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The FHIR Backpedal, Voice Interfaces, OpenNotes, and Complacency – Twitter Roundup

Let’s take a quick trip around the Twittersphere and share some of the best healthcare related tweets we’ve seen recently. Plus, we’ll add a little commentary for each tweet as well. We hope you’ll add your commentary on Twitter with @healthcarescene and in the comments.


This might be a media back pedal. Everyone I’ve talked to that really understood FHIR has always said that the FHIR standard was not the end all be all interoperability solution. In fact, they specifically noted its limitations. Of course, that didn’t keep many outlets from reporting FHIR as the cure all. Glad to see they’re finally reporting on FHIR accurately. It’s good, but not a cure all interoperability solution.


Anyone that’s heard Colin Hung speak knows this is going to be a great webinar. Voice search and voice interfaces have become extremely popular. If you want to learn how they’re impacting healthcare, sign up for Colin’s webinar.


Powerfully simple story.


I think Aimee underestimates the power of complacency. However, I hope she’s right since long term complacency will feel really bad.

December 6, 2018 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.

Is It Time To Put FHIR-Based Development Front And Center?

I like to look at questions other people in the #HIT world wonder about, and see whether I have a different way of looking at the subject, or something to contribute to the discussion. This time I was provoked by one asked by Chad Johnson (@OchoTex), editor of HealthStandards.com and senior marketing manager with Corepoint Health.

In a recent HealthStandards.com article, Chad asks: “What do CIOs need to know about the future of data exchange?” I thought it was an interesting question; after all, everyone in HIT, including CIOs, would like to know the answer!

In his discussion, Chad argues that #FHIR could create significant change in healthcare infrastructure. He notes that if vendors like Cerner or Epic publish a capabilities-based API, providers’ technical, clinical and workflow teams will be able to develop custom solutions that connect to those systems.

As he rightfully points out, today IT departments have to invest a lot of time doing rework. Without an interface like FHIR in place, IT staffers need to develop workflows for one application at a time, rather than creating them once and moving on. That’s just nuts. It’s hard to argue that if FHIR APIs offer uniform data access, everyone wins.

Far be it from me to argue with a good man like @OchoTex. He makes a good point about FHIR, one which can’t be emphasized enough – that FHIR has the potential to make vendor-specific workflow rewrites a thing of the past. Without a doubt, healthcare CIOs need to keep that in mind.

As for me, I have a couple of responses to bring to the table, and some additional questions of my own.

Since I’m an HIT trend analyst rather than actual tech pro, I can’t say whether FHIR APIs can or can’t do what Chat is describing, though I have little doubt that Chad is right about their potential uses.

Still, I’d contend out that since none other than FHIR project director Grahame Grieve has cautioned us about its current limitations, we probably want to temper our enthusiasm a bit. (I know I’ve made this point a few times here, perhaps ad nauseum, but I still think it bears repeating.)

So, given that FHIR hasn’t reached its full potential, it may be that health IT leaders should invest added time on solving other important interoperability problems.

One example that leaps to mind immediately is solving patient matching problems. This is a big deal: After all, If you can’t match patient records accurately across providers, it’s likely to lead to wrong-patient related medical errors.

In fact, according to a study released by AHIMA last year, 72 percent of HIM professional who responded work on mitigating possible patient record duplicates every week. I have no reason to think things have gotten better. We must find an approach that will scale if we want interoperable data to be worth using.

And patient data matching is just one item on a long list of health data interoperability concerns. I’m sure you’re aware of other pressing problems which could undercut the value of sharing patient records. The question is, are we going to address those problems before we began full-scale health data exchange? Or does it make more sense to pave the road to data exchange and address bumps in the road later?

