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The Path to Interoperability

Posted on August 28, 2014 I Written By

The following is a guest blog post by Dave Boerner, Solutions Consultant at Orion Health.

Since the inception of electronic medical records (EMR), interoperability has been a recurrent topic of discussion in our industry, as it is critical to the needs of quality care delivery. With all of the disparate technology systems that healthcare organizations use, it can be hard to assemble all of the information needed to understand a patient’s health profile and coordinate their care. It’s clear that we’re all working hard at achieving this goal, but with new systems, business models and technology developments, the perennial problem of interoperability is significantly heightened.  With the industry transition from fee-for-service to a value-oriented model, the lack of interoperability is a stumbling block for such initiatives as Patient Center Medical Home (PCMH) and Accountable Care Organization (ACO), which rely heavily on accurate, comprehensive data being readily accessible to disparate parties and systems.

In a PCMH, the team of providers that are collaborating need to share timely and accurate information in order to achieve the best care possible for their patient. Enhanced interoperability allows them access to real-time data that is consistently reliable, helping them make more informed clinical decisions. In the same vein, in an ACO, a patient’s different levels of care – from their primary care physician, to surgeon to pharmacist, all need to be bundled together to understand the cost of a treatment. A reliable method is needed to connect these networks and provide a comprehensive view of a patient’s interaction with the system. It’s clear that interoperability is essential in making value-based care a reality.

Of course, interoperability can take many forms and there are many possible paths to the desired outcome of distributed access to comprehensive and accurate patient information.  Standards efforts over the years have taken on the challenge of improving interoperability, and while achievements such as HL7, HIPAA and C-CDA have been fundamental to recent progress, standards alone fall far short of the goal.  After all, even with good intentions all around, standard-making is a fraught process, especially for vendors coming to the table with such a diversity of development cycles, foundational technologies and development priorities.  Not to mention the perverse incentives to limit interoperability and portability to retain market share.  So, despite the historic progress we have made and current initiatives such as the Office of the National Coordinator’s JASON task force, standards initiatives are likely to provide useful foundational support for interoperability, but individual organizations and larger systems will at least for the time being continue to require significant additional technology and effort dedicated to interoperability to meet their needs.

So what is a responsible health system to do? To achieve robust, real-time data exchange amongst its critical systems, organizations need something stronger than just standards. More and more healthcare executives are realizing that direct integration is the more successful approach to taking on their need for interoperability amongst systems. For simpler IT infrastructures, one to one integration of systems can work well. However, given the complexity of larger health systems and networks, the challenge of developing and managing an escalating number interfaces is untenable. This applies not only to instances of connecting systems within an organization, but also connecting systems and organizations throughout a state and region. For these more complex scenarios, utilizing an integration engine is the best practice. Rather than multiple point-to-point connections, which requires costly development, management and maintenance, the integration engine acts as a central hub, allowing all of the healthcare organization’s systems from clinical to claims to radiology to speak to each other in one universal language, no matter the vendor or the version of the technology.  Integration engines provide comprehensive support for an extensive range of communication protocols and message formats, and help interface analysts and hospital IT administrators reduce their workload while meeting complex technical challenges. Organizations can track and document patient interactions in real-time, and can proactively identify at-risk patients and deliver comprehensive intervention and ongoing care. This is the next level of care that organizations are working to achieve.

Interoperability allows for enhanced care coordination, which ultimately helps improve care quality and patient outcomes. At Orion Health, we understand that an open integration engine platform with an all access API is critical for success. Vendors, public health agencies and other health IT stakeholders are all out there fighting the good fight – working together to make complete interoperability among systems a reality. That said, past experience proves that it’s the users that will truly drive this change. Hospital and health system CIOs need to demand solutions that help enhance interoperability, and it will happen. Only with this sustained effort will complete coordination and collaboration across the continuum of care will become a reality.

About David Boerner
David Boerner works as a Solutions Consultant (pre-sales) for Orion Health where he provides technical consultation and specializes in the design and integration of EHR/HIE solutions involving Rhapsody Integration Engine.

AHA urges agencies to speed up EMR choice expansion

Posted on June 23, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

In a move that shouldn’t surprise anybody, the American Hospital Association is urging CMS and the ONC to hurry up and finalize new rules which would expand choice for certified EMRs.

The AHA letter argues that its members are on the verge of walking away from Meaningful Use. But if CMS and the ONC speed ahead with with the new proposed rules — which would offer more choice in specific meaningful use requirements they must meet this year — hospitals will be much better equipped to proceed.

Why the rush? Well, for one thing, the letter argues, time is of the essence for hospitals, which have to decide their meaningful use strategy for fiscal 2014. If they must make choices before the new rule is finalized, it could cause them “significant financial and operational harm,” the AHA contends.

