In this episode of The HEALS Pod I had the pleasure of speaking with Michael Gagnon, the executive director of the Health Information Exchange in Nevada. Michael shared insights into the challenges and importance of building a comprehensive health information exchange network.
The conversation delved into the complexities of connecting various healthcare providers and the critical role of the Health Information Exchange in facilitating seamless communication between different medical facilities. Michael highlighted the need for standardized protocols and the challenges of interoperability in the healthcare system.
We explored the history of the Health Information Exchange in Nevada, its inception, and the funding challenges it has faced over the years. Michael emphasized the value proposition of the HIE, citing real-life examples where access to shared medical records has saved lives and prevented medical errors.
The discussion also touched on the evolving role of the Health Information Exchange in the future, including the potential for leveraging AI and data analytics to improve healthcare outcomes. Michael stressed the importance of data privacy and security in the context of sharing sensitive medical information.
Furthermore, we discussed the need for public policy support and funding to drive the success of the Health Information Exchange. Michael highlighted the potential cost savings and efficiency gains that could be achieved through a well-integrated healthcare data network.
Full Transcript
Diego Trujillo:
Ladies and gentlemen, welcome to another fantastic episode of The Healed Spot. I’m very excited today to be able to share with a friend of mine that I think carries a very noble goal, one that I wish would accelerate a little bit quickly that it has. But he is the executive director, if I’m not mistaking, of the Health Information Exchange here. Michael Gagnon joins us today. How are you doing today, Michael? I’m doing great. Thank you, D.A. It’s wonderful to be able to have you with us, to be able to share with the listeners. I know that the Health Information Exchange has been a passion. Uh, every time I talk to you, you, uh, not only do you know a lot, a tremendous amount about the health information exchange, but the, the delicate nature of what building and, uh, something that would seem very obvious, uh, at least from, from my point of view, knowing nothing with health information exchange. And so I wanted to have you on today to kind of dig in a little bit and find out, well, why, what is the hangup? What are the challenges? What are the arguments? Um, you know, for me, when you talk about a health information exchange, right, I would just say, well, yeah, it’s just a way that all the medical records and all the doctor’s offices kind of speak with each other, right? That’s correct. I don’t know if that’s an oversimplification.
Michael Gagnon: No, not really. It’s, uh, it’s actually quite- Is that pretty spot on?
Diego Trujillo: Yeah. But it seems a lot more cumbersome when I hear you guys talk about it. It, uh, and when I say cumbersome, I mean, yes, we’re not gonna, running a USB cable from one computer to the other, right? This is, this is, uh, very interesting the way that all of these systems kind of have to come together. How do they share the information? Can you tell us a little bit about, uh, the Health Information Exchange here in Nevada for those that haven’t heard a lot about it?
Michael Gagnon: Sure. Healthy Nevada is a non-profit that’s been in business for about 12 years. Uh, we manage the Health Information Exchange for the state. No, it is not as simple as just connecting two cables together because the standards just don’t really exist, um, out there and really only honestly aren’t really adopted enough to make them really work well. So it takes an organization like ours to kind of be the middle man in the middle where in the system to make those things work and to take in the information from all the records and then make it useful for other providers.
Diego Trujillo: So what is the size, just for people that are listening that have no idea, right? So our Heals listeners come from a variety of backgrounds. So some of them might not be familiar enough with technology enough to call me out and say, hey, you can’t just connect two computers with USB. You’d have to use an ethernet cable or another system. But what is a way that you can kind of explain what it is that you guys do and how this idea originally came to be?
Michael Gagnon: So it all started back when the Office of the National Coordinator was formed back in around 2009, and they started to realize that they were going to put electronic health records in all the provider offices and hospitals, and they needed a way to connect those organizations together. And so there was funding through something called the HITECH Act to make that happen. And we were not actually one of the recipients of some of that money, but instead got a grant from Southwest Medical Associates and UnitedHealthcare to get our network started in Nevada.
Diego Trujillo: So this was federally, they were funding different projects for this. That’s correct. And Nevada wasn’t included in that.
Michael Gagnon: Uh, Nevada did get some money, but the state started to create their own health information exchange at the time, and it just didn’t make it.
Diego Trujillo: Okay.
Michael Gagnon: Um, was it uncommon that that happened in other states? Um, but Healthy Nevada was a private organization that got started around the same time, and did actually make it, and, uh, and was successful in getting, uh, hospitals and providers connected.
Diego Trujillo: What do you feel is the key differences that led to the, the private entity succeeding, or at, at the very least, right, uh, still existing?
Michael Gagnon: Yeah, I think partly it was the organization that was behind it at the time, which was Health Insight, which was the quality improvement organization for the state. And then it really came down to the management and the board and the hospitals that were supportive of making it happen. I think they were the real key reason that it worked for Healthy Nevada, but did not work for the state of Nevada.
Diego Trujillo: Okay. And it’s very key when people think about this. One of the things that I think is kind of often overlooked is the different talents that kind of have to come together to make this happen, right? You don’t simply need an MBA to run a good business as far as the entity goes. There’s also the technical side. How are they communicating, the political side, and how are they going to engage? organizations, the outreach and the marketing that’s necessary. Have you had a lot of trouble bringing all of those pieces together? Do you find it difficult? Or when you stepped in, how did you begin to engage with all those different areas?
