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Could Vendors Create Interoperability Retroactively If the Government Passed a Mandate?

Posted on May 13, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

In response to Anne Zieger’s post titled “HHS’ $30B Interoperability Mistake“, Richard Schmitz sent out this tweet:

Then, Anne Zieger responded with an intriguing question:

While I don’t think we should peg all the blame on the EHR vendors (many hospitals didn’t want interoperability either), there have been good economic reasons not to be interoperable. Anne’s question is a good one: “Could vendors create interoperability retroactively if the government passed a mandate?”

I think the question is simple: Absolutely.

If EHR vendors had to be interoperable, they would do it. In fact, most EHR vendors have already solved the technical challenges. In some limited areas they’re already sharing data. The problems of healthcare interoperability are not technical, but all financial and political.

I’m hopeful that ACOs and value based reimbursement will push healthcare interoperability to the forefront. However, that will still be a long haul before it’s a reality. What do you think? If there was a mandate would EHRs be able to be interoperable?

Health System Investment in Single EHR Platform

Posted on March 6, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

I heard about this investment at an ACO conferences in Las Vegas. It had been a while since I’d written about the hospital subsidizing the cost of an EHR for their affiliate providers. We all know they’ve been implementing an EHR with their owned practices. However, in a lot of areas the hospital is also spending a bunch of money subsidizing the cost of EHR for their affiliated providers as well.

The above comment is even more interesting in the context of an ACO. Basically, this health system’s progress towards an ACO gave them a really great reason why they should spend money on an EHR for even their affiliate providers. They obviously saw a lot of value in having all the providers and hospitals on a single EHR. Otherwise they wouldn’t have made an investment like this.

This also seems to highlight their bleak outlook on healthcare interoperability. If interoperability was a reality, would they really care that much about having everyone on a single EHR platform?

What is absolutely clear to me is that an ACO needs technology to connect all of the entities in the organization. The single EHR approach is one way. However, there’s a really strong argument to be made that most ACOs are going to be a heterogeneous environment. Where does that leave the ACO?

FHIR Adoption Needs Time to Mature

Posted on January 7, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

In John Halamka’s look at Health IT in 2014 he offered some really great insight into how regulators should look at standards and adoption of standards.

Here’s one section which talks about the lesson learned from meaningful use stage 2:

“Stage 2 was aspirational and a few of the provisions – Direct-based summary exchange and patient view/download/transmit required an ecosystem that does not yet exist. The goals were good but the standards were not yet mature based on the framework created by the Standards Committee.”

Then, he offers this money line about FHIR and how we should handle it:

“We need to be careful not to incorporate FHIR into any regulatory program until it has achieved an objective level of maturity/adoption”

There’s no doubt that FHIR is on Fire right now, but we need to be careful that it doesn’t just go down in flames. Throwing it into a regulatory program before it’s ready will just smother it and kill the progress that’s being made.

2015 Hospital Healthcare IT Predictions

Posted on January 5, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

At the start of 2015, I thought I’d put down some predictions on what will happen in the world of healthcare IT and EHR. These won’t be crazy predictions, since I don’t think anything crazy is going to happen in healthcare in 2015. We’ll see some clarity with a few programs and we’ll some some incremental change in things that matter to hospitals.

ICD-10 – I predict that ICD-10 will again be delayed with the next SGR fix. I don’t have any inside information on this. I just still believe that nothing’s different in 2015 that wasn’t true in 2014 (maybe AHIMA’s lobbying harder for no delay). I think another delay will put all of ICD-10 in question. Let’s hope whatever the decision is on ICD-10, it happens sooner than later. The ICD-10 uncertainty is worse than either outcome.

Meaningful Use – MU stage 2 will change from 365 days to 90 days. It will probably take until summer for it to actually happen which will put more people in a lurch since they’ll have even less time to plan for the 90 days than if they just made the change now. MU stage 2 numbers will be seen as great by those who love meaningful use and terrible by those who think it’s far reaching. The switch to 90 days means enough hospitals will hop on board that meaningful use will continue forward until it runs out of money.

EHR Penalties – Doctors will be blind sided by all the penalties that are coming with meaningful use, PQRS, and value based reimnbursement, even though it’s been very clear that these penalties are coming. Doctors will pan it off on “I can’t keep up with all the complex legislation.” and “I knew the penalties were coming, but I din’t think they’d be that big.” Watch for some movement to try and get some relief from these penalties for doctors. However, it won’t be enough for the doctors who want to start a perpetual SGR fix like delay of the EHR penalties. Many practices will have to shut down because of poor business management.

Direct to Consumer Medicine – Doctors will start to move towards a number of direct to consumer medicine options such as telemedicine and concierge medicine. These doctors will love their new found freedom from insurance reimbursement and the ongoing hamster on a treadmill churn of patients through their office. How far this will go, I’m not sure, but it will create a gap between these doctors who love this “new” form of medicine and those who feel their stuck on the treadmill.

