by Rick Kuwahara COO of Paubox
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An Interview with Carrie Nixon: Data, Privacy, and Innovation in Healthcare
by Rick Kuwahara COO of Paubox
The Paubox Encrypted Interview Series allows us to chat with leaders in healthcare IT, compliance and cybersecurity to pick their brains on trends and best practices.
In this Encrypted Interview, we chat with Carrie Nixon, Managing Director of Nixon Law Group, a law firm focused exclusively on healthcare innovation, helping cut through the complexities of the healthcare industry for their clients and accelerating their clients’ healthcare businesses.
Early career and professional growth
Rick Kuwahara: You started your career as Assistant Policy Director in the US House of Representatives, but soon after went to law school. What drew you to make that move into the legal industry? And in particular your focus on the issues around healthcare?
Carrie Nixon: I always knew that I was going to go to law school. But I wanted the opportunity once I graduated from college to get a little bit of real life experience prior to going back into another school environment.
I had always been really interested in politics and policy, and so I decided to try to get a job on Capitol Hill.
I eventually ended up with a wonderful position as Assistant Policy Director at the House Caucus. And during the course of that time, I ended up dealing with a lot of health care policy.
And at that point, the Children’s Health Insurance Initiative was really a hot item on the Hill, and the whole policy debate just really triggered my interest in healthcare policy.
So when I went to law school, I focused on healthcare as much as I could, although frankly, that’s not a lot in law school unless you go to a very specialized law school.
But after graduation, I started my career at a large law firm in their healthcare practice. And that’s really where I began to know that healthcare law was where I wanted to spend my time.
Rick: You started Nixon Law Group in 2010. Did you always know you’d want to start your own firm?
Carrie: Oh, no, I most definitely did not.
I had no idea that I would be starting a business much less starting a law firm. I think I always thought I would either be in private practice at a large law firm or you know, working in the public sector in law in some way, shape or form.
But when I left my law firm in DC, after a number of years there, I actually left it to do a stint in the nonprofit world and did that for a little while.
I got back into politics at some point and then I had my daughter and decided that after six months or so off with her, I wanted to really get back into the practice of healthcare law.
Eventually, I decided in 2010, to go ahead and start my own law firm. I thought this is the time to do it. This is going to let me create the practice of law the way I want to do it, and why not?
And you know, of course, if you’ve never started a business, you kind of go into that kind of endeavor with starry eyes, and it’s tough.
It’s definitely a difficult undertaking to be on. At first I started my practice with just me. But, you know, through hard work and learning a lot of lessons we’ve grown the firm.
We have focused our energies exclusively on healthcare innovation, and we’re practicing law the way we think it should be practiced to the benefit of our clients.
Rick: Great. So what’s the biggest challenge or mission you have at Nixon Law Group?
Carrie: Well, my law partner and I’ve spent a good deal of time thinking about our firm’s core values.
And one of the core values that we established I think really speaks to the question you asked.
That is, that core value we’ve framed as “wearing a lawyer’s hat, but walking in our clients shoes.”
It is really important for a lawyer serving early stage companies or companies that are innovating in some way shape, to be able to understand where those companies are coming from.
And when they come to you with a legal question, to be able to think about that question and say, “Okay, the way they’ve proposed this particular business model is not going to work.”
It’s not going to be compliant within the healthcare regulatory framework. But let’s look at it a different way. How can we achieve the goal that they’re articulating with another type of business model?
You know, we make it a point that if we’re going to have to say, “No, the law or regulations prohibit you from doing something this way,” to then pivot and say, “But have you thought about doing it this other way?”
And, you know, our clients, I think, really appreciate that mindset. I think it’s the best way to serve them.
If we are just sort of the people who say “No” all the time, they are not going to want to talk to us and then maybe they are not going to be successful in creating business models or arrangements that are compliant.
So that’s a core value we have that addresses a challenge I think that our clients face, which is a gigantic, complex regulatory landscape around healthcare. And I’m very proud of what we do at the firm along those lines.