Michael Gagnon: Yeah, well, I had the distinct advantage of having helped the network get started in Vermont many years ago. Oh, okay. And so I learned a lot about how that Hall was going to work from a business perspective. I already knew a fair amount about the technology, although I’ve learned a lot more over the many years I’ve been working in this field.
Diego Trujillo: What year was that? Just so everyone can get an idea.
Michael Gagnon: It started in about 2003 in Vermont and became incorporated in 2005. Okay. And you were there from the ground? From the very beginning. So almost 20 years in the business. What were you doing before then? I was working in a hospital as the director of infrastructure. So I did software development and databases and ran the whole network for University of Vermont Medical Center.
Diego Trujillo: Okay.
Michael Gagnon: So that was useful background, but really wasn’t sufficient, honestly. You have to have the right leadership team. You have to have the right technology knowledge. You have to be really good at working with your state governments, particularly Medicaid. There’s just a variety of different things you need to be good at to make this happen. And then you have to be extremely flexible in your approach because it’s challenging work.
Diego Trujillo: And even talking with you, yeah, I’ve noticed that. I mean, just any one of those one areas, your ability to be able to pivot and navigate is essential, right? Because, you know, you have one plan and nope, that’s not the plan we’re following or this didn’t come through. Exactly. Now bringing all of those people together to try to figure this out seems like it’d be a lot larger of a challenge.
Michael Gagnon: Yeah, getting the organizations to participate and contribute into the network is also really important, right? So you have to be really good at relationship management with the hospitals. You have to be really good at relationship management with nursing homes and with the provider offices and getting them to recognize the value proposition of them sending their data out of their system to someone else. so that it comes back around to them when they do need to see that patient again. And that’s an interesting challenge as well. And then if you don’t get much support from your state, you’re running a non-profit, but it’s a high-tech non-profit. So where do you get your capital to really build out your network?
Diego Trujillo: Which means you’re flush with cash, right? Yeah, exactly. Just so much money as a non-profit.
Michael Gagnon: So much money in that, right, exactly. And so, you know, it’s kind of an interesting challenge in that regard. If you do get your seed funding from your state to make it happen, then you do subscription services, you need an important sustainability plan. You got to have a lot of different business knowledge to pull off something like this. And then there’s a specialized technical knowledge to understand what it means to build interoperability in the state.
Diego Trujillo: And what does it mean to build interoperability? Well, just for those that are listening, sometimes we use technical language and forget everyone. Exactly. When you’re talking about interoperability, what do you mean by that?
Michael Gagnon: Honestly, it means that your medical records can get to the right provider at the right time.
Diego Trujillo: Okay.
Michael Gagnon: And so that if you’re being treated in an emergency room, that information from the previous hospitalization you had or from your physician office gets to that emergency room doc so they know what medications you’re on. They know that you’ve had a previous procedure. They know what your diagnoses are. And so that’s just really important in continuity of care.
Diego Trujillo: So it would seem that it’s kind of, and this is what really struck me the first time I’ve heard about the Health Information Exchange. Back then I was in marketing, we were having Vegas Healthcare, you know, we’d have our meetings and someone came to a meeting and I asked them, well, what do you do? And they said, well, you know, I work for this organization called Health Information Exchange. And I was like, well, what is your job? Well, my job is to go let people know that there’s a central repository of information that people can contribute to and then pull from. And the concept seems so overly simple to me. And when I say simple, I mean the buy-in on, hey, do you guys think it’s a good idea that we all exchange information so that we can provide better care? It seemed like that would be an obvious yes, but it seems like that hasn’t played out that way in the community.
Michael Gagnon: It’s an interesting dilemma. And everyone gets it, and everyone believes that it’s the right thing to do. But then getting people to contribute and participate and recognize that everyone gets the data out, but they don’t always want to push the data in. And if pushing the data in costs several thousand dollars from your electronic health record vendor, then that tends to be this natural barrier to participation.
Diego Trujillo: It reminds me of the story of the little red hen. Yeah, exactly. Who will help me bake this bread? And everyone’s like, oh, no, I’m sorry. I’m really busy.
Michael Gagnon: Everyone wants to eat the bread, but not necessarily bake it or collect the wheat and mill it and all those things. Absolutely. A little bit.
Diego Trujillo: So everyone sees the value you were saying. Everyone sees the value and how important this is, yet somehow there’s a disconnect there.
Michael Gagnon: Well, think of it like when we build interstate highway systems. Someone had to decide that we’re going to build the interstate highway system and then you build the on and off ramps and that’s where the communities get their value. So think of the docks or the hospitals as being more like the on and off ramps into that. But who’s going to build the highway? Well, then that’s where the government, that’s where the states typically come in and say, no, we’re going to build the highway. We’re going to build the core mechanisms to make this work. And then you get the value proposition because you can put your gas station or your convenience store off of your on and off ramp. And so we’ve been building the on and off ramps but haven’t really built the interstate highway system is kind of the way I view it.
Diego Trujillo: That’s a wonderful way. Honestly, we’ve spoken multiple times and that explanation you just gave right there was probably the best example I’ve heard of where the challenges lie then. So here, oddly enough, it’s like everyone has the infrastructure. We have the gas stations. We have the shopping centers. We just have nothing to connect them.