Interoperability – 2015 still won’t see widespread healthcare interoperability, but it will help to lay a clear framework of where healthcare interoperability needs to go. A couple large EHR vendors will embrace this framework as an attempt to differentiate themselves from their competitors.

There you go. A few 2015 predictions. What do you think of these predictions? Any others you’d like to make? I feel like my predictions feel a little bit dire. A few show signs of promise, but I think that 2015 will largely be a transitory period as we try to figure out how to get the most value out of EHR.

New Federal Health IT Strategic Plan for 2015-2020

Posted on December 8, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

The big news came out today that HHS had released its Health IT Strategic Plan for 2015-2020. You can find more details about the plan and also read the 28 page Federal Health IT Strategic plan online. Unlike many of the regulations, this strategic plan is very readable and gives a pretty good idea of where ONC wants to take healthcare IT (hint: interoperability). Although, the document is available for comment, so your comments could help to improve the proposed plan.

I think this image from the document really does a nice job summarizing the plan’s goals:
Federal Health IT Strategic Plan Summary

When I see a plan like this, the goals are noble and appropriate. No doubt we could argue about some of the details, but I think this is directionally good. What I’m not so sure about is how this plan will really help healthcare reach the specified goals. I need to dive into the specific strategies offered in the document to know if they really have the ability to reach these goals. I might have to take each goal and strategy and make a series out of it.

What do you think of this new health IT strategic plan?

John Glaser to Stay on as Senior VP of Cerner Upon Close of Acquisition

Posted on November 19, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

In case you’re living under a rock (or more affectionately, you’re too busy working to follow the inside baseball of EHR company acquisition), Cerner is set to acquire Siemens in late winter or early spring pending all the needed approvals for companies this size. Watching the merging of these two companies is going to be very interesting indeed.

Neil Versel just reported that John Glaser, current CEO of Siemens Health Services, has announced that upon close of acquisition he’ll be joining the Cerner team as a Senior VP. I also love that John Glaser made this announcement on the Cerner blog.

I think this is a big deal since I believe John Glaser is at the point in his career that he could do just about anything (or nothing) if that’s what he desired. The few times I’ve interacted with John Glaser, he was sincerely interested in moving healthcare forward through the use of advanced IT. I imagine that’s what’s motivating him to stay with Cerner. No doubt, Cerner is sitting on a huge opportunity.

In John Glaser’s blog post, he provided an interesting insight into Neal Patterson’s comments at the Cerner user conference:

In his CHC keynote address, Cerner CEO Neal Patterson did a masterful job of conveying Cerner’s commitment to patient-centered care. Before he spoke, a patient and her nurse were introduced with explanation that the woman’s life was saved by a Cerner sepsis alerting system. Neal then shared the incredible challenges he and his wife have faced in her battle with cancer because of limited interoperability.

Neal’s keynote was very personal – about how we can make a loved one’s care journey easier by ensuring that all records – every detail – are available electronically and accurately wherever the patient receives care. It was the case for interoperability but also the case for making a patient’s life easier and the care better.

It’s hard for me to say how much of this was theatrics, but I’m glad they are at least talking the right talk. I really do hope that Neal’s personal experience will drive interoperability forward. Neil Versel suggested that interoperability would be John Glaser’s focus at Cerner. I hope he’s successful.

While at CHIME, I talked with Judy Faulkner, CEO of Epic, and we talked briefly about interoperability. At one point in our conversation I asked Judy, “Do you know the opportunity that you have available to you?” She looked at me with a bit of a blank stare (admittedly we were both getting our lunch). I then said, “You are big enough and have enough clout that you (Epic) could set the standard for interoperability and the masses would follow.” I’m not sure she’s processed this opportunity, but it’s a huge one that they have yet to capitalize on for the benefit of healthcare as we know it.

The same opportunity is available for Cerner as well. I really hope that both companies embrace open data, open APIs, and interoperability in a big way. Both have stated their interest in these areas, but I’d like to see a little less talk…a lot more action. They’re both well positioned to be able to make interoperability a reality. They just need to understand what that really means and go to work on it.

I’m hopeful that both companies are making progress on this. Having John Glaser focused on it should help that as well. The key will be that both companies have to realize that interoperability is what’s best for healthcare in general and in the end that will be what’s best for their customers as well.

Do Hospitals Want Interoperability?

Posted on November 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

I’ve had this discussion come up over and over again today in a series of discussions that I’ve had at the NYeC’s Digital Health Conference in NYC. Many people are blaming the EHR vendors for not being interoperable. Other people are blaming standards. Some like to blame HIPAA (which is ironic since it was passed to make health data portable). There are many more reasons that people give for why healthcare isn’t exchanging data and that interoperability isn’t a reality.