August 9, 2017 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

HIMSS Social Media Ambassador Debate: FHIR and Patient Focus

While at HIMSS, I had a chance to do a “debate” with my good friend, partner and fellow HIMSS Social Media Ambassador, Shahid Shah. This was facilitated by Healthcare IT News, and the debate was moderated by Beth Jones Sanborn, Managing Editor of Healthcare Finance. Shahid and I had a good debate on the topics of healthcare interoperability and FHIR. Plus, we talked about the need for healthcare IT companies to focus on the patient and whether they deserve the bad rap they get or not. Enjoy the video debate below:
…Read more

June 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.

Working to Understand FHIR

Ever since I’d heard so many good things about FHIR, I’ve been slowly trying to learn more about it, how it will be implemented, what challenges it faces, and what’s the pathway for FHIR to have widespread adoption.

So, it was no surprise that the Corepoint Health sessions on FHIR caught my eye and will be part of my HIMSS 2015. As part of that education they sent me their FHIR whitepaper which they’ll be handing out at their booth along with their sessions on FHIR. As with most things, the more I learn about FHIR, the more I realize I need to learn.

One example of this comes from the FHIR whitepaper linked above. It talks about defining resources for FHIR:

Resources are small, logically discrete units of exchange. Resources define behavior and meaning, have a known identity and location, are the smallest possible unit of transaction, and provide meaningful data that is of interest to healthcare. The plan is to limit resources to 100 to 150 in total. They are sometimes compared to an HL7 V2 segment.

The resources can be extended and adapted to provide a more manageable solution to the healthcare demand for optionality and customization.
Source: Corepoint Health

This section reminded me of a comment Greg Meyer tweeted during an #HITsm chat about FHIR’s biggest challenge being to define profiles. When he said, that I made a note to myself to learn more about what made up profiles. What Greg called profiles, it seems Corepoint Health is calling resources. They seem to be the same thing. This chart from the whitepaper does a great job summarizing why creating these resources (or profiles if you prefer) is so challenging:

FHIR Resource Examples
Source: Corepoint Health

I still have a lot more to learn about FHIR, but it seems like it does have really good founding principles. We’ll see if the powers that be can keep it pure or try and corrupt and modify its core principles. Not to mention take it and make it so complex that it’s not usable. I’ll be learning more about FHIR at HIMSS and I’ll be sure to report back. Until then, this FHIR whitepaper provides a pretty good historical overview of FHIR versus the other healthcare IT standards.

April 9, 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.

FHIR Adoption Needs Time to Mature

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.

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.

On the 2nd Day of #HITChristmas … Monica Stout from MedicaSoft

Note: In case you missed the other 12 Days of #HITChristmas, you can start with the first day here along with the story behind #HITChristmas or read all 12 days here as they are published.

On the 2nd Day of #HITChristmas we’re excited to feature, Monica Stout from MedicaSoft.

Tell us about yourself and MedicaSoft.

I’m Monica Stout and I’m the Michigander Marketing Director at MedicaSoft. I have a 2.5-year old who keeps me on my toes and have traded my (breakable) vintage glass collections for LEGOs, monster trucks, and board books. I came to MedicaSoft 3.5 years ago from PricewaterhouseCoopers (PwC) where I was a consultant at the US Department of Veterans Affairs for many years. MedicaSoft is a healthcare IT software company specializing in an HL7 FHIR-based product offering spanning an open API platform, personal health record, electronic health record and reporting & analytics. We are also an accredited HISP. MedicaSoft took a look at some of the vexing problems in healthcare and designed software to solve those problems with open, modern, interoperable, and user-friendly software.

You were recently named as a partner on the VA EHR Project with Cerner.  Tell us about your involvement in that project.

Yes, we are really excited to work with Cerner and the VA on this important initiative. At MedicaSoft, we have long expertise with VA health IT systems and expertise in industry health information exchange and data interoperability. We are looking forward to participating as a Cerner team member as they roll out their EHR in an environment where exchanging health information between VA and community care providers is increasingly important. Expect to hear more about the Cerner/VA project in 2019 as the project gets underway!

What’s a patient story that epitomizes the impact of the work that MedicaSoft is doing?  

