Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

The Path to Interoperability

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.

August 28, 2014 I Written By

Time for Government to Step Out of the Way of EHR and Let the Market Takeover?

The always interesting and insightful John Moore from Chilmark research has a post up that asks a very good question. The question is whether it’s time for the government to get out of the EHR regulation business and let the market forces back in so they can innovate. I love this section of the post which describes our current situation really well:

But as often happens with government initiatives, initial policy to foster adoption of a given technology can have unintended consequences no matter how well meaning the original intent may be.

During my stint at MIT my research focus was diffusion of technology into regulated markets. At the time I was looking at the environmental market and what both the Clean Air Act and Clean Water Act did to foster technology adoption. What my research found was that the policies instituted by these Acts led to rapid adoption of technology to meet specific guidelines and subsequently contributed to a cleaner environment. However, these policies also led to a complete stalling of innovation as the policies were too prescriptive. Innovation did not return to these markets until policies had changed allowing market forces to dictate compliance. In the case of the Clean Air Act, it was the creation of a market for trading of COx, SOx and NOx emissions.

We are beginning to see something similar play-out in the HIT market. Stage one got the adoption ball rolling for EHRs. Again, this is a great victory for federal policy and public health. But we are now at a point where federal policy needs to take a back seat to market forces. The market itself will separate the winners from the losers.

His points highlight another reason why I think that ONC should blow up meaningful use. In my plan, I basically see it as the government getting out of the EHR business. I do disagree with John Moore’s comments that the government should step away from interoperability. If they do, we just won’t have interoperability. I guess he’d make the argument that value based reimbursement will force it, but not in the same way that the rest of the EHR incentive money could force the issue.

I have learned that to really get out of this game or even do what I describe will take an act of congress. HHS can’t do this without their help. Although, they could get pretty close. Plus, maybe they could exert their influence to get congress to act, but I won’t be holding my breathe on that one.

May 22, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

$11 Billion DoD EHR Contract

Nextgov has a great article up which outlines many of the details of the soon to be bid out Healthcare Management Systems Modernization contract. I’d prefer to call it the DoD EHR Contract or AHLTA replacement contract. Certainly there’s more to it than EHR, but that will be the core of the contract and the big name EHR vendors will all be involved.

Here’s a section of the article which gives you an idea of the size of the contract:

The DHMSM contract’s estimated lifecycle value is approximately $11 billion and would include initial operating capabilities by 2017 and full functionality by 2023, according to Dr. Jonathan Woodson, assistant secretary of Defense for health affairs, who testified in February before the House Appropriations Committee’s defense panel.

Even in Washington, $11 billion is a lot of money, and it would surely rank among the largest IT-related contracts in government. What’s unique about this effort is that the Pentagon wants a single contractor to lead the integration of a commercial electronic health records system to cover its nearly 10 million beneficiaries and large assortment of health care facilities worldwide. Defense is one of the largest health care providers in the country, on par in size with the Veterans Affairs Department and private sector leaders like Kaiser Permanente.

The article also states that they want to issue a contract with one vendor. We’ll see how that plays out. I’ve seen some rumors out there about who will be bidding. No doubt it will be a combination of the usual government contractors and EHR consultant companies together with EHR vendors like Epic and Cerner.

What’s going to be really interesting is the VA and its Vista EHR (Vista Evolution) is said to be bidding on the contract as well. We’ll see if they’re the only Vista bid or if others join in as well.

Here’s another great insight into the DoD EHR Contract:

Major data gaps in patient records occur when health care is delivered to beneficiaries outside the DOD network, and today approximately half of DOD’s 9.8 million beneficiaries receive their health care outside the network.

This was an obvious complaint of the AHLTA system. The DoD and VA couldn’t even get their EHR systems to be interoperable. I’m not optimistic that interoperability will be obtainable even under this new contract. That includes DoD to VA interoperability, let alone trying to connect with the care the DoD beneficiaries receive outside the DoD network.