Michael Gagnon: Right, and we’re using old roads and dirt paths to get between them now at this point.
Diego Trujillo: And what do you feel when you talk to the state about this? I mean, it would seem like the state takes a priority on highways, as we all driving in Las Vegas know.
Michael Gagnon: No, there’s been a lot of construction. We’re great at infrastructure here, but when it comes to health infrastructure, we’re just learning. And honestly, the state took a big step forward this last year in passing a statute called AB7. And AB 7 is going to lead us, I believe, to the point where the state does start to invest in creating the interoperability framework that literally everyone in the state will benefit from. Every hospital, every provider, every nursing home, and honestly every patient will benefit from this being in place.
Diego Trujillo: Yeah, and I could see. Can you give an example of patients that have benefited from this? I know there’s been a couple that you guys have shared in the past. I just don’t want to butcher the story in repeating it.
Michael Gagnon: Probably one of the best is the patient that came in with a stroke at UMC. And Dr. Young there, who was a big advocate of ours, treated this patient. and saw them come in and knew, obviously, that they were unconscious and having a stroke. But when you have a stroke, it could either be a clot or a bleed. And the CT scan that they ran on the patient wasn’t obvious about what it was. And he paused for a minute and said, we better go check the health information exchange just to be sure. And he found a military ID in the person’s pocket, pulled it out, looked at, it just had a first and last name on it, went to the Health Information Exchange and found that that person had had a stroke, a bleed stroke, hemorrhagic stroke at Centennial Hills just a couple weeks before. And they were just about to give that patient a clot buster, which would have made that bleed even worse. And so it’s things, it’s stories like that that really kind of frame what the value proposition of the HIE really
Diego Trujillo: Right, and if you’re that patient or his family, I’m sure they understand the importance of that, right? It literally saved their life most likely.
Michael Gagnon: Yeah, it certainly saved them from harm. And if it wasn’t for the fact that they, you know, that Dr. Young is just a really great user of the HIE, that wouldn’t have happened.
Diego Trujillo: And how much time does it take away for a physician to go and do that? Are we talking about a two-hour period that he had to go and research this person, or are they pulling it up immediately?
Michael Gagnon: He pulled that, once he found the military ID, it took him like five minutes to pull up that record.
Diego Trujillo: So it works pretty quickly, the way people can tap in and draw information and kind of educate themselves to make better decisions on patients.
Michael Gagnon: Yeah, now he’s the kind of user who’s willing to log into our portal and do that. And there’s other mechanisms you can get to get to that information directly from your electronic health record. But he was very good at it. He’s been good at it. He’s been a supporter of ours for over 10 years. And he found that information and it’s a testimonial he’s done for us before. And it’s just one of those stories that we tell because it just does show the value proposition.
Diego Trujillo: Yeah. And, and how do you feel the role of the health information exchange will evolve in the coming years? Um, in other words, where, where do you see this going? Or do you think, I mean, this alone is, is an amazing value proposition, right? Uh, where do you see this expanding to provide more value? How are you guys trying to kind of capitalize on what the future may look like? I know AI is a big, a big deal, right? I’m sure companies across the country are tying to tap into these records to be able to kind of research and gather information. Is there any kind of monetization that will help sustain this kind of model? Or is it just simply you’re expected as a physician to kind of pay money to be able to share the data and receive the data?
Michael Gagnon: No, I would say what you’re mentioning is very important and probably the future of where it’s going. So think of it as being more like for medical research or for population health where you want to know what’s going on with your diabetic population in North Las Vegas. Or for, you know, improving care because you’ve got artificial intelligence based in this. You can do clinical decision support or you can do medication administration based in knowing all the information on a patient instead of just what you have in your local electronic health record in your practice. So I think the future is actually bright. This is something that we can do. It doesn’t require a lot of change in the actual provision of medical services to make this work. Um, but it does influence the way it can work. And it can really help by saving lives and saving costs. And it’s probably the way we’re going to make value-based healthcare work.
Diego Trujillo: And when you have large vendors, and I agree with you, right? If you want data now, you have to go to the MCOs, you go to the managed care organizations. They’re the ones that really carry it. Do those organizations communicate with each other or not typically?
Michael Gagnon: They often do not because they compete with one another, but they do get data from us. So all the Medicaid, Medicare organizations are part of our network, and they get clinical information from us daily. We send them real-time alerts when their patients are being seen in the emergency room or we get admitted to the hospital. But I mean real time within minutes of that person actually showing up.
Diego Trujillo: Wow, that is pretty quick. And how quickly, where do you feel the largest pushback is? So once again, I mean, I think as we explore the value of this and we discuss, it’s seemingly obvious to anyone listening that how could we improve health care? And I say this because I get interviewed all the time. Well, how do we improve health care in Southern Nevada, right? And it feels like they ask the question just to ask the question, not to listen to actual answers that will help to solve this. And this seems to me like such a low-hanging fruit for everybody. I mean, if you think of what one thing can we do that will lead to the largest amount of impact immediately, Medicaid rates, right? Raising Medicaid rates will have a large impact. Aside from that, I mean, the Health Information Exchange seems like it would be one of those things that would have an incredible community to the outcomes of our health care here.
