Farzad Mostashari | Hospital EMR and EHR

Only Incentives Will Make EHR Interoperability Happen

Today we had a really interesting #HITsm chat about interoperability, data hoarding, and sharing healthcare data. Tomorrow we’ll have a post on EMR and EHR that summarizes some of the key tweets from the chat. Although, there was one theme that really struck home to me during the chat.

The biggest barrier to EHR interoperability and data sharing is incentives.

During the chat multiple people including myself made the observation that the reason EHR vendors don’t share data is that there’s no incentive to share data. I can’t say I’ve ever seen a hospital choose to not go with an EHR because it couldn’t interoperate with another EHR vendor. The incentive isn’t there for the hospital and therefore the EHR vendor.

Think about the EHR interoeprability announcement of CommonWell. While the CEO’s of the five EHR vendors can sit there and say that they’re doing it because it’s the right thing to do for healthcare, these public company CEOs also have a legal responsibility to do what’s best for the shareholders of their company.

The reality is that CommonWell would have never happened if there wasn’t an incentive for these companies to put CommonWell together. Rather than beat around the bush, these EHR companies came together to stick it to Epic and to give them a strategic advantage over other companies that can’t or won’t share data. You can certainly make an argument for why doing this is good for healthcare as well, but if there was no outside business incentive to CommonWell then the healthcare benefit wouldn’t have been enough.

As one person tweeted during the Twitter chat, If there were money paid for sharing data, all the fear and issues would suddenly disappear and solutions provided.

When thinking about incentivizing EHR interoperability, Farzad Mostashari’s words at The Breakaway Group event at TEDMED come ringing into my ears, “Incentives and money aren’t always the same.” Cash or otherwise, EHR interoperability needs some incentive.

The Big Takeaways from The Breakaway Group Healthcare Forum at TEDMED

I had the tremendous opportunity to spend the day hearing and interacting with a group of healthcare leaders across the entire spectrum of healthcare. I was invited to the Healthcare Forum as a guest of The Breakaway Group. They’d told me that the group would have a large number of influential people in healthcare and they were right. Along with recognizable names like Dr. Farzad Mostashari, Glen Tullman and Lee Shapiro were a number of hospital CEOs, CIOs, and CMIOs. There were doctors, insurance executives, and many other executives which made for a very well rounded and interesting discussion.

I won’t go through an entire recap of the event and all the things that were shared during the various presentations. If that interests you, go and read through my @ehrandhit tweets and check out the #simplehealth hashtag and you’ll get a good overview of everything that was presented from those of us live tweeting the event.

I do want to highlight a couple key takeaways and then suggest a list of major themes we’ll be confronting in healthcare.

Farzad Mostashari, MD was the event keynote with a great view on the future of healthcare. Farzad’s intro was perfect when Charles Fred, Founder & CEO of The Breakaway Group, said, “The wedding of healthcare and technology is over and Farzad has joined us for the marriage.”

Farzad’s message covered a lot of ground including a message of optimism for healthcare, the need to affect all parts of healthcare both small and large, and using the “most underutilized resource in healthcare…the patient.” He also talked about the need for some accountability in healthcare. Farzad suggested that there’s no “scale” in healthcare that we can step on and know how well we are doing. We need the data to be able to tell us how we are doing so we can improve. Without the data we almost always overestimate how good we are and underestimate the things we’re doing poorly.

One of the most powerful concepts Farzad discussed was around being careful not to change healthcare from a social contract into a financial contract. He said, “Incentives and money aren’t always the same.” This point was illustrated brilliantly by one of the attendees who said, “An ACO should be the way we live and breathe healthcare every day and not just a reimbursement program.” I think we often need a reminder to not let the business of healthcare overwhelm the care provided.

Finally, for those of us who love EMR and EHR, Farzad offered this incredible perspective on where we are at when it comes to EHR progress, “We are at about 50% EHR adoption and about 5% workflow adjustment.” It’s the first time I’ve seen him acknowledge the idea that EHR adoption isn’t enough. In fact, the initial implementation of an EHR is just the very first step in a process of really optimizing the EHR for your workflow and for improved patient care. It does make me wonder what things ONC might do in the future to try and address the 95% of EHR workflow adjustments that remain.

I’m sure I’ll be pulling nuggets of information out of Dr. Jennifer Brull, Bill Rieger, Dr. CT Lin, Ashwin Ram, and Heather Haugen’s talks in future posts. They all offered some unique insights into quality of care, EHR leadership, patient engagement, patient portals, and EHR implementation.