I realize that nothing with the DoD health system is simple. Its an enormous system with all sorts of crazy government regulations. However, I’d hope for $11 billion, we could do better than we’re doing for our veterans.

At HIMSS, I talked with a largely military EHR vendor. They told me that they were close to being able to exchange records between different locations. That’s right. At HIMSS 2014 the amazing breakthrough was that 2 locations with the same EHR software were close to being able to exchange data.

May 1, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

A Meaningful EHR Certification

In many ways this post could be considered a continuation of my previous post on data liberation. I’ve really loved the idea of a creating a meaningful EHR Certification and that could include data liberation. Let’s be honest for a minute. Do any of you find value in the current EHR certification?

You know that a certification is screwed up when it requires certain interoperability standards and then when you go to actually implement the sharing of data between two systems you find out that the two systems are working on two different standards. They are close standards, but close doesn’t count with standards. Many have asked the question, “What did the EHR certification do if it couldn’t test the standard?” I have no answer to that question.

Now imagine we created an EHR certification that actually did require a standard for interoperability. Not a flavor of a standard, or something that closely resembles a standard. I’m talking about a standard. Would hospitals find this useful? I think so.

Another example of a meaningful EHR certification could be certifying that an EHR vendor will not hold your EHR data hostage. Think about how beneficial that would be to the industry. Instead of EHR vendors trying to trap your data in their system, they could focus on providing the end user what they need so the end user never wants to leave that EHR. What a beautiful shift that would be for our industry.

There could be many more things that could be meaningfully certified. However, this would be a simple and good place to start. I have no doubt that some would be resistant to this certification. That’s why those who do become meaningfully certified need to get the proper boost in PR that a meaningful certification should deserve. No EHR vendor wants to be caste as the EHR vendor who can’t figure out the standard and that holds its customers hostage. Yet, that’s what they’re able to get away with today.

What do you think of this idea?

April 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

eFax in Hospitals

Over the years, I’ve had the chance to interact with basically all of the major eFax services out there. I’ve even had a number of them as advertisers. This largely makes sense since healthcare it still the haven for fax. I won’t go into all the reasons why fax is still so popular in healthcare, but it’s still the most trusted form of interoperability in healthcare. As an eFax vendor pointed out to me, fax is great because it produces an unalterable document. Sure, it’s not impossible to alter, but it’s pretty difficult.

I am hopeful that fax will one day be replaced by true interoperability in healthcare. Although, I’m more hopeful that Direct Project will get us there even sooner. Fore those not familiar with Direct Project, it’s like fax, but with meta data attached to it and securely sent over the internet. Both true interoperability of data and Direct Project still have a long ways to go though. So, don’t hold your breathe on those taking out fax….yet.

A trend I have seen happening is organization replacing their current fax solution with some sort of eFax option. In many cases this shift has been driven by issues with fax when you’re in a VoIP environment. Yes, I know that many of the VoIP environments can support fax, but it takes work. In fact, it takes just as much work getting it to function as it is to just implement some sort of eFax solution.

The other real benefit I’ve seen many consider when looking at eFax is the cost structure of eFax. Instead of having to invest in faxing hardware all up front, many organizations like that the eFax can be bought on a pay as you go or usage based plan. If indeed faxing is starting to go away in favor of some other electronic transfer of data, then your organization can save money on faxing as your fax load is reduced.

There are a few trends I’ve seen with eFax in healthcare. What trends have you been seeing in your organization?

January 23, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

2013 Hospital EHR and Health IT Trends

There are a number of amazing milestones and trends happening with EHR and Healthcare IT. I think as we look back on 2013, we’ll remember it for a number of important changes that impact us for many years to come. Here are a few of the top trends and milestones that I’ll remember in 2013.

