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Andy Slavitt Talks Healthcare Interoperability and Data Blocking

Posted on February 8, 2016 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 all the reporting around meaningful use being replaced (or as many mis-reported meaningful use ending), Andy Slavitt also made a number of other points in his talk at JP Morgan’s Healthcare conference. Much like he did with meaningful use, he live tweeted his talk. Here were a couple of his non-meaningful use tweets that stood out to me.

Has there ever been any doubt that HHS was serious about wanting organizations to be interoperable and for data blocking not to exist? There hasn’t for me. It’s been one of their main goals. The problem is two fold. First, CMS is fighting an uphill battle against the economic realities that not sharing data has been very profitable for healthcare organizations. Second, CMS only has so much power available to them to make interoperability a requirement.

Despite these challenges, CMS is doing everything in their power to encourage and promote interoperability. Put another way, they’re trying everything they can to make it so that interoperability is a wise business decision for healthcare organizations. Although, much of what they’re trying to do also harkens back to a statement I heard from Jonathan Bush, CEO of athenahealth that, “Interoperability should not be used as a point of competition.”

The problem is that today interoperability is used as a point of competition. We’re seeing that change, but it’s slow and there are still many who haven’t made the change. Plus, all of the interoperability solutions that have been offered (yes, I’m looking at the popular FHIR standard) are still quite limited in scope. They’re really just evolutions on existing interoperability and not a revolution to what interoperability should and could become.

Plus, I fear that many of these new interoperability options are really just creating a new market for vendors to charge providers. When you think about it, what’s the easiest way to block the sharing of information? Just charge too much for it. More on this in a future article.

Ironically, I think my perspective on Andy Slavitt’s comments on interoperability and information blocking are not all that different from my view on meaningful use. Andy and the people at CMS are saying the right things. They’re seeing the right dynamics at play in the market place. The problem is that they’re hands are tied in many ways and the bureaucratic process could lead to something even worse if they’re not careful. No doubt they’re dealing with really challenging, complex issues. It’s good to know that their hearts are in the right place. I just hope that regulation and legislation matches it.

Interoperability Challenges (VA, DOD, Epic, CommonWell) – Where Do We Go From Here?

Posted on November 16, 2015 I Written By

David is a global digital healthcare leader that is focusing on the next era of healthcare IT.  Most recently David served as the CIO at an academic medical center where he was responsible for all technology related to the three missions of education, research and patient care. David has worked for various healthcare providers ranging from academic medical centers, non-profit, and the for-profit sectors. Subscribe to David's latest CXO Scene posts here.

The state of healthcare in the United States is fairly well known with the US healthcare spend between 17-18% of the GDP. It is one of the most expensive countries in the world for healthcare. America is also one of the few developed nations not to have a universal healthcare scheme, and one of the main barriers is interoperability challenges.

As we have just finished celebrating veteran’s day, one of the challenges in our federal system is interoperability. In order to provide these veterans with proper healthcare, the Veterans Association and the Department of Defense each proposed an update to the way medical records were stored. The proposed system involved purchasing or customizing an existing an EMR software, which would allow doctors to access patient files far more easily.

This would make it easier for veterans to switch doctors without having to worry about taking large amounts of paperwork along with them. It would also allow doctors to give their patients the best care possible without having to worry about red tape and legal hoops they have to jump through. While this makes sense to everyone, a decision has been made to have two separate systems.

We are also having the same discussion in the commercial EMR space recently where representatives from Cerner asked Epic to joing the CommonWell Health Alliance. Based on my experience Epic has done a great job at exchanging data with other Epic customers. At the request of the customer, Epic will work on creating interoperability with other non-Epic systems. The challenge is the need to create a special request for data sharing every time an Epic customer wants to communicate with a non Epic facility.

The House of Representatives have questioned the VA and DOD decisions to create these separate EHR systems. This makes perfect sense since I am also questioning the decision myself. What should have happened in this situation is the VA and DOD should have come together to collaborate on one EHR system. At the same time, the federal government should step in to create a standard for interoperability and mandate that we move towards collaboration.   If you think about the impact that meaningful use had on transforming the healthcare sector’s move towards digital, I believe the government could have the same impact on interoperability if they made it a requirement.

Where’s Interoperability Happening in Healthcare?

Posted on October 19, 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.

My tweet this morning inspired this post. Interoperability this and interoperability that. We hear all about interoperability everywhere in healthcare. It’s so important that ONC has put together a 10 year plan for healthcare interoperability. We have more interoperability initiatives than we have actual interoperability. I asked one EHR vendor recently about their thoughts on interoperability and which interoperability initiatives they were involved in. They responded that they were taking part in all of them and then they started listing off them all: Common Well, Argonaut, etc etc etc.

With all of this talk about interoperability, you’d think we’d have a wave of success stories. It’s hard for me to believe that with the hundreds of millions of dollars that’s been spent on HIEs and who knows how much money being spent by private organizations, we don’t have a wave of success stories.

You’d think by this point we’d have so many stories of lives saves, costs reduced and care improved that every organization would have to hop on the healthcare interoperability bandwagon. Peer pressure is a real thing. It’s unfortunate that we don’t have so many good interoperability stories that the peer pressure for everyone to take part isn’t reaching a maximum level.

Sadly, I think the opposite is occurring. All of the stories say that healthcare interoperability isn’t happening. These stories provide peer pressure in the opposite direction. “No one is doing it, so why should I start?”

Although, I think the real problem with interoperability was highlighted in this recent press release about the KLAS Keystone Summit. KLAS brought together 12 EHR vendors (we’ll leave a discussion of which EHR vendors were left out for another post) to “independently and transparently measure/assess the status and trajectory of interoperability.”

While it’s great that these EHR vendors have started talking (5 years ago this would have been laughable), it’s disappointing that this meeting where they supposedly “agree” to an interoperability metric then says “The next step is to put a cohesive plan in place to launch and monitor the measurement.”

Excuse me if I’m skeptical, but I feel like I’ve been here before. A bunch of vendors get together and agree to interoperability. The next step is to put together a plan which never happens and never actually reaches reality. I feel like I’m in interoperability groundhog day.

This isn’t a knock on this specific meeting since it seems to be what’s happened at every meeting which has tried to work on interoperability. We have a nice kumbaya moment where all the EHR vendor executives get in a circle, hold hands and say we’re going to work together and then it never happens.

We need to have more stories shared about EHR vendors and healthcare organizations actually sharing data. That’s going to be the only thing that will turn the tide. I don’t even care if it’s really small data sets. Let’s stop talking about interoperability and start doing it.

If you know of places where interoperability is actually occurring, I’d love to hear about it. Please leave a note in the comment or on our contact us page.

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?