The seeds that planted the idea.
Author: Robert Connely IV, Holon Chief Strategy Officer
I was immersed in the world of Healthcare Information Technology (HIT) at the age of 14. My father, Robert Connely III (right), who some referred to as the “Mad Scientist of McKesson”, was an HIT innovator, and in 1996 he brought me to his HBOC office for the day and showed me all the amazing innovations he and his team were building. At the time, I honestly had no idea what he did for a living, but I do recall the framed awards and patents lining the wall as if it were yesterday. When I turned 24, he left McKesson to found Novo Innovations and as luck would have it, I was fortunate enough to tag along. He would often lament to me about the narrow mindedness of the industry and why change was necessary for the betterment of patient safety and care. He shaped my thought process around managed care and capitation and why the use of helpful ‘assistant like’ software solutions would one day become the future. During this time, my eyes were opened to the harsh reality that many of the issues and costs we faced in HIT were a direct result of the siloed nature for how patient data was stored and shared throughout the healthcare ecosystem. I was certain no one had a full picture of a patient at any given time. This was 2006.
Fast forward a few years and a few acquisitions later, I found myself at Aetna. While there, I was an “observant student” bearing witness to masters of the healthcare universe planning for imminent regulatory change. One of my most memorable lessons was accompanying the Vice Secretary of the Peoples Republic of China to an introductory meeting with Mark Bertolini (left), CEO of Aetna. This happened at a time when the focal point of regulatory change centered around the fundamental shift to quality based care delivery in the late 2000’s, similar to prior attempts at managed care in the late 1980’s and early 1990’s. This time however, a new variable was introduced into the equation – computing technology. Perhaps this meant true managed care could be achievable given the possibilities on the horizon thanks to superior computing power. During the meeting, we were made privy to a CIA world fact file statistic that examined the correlation between the US unfunded Medicare obligation and the sum total of the world GDP. To make a long story short, to cover our unfunded Medicare obligation as a nation, we needed more money than the world makes in a given year and if a fundamental transformation didn’t occur immediately, the entire system would be at risk of collapse. For me, the paramount importance of this eye-opening moment became the catalyst that sent me down a new path and set me on a new life mission: Liberate the Data and make it Actionable.
WHO’S ON FIRST
While at Aetna, we built the most robust healthcare aggregation and exchange platform on the market, focused on a patient centric data model akin to modern day block-chain technology: The Health Information Exchange (HIE) and The Novo Grid. With a portal for all to access the single-longitudinal patient record and an agent-node grid for integrating endpoints from across the community, it was capable of both aggregating data (HIE as a noun) as well as exchanging data (HIE as a verb). It was seemingly astonishing. Unfortunately, late in 2011, we discovered a problem. At that time, I was leading a product team and I was interviewing what felt like countless providers. My question was this: Why are your logins spiking after enrollment but then significantly declining shortly thereafter? What I learned came as a shock to me. What our system didn’t do was spoon feed timely information to providers as and when they were physically with their patients. The resounding drumbeat was that providers had 7 minutes on average with each of their patients and they encountered roughly 32-40 patients daily. So, if a provider proactively queried our system, time was taken and if there wasn’t any data in the system at that moment, that time was lost. Consequently, they began querying our system after hours. It was then that I was told about the demoralizing “Who’s on First” dilemma.
I once sat down with a friend of mine who also happens to be a Primary Care Physician. He explained the dilemma he dubbed “Who’s on First”. He affirmed what we had built certainly had merit and was a significant leap forward from what had been available to clinicians in years past; however, it came at a price. He expounded on the reality that physicians, like many professionals, must always keep legal liability top of mind, even at the detriment of better patient care in some cases. This was certainly hard to hear as a somewhat emboldened though undoubtedly naive product manager. The situation was this: “If he, as a physician who only has time to query the HIE or population health portal after hours, is made privy to certain critical patient care information to which, if no immediate action is taken could result in an adverse event and the patient is not physically with him so that he can take action, and there are multiple other ‘care-team’ members also privy to this same information, then who is legally liable should no action be taken and an adverse event occur?” “Who’s on first?” he said. And then he stated, “If the patient isn’t with me at that moment, or if there isn’t a way I can take action to fix the issue, then I’d honestly rather not know about it.” While extremely difficult to hear and digest, I understood his dilemma. This was the moment a new seed was planted in my mind: What is the right moment to deliver important patient information to clinicians and how will we ever be able to specify who’s on first?
A TAP ON THE SHOULDER
From there, I decided to spread my wings and venture out on my own. There were many hills, valleys, and bumps in the “entrepreneurial road” to say the least. In fact, these days at Holon, we lightheartedly exclaim “Scar Tissue is better than Brain Tissue”. In fact, it wasn’t until Bryant Castleton, Holon’s CEO, and I came to the realization that we knew nearly 10,000 ways how not to do certain things that we decided to bring Saurabh Mathur, Holon’s CTO, and Jim Tropauer, Holon’s COO, into the mix to help us push forward. It was around that time when another eye-opening catalyst event occurred. We were fortunate enough to secure a lunch meeting with the president and CEO of the Blue Cross Blue Shield Association of America, Scott Serota (right). During this lunch, we gained an incredible amount of insight into the mind of a health plan executive. I felt like I already knew an incredible amount from my time at Aetna, but it was clear to me that every health plan executive thinks differently. From this encounter, Bryant and I learned to “focus on the STARS and look for ways to hand hold providers across the bridge to capitation – perhaps by tapping them on the shoulder when the patient is physically with them.” We were deeply enthralled in the world of payment and incentive loops between our federal government, payers, and providers and it was at this moment when the AH-HA came: We need an unobtrusive ‘overlay’ system that will surface actionable insights at the point of care – tapping providers on the shoulder when they open a patient’s chart within their EHR. The system must run in the background and present important patient information such as critical care events, gaps in care, and coding opportunities in a timely manner – keeping provider workflow top of mind at all times. And just like that – the idea for a new system was born.
In 2015, we launched CollaborNetTM to a few of the most forward-thinking pioneers in healthcare delivery. For the past 2 years we have continuously worked hand-in-hand to refine the platform and we are proud to be first to market with our interoperability solution for surfacing actionable insights into the workflow of a third-party system. Today, we are rolling out over a thousand offices. I encourage you to have a look for yourself and let us know how we may help solve your challenges.
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Robert leads strategic planning, product design and direction for Holon with a primary focus on incorporating market needs between our customers with the product we deliver. Prior to joining Holon, Robert co-founded Carematics, a SaaS based mobile care transitions company. Early in his career, Robert was part of a small team that built the Novo Grid, a Medicity acquired technology that still serves thousands of healthcare entities today. From there, he played an instrumental role in growing the Medicity business ahead of its acquisition by Aetna in 2011. While at Aetna, Robert served as vice president of international business development and solutions architecture representing far east interests. Later, he organized the team that invented Medicity’s patented Notify product line. Before moving to the healthcare industry, Robert served as principal architect with the MERLOT African Network for connecting international computer science professors to doctoral Ph.D. candidates at Addis Ababa University in Addis Ababa, Ethiopia.