Michael Gagnon: Yep. And yet each state views this differently. Some have embraced this and fully made it work, and they create public-private partnerships, and those are highly successful. And others simply are a little bit behind. And I think Nevada’s been a little bit behind. One of the wild west here. In many of its healthcare aspects, right? And it may not have been ready for something like this before. And it also took us getting electronic health records in all the practices first. Like that had to happen as a precursor to making this happen. And now that it has, it’s an ideal time to really jump into it and really fund it. And it’s not inexpensive, I’ll tell you that. It’s kind of like building a broadband network where someone’s going to put up towers and put up, you know, equipment.
Diego Trujillo: But we see the government investing billions of dollars in that, right? Exactly. You see the value and you see the return on doing these things. Right. How do we share that sense of urgency? How do people understand how important this is?
Michael Gagnon: You know, I think partly it’s just getting the word out. It’s partly letting people know what the value proposition is. It’s partly working more closely with our state Medicaid department who has access to a lot of the funds from CMS, from the federal government, to make something like this work. And it did take us working closely with our state government partners to make this happen. It seems like the regulation is just about ready to go in terms of making that a reality. And some of the funding, there’s actually $3 million in funding.
Diego Trujillo: Do we get an announcement podcast? Is that what that means?
Michael Gagnon: We certainly will, I think, pretty soon, I’m hoping. But right now, we’re kind of right on the cusp of really embracing it. And there’s other states, California, which recently embraced the same kind of thing. Montana, which recently, I mean, some of us are a little bit late to the party, but that doesn’t mean we can’t make this happen.
Diego Trujillo: What would you say is the, I mean, there’s good and bad to that, right? Sometimes you feel like we’re late to the party. There’s probably some states that were trailblazing here that really learned some hard lessons.
Michael Gagnon: And spent a lot of money to get things done and wasted a lot. And I don’t mean that they wasted it on purpose. They just didn’t know how to get it going. In the early days of when I worked on this, there was a lot of money thrown at this just to figure out how to get organized, just to figure out what the technology should do, just to start to get people connected. A lot of money spent on consultants. I mean, I think all of that was a precursor, though, and was necessary. The one thing about Nevada is being a little bit behind like this, we can be very efficient. The fact that we already have a structure in place and we can incrementally build on top of it, that means we can move ahead very quickly with a more modest amount of investment. Now it’s still not inexpensive.
Diego Trujillo: Yeah, we didn’t say it’s little.
Michael Gagnon: No, it’s probably $4 million in state funds that will generate $40 million in federal match. But that’s the other part of it, is there’s so much matching funds out there from the federal government that it also is one of those things that when you mention that to people, you go, for $4 million in state funds, we can have a fully meshed network that, you know, connects almost every provider in the state. It’s another thing that people think is kind of, why aren’t we done this already?
Diego Trujillo: Yeah. I know that’s something that definitely kind of hit me very hard. It’s like, wait, how does this not exist, right? All of these companies knew they were developing software for hospitals, for doctor’s offices. They’re all somewhat familiar. And I’m assuming, correct me where I’m wrong, I’m assuming that for them, it must have been important that they would be able to communicate with other systems. They wouldn’t design their system in a way that when it spits out data, it’s incredibly difficult to parse through. So they all had to have this in mind. Do you get a lot of support from those organizations? Are they interested whatsoever in the interoperability of their systems? Or do they just build their systems the way they build their systems and that’s it?
Michael Gagnon: No, it’s amazing recently how many vendor products come to us to be the source of their data, to make their systems work better.
Diego Trujillo: When you say vendor products, what do you mean by that?
Michael Gagnon: I mean anything that could be like a health app for a patient, or when you need to get life insurance and you need your medical records collected, or if you’re trying to do diabetes care. Those organizations are now coming to us because we’ve aggregated this information for 10 or 12 years and we have it in a repository and if they have the right rights and approvals from patients and provider groups, we can give them access to that information. We’re becoming more and more of an asset in the community for the health data.
Diego Trujillo: I think that data in general, and I’ll be very honest with you, I became friends with somebody that had studied research for data and that are data analysts, and that’s what they had gotten their master’s in. I think you know her as well. And as we’d go on hikes, I guess data was one of those things I knew existed, it floated out there. I never valued the importance of data. And it wasn’t just through casual conversation. When you have someone that’s passionate about data saying, look at what you can do with this, this, this, this. And it just, it kind of began to blow my mind how much would be possible just by knowing things, right? And having that information recorded and being able to make it make sense. The way you need to, I don’t know if I phrased that correctly.
Michael Gagnon: No, that’s a great way to phrase it. And if we want to make our healthcare system in Nevada better, we’ve got to be able to look at data, analyze it, understand where the most cost-effective use of our resources are. We want to be, you don’t want to waste money doing things that are not going to be effective. You want to recognize where the value comes. And if you’re looking at data, that’s another thing you can do with it. Not just give it to the providers to let them do better care, but also analyze data, like I was saying earlier, about, well, where is the best use of our resources? Because our diabetic population in this area is different, or our heart disease issues are here. And so you can use geographic coding of things as well to kind of understand how to best use your data for that purpose.