Although, in all of these discussions, I keep going back to the core question of whether hospitals and healthcare organizations really want that healthcare data to be interoperable. As I look back on the past, I can think of some doctors who’ve wanted it for a while, but I think the healthcare industry as a whole didn’t really want interoperability to happen. They would never admit this in public, because we all know on face that there are benefits to the healthcare system and the patient for interoperability. However, interoperability would have been a bad thing financially for many healthcare organizations.

It’s one of the dirty little secrets of healthcare. Sure, the EHR vendors never provided the interoperability functionality, but that’s largely because the healthcare providers never asked for it and largely didn’t want that functionality. They were all a little complicit in hiding the dirty little secret that healthcare organizations were benefiting from the inefficiency of the system.

I’m extremely hopeful that we’re starting to see a shift away from the above approach. I think the wheels are turning where hospitals are starting to see why their organization is going to need to be interoperable or their reimbursement will be affected. ACOs are leading this charge as the hospitals are going to need the data from other providers in order to improve the care they provide and lower costs.

Now, I think the biggest barrier to interoperability for most hospitals is figuring out the right way to approach it. Will their EHR vendor handle it? Do they need to create their own solution? Are CCD’s enough? Should they use Direct? Should they use a local HIE? Should they do a private HIE? Of course, this doesn’t even talk about the complexities of the hospital system and outside providers. Plus, there’s no one catch all answer.

I hope that we’re entering a new era of healthcare interoperability. I certainly think we’re heading in that direction. What are you seeing in your organizations?

More Epic Interoperability Discussion

Posted on October 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

Looks like Epic is starting to open up and join the conversation about healthcare interoperability. The latest is an article in the New York Times which includes a few comments from Judy Faulkner, CEO of Epic. Here’s the main comments from Judy:

In 2005, when it became clear to her [Judy] that the government was not prepared to create a set of rules around interoperability, Ms. Faulkner said, her team began writing the code for Care Everywhere. Initially seen as a health information exchange for its own customers, Care Everywhere today connects hospitals all over the country as well as to various public health agencies and registries.

“Let’s say a patient is coming from U.C.L.A. and going to the University of Chicago, an Epic-to-Epic hospital. Boom. That’s easy,” Ms. Faulkner said. “These are hospitals that have agreed to the Rules of the Road, a legal contract, that says the other organization is going to take good care of the data.”

This is a really interesting approach. Blame the government for not applying a standard. Talk about how you’ve had to do it yourself and that’s why you built Care Everywhere. I wish that Judy would come out with the heart of the matter. Epic’s customers never asked for it and so they never did it. I believe that’s the simple reality. Remember that interoperability might be a big negative for many healthcare systems. If they’re interoperable, that could be a hit to revenue. Hopefully ACOs and other value based reimbursement will change this.

The key to coming clean like this though, is to come out with a deep set of initiatives that show that while it wasn’t something you worked on in the past, you’re going all in on interoperability now. We’re a very forgiving people, and if Epic (or any other large EHR vendor for that matter) came out with a plan to be interoperable, many would jump on board and forgive them for past transgressions (wherever the blame may lie).

Unfortunately, we don’t yet see this. I’d love to catch up with Judy Faulkner at CHIME and talk to her about it. The key will be to have a full spectrum interoperability plan and not just Care Everywhere that doesn’t work everywhere. Remember that Epic has charts for about 50% of the US patient population, but that’s still only 50%. Plus, of the 50% of patients they do have, a very very small percentage of them are all stored in the same Epic system. My guess would be that 99+% of patients who have a record in Epic have their medical records in other places as well. This means that Epic will need data from other non-Epic systems.

As I’ve said before, Epic wouldn’t need to wait for the government to do this. They are more than large enough to set the standard for the industry. In fact, doing so puts them in a real position of power. Plus, it’s the right thing to do for the US healthcare system.

Will the interoperability be perefect? No. It will take years and years to get everything right, but that’s ok. Progress will be better than what we have now. I love this quote from the NY Times article linked above:

“We’ve spent half a million dollars on an electronic health record system about three years ago, and I’m faxing all day long. I can’t send anything electronically over it,” said Dr. William L. Rich III, a member of a nine-person ophthalmology practice in Northern Virginia and medical director of health policy for the American Academy of Ophthalmology.

I hope that Epic continues down the path to interoperability and becomes even more aggressive. I think the climate’s right for them to make it happen. They’re in a really unique position to be able to really change the way we think and talk about interoperability. I’m interested to see if they seize the opportunity or just talk about it.

Of course, we’ve focused this article talking about Epic. That’s what happens when you’re the A list celebrity on the red carpet. People want to talk about you. The NY Times article pretty aptly points out that the other EHR vendors aren’t much more or less interoperable than Epic. Feel free to replace Epic with another large EHR vendor’s name and the story will likely read the same.

My hope is that EHR vendors won’t wait for customers to demand interoperability, but will instead make interoperability so easy that their customers will love taking part. Watch for a future series of posts on Healthcare Intoperability and why this is much easier said than done.

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.

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

Posted on May 22, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 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 and LinkedIn.

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.