Benefits of Managed Services

And so with that, I'm going to let of course Jana and Mark introduce themselves, but I want to thank them both for being on the panel. This is from their perspective. And with that, I'm going to hand it over to Jana and he's going to introduce himself and talk a little bit about Health Connect Texas.

Well, thank you so much Peter for inviting Health Connect Texas to the main stage. My name is Jana Hussein. I am the chief executive officer of Health Connect Texas. We're the health information exchange for the great state of Texas. We coordinate care for the community by integrating all the different electronic health record systems of provider organizations large and small to create that 360 degree perspective on the patients so that clinicians have access to patient medical information available to them right at the point of care.

And we do all the great things that we do in our communities in Texas as a 501c3. We're a not-for-profit entity. We're here to serve all the wonderful communities and the richness of the communities that we serve in Texas. We have 27 million patients in our clinical data repository. That's roughly 90% of the state. We have quietly become one of the largest health information exchanges in the nation.

Great. And thank you Mark. Please.

Hi. I'm Mark England. I'm chief executive of a technical consultancy called Integrala. We're based in London, the Middle East, UAE, and in India. We're focused on improving the value and outcomes for our customers using our technical skills. We work particularly focused on integration and making solutions fully integrated within complex enterprises. About 60% of our business is in healthcare but we also work across other sectors as well and we've been around for about 18 years working with InterSystems throughout that time. I've only been with the company the last six months as chief executive, but I was their first healthcare customer 18 years ago.

And so, excellent. Excellent. I'm still the youngest, meaning the shortest time with InterSystems. So, from a standpoint of kind of Jana, let's start with you a little bit. How has InterSystems technology, before we get into the services side of things, how has InterSystems technology helped you and your business and helping patients in your community?

Sure. Sure. So Texas and southeast Texas in particular, where Health Connect was first founded in the greater Houston area. It's a very complicated healthcare market. It's one of the most competitive healthcare markets in Texas and across the nation. And really fundamentally the problem that we have is a data fragmentation problem. Data exists in multiple silos across healthcare organizations large and small. Whether it's small physician office practices, federally qualified health centers, large health systems, payers, the public health system.

And so using InterSystems tools and solutions, HealthShare, that's enabled us to aggregate, normalize, deduplicate all of this information. And then that information is available to us in our clinical data repository. And that clinical data repository serves as a foundation for us to do a lot of really incredible things to improve the health and wellness of our communities, whether that's public health, whether that's research, whether that's analytics. And recently we've been making a bigger push into non-medical drivers of health.

Excellent. Excellent. And Mark I spoke to you a little bit about the complexities of London and the care and what you do with 999 service. Can you describe a little bit of that and then come together with how you're using Health Connect Cloud in this case and how it affected your approach?

Yeah, of course. So we're using Health Connect Cloud and the outcome we're trying to focus on is improving what is in most health systems one of the most pressured points. The front door of the ED department and the congestion that happens as patients arrive on emergency pathways. And we're delivering that across London. Now, I know it's a US audience. So Peter counseled me to provide a little bit of context about London and the NHS. And so London, big city of about 10 million people. There are 30 different ED departments and as Tim Ferris said they're called trusts and they're quite autonomous, really, those 30 organizations. They choose their own EPRs. So there's about half Epic, half Cerner across London. So you've got 30 different ED departments.

But we have got some advantages over the complexity of your system where we've only got one ambulance service, the London Ambulance Service, which is delivering. It's got about a thousand emergency vehicles, 6,000 paramedics, and they're focused on getting those patients who've called 999, which is our 911, into the hospitals effectively. We have about a 50% conveyance rate. So the paramedic will arrive at the scene and only 50% of the patients they take to hospital, they decide what ED to go to and then they determine the route.

So that's the situation and we've put in place — you've probably seen headlines and I've seen headlines in the US about delays in handover between the ambulance crew and the hospital staff at the front door of the ED department. So we deployed Health Connect Cloud for particular reasons really because it's got the scale to cope with the growth which we foresee along these pathways but also it sits across so many different organizations, not just the ambulance services and the emergency department but also there are community providers, behavioral health, mental health providers in that context and many community physicians and GPs who are involved in those pathways both in hours and out of hours. So, it's a very complex system with many moving parts.

And we've started the approach focusing on the most urgent, the 999 calls that the paramedics take to hospital and hand over. And we're about 30% through the roll out. We've done some of the bigger hospitals, Imperial, Kings, Guys and Tommies, the big acute hospitals and we're seeing some really interesting impact upon the outcomes particularly focusing on the speed of handover, the safety and accuracy of the handover because what happens is as the paramedic captures the data on the patient in the community and as they get them into the ambulance and they make the decision to convey to hospital, the data moves ahead. And in Epic and Cerner, we've built a screen which gives a detailed inbound view of the patient that's on its way. And so when the patient arrives, it's often refreshed the data. If there are any more vitals taken during the transit journey.

