we want to
automate more of the processes,bring in more uses of I Machine
learning and train neuralnetworks.
So we're really beginning toleverage some of the AI
(18:33):
capabilities for probabilisticdecision-making and Clinical
decision support.
But we have we're just on apath, right you know, to get
there and it just we just comein every day and take one day at
a time and keep our eye onwhere we're headed out there and
and Keep charting a course.
I jokingly say you know there'sit's very easy to see something
(18:58):
, the new shiny thing.
You know.
I'll use the example of a dogwith a squirrel.
You know it's like you.
The dog comes out, there's asquirrel and it's like they're
gone.
They're absolutely gone to thatsquirrel and that that's chasing
something that is not on thepath right.
So, you know, I always say andI think of the Star Wars stay on
target, stay on.
(19:19):
So we, we consciously thinkevery day.
So we do.
You know, lean, agiledevelopment.
We have Chrome meetings everyday.
Sometimes they're five minutes,sometimes they're 30 minutes,
but we, we get together everyday as a team to talk about
where we are, the status of whatwe're working on, where
somebody needs help, and stayingon that path to get to where we
(19:41):
want to go.
Speaker 1 (19:43):
Okay, awesome, I love it.
I love it.
And what have been, if any,what have been the biggest
collaborations or partnershipsthat have helped you get to
where you are?
Speaker 2 (19:55):
Yeah.
So we've had the opportunity toparticipate in some interesting
and fun things.
Some of them I can't disclosebecause of, you know,
non-disclosure agreements.
But you know, I think the youknow the automation of workflow
to get the data into the HR.
(20:15):
I think that's really kind of ahuge thing.
We're working with a bigcompany.
We're working with one practicewithin a company that has a
bunch of practices, withoutnaming, being very specific on
that.
So we're looking to helphopefully roll that out to the
rest of their practices and, Ithink, becoming the trust anchor
(20:36):
you know that, connecting with2.8 million healthcare providers
I mean that's a huge, you knowaccomplishment to have become a
credit trust anchor and that'ssomething we go through
reaccreditation, which is a verytedious tedious is the wrong
word it's a very thoroughprocess.
We have to prove how we doeverything and we have to prove
(20:58):
it.
We also became a part of theDepartment of Homeland Security
Critical Access Infrastructure.
So we have 2 data centers, cisa, which is that cyber security
from Homeland Security.
They do our vulnerabilityassessments.
They determine how frequentlythey run those.
(21:19):
So they could be running themmany times a day or they could
run them every couple weeks.
Two weeks is the longest periodthat they run on the
vulnerability scans but be goingthrough that process to get on
the Homeland Security.
Our data center is a tier threedata center, which means that
for every piece of equipment wehave on the floor we've got one,
at least one more piece ofequipment that's idled, that is
(21:42):
ready to be deployed.
We have like seven internetcompanies coming through that.
We have two power stationscoming into our data center, one
from Kansas City, one from StJoe, so that if Kansas City,
which is a big city, if theylost power, we could flip over
to St Joe.
We have a second data center inDes Moines that is married in
real time with our data centerin Kansas City.
(22:02):
So there's a lot of redundancyand infrastructure that had to
be built.
That is expensive and timeconsuming.
We store the private keys onhardware security modules.
We have them married betweenKansas City and Des Moines.
Hardware security modules arevery interesting in that if they
(22:23):
detect a hardware or softwareattack they erase everything on
the machine.
They destroy themselves.
So you have to be carefulreally working with them,
because they can destroythemselves and they're very
expensive and also the privatekeys are the only way to encrypt
the information so if theybecome corrupted or somehow
(22:44):
damaged you can't get that back.
I mean, that's the sameinfrastructure that's behind
blockchain of having PKI thepublic key infrastructure.
So we mirror that.
Unlike blockchain, we keep anaudit trail of everything.
We know everything that'shappening, but the private keys
are kept private and so insecuring those.
So that's a part of thatbackground of having that
(23:07):
nuclear data center kind ofbackground of locking down the
data center, protecting people'sprivacy and security of the
people and the providers thathave the data, the insurance
companies that have the data.
It's a very important part ofwhat we do and something we take
(23:27):
really seriously is protectingthat data and having the
infrastructure in place to dothat.
