I was happy to hear that Peter Tippett, MD, PhD , Chief Medical Officer and Vice President of Verizon Enterprise Solutions put aside thirty minutes for an interview with me at the mHealth Summit. I arrived at the large Verizon booth and was immediately greeted by one of my favorite women in health technology, Nancy M. Green, Managing Principal of Healthcare Practice at Verizon Enterprise Solutions. Disruptive Women in Health Care, a group founded by Robin Strongin, just announced their list of Disruptive Women to Watch in 2014 and Nancy is on that list. Congrats goes out to Nancy… and to Dr. Tippett for having one of these top women on his team. We like that.
I always ask people to share a little about themselves before we talk business. Dr. Tippett has a really interesting story and I want to share a bit of it with you. He studied medicine in college but “hated all of the backstabbing stuff that college premed students do” and since his college required experiential learning credits, he used that requirement to do something different. He worked in the emergency room “sewing up people in the middle of the night because I had to stay in the hospital anyway.” This all led him to some great things, winding up in the right places at the right time. It’s a longer story, but he ended up working for two Nobel Prize winners for different things. With those two references in hand, he landed a full scholarship in the MD/PHD program. The PC was not born yet, but he did his PhD on the regulation of glucose in the biochemistry lab. He was published for the research and he did his modeling on a CPM computer. He was president of the computer club and was later involved with things now called mailmerge and undo, or what Peter calls “the primitive” computer stuff. But he persevered on with an internship in internal medicine and invented what was the first antivirus program. He grew a company around this and sold it to Symantec and now that’s called Norton AntiVirus.
“So they wouldn’t let me be president of Symantec, oddly enough, so I started another company after I left there. That had several names along the way but eventually we called it CyberTrust, the biggest computer security and privacy compliance services company in the world and I sold that to Verizon and that’s how I came to Verizon.” Peter’s telling me this story in a storyteller kind of way, as if we are out camping, there is a fire going and we’re exchanging anecdotes. He’s marvelously charming and humble, especially for a guy that synthesized the first immunoglobulin. He continues to talk about CyberTrust and happens to mention that the analysts called it number one “or that upper right quadrant or whatever they call it for the biggest security services company for enterprises where we manage and monitor their firewalls or monitor their intrusions or do alarms or alerts.”
Lois Drapin: So how does Verizon think about health?
“At Verizon, when you look at this whole healthcare IT transformation, the big question for technologists is: What’s taking so long? Why on earth are we 10 plus years behind banking for sharing information about our clients? In banking, we use email and we sue websites and people log into them and people share information back and forth, so why on earth don’t doctors send dictations back and forth, or x-rays or EKGs? And it turns out we worry a lot about privacy and security more so in healthcare than we did in money, and we embodied that in HIPAA..so we think it’s not strong enough or HIPAA compliant to use emails, for example.”
Lois Drapin: But Dr. Tippett, isn’t it true that with all the devices, sensors and the platforms that are being built that there are non-HIPAA data being sent by consumers to non-HIPAA compliant companies because they’re not in healthcare?
Sure, he says. “We at Verizon don’t see ourselves as an entity that is going out with a product that says buy my product. We see ourselves as an entity that is going to lay infrastructure out that is going to raise all boats in the health IT ecosystem. So, if we are looking for everybody in this trade show to be more likely to succeed or grow faster or have all the hospitals, insurance companies accelerate the transformation in health IT, what piece can we play beyond the network? We’re obviously pretty good at the network now, but what can we do beyond that?”
One of the first things that Verizon did was put what Dr. Tippett calls “HIPAA readiness” into their data centers. They sign BAAs (Business Associate Agreements) for cloud computing or co-location. He says they were early in doing that just to “get people to use less expensive faster routes to compute.”
Verizon also has an identity ecosystem that makes it easier to log into databases. “For example, you don’t even need to know you have a user id and a password…feels like single sign-on for doctors logging into multiple different places…or a patient can get to a record without even knowing how to log in. We can figure out which John Smith is which when you are trying to merge records or we can facilitate e-prescribing in Schedule II drugs or CPOe so that, for example, doctors who hate entering things into EMRs can do what I did as a doctor. I just said Discharge Betty. Get her MRI, Lasex, get her a prescription for morphine and have her see me in two weeks. Back then, someone, 10 minutes later, would hand me a clipboard and I would sign off. But imagine if you could have a clerk enter that like they did in the old days, right? The clerk enters the CPOE, the prescriptions, the discharge information and all that stuff for $9 an hour instead of $200 an hour [for the doctor]. In our world, they could get a buzz on their phone or their tablet and there’s an app that knows for sure it’s the right doctor, it’s the right patient, knows the identity and HIPAA compliance and all of that is worked out, and the doctor can just say yes, yes, yes to all that, including the morphine prescription…in which case we digitally sign it, do the two-factor identification and we do all the HIPAA and DEA.”