Here’s the list of themes from the day as identified by those who attended:

Using Data
Transparency
Need for Leadership to Change
Adoption vs. Implementation (EHR)
Patient and Family Involvement in Care (through social media often)
Change Happens at a Different Pace for Different People

And then we identified the following important future healthcare topics:

Interoperability
Social and Mobile
Patient Engagement
How Do We Ask the Best Questions
Make the Right Thing to Do, Easy
Big Data, Small Actions (for doctors and patients)
Changing Reimbursement

The Healthcare Forum at TEDMED was a well organized event that provided a lot of food for thought. My only complaint from the experience was that pretty much everyone in the room could have been a speaker at the event. Thinking about that makes me wish there had been more time to hear from those in the audience. Although, it isn’t a bad thing to leave us thirsting for more.

Read more coverage from TEDMED from Xerox on the Real Business at Xerox blog and follow@XeroxHealthcare.

Mostashari Asks EHR Vendors to Do What’s “Moral and Right”

Healthcare IT News has a good article reporting on what Farzad Mostashari, ONC National Coordinator, said at the Feb 6th Health IT Policy Committee. Farzad doesn’t mince words about some of the things he sees going on in the EHR world. Here’s a section from the above article:

“Vendors do the bulk of the heavy lifting, but as a society, sometimes competition is not in the public interest,” Mostashari said at the latest Feb. 6 meeting. “Government regulation can help in that case, but it’s not the most preferable way.”

“There are some vendors who are ‘beyond the pale’ in their conduct, and it is part of society to create codes of conduct to say this is what we believe in and this is what we do not believe in,” he added.

Mostashari said that some vendors go beyond the boundaries of what society views as proper, in their lack of opaque pricing. He said he gets complaints from providers on a daily basis, saying that some pricing or contract requirements are unfair to them, and asking if there could be some federally regulated norms around pricing.

Farzad also mentioned data lock-in as another place that EHR vendors could do what is legally right, but not necessarily morally right. Farzad called for EHR vendors to do what’s morally right, or else they’re going to go back to the regulation process. Sounds like a threat to me. Although, I’m not sure how much he can really do. Plus, are the EHR vendors that are doing these things going to care?

The other place I’m sure Farzad is thinking about is the closed gardens that so many EHR vendors have created. Farzad asked for the EHR vendors to act as a community. Sounds like a call for EHR vendors to start working together and sharing the healthcare data. HIE is and should be a huge initiative for ONC, and EHR vendors are standing in the way of that happening.

With that said, I’m afraid that Farzad’s call is falling on deaf ears. Most EHR vendors that display these practices know exactly what they’re doing and have already made the choice. They’re unlikely to change because someone in government threatens them with more regulation.

What could have the most affect in this regard is doctors, hospitals and medical groups reading their contracts and not signing contracts with EHR vendors that have language that will cause a problem for the doctor later. Once hospitals stop patronizing EHR vendors that don’t act well, we’ll see some change.

Attending CHIME 2012 Fall CIO Forum

Today I arrived at the 2012 Fall CIO Forum for CHIME. I’ve wanted to go to this event for quite a while. My fellow blogger, Neil Versel, had often told me about how great the event was and so I wanted to see it first hand.

Tonight I heard an almost emotional Farzad Mostashari speak and then got to mingle with all of the CIO’s at the evening event. A few things I’ve already noticed that I found interesting.

First, Farzad has really refined his pitch for healthcare IT. He makes a really compelling case for what’s possible and a really common sense analysis of why we need to start using healthcare IT now. If I were to put a title on Farzad’s talk at CHIME, I’d call it, “Stop with the Excuses, We Can Do Better.”

Everything at the event is high class. You can tell that no expense was spared to make sure that the major healthcare IT contributors are treated well.

I wasn’t that surprised, but it’s unfortunate that I was by far the youngest person at the conference (at least from what I saw). One wife of a CIO I talked with asked why there weren’t more young people present. Then she said, “Don’t these hospital CIOs want to groom the next generation of leaders? Why are they holding on so tightly and not preparing for the future.” It’s a good question I wasn’t really sure how to answer.

There are a lot of really powerful people at the event. It was fun to see Judy Faulkner mingling with people. I saw John Glaser. In many ways, it’s a Who’s Who of hospital health IT.

