Alright, we have got another great interview here today. We’ve emphasized before how useful we know TARTLE is for the healthcare community. To help us elaborate on that is Rick VanNess, Director of Product Development for TriCore Reference Laboratories.

TARTLE: Let’s just jump into this, Rick. What is TriCore? 

Rick: TriCore Reference Laboratories is a clinical laboratory that’s been around for over two decades in New Mexico. We’re a hundred percent focused in New Mexico. We do take esoteric tests from another hospital in Minnesota. So if it’s a very specialized genetic or tissue sample, we’ll do that for the hospital in Minnesota. But the majority of our work is here in New Mexico, and it is all blood and anatomical pathology.

TARTLE: So now let’s put it in layman’s terms, what does that mean?

Rick: Clinical pathology is the analysis of your blood. An anatomical is a tissue sample. So an example of the clinical is when you show up to your doctor and you say, Hey, I’m feeling sluggish. I’m peeing in the middle of the night. Something might be wrong with me. Your doctor will order a blood test and want to look at your A1C and make sure your glucose is on target. And we’ll analyze that blood and give the result back to the physician. And the A1C says 6.7. Your physician’s going to say, I think you’re diabetic. We need to order one more blood test to confirm that. An example of an anatomic pathology is, we go in with a variety of symptoms that might be linked to a problem associated with the liver. Your doctor might say you have nonalcoholic fatty liver disease, or you might have cirrhosis. Making sure will require a small incision and a liver sample. They’ll send it to TriCore and we’ll confirm whether the illness exists. 

TARTLE: Help us understand. How do you find that association? How do they find that understanding? So I’m taking a skin sample or blood sample from someone and then you have to analyze it, correct?

Rick: Correct. 

TARTLE: Now, do you guys have a lot of data that you work with? 

Rick: We use lots of healthcare data. We solely rely on the physician to tell us everything about that individual order. So when the physician says this patient may be diabetic, I’m going to put in these certain codes and that’s indicative of why I’m ordering this test. Now that’s essential for us to get paid, to do the test. The physician will then take the result and formally diagnose you. It’s a lot of information we need. We need the background from that physician. Some tests require what’s called the escort order entry. So we’ll ask you, are you fasting today? They say the clinical laboratory is actually responsible for the majority of medical decisions. 

TARTLE: So the data makes all the decisions. 

Rick: Exactly. 

TARTLE: So how is the ease of access? When you’re going to actually get that information from a doctor, or an insurance company, or even from an individual, is that difficult? Is there a time gap before you get it and can actually start doing your testing?

Rick: Great question. It starts off immediately. Basically by the time we touch that patient, we need to know everything about them, their, their name, their phone number, their accurate demographic stuff. We need to know everything from the provider as to why they ordered the test. At the same time, most labs are trying to get paid and are spending time talking with the insurance company.

Now, despite us getting all the data, we don’t diagnose. We send it to the physician and it’s up to him to diagnose and properly coordinate the care necessary that’s needed for that patient. For us to diagnose would be a huge liability issue. 

TARTLE: If I go in, and get a blood sample or a tissue sample at your facility is there any way for me to access a patient portal that has information and can I see the transfers actually happening between you and the doctor and the insurance company? Do I have it all in one spot? 

Rick: No, unfortunately not. The big labs have patient portals but they don’t necessarily expose you to the billing aspect. You usually hear about that later, when you get a bill in the mail for a deductible or a co-pay. TriCore doesn’t have one right now. It’s something we’re working on, but a patient can call us and say, Hey, I want a copy of that result. Or I want a copy of all my results. They have the right to that. We believe the patient owns their data at TriCore. So when they call us and say, I want this or that, absolutely we’re going to do our best to get it to them. 

TARTLE: So you guys deal with large amounts of health data, and you’re trying to do that for the betterment of outcomes. So can you tell me what it looks like for large population studies and how you’re actually moving that data to make a decision that can help people? 

Rick: Six out of 10 tests in New Mexico are performed by TriCore. When it comes to taking that data to aggregate it and understand from a population perspective what we end up doing is taking the individual 6.7 A1C results you’re talking about and making it more actionable and beneficial for the system. So what that entails is if I have a lab result for Alex, it says it’s 6.7. See, yeah, my algorithms are going to look at Alex’s history. Say, was there an LDL above a hundred? Was there an HDL below 40? Where does Alex live? Is he close to care? Has he had a micro albumin now because he’s positive for diabetes? You want to make sure he doesn’t have any indication of nephropathy or co-morbidities. So we take that individual lab result, make more information out of it and try to help your health plan. So, I’m going to call Alex today because he needs a micro albumin. And I know he’s diabetic. I need to make sure he’s not also not at risk for kidney problems. We’re going to call him up and do it. 

TARTLE: No, I think that’s important because having that data, especially in a large populace and getting it directly from the access of each individual and then blowing it out into a larger scale study is a more proactive approach to people’s health than a reactive one. And I think the reactive approach is what gets people sick and drives up the insurance costs. It creates a whole slew of problems that we don’t want to deal with. Even losing limbs, for instance, cause you didn’t know you were diabetic. So having the ability to actually track an individual with their permission, you can look at their health records from the past right now and then continue to do it forward, it creates a better approach. 