So I think those kinds ofthings you just kind of do them
and you kind of move through,but they are major
accomplishments when you lookback and say, wow, we did that,
we were part of that.
I participate in four ANSIstandards development
(23:49):
organizations, so it's reallyfun and interesting to be a part
of developing the standardsthat we use in health care.
Speaker 1 (23:59):
Yeah, 100%.
I couldn't imagine what wouldhappen if you had to lose your
your data and start over wouldbe disastrous.
Speaker 2 (24:09):
So we're not going to do that.
We back them up and we haveredundancy and yeah, that's why
you have we Kansas City to DesMoines about three and a half
hour drive down the highway.
So we used to have Kansas Cityin Dallas.
We decided to move the seconddata center to Des Moines On the
thought process, if we everneeded to go there when we
deployed the HSM's, we thought,well, it'll be right there.
(24:30):
We've merely never needed to,you know, go there to in person
to do stuff we're.
You know, it's pretty, prettyawesome.
Speaker 1 (24:40):
Yeah, so all sounds amazing and Unfortunately we
have come to the end of our time.
But what?
What advice would you like togive to other business owners
who may be listening, that arelooking to succeed in this crazy
world?
Speaker 2 (24:58):
Sure, I actually have several little nuggets, but one
of them would be Figure outwhat you want to do, not what
somebody else wants you to do.
You know it's your passion,it's your vision.
If you are, you know,passionate about what you do and
you love what you're doing,you'll never work a day in your
life.
That's.
That's a quote from somebodyelse, but it's really true and I
(25:20):
think in the beginning I mademistakes, listening to other
people what they thought Ishould be doing and I didn't
agree with them, but I thought,well, they, they know more than
me or whatever.
You know more about yourbusiness than anybody else and
you know, not that, you know, Iknow everything.
But stay true to your heart andand your, your culture, your
(25:43):
ballet values to do good thingsto help people.
In our case, that's what wewant to do.
We do this to help providersand patients and payers get the
data they need and To use thatdata to improve care and
outcomes and to reduce costs,and that's really our passion
and we look at everythingthrough that lens.
(26:04):
So if I was advising anybody, Iwould say Follow your heart and
never give up if you, if youare on your path, you're gonna
have.
You know it's a roller coaster.
You're gonna have high momentsand low moments and sometimes
really low.
To be true.
If you want to know that theentrepreneurs journey it.
There can be some really hardtimes where you think, how am I
(26:25):
gonna make payroll, or how am Igonna do Whatever, or how am I
gonna, how am I gonna createthat federated identity, how am
I going to design the softwareto achieve what I wanted to do?
But if you, if you areCommitted to it and you just
never give up, just keep going.
Too many people I think theythrow in the towel, they give up
(26:46):
.
You know we're never giving up.
I tell that to my team all thetime.
We're never gonna give up,we're gonna.
We will figure this out, nomatter how hard it is, we will
figure this out and we will getthrough it and and you know you
just then then you look back andsay, wow, you know, we did that
, you know yeah, and that's,that's the reward right and
(27:08):
helping people hearing thestories of people were getting
their medical records were madeof change In their health and
their health care In their lives.
Speaker 1 (27:20):
Amazing.
Thank you so much for that andyeah, I really love your passion
and energy in the business andI'm excited to see what the
future holds for you.
What is the best way for peopleto get in touch with Linda Van
Horn if You've got any offersfor them or if they're looking
to follow your entrepreneurialjourney?
Speaker 2 (27:41):
Absolutely Well.
One of the things that we doand you can go to our website,
which is I share medical calm wedo monthly webinars and we we
cord them and we put them up onour website.
So if people are interested inlearning more About what we do
and in interoperability, that'sa good place to go.
Also, obviously, give us a call.
(28:02):
We're available at 816-249-2555.
My extension is 101 and so Ithink the website and that and
and that, and then you know alsoyou can reach out to us at info
at I share medical calm,through email.
Amazing Well, thank you so muchagain, linda.
I've really enjoyed this timeWe've had together.
Speaker 1 (28:24):
Well, thank you, dylan, it was really good.
I appreciate your effort.
Thank you so much for that.
Speaker 2 (28:29):
Thank you, dylan, it was really good.
I appreciate your interviewvery much.
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