Don’t think this is “pie in the sky” says Dr Tippett (one of those idioms that makes me begin to ponder how it came to be). Just last week, Dr. Tippett explained that Verizon cleared through 50 million prescriptions that went through the system this year.
Another way of doing BIG
If you have read my previous article on Big company approaches, Verizon feels different to me. It’s definitely a different approach. “No one knows this is Verizon because we’re behind the scenes. We are doing the digital signing, we are doing the two-factor identification to make sure it is the right person, but we are removing the pain to also become FDA, DEA and HIPAA compliant. So the vendors out here can rely on our services and we will do our part and they will do their part. If they want to use my network, I would prefer that; if they want to use my hosting, I would prefer that; if they want to use my cloud, that would be great. But they don’t have to use any of those to make these things work. It will work on the other guy’s network too.”
Lois Drapin: How does this all fit in with your recently announced FDA-Cleared Converged Health Management solution, your remote patient-monitoring medical platform?
“We’ve got a service called Converged Health Management. And the idea is, of course, you can use our network and our devices and our devices and our partners and our platform and get the data from a glucose meter, blood pressure cuff and so on, up into our cloud. You could use our portal for the patients; you can use our portal for the doctors, but you could also have us to get the data through a tool kit and API to Epic or into someone else’s API and you could also skip our portal and use your portal. And the whole idea of this is: instead of saying, “Buy my product, it’s ready to go”–I don’t know if your patient is going to be motivated by social networking or by rewards like $10 bills to behave properly or by training, education or gamification— so why wouldn’t we have a platform that enables all of those things with more or less anybody’s EMR or anybody’s gizmos…and just bring it together so that we can take care of the hard parts for whatever you are trying to do. So, that’s sort of our theory of all of this. Not to compete, but instead to provide. In the new world of software development, we call it software as a service…or platform as a service where we are providing identity, medical record numbers, privacy permissions or maybe an e-prescribing component or maybe a compliance piece or maybe some other piece.”
Lois Drapin: But they don’t have to use your devices, right?
“Right. They don’t have to use anybody’s network or devices. I prefer they use mine. But they can use anyone’s systems…in the hospital it could wind up in an EMR or a portal that the nurse wants to use. We are not going to force anybody to use any particular method and that openness is one of the reasons that we think we are more likely to succeed. Our job is to solve… to get the data from one place to another and doing some work on it along the way, getting it in the right format doing alerts on behalf of the doctor. The way the FDA wants it. It’s not for me to say that the ADA wants you to eat less. The FDA wants my doctor to say to me you need to eat less tomorrow. Per doctor, per patient rules…or you’re not going to be FDA compliant. Those are end-to-end problems, big problems. Somebody with scale has to stand up and say I’ve solved that part of the problem. If you can say that you would join a private anonymous group of other diabetics in your neighborhood, you are not going to know who these people are but you can talk anonymously to these people and help figure out each other’s problem. We will have a doctor in there who is a monitor and if there is something that is flat out wrong we will correct it, but otherwise go for it…that part of the system we just published. And probably the hospital doesn’t have one of those. They may have a nice portal but they don’t have a social media interaction, so maybe we give them that part. Or maybe they want to give people $10 bills if their hemoglobin A1C is not better in a month and they have done five training programs and six other things along the way. Well, we have program rewards and coupons and they might take that. And we have ways to do gamification. Now gamification isn’t going to work for my sister where the $10 may, but getting points on the leaderboard….we have such a thing…all part of the Converged Health Management platform that will take the data from one healthcare vendor to any other healthcare vendor.”
Lois Drapin: Everyone is talking platform here. It’s like mHealth just woke up to platform plays. It’s discombobulating to customers right now, I imagine. How is the customer going to make a choice?
“That’s where we think Verizon is the benefit because [we] don’t care who the provider is. You can use my network or whomevers. “
Lois Drapin: What does this mean for the consumer?