Epic and Cerner Separate Themselves – This has certainly been happening for a couple of years, but 2013 is the year I’ll remember that everyone agreed that for big hospitals it’s a two horse race between Cerner and Epic. There’s still an amazing battle brewing for the small hospital with no clear winner yet. However, in the large hospital race the battle between Cerner and Epic is on. Epic had been winning most of the deals, but Cerner just gave them a big left hook when Intermountain chose Cerner.

I expect we’re living in an Epic and Cerner world until at least a few years post meaningful use. The job listings on Healthcare IT Central illustrate Cerner and Epic dominance as well.

Near Universal EHR Adoption in Hospitals – I can’t find the latest EHR adoption (meaningful use) numbers from ONC, but the last ones I saw were in the high 80′s. That basically leaves a number of small rural hospitals that likely don’t have much tech infrastructure at all, let alone an EHR. Every major hospital institution now has an EHR. I guess we can now stop talking about hospital EHR adoption and start talking about hospital EHR use?

The Cracks in the Healthcare Interoperability Damn Appear – Interoperability has always been a hard nut to crack in healthcare. Everyone knew it was the right thing to do, but there were some real systemic reasons organizations didn’t go that direction. Not to mention, there was little financial motivation to do it (and often financial disincentive to do it).

With that background, I think in 2013 we’ve started to see the cracks in the damn that was holding up interoperability. They are still just cracks, but once water starts seeping through the crack the whole structure of the damn will break and the water will start flowing freely. Watch for the same with interoperability. Some of this year’s cracks were started with the announcement of CommonWell. I think in response to being left out of CommonWell, Epic has chosen to start being more interoperable as well.

Skinny Data Happens – I was first introduced to the concept of skinny data vs big data at HIMSS 2013 by Encore Health Resources. While I’m not sure if the skinny data branding will stick, the concept of doing a data project with a slice of data that has meaningful (excuse the use of the word) outcomes is the trend in data analytics and it’s going to dominate the conversations going forward.

As I posted on EMR and EHR, Big Data is Like Teenage Sex, but skinny data is very different. Skinny data is about doing something valuable with the data. Sadly, not enough people are doing skinny data, but they all will in 2014.

Hospitals Ignore Consumer Health Devices – Consumer health devices are popping up everywhere in healthcare. We’re quickly reaching the point that consumers can monitor all of their vital information at near hospital grade quality using their smartphone and sometimes an external device. This is a real revolution in medical devices. Many are still making their way through FDA approval, but some have passed and are starting to work on traction.

With all of this innovation, hospitals seemed to have mostly ignored what’s happening. Sure, the larger ones have a few pilot projects going. However, most hospitals have no idea what’s about to hit them upside the head. Gone will be the days of patients going to the hospital to be “monitored.” I don’t think most hospitals are ready for this shift.

December 31, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Health IT Haiku

Now for something completely different, folks. Here’s some haiku verses (5-7-5 syllable scheme) on EMR and HIT issues. I’m hoping y’all jump in and give it a try next.

EMR cutover
Could it be that all our work
Comes down to this day?

Everyone freaks out
EMR has gone off line
Painful nine seconds

Meaningful Use is
Years of pain and suffering
For a bite-sized check

Can’t write haiku on
interoperabili-
ty, or can you now?

Elegant, simple
EMR interface is
Rarer than diamonds

Fifty million spent
Putting in their EMR
Which they then threw out

May 20, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.

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.

April 26, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

We Have an HIE – The Internet

Jon Fox, MD and Founder of HealthApp Connect sent me a great message:

We already have a great free HIE and it’s called the internet

He makes an interesting point. Reinforces why I called for hospital CIO’s to start making interoperability a reality as opposed to just talking about it. The technology and connectivity is there. Every hospital is connected to the internet and therefore already connected to every hospital out there. That simplifies the issues, but enough people are overcomplicating what needs to happen. Maybe we need some more people in healthcare willing to look at interoperability more simply.

February 11, 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 14 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Senators Join Initiative To Scrutinize Meaningful Use

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.

October 23, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 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.