There’s a common thread we hear from patients, especially patients dealing with complex medical diagnoses and conditions, that they have so much information and no single source of truth or place to put all of their health information that can be easily accessed and shared with their care team. Unfortunately, it’s not uncommon to hear of hundreds upon hundreds of pages of health data that patients are forced to carry back and forth to appointments. This is an area where MedicaSoft provides tangible benefits to patients. All of a patient’s health data can be loaded into MedicaSoft’s PHR, HealthCenter, and it’s there to share (electronically) and provide a complete medical history to whomever the patient chooses.

You also provide the PHR for the Delaware Health Information Network.  Tell us about that and what services you offer them.

The Delaware Health Information Network (or DHIN) is a health information exchange that serves all acute care hospitals, major laboratories and radiology facilities, skilled nursing facilities, and medical providers in Delaware and several surrounding areas such as Maryland and Washington, D.C. DHIN utilizes our PHR/patient portal, HealthCenter, which is branded “Health Check Connect” for DHIN provider practices. DHIN also uses our open NXT Platform to manage all of its clinical and claims data.

Is interoperability real or is it talk?  Can you share any numbers that help us get an idea of how much interoperability is happening?

Interoperability is real. It’s hard to put numbers on it, but healthcare providers and payers are moving beyond the talk to real applications that require the secure exchange of reliable, usable clinical and claims information. Putting those applications into play is why we all talk about interoperability. At MedicaSoft, we “walk the walk” by providing a platform that harmonizes data and makes it available in an open, standards-based way. That means that using our platform lets you integrate applications from any vendor, or build them yourself, with the assurance that they all access high quality data. The open platform approach is the way of the future!

Some recent numbers in ONC in October showed that the industry as a whole has a long way to go when it comes to interoperability, but this is a good start –

41% of hospitals reported they were able to engage in all four functions of interoperability (electronically finding, sending, receiving, and integrating data from outside their own organizations) in 2017. Numbers are increasing each year:

2014: 23%

2015: 26%

2016: 29%

2017: 41%

What can the healthcare IT community do for you and MedicaSoft?

The healthcare IT community has already done so much for me in providing such great collegial relationships and friendships over the past couple of years. #HITMC, #HITsm & #HCDLR are phenomenal Twitter communities comprised of smart, thoughtful, motivated individuals really striving to improve healthcare. As far as helping MedicaSoft, continuing to connect us to folks who need our products or services is always super helpful as is helping us get out the word about the great (new) work we’re doing at our company.

Be sure to follow all of the 12 Day of #HITChristmas.

December 14, 2018 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.

Interoperability Is On An Accelerated Trajectory Says Redox CEO

The lack of interoperability in healthcare continues to be a vexing challenge for Health IT companies, IT departments and patients. Redox is a company taking a unique approach to solving this problem. They have built a platform of reusable data connections between healthcare providers and the innovative cloud-based companies that have products those providers want to use.

Redox recently held their second annual Interoperability Summit at the new CatalystHTI facility in Denver Colorado. Over three hundred people attended the event. The diverse audience included: startups, hospitals, large HealthIT vendors, payors and government health agencies. The sessions at the Summit reflected the diversity of the audience and ranged from topics like “Hacking the Health System Sales Cycle” to “FHIR: Be the Right Amount of Excited”.

During the Summit, I sat down with Redox CEO, Luke Bonney, to talk about the state of interoperability, the willingness of the industry to share data and what advice he has for the dozens of startups that approach Redox each month.

Below is a transcript of our conversation.

What is the state of healthcare interoperability today?

I think we are in a good state right now, but more importantly I think we are on an accelerated trajectory to something better.

An accelerated trajectory?

Yes, but in order to explain why I’m saying that, we have to take a step back.

In my opinion healthcare interoperability is inextricably tied to the adoption and migration to the cloud. We will never have true data liquidity, which is the state that everyone wants – physicians, clinicians, administrators, patients, providers, payers, etc – until healthcare fully embraces cloud architectures and cloud thinking.