Meanwhile, if the agencies don’t push these rules through quickly, “many providers are likely to conclude that they cannot meet meaningful use this year and abandon the program,” wrote Linda Fishman, AHA senior vice president of public policy analysis and development, in a letter to CMS Administrator Marilyn Tavenner and National Coordinator Karen DeSalvo, MD.

The letter also takes on other issues. It asks that CMS and ONC clarify the rules implementation, offer more flexibility in the reporting of clinical quality measures, shorten the MU reporting period for 2015 in analyze lessons learned from Stage 2 before finalizing Stage 3’s start date, according to HealthcareITNews.

The AHA’s letter comes at a challenging time for the meaningful use program generally, which has of late attracted broader attention than it has in the past.

Not only are industry groups pressuring ONC, legislators are too. For example, at a recent health IT conference, U.S. Rep Tom Price, MD, R-GA, argued that meaningful use is “maybe not even doing what needs to be done as it relates to patients and physicians.”

In his remarks, Price argued that meaningful use could be improved by keeping the patient front and center, making sure patients know they own their health data and establishing an interoperability standard.  But he suggests that because the MU program roadmap was laid out in the HITECH Act, it’s not as fluid as it should be and doesn’t accommodate such concerns.

The reality, however, is that there is no simple way to get interoperability; right now, we’re lucky if individual EMRs meet providers’ needs.  Despite the demands from other stakeholders, health IT vendors still have a lot more to gain by creating islands rather than interoperable products.

Can We Learn Collecting System Data from How We Collect Medical Device Data?

Posted on April 21, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

We’ve been aggregating and sharing medical device data for a really long time in healthcare. Entire corporations are built around collecting and sharing medical device data with another healthcare IT system. If we’ve been able to share this data for so long, could we possibly learn from that experience and apply it to data collection and sharing in other health IT systems?

This is an open question which I hope you’ll join in answering in the comments of the blog. Many readers of this blog are more expert on this topic than I am. So, please chime in and add your thoughts. I think there is a real opportunity for us to learn from the past.

Here are a few of my thoughts:

Motivation – This is the biggest reason that medical device data collection and sharing happened. Organizations saw the value in having this data. I think we’re starting to see a shift in motivation when it comes to collecting system data in a healthcare organization as well. As I wrote about previously, we need data sharing as part of the Health IT procurement process. This will be a slow but important shift for many healthcare organizations. Otherwise you have lethal contracts that put huge financial barriers in the way of sharing data. ACOs and value based reimbursement will continue to motivate organizations to finally want to collect and share system data.

Standards – One of the benefits that device integration had was that there was more of a standard format for sharing the data. This is a lesson for other data system collection. We need a standard. Not a bunch of different flavors of standards, but a standard.

Multiple Standards – Some in the device space might argue that they had their own issues with standards. Every device company had their own standard and you had to integrate with each different device company. This depends on the device, but let’s just assume for a minute that this is indeed the case. How then were these organizations able to collect the medical device data? They just built up interfaces that understood each device’s standard. The key is that each company established a standard for their clinical device and stuck to that standard.

The challenge with other healthcare systems like EHR is that we have so many systems. Plus, even instances of the same EHR don’t follow the same standard. I’m not sure how to remedy this in the current EHR market, but it might be the key to us ever really collecting EHR data. I guess some would argue that market consolidation will help as well.

Connected Tech – One of the biggest challenges in the medical device space was having the technology in the medical device that allowed outside connectivity. Most new medical devices come with connectivity, but in the past you’d have to buy the connectivity separately and store it in a black box under the bed. This is a huge advantage for other healthcare IT software. The data is already connected to the internet.

Those are a few of my thoughts on what we can learn. I’d love to hear your thoughts.

Data Liberation Is The First Step Towards True Collaboration

Posted on April 15, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

I generally agree with this idea. It’s really hard to collaborate with someone if you’re not sharing the data about a patient. So, data liberation can be a true enabler for collaboration.

While I think most hospital CIOs will agree with this, I wonder how many act like data liberation is an important strategy for them. Is data liberation really a core value of their hospital organization? My guess is that for most of them it is not.

One major place they can start to make this part of the culture is in the procurement and contracting process. Software vendors are going to happily keep the data as closed as possible unless you require it of them in the contract stage. Once hospital systems make data liberation part of the IT systems procurement process, then we’ll finally be able to see the benefits of data liberation.

The problem we have today is that data liberation and sharing wasn’t part of the previous procurement and contracting process. My guess is that most assumed that being able to share data would be allowed, but few people looked at the fine print and realized what it would mean to them when it came to data sharing. Thus, we’re in a situation where many organizations have contractual issues which make data sharing expensive.

