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What If EMR Interoperability Was Mandatory?

Posted on June 5, 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.

For decades, industries have haggled and coded and bargained their way into shared data standards.  Each agreement has made great technical advances possible and grown markets into forms which could hardly have been imagined before.

Traditionally, the idea has been agreeing on interoperable standards is a form of enlightened self-interest.  The equasion “interoperability=larger markets=more pie for everyone” has nearly always managed to take root even in industries as brutally competitive as networking.  Consider where we’d be without 802.11 for WiFi, for example. If WiFi manufacturers had staged a prolonged battle over standards, and the reach of WiFi didn’t blossom everywhere, the Internet as we know it might not exist.

Well, here in EMR vendor land, we’ve somehow passed the exit marked “coopetition” and wandered off into interoperability nowhere land.  Sure, tell me about the CommonWell Alliance, which looks, on the surface, something like industry cooperation, and I’ll retort, “too little, too late.”  And do I even have to say that the idea that Epic supports everybody is something of a laughing matter?

Maybe, after seeing how miserably the EMR vendor industry has failed to come together to share data, it’s time to force the matter.  I read that ONC  honcho Farzad Mostashari has occasionally threatened to do just that, but hasn’t followed through with any proposed regs on the subject.

What if the FCC, the FDA and the ONC (which are now taking comments on a regulatory framework for health IT) decide to look at standards, pick a winner and shove it down the ever-living throat of every uncooperative vendor hoping to create dependency on their way of doing things?  That would include Epic, of course, which today, hears countless hospital CIOs say they had to buy their product because everybody else did.

Don’t get me wrong, this is a very, very serious matter; any regs that attempted to force interoperability would impose untold billions in costs on vendors, not to mention their customers. But if interoperability is the real prize we’re ultimately hoping to gain — the big EMR enchilada — is it possible that it’s time to take the risk anyway?  I don’t know, but I certainly wonder.  How about you, readers?

Adolescent Data Needs Stronger EMR Protections, Group Says

Posted on November 13, 2012 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.

The American Academy of Pediatrics is calling for changes to EMRs to protect the privacy of adolescent patients, whom, it says, don’t currently get the same level of protection as adults.

According to the AAP, there are several reasons adolescents don’t enjoy the same privacy protections as adults.

For one thing, there are the legal issues. HIPAA doesn’t provide specific guidance on adolescent privacy, and the medical industry hasn’t put clear standards in place outlining when adults can access an adolescent’s health records either.

What’s more, states vary in how they handle this issue, according to the AAP report. State laws typically allow minors to consent for their healthcare on the basis of their status — for example, if they’re a pregnant or parenting teen — and on the basis of the services they seek  — such as STI diagnosis and treatment or contraception. However, while state and federal laws provide protection of privacy when minors  consent for their own care, privacy protections differ widely.

To make sure adolescent privacy is protected across all data platforms, the AAP is recommending a set of principles that it feels should ideally govern not only EMRs, but also PHRs and HIEs. These include :

*  Creation of a set of criteria for EMRs that meet adolescent privacy standards

*  Creating and implementing technology for EMRs which would allow determination of who has access to, or ability to control access to, any part of the adolescent medical record.

* Making it possible for adolescents to record consents and authorizations according to privacy laws using the HL-7 Child Health Profile DC.1.3.3 standard

*  Flexibility within standards to allow for protection of privacy for diagnoses, associated lab tests, problem lists and any other documentation containing confidential data.

* EMR systems must be able to apply state and federal confidentiality rules when assembling aggregate data to prevent identification of individuals.

The AAP has a lot more to say, but in summary, it seems to be putting the burden for protecting adolescent privacy largely on EMR vendors, though I believe it’s hoping members will advocate for these changes as well.

Either way, it doesn’t work well if there’s a protected class (certain adolescents) whose rights simply can’t be protected adequately with today’s technology.  Time to get on this issue, I’d say.

Senators Join Initiative To Scrutinize Meaningful Use

Posted on October 23, 2012 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.

A couple of weeks ago, four House GOP leaders wrote a letter to HHS head Katherine Sebelius demanding that she account for perceived failures in the Meaningful Use program.

The four congressmen had written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

Politics being what it is, the other shoe had to drop, and now a group of senators have offered their own objections.

