Talking HealthTech: 298 – Interoperability and healthcare systems integration. Robi Karp, Fluffy Spider Technologies

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There are three certainties in life: death, taxes, and a need for better interoperability in healthcare technology.  

Interoperability—the thing that will magically solve all of our healthcare problems. Since people have been talking about the lack of interoperability in healthcare for so long, it must be extremely difficult to achieve, right? Otherwise, we’d have just done it…

What happens if we reach the maximum levels of interoperability? What does it actually mean, and why is it so difficult to achieve?

Pete is joined in this episode by the main man from Fluffy Spider Technologies, and we’re diving deep into interoperability and what it’s all about. We’ll learn more about the software engineering capabilities in health technology and why they’re known as Fluffy Spider Technologies.

Meet Robi Karp

Robi Karp is the CEO and founder of Fluffy Spider Technologies, which helps clients provide better healthcare by providing interoperable digital health software solutions.

Robi has a background in software development. He is a software engineer with a degree in computer science and mathematics from New South Wales University. He worked for years as a software engineer in mission-critical type environments and started doing that straight out of university. Robi does not have a background in healthcare or medicine.

About Fluffy Spider Technologies 

Fluffy Spider Technologies (FST) began as a one-man team in 1995. Eventually, the company grew, and then it started to focus more heavily on consumer electronics. One day, they received one of those magical phone calls—it was Toshiba, and they wanted FST to work for them. This is for Toshiba Japan working through their Australian R&D centre. They were exploring new kinds of consumer electronics devices and they wanted FST to do some of that work and it started quite a long relationship. It culminated in FST being on display, on a new kind of device that nobody had ever seen before, which was a tablet at the consumer electronics show in Las Vegas in 2008. They then identified a key piece of technology that they developed, licenced it, and began working with other consumer electronics companies. They also began to collaborate with semiconductor firms. There were three main areas: televisions, set-up boxes and the associated chipsets. The other, which ended up being their biggest, was in EFTPOS terminals, and they ended up licencing this technology to a company called Verifone in the United States. They are probably the world’s largest payment terminal company and FST licensed key technology to them. It is embedded in hundreds of millions of payment terminals worldwide. All of this took place outside of Australia because there was no manufacturing industry in Australia at the time.

The story behind the name Fluffy Spider Technologies

The dot-com bubble had not yet begun in 1995, but the names were odd. The web was just up and coming so Robi thought of using the word “spider”. It was sort of like a joke back then as he thought that maybe the payments department of the contracting firm would look at it and have a bit of a chuckle. That’s all there was to it. Eventually, they got one contract after another, had to hire some people, and it all snowballed from there. It should be noted that this was in the 1990s, so these kinds of names were nearly half a course at the time.

How FST transitioned into healthcare

The semiconductor industry overseas started to consolidate back then so that kind of market got smaller for FST. At the same time, the manufacturing industry in Australia started to pick up. They started to work with a very innovative Australian startup at the time called Visionflex which was developing a telehealth hub. The initial concept of their products was about telehealth and taking video streams and data and putting them from one place to the other place and in moving video, you need some special skills and chipsets. At that time, that’s how FST got into healthcare in the first place. They had expertise with some of the media decoding chip sets that were acquired and the technologies that were needed to drive them. It opened their eyes to the whole healthcare technology system in Australia. They really got a better understanding of the digital health landscape and all sorts of things going on there, the problems to be solved. Then going a little bit further, the thing that they became interested in was that of interoperability—How is it that we can have all of these sorts of systems that can’t talk to each other? 

Thus, about three years ago, FST as a business shifted its focus entirely to digital healthcare, specifically looking at how it can work on that interoperability piece.

FST as a Software Partner

FST’s specialty isn’t developing apps that nurses or clinicians use on the front end; instead, they collaborate with other software partners, powering the kind of behind-the-scenes work that they do.

At the moment, there are no apps unless somebody wants to build one. For the time being, FST can be thought of being a software partner. A few of the projects they’re working on include the development of a customized workflow for one of the state health departments with the HL7 and all of the existing kinds of technologies around interoperability; and for another customer, they are doing something similar wherein they are doing the integration piece—in one end, it’s HL7, and on the other end, it’s using FHIR. In some cases, what they are doing is just doing a part of it. As a result, they may simply perform the integration or provide resources. In other cases, they handle the entire system from start to finish. They’ll meet with stakeholders, gather technical requirements, and draught proposals. They consolidate complete end-to-end solution quotes with timelines and support. 