Healthcare is still predominantly an “on-premise” world. It’s not wrong. It’s just how the industry has grown up. We installed servers behind our own firewalls. As we added systems we bought more servers and of course we added them to the other servers behind the firewall. Eventually we built connections between these systems so that they could talk to each other. But because everything was behind the firewall and because we were really just sharing data within the same organization, we didn’t give much thought to sharing that data in a standard way. As long as we were behind the firewall we could safely exchange data.

When you approach things from a cloud perspective, the thinking is completely different. When you build cloud applications you HAVE TO think about data portability and security. You HAVE TO work out ways to connect systems together across the Internet without a single big firewall acting as your shield.

So as people move more and more to this way of thinking we will see more movement towards frictionless data exchange.

So is healthcare moving more to the cloud?

Working at EPIC and now at Redox, I’ve had a front-row seat to this change in attitude towards the cloud by healthcare providers. Prior to 2015 healthcare IT leaders were still asking “What is the cloud?” and “Why should I bother with it?”. But today leaders are starting to ask “How can I better leverage the cloud for my organization?” It’s great to see so many proactively looking for ways to adopt cloud-based applications.

I also think that the consumer tech giants are helping propel healthcare forward. Companies like Amazon and Google have always been cloud-based. As they push into healthcare they are going to have a huge advantage versus on-premise legacy companies. As they gain traction so too will the cloud.

I can see how embracing the cloud will help healthcare achieve secure connectivity and certainly scalability, but even if we move completely to the cloud won’t we still need to exchange data in a standard way in order to achieve true interoperability?

Having a data standard would certainly be helpful.

Is that going to be HL7 v2? v3? FHIR? Smart-on-FHIR? Or something that Commonwell Alliance puts out?

(Laughing). We do seem to have a lot of standards don’t we.

Actually this is what is driving Redox. There really isn’t a ton of incentive to tear out the investments already made in HL7 v2 or v3. It works for the use cases where it has been deployed. The same applies to FHIR and Commonwell. All these approaches work wonderfully for specific use cases, but I really doubt any one of these approaches is going to be the single solution for all of our interoperability challenges.

Think about it. If I’m a CIO at a hospital and I have a working HL7 v2 integration working between two systems, why would I waste precious resources to move to a different integration standard if there is really nothing to be gained from it? It’d be a waste of time and resources.

The one good thing about all these standards and interoperability initiatives is that we are building an audience that is asking the right questions and pushing healthcare in the right direction. APIs are the right thing to do. FHIR is the right thing to do…and so on. All are relevant and needed.

So if not a universal data standard, what do we need?

The way I see things we might not need a single data standard if someone can build a common platform through which data can be shared. That’s what we’re doing here at Redox. We’re taking a pragmatic approach. Whatever data standard you are using internal is fine with us. We’ll work with you to find a way to share your data through our platform. And once you share it with us once, you don’t have to rebuild that connection over and over again each time a different company wants to connect. We handle that.

Is that the problem Redox set out to solve?

Actually when we started Redox we really just wanted to make it easier for cloud-based healthcare companies to scale and grow. What we realized is that one of the biggest impediments to growth was integrating legacy on-prem systems with cloud-based applications. Even if these companies could convince hospital IT teams to put their integration on the priority list, it would take a long time to actually get it done.

So we built the Redox engine to make this easier. Our goal wasn’t to solve interoperability per say, we just wanted to bring innovative web developers closer to healthcare providers so that they can solve problems together.

But because we were cloud from Day 1, we wanted to build everything in a reusable way, so that once we built a connection to one hospital, we wouldn’t have to build it again when the next company wanted to connect with that same hospital. This network effect wasn’t something we originally set out to build, but now it’s central to our success. It’s why we can talk about being a platform that enables data sharing vs being a tool that helps systems share data.

