Addressing Social Determinants Through Digital Health

Transcript

Bryce 

Welcome to Digital Health Transformers, a podcast series. This podcast will explore the dynamic world of healthcare innovation, one conversation at a time. I’m your host, Bryce Barger, and today, we have an awe-inspiring guest at the forefront of transforming the healthcare landscape.

In today’s episode, we are thrilled to welcome our guest, Aaron DeMontmourcy, Director of IT Security and Compliance at Elevate Health. His expertise lies in the critical intersection of IT security and healthcare, which is important to us all. With almost 20 years of experience, he brings a wealth of knowledge as an accomplished IT security professional and a decorated veteran.

Aaron’s been dedicated to safeguarding information assets and infrastructure. His forte is strategically developing and executing comprehensive information security and IT risk management programs. Starting as a network switching systems operator in the US Army, he continued his passion throughout his career. I’m sorry; he continued his passion for info security throughout his career.

Aaron’s cross-industry experience provides a unique perspective on fortifying digital healthcare, from performing cyber attacks and defenses as an information security analyst at the US Army to heading IT sec and compliance at Elevate Health. Join us today as we dive into Aaron’s journey and his perspective on how digital health can help address social determinants. Thank you for joining us today, Aaron.

How are you?

Aaron 

I’m great. Thank you for asking. And you guys are doing great things in the healthcare space.

I am so thrilled to be here. Thanks for having me on.

Bryce 

We appreciate it. You know, just getting started into your personal, professional story, your journey from the US Army to healthcare is remarkable. And something that you might not see every day.

It’s probably more common than many know, but it’s a remarkable journey. What influenced you to switch from that kind of government, that US Army role, to healthcare?

Aaron 

So, yeah, that’s a rather lengthy story. I’ll try to boil it down. I fell into healthcare, believe it or not.

So, the kind of story is that I did six years of active duty. I went to Iraq twice. You know, I got blown up one too many times.

And yes, just one too many times. And I was like, you know what, I have a family and kids. I want to see you grow up, graduate, you know, do great things.

So, I’m going out of active duty for a bit. You know, wait this thing out. You know, flashback, it was a 20-year war, ain’t nobody waiting that out.

Yeah, no way. Yeah, no, not at all. So I went into the reserves for another six years, just waiting that out, completely switched roles.

I went from IT to watercraft engineering, which is not very similar. But you know, it is what it is. I thought it was fun.

So yeah, during that time, I found getting a role in the civilian sector challenging. I had a lot of experience, but I didn’t have a piece of paper saying I knew what I was doing. So I doubled back and just went to school, right?

I did that full-time for four years and got my bachelor’s degree. And I’ve noticed a lot of veterans struggling with the same thing. So anyway, while I was going to school, an opportunity came up to work for the late Paul Allen on his estate on Mercer Island, taking care of all the technology.

That was an incredible role. And I was very thankful to have that. Ultimately, however, it wasn’t the best fit for me for several reasons.

So, I ended up with another healthcare organization. And dual rolling as a security manager and an engineer, right? During that time, I got into InfraGarden, a public-private partnership between the FBI and the private sector that is still ongoing today.

I recommend that anybody in the security space get into InfraGarden as a member; there is much valuable information there. But they were standing up as a healthcare component during that timeframe, right? And I was already in the healthcare industry.

And what it ended up being was more or less a glorified listserv for people in the healthcare space revolving around cyber security. So I got pulled in with a team of about 20 or 30 other people to vet this infrastructure that they had built. Ultimately, this turned into HSCC or the health sector.

Oh, geez. What is that acronym? It’s the health sector.

Let me look that up. Because I want to, I want to ensure I’m speaking correctly. Okay.

Ultimately, that turned into the Health Sector Coordination Council Cybersecurity Working Group. So that’s how that spun off. And it’s been great watching that flourish as well.

But yeah, I went to an MSP and supported 40 clients. Again, we had a bunch of healthcare clients, and you know, they had cybersecurity and compliance needs. And I left that organization roundabout when COVID hit.

It was devastating to a lot of businesses. And so I came to Elevate Health, based on someone I had previously worked with at that first healthcare organization I mentioned. He said, Hey, you know, we need a director.

You know, we need this role. Do you want to come? Do you want to come to work with me?

And I’m like, yeah, sure. Applied. And you know, here, here I am, right?

In about two and a half years, I’ve completely reorganized IT security and compliance for the organization.