It will take a cycle of new contracts for this to be fixed, but even then it won’t be fixed if you’re organization doesn’t add this to their agenda. Software vendors happily provide the customer what they demand. We need more hospital organizations demanding data liberation.

ED Alerts Help Health Plans Cut Costs

Posted on February 4, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

As readers of this publication know, many hospitals are interested in participating in HIEs, but are buried in projects already and not so sure the investment will pay off.  But here’s an instance where a very modest HIE application helped a health plan save real money in just six months without having to do an expensive buildout.

According to iHealthBeat, a new study by the Agency for Healthcare Research and Quality has found that simply sending near real-time alerts to health plans when a member is admitted to the hospital ED could help the health plan save money and get patients into primary care.

To do the study, Indiana Health Information Exchange programmers developed an application which sent daily alerts about health plan members who visited EDs at nine Central Indiana hospitals. As part of the pilot, the alerts were sent to the participating health plan within 24 hours. The health plan then used this data to replace non-urgent ED visits with primary care visits, iHealthBeat reports.

During the six-month pilot, the health plan was able to reduce nonemergency ED visits at participating hospitals by 53 percent; the same time primary care visits among plan members jumped to 68 percent during the pilot period.

The bottom line in all of this was that after using the daily updates to guide patient behavior, the health plan was able to save $2 million to $4 million over six months. While I could be wrong, I don’t believe there are many test cases out there that can demonstrate the effectiveness of hospital to plan communication and brag of this much success.  While this isn’t exactly an argument for all hospitals to have HIEs, this does suggest that shared, timely information on important patient behaviors can be extremely valuable.

NYC Health Systems Get $7M To Share Data

Posted on January 29, 2014 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Seven New York City health systems have gotten a delayed Christmas present — a $7 million grant designed to encourage data sharing initiatives and improve patient recruitment for clinical trials. The primary goal of the project is to use evidence-based research to help patients make good decisions about their healthcare.

The funding comes from a group known as the Patient-Centered Outcomes Research Institute, or PCORI. PCORI, which will create a clinical data research network in NYC, has already created 29 such networks across the nation, according to Healthcare IT News.

These networks, collectively, will form PCORnet, a $93.5 million patient-centered research initiative. The New York City Clinical Data Research Network (NYC-CDRN), a  consortium of 22 regional organizations, will work together to develop systems supporting data networking efforts and advance patient-centered research, Healthcare IT News reports.

NYC-CDRN will kick off their efforts by identifying patients with diabetes, obesity and cystic fibrosis. It will then partner with patients and clinicians by creating disease-specific community groups.

The NYC-CDRN network will connect medical records for 6 million New York City residents, then anonymize the records, and over the next 18 months, will work to standardize the data. Ultimately, the goal is to allow patients and providers to have access to evidence-based information they can use to make smart healthcare choices.

This should be an interesting project to watch over the next year and a half. PCORI is doing a lot of forward-thinking work with its money, including $5 million to the NIH for a tool called PROMIS designed to help with comparative effectiveness research. PROMIS has existed since 2004, but PCORI is now helping it move forward, making the $5 million in funds available  in research grants up to $500,000 for projects up to two years in length.

Do Hospitals Care About Blue Button?

Posted on January 16, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Jennifer Dennard has been doing a series of blog posts detailing her “Blue Button Patient Journey.” It’s a really insightful look from the patients viewpoint about how Blue Button and patient engagement with their medical records is doing.

My gut reaction when I read that post by Jennifer was that is all felt way too complex with so little value to the patient. Which of course led me to the conclusion that patients aren’t going to do this.

If patients don’t care about Blue Button, is there any reason we should believe that hospitals are going to care about Blue Button? I think we all know the answer to that question.

It would be interesting to go around the hospital and ask people what they thought of Blue Button. I have a feeling hospital employees answers would be more like a Jay Leno “Jaywalking” video than an deep explanation of Blue Button.

Of course, I’m sure that hospitals will be adopting Blue Button more and more. However, most of the people in the hospital won’t know that it’s happening. They’ll just be Blue Button enabled by default when they implement their EHR’s patient portal. Maybe that’s not such a bad thing.

Think about how beautiful it will be to have all of your healthcare data Blue Button enabled. It could open up some really interesting possibilities. In fact, if those in the hospital knew about the data being available through Blue Button they might try and stop it from happening. Freeing healthcare data is a good thing and Blue Button is one step towards freeing the data.

Once those in the hospital realize the health data has been available to patients through blue button all along, then they’ll realize that giving patients their health data won’t cause the universe to implode. Hopefully by then we’ll have some really great applications doing beautiful things with all that blue button data.

