Shereese Maynard, MS, MBA

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Editor’s note: This is an opinion piece written by a key opinion leader in healthcare information technology (IT). It is not hard news.

Earlier this month, I attended the fifth annual Health IT Marketing and PR Conference, in New Orleans, Louisiana. The gathering came on the heels of the annual HIMSS conference and is referred to by a few attendees as HIMSS’s less stuffy, younger sister. But a funny thing happened while attending the conference this year: I was stopped at least 3 times and was told I was “Twitter famous.”

I was initially put off by the comments, not sure of the implications. But a colleague reminded me, “Influence in this business is gold.” That statement could be very true. During my presentation, the hashtag for my session, “Six (HIT) Chicks,” garnered more than half a million impressions in less than 30 minutes. On the surface, this seems like a good thing, but if everybody’s posting, who’s listening? Our society is so focused on influence; my experience made me wonder, are we getting our thoughts on health IT and innovation heard or are we simply becoming popular?

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According to Couch MedComms, healthcare-tech influencers are not only affecting doctors and pharma, they’re also affecting the business side of the industry. By engaging with tech companies, using existing and emerging technologies, and sharing experiences, influencers answer questions many of their followers have. Likewise, their interactions with technologies, the nit and grit of using products, shapes the expectations of their audience. Followers, at least 57% of them, according to Good Influence, purchased something solely on the recommendation of a social media influencer, second only to family and friends’ recommendations (83%). It begs a few questions: Are we using influence to encourage true thought leadership, are we being accountable, and should regulatory restrictions shape social media influence in healthcare?

Thought leaders are usually identified by their unique approaches to the questions their audience has and their expertise in a specific industry. I’d add that thought leaders become influential and are most effective when their passions coincide with the passions of their followers. No place is this truer than in health IT.

Currently, the healthcare industry is struggling to properly leverage and optimize innovation. If the years following the passage of the Affordable Care Act have taught us anything, it’s that we don’t need to be first, but we need to be precise. Shiny things and talking points don’t improve outcomes or lower costs. Defining the “job” answers the needs of both patients and clinicians.

For healthcare organizations seeking innovative solutions, what a vendor’s product does matters less than how what the product does solves a problem and does the “job.” This is where true thought leadership has the greatest impact. It’s disruption as intended for our industry. Influencers recognize this theory and leverage it successfully.

Accountability for what is being shared by healthcare IT influencers doesn’t differ greatly from other industries. Health IT influencers have conflicts of interest, which should be disclosed whenever sharing information across platforms.

Also, the responsibility for researching a product’s claims falls to the influencer. Last month, I shared my excitement about a vendor’s claim of an actual blockchain use case, only to test it at HIMSS18 to discover it didn’t indeed exist. Without shaming the vendor, I believed it was my responsibility to share my findings with my followers. To that I say, we learn every day.

HealthIT influencers should also share any sponsored posts or promotional considerations. Responsible sharing builds influence.

Influence and thought leadership are not likely to disappear. Given that what influencers share shapes how the industry delivers care and how patients respond to innovation, it would stand to reason that regulation will soon follow. This would be a mistake, in my opinion. Regulation rarely keeps up with innovation, and any attempt to control what’s being shared could cause more harm to an industry already faltering in its recognition of patients and clinicians as beacons of value-based care.

Healthcare in the US is a business model first. To that end, thought leadership is also an important part of any health IT content marketing strategy. Influencers provide valuable insights, but those ideas need to be tempered with what will work not only for business but also for patients and clinicians. Objectivity about the job is just as important as the job itself. Choosing to share brings with it a responsibility to not let brand or vendor interest jeopardize the integrity and efficacy of our words. When it comes to thoughts that influence, no matter where you go, they are yours, forever. Sharing responsibly is the job.

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Editor's note: This is an opinion column written by a key opinion leader in healthcare technology, who's responding to a broader discussion on gender and blockchain that has been taking place across the internet. This is not a news story.

Last October, on an invitation from a colleague, I attended an event for blockchain thought leaders. I was flattered to be included. Although I’m quite visible in the blockchain community, I don’t know if I’ve ever thought of myself as a thought leader. Don’t those people wear tweed?