Diego Trujillo: Yeah. And, and I think as a society, right, when you look at, and you’re talking just about health data, I think if you would have asked people 15 years ago, how important is data? They would have kind of shrugged their shoulders and been like, uh, kind of. I think, uh, as we’ve seen social media grow and as we’ve seen media and tech companies take off and, and we started realizing as a population, well, hold on, these people figured something out with this data. It’s very important, right? Google gives you all of these things for free. What are they trying to get here, right? Well, what is the privacy? And again, data begins to kind of come up, data on privacy specifically, with Cambridge Analytica. And the way we watch these companies in such a targeted way be able to collect information and know how to kind of guide populations in general is, it seems that data has kind of come to the forefront. Right. Which means you’re in a good position right now, right? as people realize the value of, wait, oh, yeah, we could see how it helps when I’m browsing the internet, while I’m using different things, right? I talk to people sometimes, because they’ll talk about privacy and cookies, and they’ll complain, and I’ll be like, man, we had to grow up, I grew up in a world where I would, right, it was like, you had to watch television, and that’s how you get your cartoons, and then you got fed seven commercials, so you always had to run to your mom and dad and tell them, I need this G.I. Joe toy, right? And they’d plant this urge in me. But now all of a sudden, and I would tell people, I was like, you realize that now they know kind of what you’re into. You get served ads based on the data they have on you that are more relevant to you. As a person that, listen, I don’t think as a society we’re going to get away from advertisements. But if I have to deal with them, I’d rather deal with advertisements that are more relative to me. Uh, if that makes sense, right? Absolutely. So for me as a 39-year-old man, right, that drives or is interested in these seven things, right, if you’re gonna advertise any hiking stuff to me, I’m gonna immediately watch your ad. Right. Um, however, if you’re talking about Charmin or, you know, uh, dish soap, I might not be so interested. It might not be so effective. Now, we all see how this has changed our lives for the better in those areas. You mentioned it with, as a patient, right? There’s life-saving implications, but now you’re talking about the actual public health using it to understand diets, to understand what’s affecting us specifically. I’m sure they may be able to start picking up on trends. Um, especially with the advent of, uh, of AI and the integration of AI, where now the machine can automatically say, hey, something’s happening here. You know, there’s 37 people in the last two weeks that have shown up with this very rare or not typical, uh, condition. Right. Is that something you could see happening with the data as well?
Michael Gagnon: Yeah, we’re already doing that with Southern Nevada Health District, where we feed them information regularly, and they can look at patterns in that data to tell that, for example, a sinusitis infection is happening in the area, and what does that mean, and what’s the implications of that, and how do they treat that?
Diego Trujillo: Did you just pull a random example, or is that happening right now? No, that’s an actual one we’re working on. I know, I just went last week, and I was like, okay, what a coincidence, sorry, and somebody else called me, and they’re like, I swear I’m not lying, I’m sick. I was like, no, no, no, is it nasal? Yeah, I just went through that.
Michael Gagnon: Let me address, though, the privacy and security aspect. So health information exchanges take that extremely seriously. And it’s more of a closed network. It’s not really as open a network as the other things you do on the internet. We only allow certain providers and certain groups in. We only have certain connections to those organizations, and those are all privatized over. They flow over the internet, but they’re all through virtual private networks so that they’re all private. We then have the highest security accreditation that you can get called HITRUST. And we have a very small staff that’s highly trained. And I was the privacy and security officer for a large medical center in Vermont. And the thing that kept me up at night were my 6,000 employees. A very small percentage of them might want to do something malicious, but another percentage would actually potentially do something accidental. But when you have a small team, highly trained, it actually helps with the security and privacy of the information because they’re very attuned to what they’re doing and why they’re doing it. And that goes a long way. And then being very cautious about who you give access to it, under what conditions. We just recently added what’s something called multi-factor authentication. This is where you have to use your phone and you get a code, six-digit code you have to put in. So we’re like tightening up it even more. And we did that because of the things that happened with the change healthcare thing that happened with Optum. So we need to stay in front of that. We always stay in front of it. No HIE in the country has ever been breached. So many other organizations have been, but no HIE in the country, not in any state, has ever been breached. And it’s partly because we’re just so attuned to how important this is.
Diego Trujillo: Yeah, that’s what like 90% of it has got to be, because I’m assuming the number one hang-up on people wanting to participate on this is, yeah, but how secure is the data?
Michael Gagnon: Partly, and partly they want to make sure that it’s private and only shared, but when we explain all that, that it’s really going to someone treating them, or it’s another doctor or it’s another hospital treating them, and now they don’t, might not have to have lab tests repeated or get stuck again for a blood draw, or might not have to have an imaging exam repeated. They’re all really for it. The vast majority of people, 95% of people opt in and say they want to participate. And then a small number of people simply want their data to be private, and we honor that as well.
Diego Trujillo: Yeah. So it’s not automatic. Each patient individually would have to sign a consent to participate.
Michael Gagnon: That’s correct. That’s the way it’s set up here in Nevada, that everyone has to what’s called opt-in or give informed consent to participate.