Data privacy and policy
Rick: To say the least, privacy seems to be a huge focus lately in the news, and especially on Capitol Hill with inquiries into the Ascension Google partnership to the Data Privacy Act. What’s your take on how we’re handling privacy and security, especially with the adoption of more mobile health technology?
Carrie: Well, it’s a really important issue, obviously. Consumers are becoming more and more attuned to how their data is potentially being used, as well they should be.
They need to know why their data is being used, how it’s being used, and they need to have the right to have some control over that.
So I think the attention on the issue is certainly well deserved, but having said that, the Ascension Google partnership is a really interesting issue.
It has surfaced these privacy implications for folks in the media and made it a big deal. But to be honest, it is standard industry practice for digital health companies to work with healthcare providers and to work with healthcare payers in partnership, sharing data with the goal of improving the outcomes and reducing the cost of care.
Now, there should be, and I think there is, a public pressure to be responsible, but the media portrayed the Ascension and Google partnership like it was something out of the ordinary and like something was done incorrectly. And to be honest, that’s just not necessarily the case.
And in fact, I have read how they structured some of their agreements and their data sharing and it really is typical practice.
So if we get to the point where the public pressure is pushing too hard in the direction of not allowing for the sharing of healthcare data, there is a trade-off there.
We absolutely are hampering our ability to identify new diseases, cure diseases, intervene early with diseases, if we put the kibosh on that data sharing among parties that should be looking at and sharing data.
I don’t think there’s anyone who doesn’t want to find the cure to a particular disease. That is in everyone’s interest, right?
Now, it may be that it would be very helpful for companies like Google and Ascension to make it crystal clear to the patients with the patient data that they are interacting with, make it clear to those patients that their data is being used in a way that is not implicating them specifically and is being used to help find a cure to X disease or identify this particular issue relating to healthcare. I think that’s something that everyone wants.
Rick: Right. And I think that that’s a good point, helping make consumers and people feel comfortable because a lot of it is even de-identified, and what does that mean to individuals?
People are hearing that companies are sharing data, but they don’t quite always… They’re thinking of data like Facebook and data mining versus de-identified data that can help, like you said, push forward health.
Carrie: Yeah, that’s exactly right. There’s a real lack of understanding of how data can be very successfully de-identified and how that de-identified data has significant, significant value. I think if people understood that, they would be a little more comfortable.
Rick: Overall, it does seem like sometimes policymakers are playing catch up with the speed of innovation in healthcare. Do you see that always being the case?
Carrie: You’re right, it is absolutely the case right now.
Technology is evolving in the healthcare sector at a rate where policymakers simply are not able to keep up. And I sure hope that that won’t always be the case but realistically, I think it’s likely to continue.
It is simply a fact that when a new technology or a new intervention comes out, it’s going to take our policymakers and regulators a little bit of time to figure out the parameters that they should be putting around that technology.
And oftentimes, we see cases where a technology hasn’t even entered the minds of policymakers or regulators. It is so new that it’s not something that has even been remotely considered in the past, before. And so they’re constantly having to evolve new frameworks for thinking about these things.
It’s a sticky situation because we don’t wanna be in a position where we see innovation superseding patient safety considerations, that’s the big thing. But by the same token, we don’t, again, want to constrain innovation.
So it’s a fine balance to strike when regulators are having to consider entirely new frameworks that have entirely yet unconsidered ramifications for patient safety.
Innovation and helping address COVID-19 pandemic
Rick: Are there any trends or technology that you’ve seen that could really help make an impact, especially in response to the coronavirus?
Carrie: Oh, most definitely. One thing that really comes to mind are remote patient-monitoring technologies.
This has been an area that has just exploded in the healthcare industry over the last two to three years, in large part because Medicare has finally decided to provide reimbursement for remote patient monitoring.
So that means that a patient can wear some sort of peripheral device, that may measure their vital signs or may measure their glucose levels, and that device will remotely transmit to their medical providers that information.