Solving interoperability is only partly a technology challenge. There is also the challenge of getting the healthcare ecosystem to actually share their data. Because Redox works with so many players in the ecosystem, have you noticed any change in attitude around sharing data?

Let me start by saying that I think everyone WANTS the data. There’s incredible value in health data. Medical records are a gold mine for researchers, public health authorities, pharma companies, payors, etc. Everyone would love nothing more than to build a comprehensive health record for their own purposes. The challenge of course is that it’s not easy to do that today. As you said, this is partly because of technology and partly because no one really wants to share their data altruistically.

I think there is one party that truly wants data to be shared and that’s patients. Patients are way more interested in sharing data than anyone else in the ecosystem. As a patient, data should follow me wherever I go. I never want to wonder if my doctor has all my medical information. I want people to have the data because I want the best outcome possible and my data can help make that happen.

I think companies and organizations in the healthcare ecosystem are slowly waking up to the fact that sharing data helps support their customers – whether those customers are providers, payors, members, patients, clinicians or government agencies. Sharing data makes things better. And as financial pressures in healthcare mount, everyone is looking for ways to do more, better, faster and with more accuracy. Sharing data is necessary for that to happen.

Redox works with a lot with startups and small/medium sized HealthIT companies. What advice would you give to those that are considering working with Redox? What should they have considered?

There are two key questions that I think every HealthIT company should ask themselves. Frist, what is the value your product or service provides? Second, Who is the buyer? Success in healthcare is less about whether your technology and more about aligning three things:

  1. An actual problem that needs to be solved
  2. A solution to that problem
  3. A buyer who can make a buying decision in a healthcare organization

I see a lot of companies that don’t really consider this last question. You can create an amazing product that solves a problem in healthcare but if the target audience for your product cannot make the buying decision then you have a difficult road ahead of you.

Beyond these questions, I would advise companies to really consider how their products integrate into the clinical or administrative workflow. Many startups begin with an application that isn’t integrated with existing hospital systems, like the EHR. But after they gain a little bit of traction they realize they need to become more integrated. But building in real-time data exchange into an application isn’t easy. You need to really think through how your product will handle this.

Lastly I would caution healthcare entrepreneurs about building their applications on the assumption that FHIR will be universally adopted. It isn’t and it will likely take years before it gains real-world traction. There is a lot of excitement around FHIR, but it isn’t the best solution for all situations.

Final Thoughts?

One thing I am encouraged by is the number of people and companies from outside of healthcare that are coming into this space. I think they bring an energy and perspective that will help us all get better. Granted, many of them have stars in their eyes and don’t realize how tough healthcare can be…but, the fact that they aren’t burdened with any legacy thinking is exciting. Healthcare needs more outside thinking.

November 16, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

My MEDITECH MD and CIO Forum Experience

I recently had the pleasure of attending the annual MEDITECH MD and CIO Forum. Not only was the venue and MEDITECH hospitality great, but they also ordered up beautiful fall weather for the event in Boston. Although, I have to admit that it must be intimidating to speak at an event hosted in the round. Luckily all of the keynotes really delivered (See my post about Ted James, MD’s keynote).

As long-time readers know, there’s almost nothing better to me than attending a user conference. At user conferences, you hear the “from the trenches” perspectives on what’s life really like on the front lines of healthcare and technology. In many cases, you listen to sessions and discussions at lunch that sounds like they’re speaking another language. For the most part, that’s basically what they’re doing. The language of an EMR user is really unique and different and it’s what makes an EHR user conference like this so special. Those attending speak the same language and are able to uniquely help each other.

Given users’ propensity to share the good, the bad, and the ugly, it was really great that MEDITECH invited me to attend their MD and CIO Forum. The good news for them is that I’ve been to enough EHR user forums that I’ve heard it all. Nothing really shocks me anymore and every EHR vendor has their challenges. In one session, someone commented on the 500 open tickets they had with support. I think it kind of scared MEDITECH that I was hearing this. However, I’d recently heard from someone using their competitor’s EHR who had 4000 open tickets. Only 500 tickets sounded quite good comparatively. Perspective and nuance really matter when you talk about problems. That’s something that’s often missed by many media these days.