Diego Trujillo: Okay. So if you want to stay off the grid, you’re good. Yeah. Right? Until you need it. Then you say, how come you don’t have my info? Yeah, exactly. We always used to joke around because we’d work in secondary services. So you’d have a case manager call and say, hey, do you know a home health that can go? And they would name the most random places in Nevada I had never heard of in my life. And I’m born and raised in Nevada. And I was like, well, no. And they’re like, there’s nobody that goes out there? And it was funny how they would be shocked. And you’re like, well, you know how you chose to move away from society? Yeah, it turns out that you accomplished that goal, right? Successful. And then you get upset when there’s not companies that service that, right? No, that’s very interesting. As an HIE, what was it that drew you the most to this project? What do you say kind of fuels you? And I say this honestly because you’ve shared a little bit in the past about how big of a struggle. Again, I felt like this would be an alley-oop, slam-dunk. You know, someone threw the ball up, Michael grabbed it, slam-dunked, everyone’s on board, let’s get this going. And it seems to not have been this way. Nope. There has to be a vision in you, something that really pushes you to say, okay, we cannot give up on this, it’s too important. What is that, if you can explain it to the audience listening?
Michael Gagnon: Honestly, it’s been a passion of mine since I first saw the opportunity for what this could do. There’s no downside to it, honestly. You know, it’s just the sharing of information in this way is just all positives. And once I started to understand what needed to be put in place, I studied computer science, and so I said, this is something I know that we can do, and it has to be done. I’ve become jaded at times because of how complicated it is to do, but I’ve never lost my sense of the mission and vision that this has to happen, and it can really be the driver for improving the value of healthcare, and it can help patients. We feel like we are the only patient-centered service in the state, and I don’t mean that other organizations don’t care about their patients, they do. I mean that no one else collects all the data in a single place, and aggregates it and makes sure you’re the same person and makes it available to everyone else.
Diego Trujillo: That’s a key thing. Seemingly, there’s no way that that could ever happen without an organization or a convener that actually brings that together.
Michael Gagnon: That’s exactly how it has to happen. You have to create a network above the individual provider organizations to make that happen. It’s the same way banking did with ATM cards. When each bank didn’t connect to every other bank, they created something called an interbank network that connected all of them together, and that’s how they shared data so you could get your money in any place. What we are is like an interbank network, but for providers.
Diego Trujillo: Yeah. And so where do you feel the greatest challenges currently right now? If you could name one thing that you’re like, you know, as an organization or as a community, this is the largest hang up we have on making this happen.
Michael Gagnon: The only thing that’s holding us back, Diego, is the funding right now. You know, I’ve been in this long enough. We have an excellent team. We know exactly what technology would put in place. We are following in the footsteps of others who’ve been the trailblazers, so we don’t have to invent new things. And yet, we probably could invent new things and make sure that they’re unique to Nevada. But honestly, it’s just the capital funding to build out this network and knock down those barriers we talked about earlier.
Diego Trujillo: And following that up then, what can I as an average citizen, you know, as Diego Trujillo that just, you know, works his nine-to-five job, what can I do to help push this forward or to make these things happen?
Michael Gagnon: Well, we may reach out to all of you to sign some kind of petition or to become much more aware of the fact that, you know, we’re around and that this exists and this is a value proposition for every citizen of Nevada.
Diego Trujillo: Yeah. I think the, the awareness, I agree with you on that. Again, when I heard about this, I was like, wait, this hasn’t been done? How has this not been done yet? Right? It seems so obvious. Um, but getting people to actually mobilize and engage sometimes can be a little bit difficult. How has been the feedback with legislators over the years and up until now? Do you, do you sense that? So we talked earlier about that, that kind of change in perspective towards data, right? Where now people are like, Oh, what you have is very valuable. Are you seeing that same, that same knowledge or that same feeling within the legislation?
Michael Gagnon: I think it’s flipped here in the last legislative session, and that’s a good thing. I think the federal government pushing what’s called the trusted exchange framework and their cooperative agreement has caused us to realize that we have to do something about this. And so some of the state legislatures have gotten involved with that and started to push it forward and started to create the framework and the statutes that would push for the regulations that make this happen. And so that’s been good. It’s been a challenge up to now, but I think it’s finally coming around. Honestly, the national networks are really important, but not sufficient to meet all the needs. You need a local network and you need national networks both. And it’s the same way, like I said, with banking ATM cards. You have national networks and then you have international networks.
Diego Trujillo: Who runs the national networks out of curiosity?
Michael Gagnon: Well, there’s several organizations. One called the Sequoia Project has been around the longest. They were funded by the federal government to create something called the eHealth Exchange. But there’s others, Commonwealth, Care Equality, Epic has its own network. All of those are useful. All of those are necessary. They do interstate connectivity. And that’s valuable, but you still need your local connectivity. You still need to know what immunizations have been done inside your state. You still need to know what’s going on in the emergency room so you know how to look for public health issues in your state. So there’s some state-based things and there’s some national things.
Diego Trujillo: Zooming out real quick to the national, it would seem like forcing from a national standpoint that the government should be the one kind of running this. And I say this only because some of the companies you named are vendors, right? They have a very specific interest on being number one and, you know, competing better than everybody else and making sure that the other guys don’t succeed, right? And that they do just because of the shareholders. So how… How do you kind of get over that? I’m trying to think about without nationalizing it, which is a very, right, everyone’s scared of that word. But, uh, but really without it being something that is nationally ran.