Bryce 

Very impressive. And I’m seeing SDOH in my notes. What does that acronym stand for in the security world?

Aaron 

So, that’s not necessarily a security acronym. That’s the social determinants of health. So, in the health, healthcare spec, and healthcare space.

So, what that is is looking at the socioeconomic conditions around healthcare as they apply to community members.

Bryce 

Gotcha. Okay. And kind of what are some of the kind of the, what are some of the challenges that come with addressing, with addressing those, those kinds of social determinants and especially in the, in the healthcare ecosystem and kind of what challenges did your organization kind of experience while working towards equity?

And how did you guys mitigate those, if you will? I know that’s a convoluted question.

Aaron 

Yeah, no, no, no. I think I know what you’re getting at. Yeah.

So, with SDOH, there’s no hard left and right limit, right? So, when you look at this data, what does this mean? So you need this data’s big picture, analytics, and visualization to understand what that means.

We looked at it because we needed to wrap a framework around it. Early on, with SDOH work, we learned about the framework of vital conditions. It’s seven buckets. If you will, how can I say this?

We’ll have to redo this part. So early on in the process, we learned about the vital conditions framework. And it’s seven buckets that tell us or give us information or insight into different aspects of social determinants of health.

So vital conditions then become the model from which we look at that data and the lens through which we interpret that data. As an accountable community of health, we found that this is a unique opportunity to help everyone recognize that they have a part in creating a thriving system and community. Looking at how intertwined systems and well-being are, we can demonstrate that we all play a critical role in creating a future in which we all want to live.

And so the vital conditions gave us a perspective, a lens, a framework to look at that data, interpret it, and give us actionable things that we can do to help improve, you know, SDOH within our community.

Bryce 

Gotcha. Sure. Yeah.

And it’s such an SDOH, it’s such a, it’s such an aspect that I don’t think a lot, it’s, it’s a lot of people touch on, a lot of people look at that. Many people understand what goes into that and how that affects a community and a whole group—switching roles in the data security of SDOHs.

With Elevate Health, you guys focus on addressing those social determinants. How do secure data sharing and integration enable better collaboration between the providers, the community, and other stakeholders within the healthcare system?

Aaron 

Yeah. So, one of the many problems we have in the healthcare space, we’ll call it integration. Few platforms and organizations are integrating, right?

And this is a barrier to quick and efficient service. So when you go to a provider, or you go to a hospital or whatever, and you know, you have some underlying condition you’re being seen for that you are normally seen for, you know, at another provider, that organization doesn’t have your records for that doctor to look over to, you know, facilitate, you know, healthcare services for you. So, how do they get that record?

So we have a couple of different things that we use. You know, faxing is meh. You know, you fax, you fax, you fax your record over, somebody’s got to digitize it, throw it in the EMR, and you know, it’s inefficient.

We all know the challenges with a secure email. And then courier services, right? Okay, well, now you have somebody going to go pick up this record, bring it, they’re going to digitize it, it’s worse than, you know, it’s worse than faxing.

So it is, it is. And you know, legislation is a piece that needs to come up with some of that as well. You know, modernize a little bit, but that’s a whole different topic in and of itself.

But yeah, so the other, the other way is that you know, for the ones that are integrating, right, you know, you see a lot of HL7, you see a lot of API work with integrations, and API is kind of the go-to right now. But there are challenges as well, you know, that have to be monitored and audited; you need to look at that code periodically and make sure that it’s doing what it’s supposed to do. And then the mechanism for talking across that API, right?

Like, how are you securing that? So, you know, we went, we kind of went from one realm to the other. And, you know, both have their challenges.

In a modern digital world, the, you know, with APIs, we have a lot more challenges, but we also have a lot of tool sets now to secure that. You know, one of the organizations one of the healthcare organizations I work for, we pass data via HL7 through a VPN tunnel, right? APIs, you know, were a thing at that point, but, you know, we just had yet to come up to, you know, the times with that.

So, HL7 via a VPN tunnel was our go-to at that point. But yeah, but this also opens up governance issues, right? Who owns the data at that point if you’re doing real-time data sharing?

And this is the real big key for integration, and why it’s not a broad thing in the healthcare space is, you know, who owns that record? And when you pass the record, you know, what are the conditions around that the other organization can store, use, et cetera, you know, that record. Governance is a big issue.

And we need legislation around that to help push people to integrate more. Because let’s face it, you know, healthcare is critical infrastructure through and through. And, you know, if you want to provide timely service for people, right, in their time of need, and you need records, you need data on this, real-time data sharing, whether you’re talking about HIE, CIE, you know, other integrations, these are what’s needed in the healthcare space.

