Episode 1.1 - Introduction to eHealth Legal Pulse

Episode 1 is an introduction to Steve Gravely and eHealth Legal Pulse. In this episode, Steve talks about Gravely Group, who we are, his history in the healthcare industry, and what this podcast is all about.

Transcript

00:05
Hello, everybody. My name is Steve Gravely. I am the CEO and founder of Gravely Group, and I want to welcome you to the inaugural podcast of a brand new podcast series that we are rolling out about e health th Digital Pulse. And this podcast is going to hopefully be educational for you, maybe entertaining and probably thought provoking in terms of both the legal and policy and strategic issues that I'm dealing with. That you're probably dealing with or your customers or clients in the new healthcare landscape where digital health information, digital technology is really at the forefront of the delivery of care, treating patients, and certainly at the forefront of federal policy out of Washington and policy coming out of the state capitals of all the states. So we're going to dive into a pretty broad range of topics over the course of the podcast. We're not going to try to limit ourselves to just one particular issue. 

 01:44
We're going to talk about a lot of different issues. And for some, I'll invite experts in, folks I work with, friends of mine who are subject matter experts in various aspects of healthcare, more specifically, digital health care. And we'll just talk about topics that are on our mind. And so, with that said, I'm happy that you're listening to this podcast. Welcome. Congratulations on finding us. And let me start by just talking a little bit about Gravely Group, who we are and our history, a little bit of my history, and then we'll jump into some discussion. So, Gravely Group is a professional limited liability company. It's a law firm. I'm a lawyer, and so we are registered as a law firm. But we provide both legal and strategic policy guidance to healthcare provider organizations, health payer organizations, suppliers of services and products to the healthcare industry health information networks. 

 03:04
Health information exchanges, state and federal governments, and really, anyone that is involved in the design or delivery of health care and is doing that through the use of electronic health information or digital technology. And I have to say, in September of 2023, that's really everybody. So it's a wonderful field to be in. I started Gravely Group five years ago, in June of 2018. Before that, I had worked in big law, as we like to call it. Big law is just a label that applies to really large law firms. I was an equity partner at a law firm called Trotman Sanders, headquartered in Atlanta. I was in the Richmond, Virginia, office and was in charge of the healthcare practice for the entire firm. I was there for over 18 years, and it was wonderful, great firm, and I enjoyed all my time there. But I realized that I wanted to just do things a little bit differently than big law can do. 

 04:32
I wanted to be able to lower my hourly billing rates dramatically and offer my services at a much lower cost because I could see where the rates that I was being required to bill were a barrier for some of the organizations that I really wanted to work with. I also wanted to just operate out of a more nimble platform where I could pivot more rapidly as the healthcare industry continued to change. So for me, it was the right decision at the right time. And so now, five years in, I am now launching this podcast. I was thinking about doing that a few years ago, then something called The Pandemic came around and the world sort of got turned upside down. But now is the right time. I'm a firm believer in things happen the way they're supposed to, when they're supposed to. And so I'm really excited about launching this podcast now, and I hope that you'll become a regular listener and that what I'm doing here will be of some value. 

 05:52
So, a little bit about me. Obviously, I've been practicing law for a long time. I actually am a lifelong Virginian, I'm proud to say. I was born in the southern part of Virginia and lived in a small town, and then moved from there up to the Washington, DC area. That was interesting. And then bounced around with my dad's jobs before heading off to college at the College of and Marion, Virginia, and got an undergraduate degree in economics from the college. And I really wasn't quite sure what I wanted to do all through college. And even in my last year of high school, I was a volunteer firefighter and emergency medical technician. I was among the first class in Virginia of EMTs emergency medical technicians. And when that was a new wave washing through the country in the 1970s. And so, even though I was a volunteer, I logged a lot of hours. 

 07:03
I basically lived at the firehouse. All my roommates loved me because I wasn't there very often, and so I lived at the firehouse. I worked at the local hospital in the emergency room, and I thought about going to med school, but that wasn't in the cards for me. And so, upon graduating from Wayman Mary, I was given a wonderful opportunity to go to work for a large teaching hospital and for Kenya and be an administrative extern for a little over a year, where I worked in different parts of the hospital doing administrative projects. And then every other weekend, I went on duty at 04:00 on Friday, and I was the nighttime administrator for the entire house. I have to tell you, I learned so much. It was wonderful. I loved every minute of it. Working twelve out of 14 days was sometimes difficult, but I was young and single, and it worked out perfectly, and I was like a sponge. 

 08:13
I just was able to absorb so much. I learned so much from that health system and from the staff there, and really fell in love with healthcare operations. And so I was fortunate enough to be accepted into a master's Program in Hospital Administration at the Medical College of Virginia in Richmond. It's now Virginia Commonwealth University. And I obtained my master's in hospital administration. I worked for a few years in several different hospital settings and then decided, for family reasons, that my wife was also a hospital administrator and we decided that we needed to diversify our careers. And so I went to law school in the 1980s and obtained my law degree from the University of Richmond in Virginia. Pretty much since graduating, since the mid eighty s, I would say I actually had the privilege of serving a one year clerkship with the Virginia Supreme Court. 