Rick: You just literally spelled out the business model of what I do. The laboratory is classified as ancillary in healthcare. I can’t do anything unless the physician orders it. Even if you come back to the lab and I know you’re diabetic, your 6.71 C, right? And your physician ordered the lipid panel, but he didn’t order the micro albumin. I can’t call the physician. I can’t ask you to call your physician. I can’t change anything. We want to be able to say, Alex, come to us first. We’re going to make the interaction with your physician more beneficial.

TARTLE: That makes sense. You’re the data house. You are the data analyzer and are the ones that give the physician the foundation to make a decision. So why don’t you just cut through some of the red tape? Cause when it comes to health, the longer you wait, the sicker you’re going to get. If they can just do it with one person at the tertiary level, just do it right there. It will improve outcomes. And they’ll have all access to that data. Then they can see how it moves back and forth. And being able to do those studies in the long-term, you would have the most promising research facility probably in the globe to have that ability to get data from all those people. And you move from a 6 out of 10 to a 10 out of 10. I would hope that data in the future can help solve these problems. What you are doing at TriCore aligns with what we believe at TARTLE. I think other people need to see that message. 

Rick: Well, I appreciate that. On that aspect of TARTLE and what your guys’ mission is, I find it very, very interesting. So if you want to elaborate on that and maybe we can align on why it’s important for an individual to own their own healthcare data, to understand how it’s used and perhaps even the value around it. 

TARTLE: The first thing that we focus on  is that there’s a monetary value, a measurement to this information about you. But beyond that is that it can solve some of our most pressing questions. Even questions about your own health can be solved. It’s just about getting that access, getting that data in the hands of the right people that want to do good with it. And those are the people that we would hope would be on the exchange like you, when other facilities, other biopharma come and realize they now have access to individuals. Their full EHR records, their DNA records, full genome sequence, behavioral data. This can tell us a much greater story. Then your resource use becomes much more efficient. You become much more proactive and that’ll lead to saving those lives. And doctors will have a stronger foundation when they give a clinical recommendation to somebody on how they should go and live their life. But it’s all going to start with people understanding, Hey, this is our health record. This is the information I’ve created. This is how I’ve treated myself. There is a value to it. Why don’t I combine all those things into one package and do a massive amount of good, not only for myself, but everyone else, because my information will help save other lives too? It becomes altruistic at that point. 

Rick: You’re a hundred percent right. I think you said something that I was thinking about the biopharma aspect. So if I were able to share with the biopharma company that I am hepatitis C genotype three, that would give the biopharma company an idea of how many genome type threes are out there. And if I have the other information related to this patient, I can now ask if the patient needs this drug? And what’s going to be the effect, how am I going to change their life? And I think that would dramatically change a lot of healthcare decisions because it’ll encourage understanding the whole life of a patient, not just creating a drug specific for a specific disease. I know based on all these individuals that have shared their information with me, how it’s gonna affect them before and after the drug is prescribed. 

TARTLE: And what’s interesting about it is that you’re not only introducing the drug and seeing how it’s affecting one person. You can see the change day to day with the records being shared with these companies, you can see how the drug is affecting an entire population of people across a period of time. And that’s, that’s a fantastic tool of study and that gives you that immediate feedback that you’re going to want. Even if the drug gets passed by a class three FDA trial. Fantastic. But now let’s see how it actually works in the real world outside of just a small group of people that were handpicked. I hope we can do a lot of good with it. And I hope in the future, we can find some integrations with you guys at TriCore and that we pair these missions.

Rick: Yeah, because I think it’s really important for everyone to understand healthcare is always committed to improving, but with the nuances associated with HIPAA and what’s called sensitive testing there’s a lot of things we can’t do to share with other organizations. So it would be great if individuals can own their own information, own their health and understand that sharing their information can be beneficial to others. 

TARTLE: It’s going to help you in the end as well as now, and think about that, breaking through all those legal barriers that you have. It’s consent when I’m an individual giving that to another corporation or person or entity. I don’t have to worry about all those steps in between. I can just directly share; there’s no waste of time, no legal paperwork. There’s no financial waste. It’s just one and done. Now we remove the middleman and it just becomes a more seamless process. And that’s the point of the marketplace. Is there anything else you wanted to touch on? 

Rick: I just admire what you guys are doing. There is value in healthcare data. What we do is we focus on the information. And if your users are more aware of that, they’re more understanding in the bigger global picture, and can understand companies are trying to do things that help benefit people. 

TARTLE: I appreciate that. 

Rick: It’s, like I said, my CEO is very firm on the fact that the data belongs to the patient. We’re never going to share it with someone without their consent. 

TARTLE: And how would people find either you or more information about TriCore? Where would they go? 

Rick: You can go to our website, tricore.org. You can review our privacy policy and all those types of things that are related to protecting information. 

TARTLE is constantly trying to build better relationships with the healthcare community and helping to improve the lives not just of our users but of people everywhere. 

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