Kaiser Permanente Branch Joins Epic Network

Posted on December 26, 2013 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Though it apparently held out for a while, Kaiser Permanente Northern California has signed on to Epic Systems’ Care Everywhere, a network which allows Epic users to share various forms of clinical information, Modern Healthcare reports.

Care Everywhere allows participants to get a wide range of patient data, including real-time access to patient and family medical histories, medications, lab tests, physician notes and previous diagnoses. The Care Everywhere network debuted in California in 2008, and has since grown to a national roster of more than 200 Epic users.

Many of the state’s major healthcare players are involved, including Sutter Health, as well as prominent regional players such as Stanford Hospital and Clinics, USCF Medical Center and UC Davis Health System, according to Modern Healthcare. Kaiser Permanente Southern California also participates in the network.

According to Epic, the Care Everywhere system allows patients to take information with them between institutions whether or not both institutions use the Epic platform. Information can come from another Epic system, a non-Epic EMR that complies with industry standards, or directly from the patient.

But of course, the vendor likes to see Epic-to-Epic transmission best, as it notes on the corporate site: “When an Epic system is on both sides of the exchange, a richer data set is exchanged and additional conductivity options such as cross-organization referral management are available.”

Care Everywhere also comes with Lucy, a freestanding PHR not connected to any facility’s EMR system. According to Epic, Lucy follows patients wherever they receive care, and gathers data into a single source that’s readily accessible to clinicians and patients. Patients can enter health data directly into Lucy or upload Continuity of Care Documents from other facilities.

While connecting 200+ healthcare organizations together is a notable accomplishment, Care Everywhere is not going to end up as the default national HIE matter how hard Epic tries. As long as the vendor behind the HIE (Epic) has a strong incentive to favor one form of data exchange over another, it cuts down the likelihood that you’ll have true interoperability between these players. Still, I’ve got to admit it’s a pretty interesting development. Let’s see what healthcare organizations have to say that try to work with Care Everywhere without owning an Epic system.

P.S. It’ll also be interesting to see whether Epic is actually “best” for ACOs, as a KLAS study of a couple of years ago suggested. More recent data suggests that best-of-breed tools will be necessary to build an ACO, even if your organization has taken the massive Epic plunge.

Challenges of Interoperability in Healthcare

Posted on December 5, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

At AHIMA’s annual conference, I had a chance to sit down with Steve Bonney, VP of Business Development and Strategy at BayScribe. In this video interview, Steve and I discuss the challenges of getting structured data in healthcare and how you can use good technology to get the healthcare data without disrupting the physician workflow. Steve also discusses some of the benefits of having interoperable data in healthcare. Then, I ask him if Meaningful Use is going to make structured, interoperable data a reality.

If you’re interested in healthcare data exchange or interoperability, then you’ll enjoy this video.

Will the Future of Healthcare Be Data Driven?

Posted on November 15, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

The past couple days I’ve had a the opportunity to interact with many of the top healthcare professionals in New York City at the Digital Health Conference. As I think back on the many talks I’ve heard at the event or had with attendees I’m struck by the power that data can hold for healthcare.

Whether we’re talking about the SHINY HIE which will exchange the healthcare data across the state of NY or if we’re talking about the multitude of sensors that are collecting more data than we can process, it’s becoming quite clear to me that healthcare is heading towards a very data driven world. Soon the day will come when very little is done in healthcare without consulting the data. Although, most of that “consultation” will just happen seamlessly as part of the process.

Most doctors already do this today, but on a much smaller level. A doctor consulting a paper chart as part of the care is a doctor looking at the data before providing care. Now imagine that times a million. That’s where we’re headed.

This was really driven home after Jim Messina’s keynote today. In his keynote, he talked about the detailed ways he and the Obama campaign used data to target their efforts. I can’t do his talk justice in this post, but the way he was able to use data to look at the population was remarkable. We need to apply that to healthcare as well.

I’m not talking some pie in the sky “big data” project that so many like to espouse. I’m talking about using the data to really change people’s lives.

I think a lesson can be learned from Jim Messina. He said that for the first year or two they really struggled with these efforts. My guess is that they were still gathering the data sources and trying to find the meaning in the data. The point is that it wasn’t an overnight thing. It took them time, effort, and focus to finally get their arms around the data in a way that they could benefit from it.

Although, Jim Messina’s efforts had one thing that seems to really be lacking in healthcare: a clear goal. Jim Messina had a clear goal of getting Obama reelected. Everyone knew and understood that goal. We need a similar clear goal in healthcare. I think that goal should be: better quality care at lower cost. The challenge is that this goal goes against some of the economic realities for many institutions. However, for those organizations looking long term, nothing will benefit them more financially than reaching this goal.