Sens. John Thune and Dr. Tom Coburn of the Finance Committee, and Richard Burr and Pat Roberts of the Health, Education, Labor and Pensions Committee have formally requested that CMS and ONC staffers meet with the latter committee regarding the final rule for Stage 2 of Meaningul Use.

In a letter to HHS, the senators raise several questions:

* Do EMRs sometimes increase utilization of diagnostic tests, and if so, how should the government respond?

* Have some providers gotten subsidies for EMR systems they had in place prior to the kickoff of  Meaningful Use? If so, what is HHS doing to claw back such payments and prevent future outlays of this kind?

* Has the use of EMRs boosted providers’ billing of Medicare, and thereby raised the cost of the program?

* What is HHS’s strategy for “meaningful interoperability”?

Interestingly, the senators’ letter stops short of demanding a halt on MU payments, which the congressmen did in no uncertain terms.  But they’re clearly antsy about the future of the Meaningful Use program, which has paid out $6.6+ billion in incentives to date.

And you know what?  It’s about time that Congress got interested in the future of EMRs and Meaningful Use specifically.  Better to have them breathing down HHS’ neck now than further down the line when there’s far less opportunity to turn the MU battleship.

Congressmen Want Halt On Meaningful Use Payments

Posted on October 8, 2012 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.

Four congressmen have thrown what could be a monkey wrench into the rollout of Meaningful Use Stage 2 regulations, arguing that Meaningful Use rules are weak and ineffective and that MU incentives have gone awry.

The four have written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

In the letter, the congressmen somewhat spitefully quote the recent piece from The New York Times which suggests that EMRs are raising costs by encouraging upcoding. “Perhaps not surprisingly, your EHR incentive program appears to be doing more harm than good,” the letter says. (Oh, snap!)

What do the congressmen want? A) To see CMS suspend all incentive payments until “universal interoperable standards” are promulgated, B) to require higher level of performance from Meaningful Users (upping percentages of, for example, transfers that need to be done electronically) and C) to see HHS “take steps to eliminate the subsidization of business practices that block the exchange of information between providers.”

Of course, the health IT leaders of the world are aghast. HIMSS, for example, has already issued a statement opposing the incentive payment halt.

But there is a nuanced conversation to be had here. While I admit I’ve ridiculed the tone of the congressional letter a bit, I think there’s some merit in the complaints. Interestingly enough, the most substantial complaint (letter “C”) in the missive is discussed the least in the text.

Let’s think about what John rightly calls “Jabba the Hutt” EMR vendors. What incentive do they have to change their business practices and make their products interoperable if the only threat to their business is academic discussions about Blue Buttons, The Direct Project and 17 flavors of HL7?

No, my friends, while I disliked the nasty, hectoring tone of the letter, I think we should take the authors’ objections seriously. We are at an interoperability crossroads and there’s no immediate end in sight.

What Won’t Happen In #HIT By September 2013

Posted on September 7, 2012 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 part of the upcoming National Health IT Week (#NHITWeek), which takes place September 10 through 14th) my august colleague John has written up a list of ways in #HIT is likely to make a difference over the next 12 months.  (He makes some great guesses; definitely give the post a look.)

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?”  Here’s some of my predictions:

* EMR-to-EMR interoperability:  Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

High penetration by HIEs:  With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

Major uptick in open-source HIT  use:  Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

Epic controls the hospital EMR world for good:  Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak.  But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring:  Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs.  I just think we’re going to remain stuck with some of these legacy issues for some time to come.

Are Best Of Breed EMRs Going Out Of Fashion?

Posted on September 4, 2012 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.

This week, I visited a hospital which belonged to a health system going with Epic. This hospital, one of the smaller facilities in the chain, was running Picis in the ED and (I think) Cerner throughout, but the decision had been made to convert everything to Epic sometime soon, a tech told me.

I can’t say the news was surprising, but it was disappointing nonetheless. The community hospital in question has given me excellent service, and my guess is that when Epic barrels in, it will lose its way — at least for a while — frazzling the staff and decreasing the quality of their interaction with me.