“Well, the consumer is going to drive a lot of this. Right now each hospital makes you log into each hospital and each HIE makes you log into HIE. I can enable all that by making it all log in as a single sign in…you can pick it. I can make the consumer’s life easier…we call this reducing friction for things like login or with our universal identify platform. But on the other hand, we should be able to make it easier for the enterprise to give the consumer a range of choices. Right now, each hospital or each insurance company says “here is my narrow description of what you need to do if you are going to deal with me.” But that’s not how the Internet works…the Internet worked by some using Macs, some using PCs…DOS computer or Linux…right? It all works, and in my way of thinking, in the future the way this is going to work in healthcare is the same thing. A person is going to want to interact on their personal health record, another person is not going to want to interact and want their daughter to do the things for them. Another is going to want their neighbor to talk to the nurse. And who is going to keep track of which privacy permissions which patient has?”
Lois Drapin: Can we spend a few minutes on data. Everyone says here that we have de-identified data, it’s not a problem. How can that be?
“Most of that is so de-identified that it’s hard to find value in it for the researcher. I am less worried about people repackaging de-identified data than to be worried about people taking the identified data in the entire social media site. You give them your name, your photo, and the places you have been, but then people feel bad deducing your salary or what job you had from all the stuff you have given them. Our model at Verizon is just the opposite. We want people to come in through a front door where we say we are in between all that other stuff on the other end. And we will take your identification stuff and only give it to people. So, if you log into our universal identity system, we’ll give them only the minimum they need to get things going or to get you going. Let’s say, these two things or that one thing. We think on the opt-in side is where people are going to become more private and take more control of their data because they get to say what is the minimum to give to play whatever game they want to play.
So, we think the universal identity will help in that space. We also think the permissions problem is a big problem. My mother relies on her son and her daughter because she doesn’t want to use a phone or a PC, but she’s got her 90-year-old problems but still healthy and does Tai Chi and all that. Every once in a while she will interact with the healthcare system. But she prefers not to do any of that stuff. So, shouldn’t there exist a system for my mom? One that gives permission for that son to have access and that daughter and that neighbor? Why wouldn’t you call all those people and say, “Oh my gosh, the glucose just went over the roof, can someone get over to Lois’ house because we know there is permission?” Right now, there is no central repository of who has permission and we think we can provide that.
And if that enterprise is using a mobile messaging company…you could give that to that company. We’ve got two APIs. One API is where we can give it to all the caregivers of Lois, the other one, please tell me who I can talk to and I will tell you.
Each person that we work with will give us attributes and we already have tens and millions of people who use our system, so we are in a good place to grow that. Somebody has got to be in a place where you can get that question answered. You don’t want every gizmo maker, every hospital or everybody to have yet another privacy permission.
Lois Drapin: Dr.Tippett, we’re way over your schedule. Your people are here. You are a visionary, where do you think this is all going? What is this going to look like in 10 years?
Doctors are mostly consultants and have been for 200 years. They look at you and listen to you and your symptoms and given what they know, what they think is going on and what they think will help you, right? We’ve converted that consultancy into specific things like writing a prescription or making a diagnosis, but fundamentally they are consultants. There are lots of procedures that doctors do, but think of the consulting part of doctoring. In the history of information technology, consultancies have become managed services. Managed services have become software companies. That is the way of all things in hi-tech, so I think that doctoring, the majority of it, will move to a managed service and that will move to software. This will happen… just as we don’t go to a travel agency anymore when we want to go to Africa—we just go online and look at the pictures and movies and pick our things. It became a software. And when you look at computer security, some of that has made it all the way to software, but something like monitoring and intrusion detection stuff have stopped at the managed service level where you still have smart people rewriting the rules continuously because the world is changing so fast. So, doctoring is going to follow the same thing. In 10 years, maybe we will be 20 percent there or 10 percent. But that’s the pathway. How do you do that and still be FDA compliant? That’s tricky, but I don’t think it’s impossible. You can still have a doctor make a recommendation about behavior changes for a patient or medication changes, but the fact is that the managed service, which looks at all of the data, figures out the best person that has these three drugs and that age and this other side effect as we get more and more data. In an anonymized data model we should be able to figure out the exact best next step for those people, right? And so the managed service will do a better job of making the recommendation, and the doctor can now make his or hers. So, the doctor could be part of the ‘I approve’ or this would have been mine if I had I known all this information, and all of sudden we end up with all more accurate, more personalized care that still has doctors involved but they are there for the edge cases and they’re there in the middle term…they are helping manage a business system.”
As I turn off my Zoom H6, I wonder what Dr. Tippett’s backstabbing pre-med students would think of all this today.