Michael Gagnon: Uh, I think it really needs to have national standards. Like we, we don’t impose like, uh, TCP IP networks across the country. We let individual organizations do that. So you can privatize that part of it, but you have to have the national standards in place and the rules of engagement and what you want to get accomplished. And then you can let the private sector kind of be involved with making that happen. State governments are very good at policy creation, but often not so great at running, especially complex networks like this. Yeah. You know, and so it’s kind of isn’t even, even our, you know, electrical grid is run by a private company, but with public oversight. That’s kind of the ideal model we want to see in Nevada is let the, let one you know, kind of network us, Healthy Nevada, run that network for the state. But we’d welcome the public oversight. We’d welcome the public opinions on this. We’d welcome, you know, public meeting law and make that happen.
Diego Trujillo: So you would see this functioning as a utility?
Michael Gagnon: Pretty much. And as a matter of fact, there’s federal language now to define something called a health data utility. And it’s recently passed as part of the Labor H Bill and was signed by the president. And so now it’s not yet something that’s coded into law. It’s more of a recommendation. But the CDC and the Office of the National Coordinator and CMS are all starting to promote the concept to say this is a logical way to build out your network in your state.
Diego Trujillo: Now when you mention funding, what would it look like? Are we, are you not able to draw some funding, for example, by letting AI companies have access to data or allowing some of these companies to look at this data? Are you able to monetize? Again, keeping in mind that this is a nonprofit, right? So it’s not for Michael Gangman’s new yacht. But this is rather for the ongoing mission of the organization, right?
Michael Gagnon: That’s certainly something we could consider, but that’s something I would ask the governance, like I ask my board those kinds of questions. Okay. And make sure that they are comfortable with what we’re doing in that regard because some things can be considered, you know, kind of safe, like medical research, and other things maybe not so much. You’re kind of just trying to privatize the information or selling… Marketing diabetic materials. Yeah, we’re not really into, like, you know, kind of selling the data. We’re there to make sure that the, you know, and we actually welcome governance of that because I think that’s where the state needs to play a role. They need to play a role in understanding what’s something allowable for this data, you know, what our citizens really want. Now, if a private citizen signs a release form, that data can go anywhere it wants to. That was a federal law passed called the 21st Century Cures Act. They can have their data go to an app on their phone. They can have their data go to TikTok if they really want to. Now, we wouldn’t necessarily promote that, but we would also be required by law to do it. So, I think there’s some rules that we need to put in place, policies, usefulness. In Vermont, we had a board that did this. It was called the Green Mountain Care Board. They governed what was allowable for data to be used in that health information exchange. We’d welcome that same thing in Nevada. It gives us the guardrails to work within, and I think that’s an important thing for the government to do. not necessarily to run it, but to give us the flavor of what’s allowable, what’s reasonable, what helps the citizenry, what’s considered something that’s allowed.
Diego Trujillo: And I agree with you. It feels like this almost needs to become like a partnership with the legislature and kind of engaging them. And I would venture to guess, right, as we get younger politicians in office that kind of understand, this has been one of my frustrations, and I don’t know if I should vocalize this on the podcast, but I will. No, of my frustration of watching a 70-year-old man asking the CEO of Google if his iPhone can blah, blah, blah. You know, well, how come when I look up on my iPhone, he goes, yeah, we don’t make the iPhone. It just… And I say this for this example. We used to revere within human beings, right? Going back thousands of years, we’d sit around the fire. And why was a old person so revered? Because they had experience. They would be able, they knew more about the world than anybody else. They could share more and they would be able to advise and tell stories that would help to shape. And it feels like with technology, that really got flipped on its head, right? You look at a 15-year-old on a cell phone versus a 70-year-old person on a cell phone and the way that they engage with that. And I don’t say this as a criticism. There are some 70-year-old, I will include my mom in that, very much admire the way she adopted technology and really pushed to learn. But some people were always very resistant to it. Well, I’m just not good at those technological, you know, I wish we could have said, hey, I’m just not good at that algebra stuff. And our parents would have been like, oh, then don’t worry about learning it, right? However, this has real-world implications in how we build our society. I know there’s even criticisms, to the way that we handle our privacy and data here versus like Europe and the way the European Union takes its approach on privacy, right? Yes. And it seems like they’re much more awake and alert at least to the value of data, to how to protect data, and then how to shape the society they want to live in. Where it feels here, as a population, we may be more flippant, and maybe not knowledgeable enough.
Michael Gagnon: A little too independent, maybe, in terms of that regard. Like, there’s some things where it doesn’t work to have everyone control everything uniquely, but you need to have some kind of underlying capabilities, right?
Diego Trujillo: Yeah.
Michael Gagnon: And you’re right about the age of people are more comfortable with the information sharing, use of iPhones, use of any kind of cell phone, smartphone device. And that’s starting to change. And I think that can be a good thing. Yeah, we still need to worry about privacy and security, like we said before about these things. But really it takes one champion who gets that this saves lives and this saves money. And if you get that one champion and they’re powerful enough in the state government, they almost always pull it forward. That’s another theme we found and we did a little research study with UNLV actually about what makes for a successful health information exchange. And to begin, it needs to have public policy and public funding. That always takes one champion, someone pushing it forward, because it’s so esoteric a kind of capability that it just takes one person going, no, we’ve got to do this for this reason. And they don’t have to understand how it works. And then you have to also build trust. Someone like I have to gain trust of people that I’m going to do the right thing. Right. And that it’s going to be the right mission and we’re not going to sell this information. We’re going to do it for the right reasons. We’re providing a public service. That’s the way we view it. And once it flips to that, That’s when you start to make progress and you get the investment. And it’s not, like I said, it’s not a small investment. So it does take people going, okay, how important is this? By the way, we think that for a $40 million investment, we would save $153 million per year. in savings, just in hard costs, just in things like non-repeated tests, just in things like non-repeated imaging exams.