But when the patient arrives, the handover process is expedited and the data is already in the system and so it can focus on an accurate conversation between the clinicians handing over and not the transcription of the key information. But also our more forward thinking hospitals are starting to look at the inbound screen and say can we get the patient to the right place first time for the right care and it might not be ED, it might be straight into a stroke pathway or it might be straight into a frailty pathway. And we see that as a really important way of splitting the queue of patients that is backing up an ED, taking maybe 5% of that away. So that's what we're working on and the Health Connect Cloud is working very well at the moment but with much complexity, in particular organizational complexity at that scale.

Well and I think both examples are powerful because they're about improving patient care, clinician experience and of course safety for ambulatory care. So Jana, talk a little bit more. Now we're focusing a little on the managed services relationship because you are one of our foundational clients in the US data centers which is kind of interesting. Just talk about that journey because you've been with us along the way.

Sure. So Health Connect Texas, our journey goes back nine years and we jumped all in on managed services back in call it 2016, 2017. And that was very intentional. The way that I view our managed services relationship is that it enables us to, number one, focus. It enables us to operate at scale and number three it enables us to have greater impact for our communities.

So on the focus side, I think that we are interoperability experts. We're not data infrastructure experts and as interoperability experts, we need to focus on the things that we're good at. Which is taking data and making that data come alive. I think that from an IT infrastructure perspective, having managed services control that aspect of our business frees up our time to focus on higher value added activities that we as a health information exchange need to focus on. We need to focus on our communities and be more engaged with that. And managed services allows us to free up that time.

And then on scale, we have 27 million patients that we serve across all 254 Texas counties. That's across rural areas and the urban areas and in the triangle region we have a lot of penetrance, that's Houston, Dallas, Austin, San Antonio. That area is roughly call it 22, 23 million patients and so that kind of scale requires an infrastructure that's reliable, consistent and allows us to do the incredible things that we do with our InterSystems tools.

Excellent. Excellent. Thank you. And then you've mentioned a little bit about the scalability. What other kind of connectivity and ease of engagement did you feel like you got from the SaaS and the managed service engagement?

Yeah, I think the security and high availability angle is, because I've been a chief information officer in a trust myself previously, you struggle to manage infrastructure and infrastructure expertise. And to be able to have an infrastructure partner like yourselves and AWS, these are the most critical of pathways if we're making decisions about patients on a stroke pathway where it's absolutely critical, time to needle etc. Those sort of pathways that will determine the level of disability for life. We want to be really sure that we've got the most robust solution that will be highly available. And I was very impressed, to tell a story, last year there was an outage on AWS. In fact I don't really understand how you did it but AWS went down, some problem in South Carolina, I'm not sure what it was, because we lost access to HubSpot and various corporate systems so we realized something was up with AWS. And my first thought was what's happened to the Health Connect Cloud. We only had three sites live at that point, but for some reason, you failed over between a couple of locations within AWS and it just carried on seamlessly. And it's that level of reliability and availability that we need, but also scale.

If you've got an individual on-prem solution, we're very quickly uncovering more use cases that need integration within urgent emergency care. The first one we found was we were looking at the 50% of patients, as I said, who are conveyed to hospital. The 50% who aren't conveyed to hospital have still sought emergency care. So they've dialed 999, an ambulance has been sent to them and they've decided not to take them to hospital. The likelihood of those patients popping up somewhere else in the urgent emergency care system in the coming weeks or days or hours even is quite high. And at the moment there was no access to those records. So London Ambulance Service came to us and said could you take the details of the non-conveyance and put it in.

And then it only took another few months and they said, "Well, we've got a whole non-urgent number 111 where often if you call 111 seeking help, you don't want an ambulance, but you want support and guidance." And that information is very fragmented at the moment. And 30 to 40% of those calls end up speaking to a clinician for a consultation. And so they were saying again, high risk of popping up elsewhere in the system. Is there a way we could use the Health Connect Cloud to bring that data together in the London Care Record? So, I think both on the high availability piece and on the ability to scale, because you can just see it.

We're not sure where it's going, but we can just see more and more opportunities to join up pathways. And also on the cyber side, I think cyber's on everyone's minds, but when you see the ability to expose vulnerabilities and exploit them and the generative AI potential to change the cyber game, I think having big partners who've got the resource to focus on it is really critical.

Yeah. And I want to piggyback on that. In Texas, obviously a very conservative state, and we work with a lot of organizations that take a very serious stance when it comes to a strong security posture. And I think for a lot of HIEs, the vast majority of HIEs in the nation are not-for-profit organizations and we run fairly lean. My team is on the larger end, we're almost 50 people, but the vast majority of HIEs are tiny. And we're across the nation, a lot of HIEs are managing copious amounts of protected health information. We have 27 million patients in our clinical data repository, hundreds and hundreds of terabytes of data. And so the institutions that bestow their most privileged and confidential information and their protected health information with us, we need to ensure that data is protected and secure.