However, I ‘d better get used to this trend. As Healthcare Technology Online editor in chief Ken Congdon notes in an excellent editorial, the pendulum is definitely swinging toward enterprise-wide EMR implementations, a direction encouraged by the standardized demands imposed nationwide by Meaningful Use.

If interoperability was easier to pull off, things might be different. But with HL7 and other integration standards and languages still not quite up to the job, one can see the sense of going with an enterprise option.

Here’s the story one CIO told Congdon as to why he’s deploying Siemens Soarian solution:

Michael Mistretta, CIO of MedCentral Health System  [said:]  “Vendor management was a key consideration in our decision to use a single vendor approach to EMR implementation,” says Mistretta. “With a single vendor, I only have one finger to point at. It simplifies my environment because I don’t have Siemens telling me it’s McKesson’s problem and vice versa. Also, the built-in interoperability is key. There is a trade-off in the fact that the system does not provide prime functionality to certain departments or specialties within our health system, but at this point in time, it’s much more beneficial for our organization to have the ability to share data across the continuum of care quickly and easily.” 

CIOs of large hospitals also told Congdon that enterprise system replacements were much cheaper than going through a long-term, highly-complex integration effort.

In an interesting twist, however, hospital IT leaders from mid-sized to smaller hospitals have reached the opposite conclusion, Congdon reports. They’ve been telling him that buying an enterprise system would be much more expensive than sticking with what they had and making it interoperate.

I see a market opening here. If enterprise EMR vendors can get their pricing in line for smaller hospitals, they may have a lot more wins coming their way than they expected.  Interesting stuff.

Group Develops EMR-Less HIE Technology

Posted on August 22, 2012 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.

A pair of major tech players and a group led by Geisinger have come together to create tools making health information exchanges accessible to providers who don’t have an EMR in place. The tools are aimed at skilled nursing facilities, but from what I can see, the approach would work for other providers too.

Federal standards already require SNFs to submit MDSs — which are electronic patient assessments — to both the Medicare and Medicaid programs. The thing is, MDS data doesn’t conform to the Continuity of Care standard, so it can’t be shared amongst various providers across an HIE.

What’s happening is that Geisinger’s Keystone Beacon Community and GE-Microsoft joint venture Caradigm have created a MDS (minimum data set)-to-CCD transformer which turns patient care data into a Continuity of Care Document.  Providers can then take their CCD document and transfer it to  an HIE.

The Keystone Beacon Community, which is part of an HHS-backed program established in 2009, was launched to speed up the ability of health IT to transform local healthcare systems.  Keystone includes a network of 17 central Pennsylvania providers, including medical practices, hospitals, long-term care communities and others.

I’m not surprised to see Geisinger driving this train, as it’s been ahead of the EMR curve for many years. Geisinger is also large enough to conduct a real test of new technologies, as its network single-handedly serves more than 2.6 million residents of 42 area counties.

Still, I’ve got to wonder whether efforts like the Direct Project aren’t a better place to invest energy at the moment. It seems to me that Direct Project technologies are far simpler to deal with and still get a great deal done. But then again, maybe I’m just being a party pooper.  Nonetheless, I can’t help feeling that in this situation, less (complicated technology) is more.

HL7 Invites Clinicians To Help With Standards

Posted on June 8, 2012 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.

I don’t know about you, but I’m always interested in ways in which clinicians get a chance to make health data use more to their liking.  In that spirit, here’s an item from Information Week which just caught my eye — one I think you’ll find it interesting too.

Apparently, the HL7 organization has launched a new pilot membership program allowing clinicians to join and share their knowledge of clinical requirements.  The hope is that clinicians will help HL7 develop in a direction that better supports patient-centered care, IW reports.

Anyone who’s involved in direct patient care, including doctors, nurses and pharmacists, can join HL7 for one year for $100.

Clinicians who join will be encouraged to plug in to the group and:

* Improve the usefulness and quality of HIT standards developed by the group, and by doing so, make EMRs more usable

* Help other members understand how data standards affect how they deliver care

* Make sure that HL7 standards can support useful exchange of data between EMRs and across HIEs

While one would hope HL7 takes clinician needs into account regardless  of whether they’re members, it’s good to see the organization making a real pitch for physician membership.