Typical for me, I arrived at the meeting well ahead of everyone. The event was held at a trendy craft brewer’s restaurant-meets-incubator. It was quite the concept and quite the interesting space. I asked the host if he knew the location of the blockchain event. He body-checked me and responded, “The boys meet downstairs.” I wasn’t sure what I’d done to offend the guy, so I thanked him and proceeded to the lower level. Honestly, I might have expected the icy response if we were in New York, but this was Philadelphia, the City of Brotherly Love. 

Eventually, 15 or so men arrived—and just 1 other woman. When my colleague arrived, he greeted me with, “Shereese, I didn’t think you’d have the balls to show up, but I did want to see the rest of you. Welcome to our man cave.” I remember glancing at the other woman in the room for some sign of solidarity in mutual mortification, but there was none. For the remainder of the evening, she seemed more concerned with fitting in rather than raging out. But that’s another issue.

I left that meeting angry. While I held my own on the topic, I remained silent about the atmosphere. I forgot to use my voice, and that rarely happens. But in this still emerging community, I find myself and so many other women where we were when we first entered the world of healthcare innovation—isolated. Men don’t include us because they don’t want us in the blockchain space, and women don’t embrace each other because we believe that there can only be 1 woman at the table.

The blockchain community has become quietly and deeply misogynistic. It has also gone mostly unchallenged in its embrace of bro culture and the manosphere.

Healthcare innovation has not gone unaffected. Conferences and conventions designed around emerging blockchain uses in healthcare are held as man spaces, replete with male-only panels and mostly male attendees. In an already male-dominated industry, this should be alarming. Women have gained footing in healthcare innovation and should see this trend toward the “manification” of innovation as a causal mechanism for outrage.

Again, I’m still waiting for the solidarity in mortification.

This manscaping of blockchain innovation hardly exists in the shadows. A great example is 

, which is slated to launch on February 20. This initial coin offering (ICO), which promotes the coin as “power to the people,” has been in the works for months. With only minor setbacks, the brand is 

 named after one of the most radically misogynistic communities of our time. Although some have challenged RedPill Coin as a scam, some women in tech and those who are in favor of inclusion and diversity have challenged the concept. Many faithful RedPill followers proudly display the MGTOW (Men going their own way) tag on their social media profiles, with one calling RedPill the “Top ICO of 2018.” Can’t we do better than this?

How, now, do we add blockchain to our already overburdened list of boundaries to be crossed? The Time’s Up and #MeToo movements have brought to light many issues still facing women in our society, but blockchain and the many arms surrounding it seem to embrace anti-female subcultures. Is the blockchain community too small to be concerned with the cancer that grows within? Should we assume that larger movements will eventually spill over into the blockchain space? And should women in healthcare tech shoulder this burden when we already fight so many battles each day?

I’ll simply state: If not us, who? If not now, when? If not through solidarity in mortification, how?

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She thought she was attending the blockchain event as an equal, but her colleagues saw things differently.

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According to the West Health Institute, improving interoperability between health systems could save the United States an estimated $30 billion per year in healthcare costs. With the current administration citing interoperability as one of its 2 top healthcare priorities, along with the implementation of the 21

 Century Cures Act, the promise of interoperability should be a foregone conclusion. But legislative priorities can be a funny thing. What happens when an administration’s own policies are not necessarily aligned with their priorities?

Trump Administration Priorities That Support Interoperability

In late 2016, President Barack Obama signed the 

. Part of that law directly encourages interoperability, defining the term and outlining monetary penalties for organizations who fail to ensure data sharing. Vendors and providers caught hoarding data could face stiff penalties.

Given President Donald Trump’s promise to roll back the Affordable Care Act, or Obamacare, worries quickly arose about the future of the Cures Act when he was elected. But unlike Obamacare, the 21

 Century Cures Act garnered bipartisan support when it passed, and the administration’s early actions seemed to indicate a commitment to the bill. Although parts of the Cures Act have yet to be realized, the plan remains in place and the law will receive additional funding in 2018. Framework development is still in the comment phase, according to 

, but it appears interoperability will remain a focus.