Because as Mark pointed out, cyber events happen very frequently. And so this is one very strategic area that we rely on managed services for, to protect our data assets from malevolent actors. And I think if you haven't, everybody's probably seen the news lately, that threat surface is growing at exponential rates because even if AI may not be profitable, it's certainly being used for other reasons, which in some cases, sorry, talking back to Tobias, but from a standpoint of that security I think working together on how we make sure that happens across the board. And I think your comment of high availability is something that we bring to our core because we make sure there's the software and the management and the customizations and the other pieces but from a foundational element we work with clients on their level of protection. And in that specific example of outages, without getting technical, we take multiple steps across protection zones to make sure that you will experience what you experienced and that's the power of what we do working together and designing to your kind of desires and goals.

From a standpoint of innovation, you've already talked about a couple of examples. Mark and Jana, you're thinking about kind of your growth. You're actually, I'll let you mention it, but you're kind of changing that a little bit and so let me let you do that and then I'll come back.

Yeah. So Health Connect Texas has gone through a period of innovation and growth. We recently merged with our community information exchange, an organization called the Patient Care Intervention Center, PCIC. And as health information exchanges we focus on a patient's longitudinal journey. A community information exchange focuses on a patient's social services journey. So is a patient food insecure? Do they have adequate housing? Do they have adequate transportation to their medical events? So all of the social determinants of health that focus on whole person care.

And so this is part of a larger national conversation that's been happening over the last several years. Health information exchanges are evolving towards providing these additional value added services. If we really want to solve some of the toughest problems in healthcare, we need to focus on these non-healthcare related issues. And so this was kind of the impetus of joining forces with our community information exchange.

So that was a 15-month journey. That transaction closed at the end of 2025. So we are in month four of this grand experiment. And I want to make a shout out to the folks at Georgia and Denise Hines and they did fantastic work. In Georgia, through the lens of a chief executive officer, the decision for an HIE to move into the non-medical drivers of health space, it's either do you build it, do you buy it, or do you partner? And I think for our friends in Georgia, they made the strategic decision to build it on their own. That is very hard to do and they are having outstanding success. So I applaud them for their efforts.

And Georgia really kind of set the stage for everyone else. And we at Health Connect Texas looked at what they did and said, "Well, it's hard to do that." So let's, but there was this wonderful community information exchange right in our backyard. And we said, let's see if our missions align so we can do some incredible things to support whole person care in Texas. So essentially we have doubled in size, we've doubled our data assets and now we have all these wonderful data assets and now we start the conversation on how can managed services take the intersection of healthcare data and social services data and really make this data come alive. And I think with the tools we saw all week that fits together and looking at how AI can advance that, and again not having to worry about GPUs as a service and other things, that's something we can help with obviously and make a little more simple.

Mark, give some of the ideas if you have of things. I know we free up your teams for certain things, but where else are you looking? And again, you've talked a little bit more about your expansion, but what other things have been a big factor for you on the cloud journey and just the difference between hosting and what you're used to as you led these different institutions and now you're using public cloud for the connectivity and the other pieces.

Yeah. Well, I think if I stick to the urgent emergency care path that we're looking at, some of the innovations happening outside of the cloud, the London Ambulance Service is looking and they've done a lot of work on ambient recording within the ambulance and at the point of conveyance decision and during the ambulance journey. And that's leading to some of the flows that we're putting in place and the clinical consultations that have happened being transcribed and then summarized and coming across those interfaces. But I think one of my reflections here today is that the HealthShare presentation yesterday, the ED presentation with the aorta abnormality, which was, because we've spent a lot of time investing in bringing together data in shared care records. HealthShare is one of the systems quite widely used in the UK and local health and care record aggregations.

But the more you talk to people and clinicians who work in the urgent emergency care pathways, if you're an out of hours GP and you get a phone call coming in and you open HealthShare, you're just faced by thousands of artifacts and it's very difficult to tell any signal from that noise and you just start taking the history on the phone and you try and manage the patient there without almost without recourse to the record. And to see that HealthShare example yesterday where those five different records across five different providers were bought together and then summarized with some context as this is an ED presentation.

It's really inspiring to see those sorts of use cases because I think within our system and with where we're operating I can see immense benefit from that and it'll be a strong pull for that sort of technology. You won't be pushing that on people because people are saying at the moment I just can't make sense of it. And so I think that's an innovation case that's very strong.