While at the Forum, MEDITECH made a number of interesting announcements. Read on for details below and check out the 4 video interviews we live streamed from the conference on Facebook. The biggest announcement from my viewpoint was around voice enabling the MEDITECH EHR software. Together in partnership with Nuance, MEDITECH created a simple way for users to request information from the EHR using their voice and even to create orders. On the mobile side, they’re creating similar functionality in partnership with Google’s voice recognition. No doubt this is just the start of voice enabling the EHR.

It’s easy to see how voice will become really valuable if providers are able to get information and create orders while their hands are tied up examining the patient. MEDITECH was also smart about the voice created orders. It doesn’t just order things automatically but queues up those orders for the doctors to approve later. This is a common step we’ve seen smart vendors take when adding voice and other AI to the documentation process. We’ll see over time whether the accuracy and trust reach the point that this human verification process is no longer needed.

MEDITECH also announced a number of things around interoperability. First, outbound FHIR integrations are included in every MEDITECH EHR. Plus, they’re working on inbound FHIR integrations. They didn’t set a timeline on inbound integrations but they did say they’d be “coming soon.” MEDITECH also talked about their new API called MEDITECH Greenfield. If you want more information on Greenfield, be sure to read our interview with Niraj Chaudhry where we cover it in detail.

Another interesting announcement was MEDITECH’s new population health oriented integration with Arcadia.io. It’s great to see MEDITECH embracing outside third party data that can help their users provide better care to patients. Plus, the integration looked really seamless from a physician user perspective.

Another big takeaway for me came from a session on governance and end user buy-in. The takeaway was simple. Enduser buy-in and governance are a challenge regardless of what EHR system you choose. To get more specific insights into how to improve buy-in and governance in your organization, check out the live tweets I shared on the #MDCIO2018 hashtag on Twitter.

A few other observations from the event are that I don’t think most people appreciate what a huge step forward Expanse (their latest EHR platform) is for MEDITECH and their users. I’ve often written that there’s no one feature about EHR software that’s hard to implement. However, it’s the 1000 features you need to create a complete EHR that makes it such a challenge. It was a pretty brave thing for a 50-year-old company, MEDITECH, to go back and start nearly from scratch using the latest technology to create Expanse. That means that Expanse is still a work in progress where they’re adding features as fast as they can. However, it also is true that it might be the only EHR software that was built in the post-meaningful use era.

I was also surprised by a number of users I talked to who commented on how the price of MEDITECH really mattered to their organization. I’m not sure if these organizations had read the many stories of expensive EHR implementations damaging healthcare organizations financially or if they were just more fiscally conservative organizations. Either way, you could tell these users appreciated that MEDITECH charged a much lower price for their software than other EHR competitors out there.

All in all, I had a great experience at the MEDITECH MD and CIO Forum. Their users really reflect the culture of MEDITECH. They’re largely unassuming and just want to do what’s best for their patients. It was actually fascinating to see how the same cultures seemed to attract. No doubt, their users were still suffering from burnout like so many others. That’s common across all of healthcare. They also still had their long list of features and functions they wanted to be implemented. However, I have yet to attend an EHR user conference where that wasn’t the case.

Note: MEDITECH is a sponsor of Healthcare Scene.

October 29, 2018 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.

Report Champions API Use To Improve Interoperability

A new research report has taken the not-so-radical position that greater use of APIs to extract and share health data could dramatically improve interoperability. It doesn’t account for the massive business obstacles that still prevent this from happening, though.

The report, which was released by The Pew Charitable Trusts, notes that both the federal government and the private sector are both favoring the development of APIs for health data sharing.