Bryce 

Yeah, 100%. And another aspect of that is touching on the legislation piece, which is just, unfortunately, not there yet. And probably soon, it will depend on how things are going. Still, there are a lot of great companies out there that are trying to look at it more from the consumer aspect, from the patient aspect side of it, where they can keep just a nice health record of themselves, where they have, where everything is organized into different folders. Everything is, so when they go to a new physician or say they have diabetes. Then they have a cancer scare come, so they have to go over to an oncologist, and they have those records, where it’s easy, they’re not having to have the doctors run around and fax and forward an email. And you’re 100% correct about how much of a game changer it is because I think when you do that, you involve, the patient becomes involved in their care even more than they are currently, which is, I think, very important to be having the patient, the consumer, buy in to their healthcare system, and their healthcare in general. So, that is a great point you touched on.

You’re switching topics over to digital health and its impact on the social determinants of health. Digital health is a game changer for addressing these social determinants. We’ve seen that.

What health tools do you think can add value to underserved populations?

Aaron 

It’s less of a tool than big data. You can throw many tools at data and extract different insights. However, you need to wrap some analytics and visualizations around that data, and your data will determine your tool.

There’s a lot of tools. There are a lot of general tools, and you can even homebrew your tools if needed. So the tool is less valuable in this space, as is the data, being able to interpret it, and knowing what you need to get out of the data, right?

So, it’s understanding the big picture. And, you know, when we talk about going back to the previous point, we talk about people owning their records, right? The big thing is people need to feel like their health records are their own and available to them in any manner, whether paper, digital, et cetera.

But, you know, there’s an access issue in the community. So computers, phones, and the internet are critical components of a critical infrastructure system that, if people have access to it, they can interpret their records, right? They can understand. Okay, well, I was prescribed this, and I was told this procedure was warranted, right?

They can understand that themselves by having their records. So it gives them agency and freedom, especially freedom of choice to pick the system that works for them or even, you know, pick kind of lower-level providers, you know, ultimately finding the provider of choice that they like and feels that you know, cares for them.

Bryce 

Yeah. That leads directly in a perpendicular way. Is fostering digital health literacy, particularly among vulnerable populations, important? Also, ensure that that’s at the forefront and that they understand how to read and view their digital health.

Aaron 

Yeah. Literacy is, don’t get me wrong, is a critical component. But what we’re seeing in the community is access issues.

You know, not being, maybe it’s not having access to it at all. Yeah. It could be people who don’t have access to a computer.

You know, maybe they live in a rural sector of their region, and, you know, they don’t have a public library. They need better cell service. You know, they don’t have internet.

Maybe, you know, they don’t have the money to pay for those things. Right. Access is the critical component that we’re seeing, not so much on the literacy end.

So, you know, making strides towards getting people access. Internet is, you know, what was it a couple of years ago, they came out and said, you know, this is critical infrastructure, you know, ISPs, you need to start rolling this out to more people, you know, start coming up with more affordable plans, those kinds of things. So we’re seeing that kind of access issue get smaller and smaller, but it’s still a large issue.

Bryce 

Yeah, for sure. I know AI is one of the hot buttons and a hot topic in the world right now, and it’s one of the top emerging technologies that’s now impacting healthcare, mostly for good at this point. How can we leverage this to improve care access for those communities?

Do you see these innovations, or I’m sorry, do you think these innovations can be made culturally sensitive and inclusive for all communities?

Aaron 

So, I’m an AI evangelist. I embrace the AI overlords if you will. But I think AI, particularly generative AI, has little reason to be in the industry.

And so, to frame it right, AI can speed up, you know, speed up and improve accuracy with scheduling and records and stuff like that. Processes, right? Yeah, exactly.

It has no place in healthcare delivery, right? Like it should not be making any decisions. Okay, you go to your provider or your system’s website, and there’s always this helpful little chatbot sitting in the corner, right?

Yeah, hey, how can I help you? You start punching in; oh, I feel like this, right? Like, the AI chatbot should not be filling the role of a doctor or a nurse and saying, oh, well, it sounds like you’re dying.

Maybe you should come to see us. Like, that’s not a thing that should be happening. I have an appointment on such a date and time.

I can’t make it. Is there anything available? The AI chatbot checks the calendar and the scheduling system, and, you know, that may allow them to reschedule that appointment.