Diego Trujillo: And this is not just a random number you pulled out.
Michael Gagnon: This is actual data you have. This was a study that was done in New York, and we just adopted that and changed the dynamics and the numbers to be adopted into Nevada. And because New York is actually a little bit more mature health care market, that number is probably actually higher here. Wow.
Diego Trujillo: Yeah, they’re not making as many mistakes as we are here, or repeated testing, or whatever it may be.
Michael Gagnon: Yeah, and they’re just a little bit more integrated networks and such, you know, versus us where we’re a lot more independent, especially in Southern Nevada. And that means then that the data sharing is even more important.
Diego Trujillo: Yeah, no, and I’d agree. I would say the biggest challenge, I mean, just listening to your story, right, is just, you show up as a new kid on the block to tell everyone, hey, you can trust me, we’re building something good here, and we need government money for it, right? And everyone’s like, uh, who’s this guy?
Michael Gagnon: I tried that with Director Whitley in the first few weeks I was here in the state, and it didn’t go over so well. Yeah. Honestly, you know, you just gotta build trust, and the relationship we have now, yeah, is much better. I’ve been here for nearly seven years doing this. We’ve built up some credibility over that time. We’ve accomplished some things. We did pull off one small project a few years ago where we connected several underserved hospitals and the state public health lab and such. And we started connecting to the Southern Nevada Health District at the time. And now we’ve built upon those incrementally, a little too slowly as I would want it to go, but made incremental progress. And so now it’s starting to flip around. I think, you know, Director Whateley feels like he has an edict from this AB7 statute that was passed to do something about this. And I think we’re going to see this change a lot in the next two or three years.
Diego Trujillo: Well, and the exciting part is you’ve also, again, you’ve worked for seven years to demonstrate you’re not a flash in the pan, that you are committed to this vision, that there is integrity in, you know, behind this project. You have the momentum with that trust. Now all you need is for it to be a priority, and it seems like that’s what’s happening.
Michael Gagnon: I’m really excited about it. I think the future in Nevada for this kind of stuff is just about to hit, and we’re gonna see tremendous change. In the next legislative session, I expect we’ll see several bills to try to fund really important projects like maternal child health, like chronic kidney disease, like connecting up the jails and prisons, of which most of those end up on Medicaid after they’re out of that, or have substance abuse issues. I think we’ll connect up mental health, All of those things are incredibly important to this marketplace.
Diego Trujillo: Just solving one of those alone. Yeah, one of those alone could be tens of millions of savings. Just one of those would be a huge savings. And the fact that you have one system that can benefit all of those is a tremendous impact. Well, you mentioned that, uh, you know, you have to, I can very much relate with that, having to build trust and saying, yeah, I know I’m a new guy, but this is what I’m about. And right. And that takes time. Right. And I hope that the people listening to the podcast, uh, will, will at least have a little more trust after this podcast, understanding a little bit more about you, your background. Um, is there anything you could leave with the listeners today of things that they can do that may listen to this and say, yeah, this is a great idea. What needs to be done? Or is there an email list they can be put on so that, you know, when it’s time to mobilize or to let our legislators know, hey, this is a very simple, you know, a very simple solution that can benefit a lot of areas. How can people stay connected? How can they stay informed?
Michael Gagnon: Yeah, if you’re a provider, we’re on healthynevada.org. You go to our website, you can actually participate in many ways, but the most important way might be go on and sign up for who you think you need information from. By the way, we’re going to be coming out with a survey here pretty soon too, and we’ll make sure that the listeners and others in the community get that survey. And it will help us understand what we’re doing well and what things still need investment and where to best spend our dollars, should we get them, to make things better for all the providers in the state and all the patients in the state.
Diego Trujillo: That’s excellent. And for everyone listening, that is HealthyNevada.org. H-E-A-L-T-H-I-E, Nevada, N-E-V-A-D-A.org. So make sure to get on, stay up to date on kind of what’s happening with the Health Information Exchange. I think this is something that everyone could support. Again, going back to the beginning of the podcast, the first time I heard about this, well, this is an obvious, like, yes, this would benefit for many reasons without anyone even explaining it to me. I definitely want to encourage our listeners to be able to stay in touch and to kind of know what’s happening as the legislative session gets a little bit closer to see what we can do to really move the needle on this and begin to make an impact. I think you’re at a very pivotal moment. And I know you’ve stuck around this for a few years, but I think the priority on data and understanding what this can really do for our society and how transformative it can be is a concept that a lot of people are understanding. And I’m very excited for what Healthy Nevada will become.
Michael Gagnon: Well, thank you for having me here.
Diego Trujillo: Well, excellent. Well, ladies and gentlemen, that has been another episode of The Heels Pod. We thank you for joining us today. Again, make sure to check out HealthyNevada.org. H-E-A-L-T-H-I-E-N-E-V-A-D-A.org. And thank you very much for tuning in again. Have a great day.