So say a patient has high blood pressure and they use a Bluetooth-enabled blood pressure cuff, that blood pressure cuff can remotely transmit the patient’s blood pressure readings on a consistent and regular basis to that patient’s healthcare provider who is, in fact, monitoring their hypertension.
And when the healthcare provider notices that there’s some sort of abnormality with the data that they’re seeing, for some reason, there’s been a spike in blood pressure that has lasted for a while, they can note that and they can call that patient up, and say, “Hey, what’s going on with your blood pressure? Tell me a little bit about what’s happening. Are you out of your medication? Do you need a refill?”
And there’s a real value in that, to identifying a potential problem early rather than having the patient end up in the ER because their blood pressure has been so high for so long. And in the long term, really reducing cost.
So I’m really enthusiastic to see all of the remote patient monitoring companies that have entered the market. And I’m really enthusiastic about Medicare’s decision to start reimbursing for those technologies because it means we’re going to see some really innovative devices and metrics that are now available out there, that are gonna move the needle in healthcare.
Now, this technology, remote patient monitoring, really has implications that I can see for both diagnosing and monitoring folks that may have the coronavirus.
So for example, we know that there is enormous concern right now about overwhelming healthcare facilities, hospitals, ERs, medical clinics with people who are concerned that they may have coronavirus.
And this remote patient monitoring technology allows those people to really be diagnosed and treated from home.
So a patient can call their physician or interact with their family physician and say, “Hey, I’m a little bit worried. I traveled overseas, I was just told that I was interacting with someone who is now infected. I may need to be monitored for coronavirus or what should I do and how do I know to tell you?”
One thing that can be done for them very readily is their temperature can be monitored at home with that data being remotely transmitted to their healthcare provider.
Their pulse ox levels can also be remotely monitored and transmitted via a Bluetooth pulse ox monitor to their physician. So at such time when a patient is experiencing a spike in fever and maybe their pulse ox levels are going down, maybe their physician then calls them and says, “Hey, it’s time to come in to test. We’re seeing symptoms and your fever is high, and it’s been that way consistently for a period of time. Come on in, and we need to do a test.”
If that person tests positive, they can, again, rather than having to go immediately into a healthcare facility, they can remain at home and be monitored remotely, where they are not interacting with others, out in the public.
And at the point at which if and when their respiratory rate or their pulse ox levels get outside of a particular range, then their physician is gonna be aware of that, and can call them immediately and say, “Hey, at this point I think you’ve reached the point where you need to come into the hospital.”
So, I think it is a really amazing opportunity for diagnosing, and for managing this coronavirus pandemic that we’re dealing with. I’m concerned that not enough healthcare providers are fully aware of these new remote patient monitoring technologies and in fact the reimbursement that’s associated with them.
And therefore don’t know that they are a great way to monitor and to diagnose coronavirus. I’m hopeful that the administration will bring to their attention the opportunity that remote patient monitoring technologies provide in this time of crisis.
Rick: How do you keep up with industry trends? Any good podcasts, blogs, influencers or newsletters that we should be following?
Carrie: Sure, in terms of blogs or new sort of news aggregators, I really look to Rama on a Healthcare and Healthcare Dive.
I think they do a great job of aggregating really interesting articles across the sector. Those and those come out on a daily basis. So they’re really useful.
In terms of podcasts, I really like Digital Health Today. And in full disclosure, I’m an ambassador for Digital Health Today, but they put together some very interesting segments on digital health innovation.
And finally, another podcast that does not necessarily focus exclusively on healthcare is Today Explained. They cover a lot of topics but they also do a great job of explaining in very user friendly terms to the public, an issue in the healthcare industry that is timely.
Rick: What do you do to de-stress and relax?
Carrie: I typically go for a walk with my husband and my dog in the park across from our house. That is my go to every day to start the day and the day so that’s one de-stresser. And another is hot yoga. I can’t live without my hot yoga.