It notes that while the federal government is working to expand the use of open APIs for health data exchange, the private sector has focused on refining existing standards in developing new applications that enhance EHR capabilities.

EHR vendors, for their part, have begun to allow third-party application developers to access to systems using APIs, with some also offering supports such as testing tools and documentation.

While these efforts are worthwhile, it will take more to wrest the most benefit from API-based data sharing, the report suggests. Its recommendations for doing so include:

  • Making all relevant data available via these APIs, not just CCDs
  • Seeing to it that information already coded in health data system stays in that form during data exchange (rather than being transformed into less digestible formats such as PDFs)
  • Standardizing data elements in the health record by using existing terminologies and developing new ones where codes don’t exist
  • Offering access to a patient’s full health record across their lifetime, and holding it in all relevant systems so patients with chronic illnesses and care providers have complete histories of their condition(s)

Of course, some of these steps would be easier to implement than others. For example, while providing a longitudinal patient record would be a great thing, there are major barriers to doing so, including but not limited to inter-provider politics and competition for market share.

Another issue is the need to pick appropriate standards and convince all parties involved to use them. Even a forerunner like FHIR is not yet universally accepted, nor is it completely mature.

The truth is that no matter how you slice it, interoperability efforts have hit the wall. While hospitals, payers, and clinicians pretty much know what needs to happen, their interests don’t converge enough to make interoperability practical as of yet.

While I’m all for organizations like the Pew folks taking a shot at figuring interoperability out, I don’t think we’re likely to get anywhere until we find a way to synchronize everyone’s interests. And good luck with that.

September 26, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Do We Need Another Interoperability Group?

Over the last few years, industry groups dedicated to interoperability have been popping up like mushrooms after a hard rain. All seem to be dedicated to solving the same set of intractable data sharing problems.

The latest interoperability initiative on my radar, known as the Da Vinci Project, is focused on supporting value-based care.

The Da Vinci Project, which brings together more than 20 healthcare companies, is using HL7 FHIR to foster VBC (Value Based Care). Members include technology vendors, providers, and payers, including Allscripts, Anthem Blue Cross and Blue Shield, Cerner, Epic, Rush University Medical Center, Surescripts, UnitedHealthcare, Humana and Optum. The initiative is hosted by HL7 International.

Da Vinci project members plan to develop a common set of standards for data exchange that can be used nationally. The idea is to help partner organizations avoid spending money on one-off data sharing development projects.

The members are already at work on two test cases, one addressing 30-day medication reconciliation and the other coverage requirements discovery. Next, members will begin work on test cases for document templates and coverage rules, along with eHealth record exchange in support of HEDIS/STARS and clinician exchange.

Of course, these goals sound good in theory. Making it simpler for health plans, vendors and providers to create data sharing standards in common is probably smart.

The question is, is this effort really different from others fronted by Epic, Cerner and the like? Or perhaps more importantly, does its approach suffer from limitations that seem to have crippled other attempts at fostering interoperability?

As my colleague John Lynn notes, it’s probably not wise to be too ambitious when it comes to solving interoperability problems. “One of the major failures of most interoperability efforts is that they’re too ambitious,” he wrote earlier this year. “They try to do everything and since that’s not achievable, they end up doing nothing.”

John’s belief – which I share — is that it makes more sense to address “slices of interoperability” rather than attempt to share everything with everyone.

It’s possible that the Da Vinci Project may actually be taking such a practical approach. Enabling partners to create point-to-point data sharing solutions easily sounds very worthwhile, and could conceivably save money and improve care quality. That’s what we’re all after, right?

Still, the fact that they’re packaging this as a VBC initiative gives me pause. Hey, I know that fee-for-service reimbursement is on its way out and that it will take new technology to support new payment models, but is this really what happening here? I have to wonder.

Bottom line, if the giants involved are still slapping buzzwords on the project, I’m not sure they know what they’re doing yet. I guess we’ll just have to wait and see where they go with it.

September 20, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.