The appointment of Seema Verma as administrator for the Centers for Medicare and Medicaid Services, can also be put in the win column for interoperability. Although tasked with upholding the principles of Obamacare, a program she fought hard to dismantle, Verma remains committed to innovation that connects even the poorest segments of the population with their health data. According to Mattie Quinn of Governing.com, Verma wants to loosen bureaucratic restrictions on innovation while “emphasizing that recipients take personal responsibility for their health.” Verma would be “focused on interoperability and patient empowerment,” according to her recent comments at the Office of the National Coordinator for Health Information Technology’s (ONC) annual meeting.

In mid-December, Jared Kushner, the president’s senior adviser and son-in-law, held an electronic medical records (EMR) and interoperability meetup at the White House. The meeting, co-chaired by Verma and acting Department of Health and Human Services (HHS) Secretary Eric Hargan, indicated the administration’s commitment to interoperability initiatives. Whether the breakout sessions yielded anything tangible remains unknown, but the administration seems to be keeping its promise to encourage better sharing of information.

Trump Administration Policies That Challenge Interoperability

Although interoperability remains a Trump administration priority, financial resources to support that priority seem to fall short. The ONC, which develops and enforces key health information technology (IT) strategies, could see its capabilities reduced. In March 2017, the ONC announced a 37% reduction in financial resources. In practical terms, it will have to make due with a budget of just under $40 million and a task list that has not changed.

The ONC’s 2018 appropriations estimate states that “interoperability is crucial to ensure information is available when and where it is needed.” It also lists several support offices that will cease to exist: The Office of Care Coordination, the Office of the Chief Privacy Officer, and the Office of Clinical Quality and Safety will all be eliminated, which could make interoperability standards harder to develop and enforce. Health IT adoption programs may also be shut down. The program helps rectify EMR issues arising from implementation, a vital component of interoperability.

With resources greatly reduced, innovation may take a hit. The American Medical Informatics Association’s vice president of public policy issued a statement last March claiming that Trump’s proposed cuts to public health budgets would greatly hinder “our national capacity to advance and deploy better cures for patients faster.”

The greatest impact is likely in the area of adoption support. In place of direct assistance, this could result in greater focus on education, monitoring, and removal data blocking practices that block the flow of data. Hundreds of billions of dollars would be cut from all agencies under the HHS umbrella over the next decade. Although the ONC states that resources from the closed offices will be reallocated into other departments to make the agency leaner, it would be naïve to suggest that interoperability initiatives would not be negatively affected.

The Interoperability Standards Advisory (ISA) was formed to coordinate the assessment, identification, and public awareness of interoperability standards. Last year, its scope was expanded to include consideration for research and public health interoperability, and for 2018 it has been updated to include recommendations made by the public during the comment period. ONC said it will continue to support the creation of the recommendations, and vendors and providers would be well-advised to pay attention to updates from the group. It might help them make more informed choices with their interoperability goals and to understand the limitations of those choices.

Until the actual framework for interoperability standards has been completed, it will be hard to measure actual impact of these meetings and policies. But both related agencies and the healthcare industry continue to recognize the importance of interoperability. Even with a considerable reduction and redistribution of resources, healthcare entities could still find a way forward by hiring the right talent for their IT initiatives. They will also have to be smarter about how they map out adoption of interoperability standards.

It’s widely accepted that wasted resources are a major problem that drives healthcare costs. Adopting workflow solutions and comprehensive data aggregation strategies and understanding how consumerism affects interoperability may help organizations meet interoperability goals. Institutions should also adopt their own ongoing training standards as fundamental policy. Investing in resources to become more efficient can be a way to lessen the negative impact of any new administration’s policies.

Shereese Maynard, MS, MBA, is a healthcare strategist and policy expert who has worked with hundreds of providers across the country. For the past 5 years, she has served as the managing director of EnvisionCare and speaks nationally on health IT and blockchain uses in healthcare.

Although the future of the initiative is unwritten, healthcare organizations can prepare for policies to come.