While there are many Hospital CIOs at the event, there are also a lot of vendor representatives. Not surprising considering the amount of budget these hospital CIOs control.

I was amazed at how many people were “old friends.” You could see that many of those attending have been doing so for years and this was their annual visit with colleagues. As a first time attendee, you’d think that I might not feel very welcome, but the opposite was the case. All of the hospital CIOs I met were very friendly, kind and happy to engage.

More on the event tomorrow. If you’re in Palm Springs at the event, I’d love to talk with you. Just leave a comment below or send me a tweet.

A Big Year Coming For HIEs, With Epic Leading the Way

Folks, I’m afraid that when it comes to Epic, I haven’t followed the old “if you have nothing nice to say, don’t say anything” rule. In fact, I’ve been a fairly ruthless critic of the company, whose veni, vidi, vici attitude rubs me the wrong way.

That being said, I was fascinated to note that Epic may be at forefront of hospital EMR vendors enabling health information exchange. If Epic’s own claims are to be believed, it’s a force for clinical data sharing unlike most out there today.

A couple of days ago, ONC chief Farzad Mostashari told the Health IT Policy Committee that he expects to see a big ramp-up in HIE implementations this year. He believes that the necessary elements for interoperability are falling into place, including standards, identity authentication certificates, governance requirements and the availability of directories.

Mostashari cited efforts by Epic as a model for what can be accomplished in 2012. And Judy Faulkner, Epic CEO and a policy committee member, told members that hospitals using its product have already exchanged 800,000 documents nationally. She expects users to begin sharing documents overseas, as well.

What’s more, Faulkner contends that as standards fall into place, sharing across vendors will be”almost equally as simple” as Epic-to-Epic sharing. I find it hard to imagine, but if she and her team can pull that off, it will indeed be impressive.

I’m rather skeptical that it will be as easy as Faulkner suggests, for practical reasons as much as technical ones. And given that Faulkner has asserted that hospitals should go all-Epic rather than mix and match systems, it’s hard to imagine Epic as a “we interoperate” kinda company.

On the other hand, given Epic’s status as a market leader, this may be one of the few chances the industry has had to pull together and find a common way to share data. As much as it sticks in my craw, and believe me, it does, I have to admit that Faulkner & Co. may have something there.

Industry Does Too Little, Too Late On HIT-Related Safety Issues

This week, a pair of HIT organizations — including a HIMSS-backed group and an alliance focused on HIT safety — came together to help track HIT-related patient safety problems. The two groups have broad-based vendor support, and they seem to have the right goals. Unfortunately for them, though, the HIT safety ship may have already sailed.

Participants in the current linkup include the iHealth Alliance, part of the EHR safety group EHRevent.com run by the publishers of the Physicians’ Desk Reference, and the HIMSS EHR Association, a collection of 44 EHR vendors working together to work on key industry issues.

The safety group, which offers a quick form allowing people to report EHR-related safety concerns, is an official, federally-certified Patient Safety Organization. That gives providers the chance to report such events in a privileged, confidential manner.

That being said, regulators seem to have gotten the jump on the software folks. As some of you may know, regulators are already preparing to begin, well, regulating HIT safety results. The FDA, which issued draft guidance on mobile medical apps this summer, may cast its eye on EHRs at some point.

Another possible angle comes from the Institute of Medicine, which recently issued a report recommending that HHS create a new watchdog agency investigating health IT safety issues. National Coordinator for Health IT Farzad Mostashari recently told reporters that his agency, the ONC, has already begun developing an EHR safety and surveillance plan which should be out within the next 12 months.

(If you want this process to be as painless as possible, you’d better hope that the IOM gets its way; vendors, you don’t want to face the kind of FDA struggles pharmaceutical companies do, right?)

Honestly, someone who’s watched regulators do their thing for decades, I’m betting this latest industry effort will be too little, too late.

Folks, as I see it the only way you’ll get the agencies off your back is to start reporting on safety issues with EMRs/EHRs and other health IT tools aggressively. But given that many organizations aren’t even at the stage where their EMR installation is stable, good luck!

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Only Incentives Will Make EHR Interoperability Happen

The Big Takeaways from The Breakaway Group Healthcare Forum at TEDMED

Mostashari Asks EHR Vendors to Do What’s “Moral and Right”

Attending CHIME 2012 Fall CIO Forum

A Big Year Coming For HIEs, With Epic Leading the Way

Industry Does Too Little, Too Late On HIT-Related Safety Issues

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