And I think just to jump in on that, I think that's where the partnership goes. And John mentioned this in his presentation. It's that one of the things we're trying to do in the managed services space too is there's a lot of different components to make a solution. And so what we're asking clients is, if you're interested, work with your teams and InterSystems to talk about your objectives and your goals and the outcomes you're trying to achieve as a way of us being able to look at it and come back with those proposals and solutions together. So I think it's definitely a partnership and it's a relationship and that's the most important thing I think for all of us.

Yeah and our managed services relationship, as I mentioned, goes back nine years and I don't want to be Pollyanna about it. Managed services relationships they ebb and flow, right. I think there are times when you have spirited conversations on the phone with your partners on the other side. And I think I'm going to take a quote from everyone's favorite rock star, Don Woodlock. When he opened up the leadership conference on Tuesday, he said, and Don, what was it that you said? You said that progress happens when friends disagree. And I think that's such a fantastic quote because that encapsulates our managed services relationship. That we can agree to disagree without being disagreeable.

And we work collaboratively together to ensure the best outcomes for our communities and the institutions that we serve. There's in the managed service context, just to take it away from what I've been talking about in London, I think there is a Health Connect Cloud offer that reduces the barriers to entry for organizations who have a really strong but might be quite narrow integration need. And I think with private health companies now, they might be not so much health tech as companies that are focused on diagnostics or focused on telecare. And their core business is getting a radiologist looking at a CT and providing a safe and timely report. And that's their core business. Dealing with all the integration and the complexities of the different vendors, every time they get a new customer or a new contract, they need to integrate into a new provider or a new plan. And it's the brake on their actual business development and growth. But they are often working with a very small integration team at a very small level.

Now, if you're going to have an on-prem solution and a high license cost and a high entry point, I think you've got the ability in Health Connect Cloud to present it as an entry point which gives you all that high availability, the cyber security and the functionality that's required. And we can build our services on top of that, our support services, and we can offer that to smaller companies and in fact smaller providers as well. We have providers in the community and mental health space. Healthcare is becoming more and more joined up. It's such a team effort and they're being asked to bring their data and integrate it in various situations, but they don't have the capability. They're smaller organizations and their digital teams are very threadbare. And so if you've got a managed service that has the right entry point and can grow with them, some of those private health companies will grow. Diagnostics is a very fast growing field. Some of them will be very successful and we'll all win on a managed service basis which is based on volume.

And so I think that's an area where your cloud offer and us together with a comprehensive managed service we can offer is an opportunity for all of us.

Yeah. And again, I mentioned in the beginning the investments we're making in this space to continually drive more SaaS, drive more of that fully turnkey solutions for those clients who want it. I think that's going to make total sense for certain clients. For others just the infrastructure, whatever works. But especially if you're trying to get to a journey on public cloud, that is one of the lowest barriers of entry to just get it provisioned very quickly, start to consume and be able to connect people and deliver results. That is very powerful. And again, you'll see that across more and more of our platforms especially in the next six to 12 months so very excited about that.

What I wanted to do is kind of hand it to both of you for final thoughts on how you look at this as you go forward, how your organizations look at that relationship. And so I'll start with Jana, but then Mark close us out.

Sure. I mean, I think that for us, our managed services relationship enables us to think bigger. It allows us to be bolder. It allows us to focus on the things that really matter. It frees up our time. We are interoperability experts. We are citizens of the great state of Texas that want to improve the health and wellness of all Texans. We're not data infrastructure experts. And so that relationship allows us to focus on the things that we're good at. We have a motto at Health Connect Texas which is connected for a healthier Texas and through our managed services relationship I really do feel that embodies the core motto of our company.

Thank you.

Yeah, I can see exactly, we're not infrastructure experts. We're much more, we understand interoperability. We understand the outcomes that our clients are trying to achieve and the idea to have such a robust managed service partner. But also, as I said, I've only been in the role about six months so I'm slightly out of date with InterSystems technology. It's been great to come here and see the platforms you're building and the capabilities that are embedded within them because I can just see that together we've got an opportunity to take those and present them and build them into clients' workflows and processes and release value for all. Because as the last speaker was describing, there's so much hype and noise and it might be keeping your stock market up over here but it's hard to see quite where this really sustainable enterprise-grade embedded value is going to come out of AI. But I can really see some of the efforts you're making in investing in the platforms. That case yesterday when you were talking around the ward system taking over the shift and the preparation of the discharge summary, you can just see within the healthcare context quite what the potential is and that's not the sort of thing we can build.

We're not infrastructure experts but we do have software teams. We haven't got the engineering capabilities that you've got and the pedigree. So I think it's a very symbiotic partnership. And we were discussing how InterSystems exploits the AI market and do you want to grow bigger teams or is it best to let your partners grow their teams and feed the benefit through in that way. I think that's an interesting discussion.

Yes absolutely. Well first of all I want to thank you both for joining us and giving your perspectives and appreciate of course the partnerships we've had for so long. So again thank you very much and thank you all and we'll see you next year. Thank you.