Hospitals, if you want to be at the cutting edge of interoperability I’d offer to pay even that trivial $100 and encourage clinicians to share what they learned within your organization.

By the way, I was particularly intrigued by a side issue mentioned in the article, which was that HL7 has created an infrastructure for connecting personal health data — notably genetic records, IW reports — to care delivery.

Tying in personalized medical data sounds like a very fruitful direction for future HL7 deployments, as it will encourage more such research and create the kind of virtuous cycle we all hope to see. (Research used, more research produced, more used, better care and so on…)

The Depressing State Of HIEs

Posted on May 3, 2012 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.

Ladies and gentlemen, I’ve been following the progress of HIEs since the mid-2000s, and the story has always seemed to be the same.  HIE gets sparked by a grant or some entrepreneurial thinking, gets to rolling, looks promising, then dies because there’s not enough cash to keep things working.

Seven or eight years later, I’d love to be telling y’all that the HIE has magically matured, and that regional HIEs are taking off rapidly now that it’s clear everyone will need to be part of one at some point.  Well, I’m afraid that even that modest hope — let’s forget the National Health Information Network — doesn’t look like it’ll be fulfilled soon.

The latest downer came from the National eHealth Collaborative (NeHC), a public-private partnership funded by ONCHIT.   While the report was apparently intended to help HIEs grow, it also did much to remind us of the obstacles facing most public HIEs.

As Chris Muir, state HIE project manager for ONC recently told a press conference, the $564 million in federal funds that have been laid out to date to jumpstart HIEs haven’t gotten the job done.  He noted that in many regions, infrastructure doesn’t exist to support HIEs, but even if it does, few providers sign up. Then, even if they sign up, most participants don’t take full advantage of the network.

And wouldn’t you know it, the growth of ACOs has ended up spiking some HIE projects. For example, a successful HIE noted in the NeHC report told the conference that ACO growth is hampering his organizations operations. Some ACO providers are now blocking access to their data so competitors can’t get to it, said CEO Tom Fritz.

There’s also some technical obstacles faced by the HIEs, but those, I must say, seem solvable in an era when people are already making determined strides to allow interoperability between HIEs and outpatient EMRs. One group of federally funded HIEs, the Beacon Communities, is developing a continuity of care document that can be automatically exported to an exchange via a pre-arranged trigger, said Jason Kunzman, Beacon Community senior project manager for ONC.

Well, this is all well and good. But I still think I’ll be keeping my basic medical info on a thumb drive for now.

HL7 Offers Some of Its Wares For Free

Posted on February 23, 2012 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.

Health Level Seven made an interesting announcement at HIMSS12 this week, announcing a pilot project in which it will give away some what it terms “key intellectual property” at no charge.  HL7  is offering no-charge licensing of its domain models (DAMs) and functional profiles.  This is the first time HL7 has offered such a deal. Given some of the ongoing issues in implementing HL7, which hasn’t always contributed to interoperability the way the industry has hoped, I think the jury’s out on how effective this will be.

For what it’s worth, HL7 is beginning by giving It makes sense that HL7 would start by giving away DAM licenses, as the DAM requirements allow providers to take the first step of analyzing the business of a specific clinical domain. This is the first step in creating HL7 standards for a specific clinical area. Once the DAM analysis is completed, organizations have a source they can use to design HL7 standards.

In addition to the DAM rules, HL7 is also licensing some stand-alone DAMs which address some important clinical processes, including cardiology, acute coronary syndrome, clinical trials registration and results and its analysis model for vital records.

The other prong of HL7’s offer is free licenses for the HL7 Electronic Health Record System Functional Model (EHR-S FM), whch specifies the key requirements for an EHR.  THe profiles offer details on key features and functions of EHRs, including criteria for supproting medication history, clnical decision support, privacy and security.

HL7 is offering several specialized profiles at no cost, including child health, behavioral health, long-term care, clinical research and records management and evidentiary support.

HL7 also announced a collaboration with the National Cancer Institute at the show, under which it the two will use the HL7 Clinical Document Architecture to connect clinical trial data to patient EHRs.  The two parties say the project should bring clinical trial data straight to practicing physicians as quickly as possible, helping to close the infamous “bench to bedside” gap.  This actually sounds more promising than the above; let’s hope we see some  quick action here.