They address the entirety of the digital health ecosystem as their customers are both the technology vendors and hospital systems or healthcare providers. They work with small startups and in some cases, it’s as simple as providing them advice. They are gradually collaborating with larger organisations, and FST is now registered to provide software development services to the New South Wales Health.

Interoperability

From a technical point of view, interoperability is about making different parts—the software and the hardware that comprise our healthcare system—talk to each other seamlessly. It is exchanging data so that the population’s health overall is improved.

There are standards such as FHIR that will provide good ways to securely share specific data, but interoperability as a whole must conceptually include existing systems, and existing systems may use older protocols because the goal is to securely and easily share data. So, if there’s an existing system there and it’s talking HL7 and that’s what you got to use. You can’t change all of the systems overnight since it’s not practical. You need to work with what’s there. Interoperability is the entirety of it.

FHIR is the popular and up-and-coming modern standard for healthcare interoperability. To implement FHIR in a large organisation, the focus shifts from a technical problem to a domain problem, because all that is required technically is the creation of an implementation guide. The implementation guide defines what we’re sharing and how the technical guides will go away and figure out how to represent that in a technical way. But the first step is to figure out what we’re sharing that necessitates everyone in the organisation to put their most important information in one place. They must come together and define what they believe is important. And these are not technical individuals. So, in order to find them technically, they must be led into a way of explaining very precisely what they are looking for. What information are they looking for? What information do they seek? So we’re almost hurting non-technical people by forcing them into some sort of technical way of doing things.

Champions for Cloud Computing

Returning to the earlier mentioned example of the state health system, FST believes it is its responsibility to provide solutions that are best suited to the customer. They expect the solutions they propose to be always forward-thinking. In this case, what they ended up proposing was the addition of a cloud-based component. Cloud computing and interoperability are inextricably linked. FST had to be champions for cloud computing. It worked out pretty well within this organisation. They thought it was a great idea, but that isn’t always the case because people look at problem-solving in the same way they’ve always looked at problem-solving. This can be a problem when it comes to new technologies and new ways of doing things. When people think of cloud computing and patient privacy, especially the protection of patient privies, they think of it as a risk, but it’s actually the other way around. As a result, you are compelled to assist them in thinking through these issues and explaining why.

Problems being solved when it comes to interoperability in healthcare

What they’re trying to do is ultimately offer secure access to and secure storage of health data. Let’s say you’ve got a bunch of new sensors and wearables, and you have an app on your phone that tracks your blood pressure and SpO2. All of the data coming out of these kinds of wearables are fed through machine learning algorithms to generate AI algorithms so that they can monitor you. There’s a term called precision healthcare that is about looking at what’s normal for you and not baseline it on what is normal for the standard population. There is a gap in there that could be filled by having interoperable systems. 

Challenges when it comes to delivering solutions across the healthcare system

The greatest challenge right now in implementing and delivering solutions across the healthcare system is a skills shortage. Because the job market in Australia for employers is brutal, it is difficult to find software developers and specialists. The cost of living and wages are rising. All of this translates into higher prices for every single bit and piece.

Another challenge is that there’s a lack of willingness to change. A good example would be cloud computing as mentioned previously. Some of this should go without saying because cloud computing is more scalable, safer, and secure for all of these on-premises systems.

When it comes to commercial challenges when FST works with smaller companies and startups, many of them are funded through investment or grants, and those investment deals or grant applications were put in a long time ago. In some cases, in the meantime, everything’s gone up. As a result, there is now a funding gap between what they thought they could do and what they can do—a sticker shock. That is a major issue right now, and it is exacerbated by investor hesitancy, which is problematic for MedTech in particular. If you want to be a MedTech company, like a true mass-producing MedTech company, you need things like guaranteed component availability and secondary sources. MedTech companies in general get a bad rap because of investors. Most people find it difficult to invest in a MedTech company, so it takes a special type of investor. They don’t understand the process and they keep that away.

Digital health and the industry in Australia

Australia has always been a good testing ground for various types of technology. It’s always been that way because Australians are quick to adopt new things, have a high standard of living, and are generally healthy. The digital health industry in Australia as a whole is growing. There is a collective momentum going on right now, and there are innovations all over the place.

FST’s Future

The next six to twelve months are going to be about growth. Currently, they are hiring people and growing organically through these digital health projects. They’ll expand by focusing on integration with existing systems. They are going to grow by developing end-to-end solutions for people, hopefully bringing all of these things together, and incorporating existing standards like HL7. They have also been talking a lot internally and have their eye on some sort of product concept.

_{Source talkinghealthtech.com}