 09:29
Another amazing experience that I wouldn't trade for the world. It was phenomenal working with the justices on the Supreme Court and just having the privilege of watching them do their job and apply justice through our court system. Then I worked briefly for a small firm as a courtroom lawyer and then started a healthcare practice. And so really since the mid 80s, I've been focused on representing as a lawyer and as a strategic advisor, different types of healthcare organizations, as well as state and federal governments on policy issues. So that was 40 years ago, which is hard to believe. And here we are in 2023, and I'm still going strong. I've been very blessed, and I'm still going strong and loving what I do. So I won't bore you with all the different types of work I did over those 40 years. But what's interesting is that in the 1980s, digital health, it didn't really exist. 

 10:46
We didn't have electronic medical records. I actually remember one of my classmates from MCV in my hospital administration program going to work for an early generation of EMR and trying to help implement that and all the obstacles that were, you know, that occurred and the challenges that occurred. But so 40 years ago, it was a very different world, a very paper based world, and a very different world. And for the first 20 years of my career, I really wasn't that involved in dealing with electronic health or digital health. I was doing fraud and abuse, government investigations, certificate of public need, medical staff, credentialing, other stuff, joint ventures. But then that all started to change, I would say, in the early 1990s. And of course, Congress passed the HIPAA legislation in 1996, and HHS published the Privacy Rule and Security Rule in 2001, 2003, respectively. I did a ton of HIPAA education in 20 02 20 03 20 04 and then EMRs really started to come on the scene. 

 12:19
By the late 90s, EMRs were definitely in play primarily among the larger hospital systems. And then that all changed after the 2008 recession. And for those of you who are too young to remember the 2008 recession, it was pretty bad. And as part of the federal government's efforts to pull the country out of what we now call the Great Recession, congress passed the Arra American Reinvestment Recovery Act, or sometimes referred to as Aura. And one of the provisions in Aura was to stimulate, through federal subsidies, the adoption and implementation of electronic medical records for hospitals and physicians. And I really trace where we are today back to Aura and the hundreds of millions of dollars that the federal government invested through the state health departments, incentivizing hospitals and health systems, as well as physicians, to purchase and then implement electronic medical records. So now, today, virtually 99.99% of every hospital in the United States has an electronic medical record. 

 13:55
And they've had it now for years, maybe ten years. They may be on their second or third generation EMR physician practices, lied a little bit. But now, in 2023, over 99% of medical practices in the US. Have electronic medical records. And I would dare say that for younger folks under 30, maybe folks under 40, it's hard to imagine a world as a healthcare provider or a clinician working in a hospital or medical practice where you didn't have an AMR. It's just hard to imagine that world. And yet, it wasn't very long ago that this millennia, the early two thousand s, the adoption and implementation rates were very low. And so I say that because there's been a tremendous amount of change and that change has come very rapidly in the scheme of things. I've been involved in healthcare now for over 40 years, and I find that sometimes healthcare, the healthcare industry in the US. 

 15:15
Is a little bit slow to embrace change. And sometimes it takes a while for things that I thought would be implemented rapidly, sometimes it takes years for that to happen. And I've always been impressed by that. And part of that is because treating patients is the core mission of everyone in the healthcare industry. Treating them properly, treating them safely, and that engenders an appropriate level of caution when it comes to changes. However, for a whole lot of reasons, including the Great Recession, we've now catapulted into an age where every provider organization has one or more electronic medical records. We are creating digital health information at an incredible pace. Every hour of every day, millions, if not billions of bytes of digital health data are being created. And that digital health information is everywhere, which has raised a lot of complicated privacy and data security issues, but also a lot of exciting opportunities for innovative companies that want to try and use that information to enhance their products and services. 

 16:53
So here we are in 2023. My days now are spent really advising health information networks on appropriate stewardship of the data they have access to and making sure that those networks are compliant with not just HIPAA and the state privacy and security laws. But also the information blocking rule, which we'll talk about, and the 21st Century Cures Act and all the other bevy of laws, regulations and policies that health data networks are subject to, as well as helping advise governments on policy. Initiatives and trying to anticipate where are we headed in healthcare over the next five years and what types of new challenges are we going to face in the near term? So that's what I'm doing now. I love it. It's fantastic. I'm very have I'm fortunate to have my adult son, John, who just recently obtained a Master's in Public Health with a concentration in epidemiology from the University of Arkansas for Medical Sciences in Little Rock. 

 18:28
John, as an epidemiologist, is really interested in genetic epidemiology but also in public health policy. So John's working with me on some really interesting public health policy projects, and he brings a very unique and valuable perspective to some of our clients operations as they think about what are some of the challenges that public health agencies face in the wake of the Pandemic. What are some of the opportunities with respect to appropriately using digital health information to enhance predictive algorithms for trying to predict the risk for future diseases or the outcomes of specific illnesses or injuries? So you'll meet John in the podcast. He and I will team up and talk a lot of public health. I have the privilege of serving on the board of Directors for the Network for Public Health Law, and I've been on the board now for several years and long before the Pandemic. 

 19:41
And I have to say it's a privilege because I get to interact with my fellow board members, all of whom are public health professionals. They lead public health agencies in different states or they work for large, very large health systems, and they're focused on pop health and other things. And we had some really interesting conversations about the interaction of public health and the law both during the Pandemic and in the wake of the Pandemic. There are some pretty hot debates right now about different public health authority issues in the wake of the Pandemic. And so John and I'll probably talk about that some and try and keep it apolitical, which is hard in 2023. But I'm not here to push any particular political agenda from any party or any particular ideology. So that's a little bit about me, a little bit about Gradley group. And so what I want to do is I want to start by talking about a topic that's receiving a lot of press, the topic of information blocking. 

 21:00
And I'm going to launch into that in our next podcast. So be looking for that. And I want to thank you for joining us. You.