That’s a great purpose for an AI. It eliminates that human need to be there and allows that organization to focus more on the healthcare delivery space. But getting into, you know, AI and, you know, being culturally sensitive or inclusive, again, you know, I think there are strides we can make, right?

So, we can give AI language to use that is sensitive and inclusive. But the problem is it’s not going to satisfy the underlying need of, you know, various communities. Because the AI has no basis to determine what language it needs to use to be culturally sensitive or inclusive unless explicitly stated, right?

So, unless the patient or client says, hey, I’m such and such, right, and lays out, you know, their, you know, their cultural needs, the AI is going to have no idea who the other person is. So, you know, you’ll probably start to see the AI trying to include, you know, terms or content that is culturally sensitive to the wrong group, you know, et cetera, et cetera. So, there’s a lot of challenges with that.

And we’re on the path. We’re not quite there yet. I would venture to say that 5 or 10 years down the road, we might be able to start working into that space, but I don’t think that will be anytime soon.

Bryce 

Yeah. Yeah. And I see more of it in the digital health literacy aspect of it, of using AI, using some of these machine learning or, you know, natural language process, whatever it might be, to help the patient understand their diagnosis better.

So, when they go home, and they’re looking at the, you know, when they give you that sheet of paper with your diagnosis on it, and it tells you what it is and to follow these steps. And I could see it also being a tool in that aspect to be like, okay, well, let me help me understand what this is going to be, whether that, like the changes as a, after you become diabetic or diabetic, okay, well, not only are you going to be making these medication changes and these lifestyle changes, but also these changes to your health, your diet, your exercise, and all these things are necessary to have good control over a, you know, any illness in my opinion. So, I think I see it also being a tool in helping some of those underserved populations in the kind of literacy of understanding when they leave a doctor’s office or before they go to a doctor’s office, where it’s not necessarily. Still, I agree with you that it needs to be a kind of a fine line where you don’t want, you never, I don’t think you ever want that replacing the job of a nurse or someone that’s diagnosing that I put X, Y, and Z into a chatbot. It’s telling me I’ve got this, which is dangerous, but the aspect of it, of helping me understand something that my physician has told me, is a whole other point, which is a super exciting tool. I’ve got another aspect of what you were talking about as well.

Aaron 

Yeah. Well, I mean, the other side is that you touched on MLAI, machine learning AI. If you were to bring this into your EMR system, right?

And maybe you have a radiologist looking at, you know, a bunch of images, you know, MLAI can kick in and say, hey, wait a minute, I’m seeing this thing over here. You know, maybe it’s something that the provider wouldn’t have noticed, you know, because MLAI is just crunching images, you know, hundreds of thousands, if not millions of images, you know, for, you know, maybe a heart, maybe a lung, you know, whatever. And so it’s trained a lot faster than the radiologist or the physician has on, you know, looking at these images.

It’s not a replacement by any means for this, but, you know, maybe that will help, you know, find something that was spotted. Yeah, that may have been missed. That’s a good application for MLAI.

I think generative AI, and when we’re talking about, you know, sensitivity and inclusion, you know, or just generative AI in the healthcare space at all, it is kind of a route, kind of a road that, you know, we shouldn’t be going down right now. I agree.

Bryce 

Yeah.

Aaron 

Yeah.

Bryce 

The technology just isn’t there yet. I’m not saying that maybe it’s not something that they could be in the future, but I thintly it’s just not there yet. People want it to be because it’s the new shiny, the new shiny car and a new shiny toy, but you can, I think, if you’re in this space. You’re in this world, and you see it, understand it; you see where it lacks still. You see, it faces big challenges when you’re dealing with making decisions that affect actual people’s health, and you’re not worried about processes and efficiency. So, those are great points, Aaron, that you brought up.

And I appreciate it. It was a real pleasure. Those are all the questions I had for you today.

It was a pleasure talking to you, Aaron. Thank you for joining us and sharing your insights on health disparities in data security, care delivery, community care, and digital health; everything we touched on is so wonderful. I love doing these because I learned so much myself.

I’m in the digital health space, and I’ve been in it for a while, but I learn something every day when I do these podcasts. So, I appreciate your insight and your time today. Thank you so much.

Aaron 

Yeah, you’re welcome. Again, thanks for having me on. It’s been a pleasure.

Bryce 

Yes, sir. I look forward to staying in touch with Elevate Health and seeing what you guys do next.

Aaron 

Yeah, certainly.