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Healthcare Interoperability is Solved … But What Does That Really Mean? – #HITExpo Insights

Posted on June 12, 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.

One of the best parts of the new community we created at the Health IT Expo conference is the way attendees at the conference and those in the broader healthcare IT community engage on Twitter using the #HITExpo hashtag before, during, and after the event.  It’s a treasure trove of insights, ideas, practical innovations, and amazing people.  Don’t forget that last part since social media platforms are great at connecting people even if they are usually in the news for other reasons.

A great example of some great knowledge sharing that happened on the #HITExpo hashtag came from Don Lee (@dflee30) who runs #HCBiz, a long time podcast which he recorded live from Health IT Expo.  After the event, Don offered his thoughts on what he thought was the most important conversation about “Solving Interoperability” that came from the conference.  You can read his thoughts on Twitter or we’ve compiled all 23 tweets for easy reading below (A Big Thanks to Thread Reader for making this easy).

As shared by Don Lee:

1/ Finally working through all my notes from the #HITExpo. The most important conversation to me was the one about “solving interoperability” with @RasuShrestha@PaulMBlack and @techguy.

2/ Rasu told the story of what UPMC accomplished using DBMotion. How it enabled the flow of data amongst the many hospitals, clinics and docs in their very large system. #hitexpo

3/ John challenged him a bit and said: it sounds like you’re saying that you’ve solved #interoperability. Is that what you’re telling us? #hitexpo

4/ Rasu explained in more detail that they had done the hard work of establishing syntactic interop amongst the various systems they dealt with (I.e. they can physically move the data from one system to another and put it in a proper place). #hitexpo

5/ He went on and explained how they had then done the hard work of establishing semantic interoperability amongst the many systems they deal with. That means now all the data could be moved, put in its proper place, AND they knew what it meant. #hitexpo

6/ Syntactic interop isn’t very useful in and of itself. You have data but it’s not mastered and not yet useable in analytics. #hitexpo

7/ Semantic interop is the mastering of the data in such a way that you are confident you can use it in analytics, ML, AI, etc. Now you can, say, find the most recent BP for a patient pop regardless of which EMR in your system it originated. And have confidence in it. #hitexpo

8/ Semantic interop is closely related to the concept of #DataFidelity that @BigDataCXO talks about. It’s the quality of data for a purpose. And it’s very hard work. #hitexpo

9/ In the end, @RasuShrestha’s answer was that UPMC had done all of that hard work and therefore had made huge strides in solving interop within their system. He said “I’m not flying the mission accomplished banner just yet”. #hitexpo

10/ Then @PaulMBlack – CEO at @Allscripts – said that @RasuShrestha was being modest and that they had in fact “Solved interoperability.”

I think he’s right and that’s what this tweet storm is about. Coincidentally, it’s a matter of semantics. #hitexpo

11/ I think Rasu dialed it back a bit because he knew that people would hear that and think it means something different. #hitexpo

12/ The overall industry conversation tends to be about ubiquitous, semantic interop where all data is available everywhere and everyone knows what it means. I believe Rasu was saying that they hadn’t achieved that. And that makes sense… because it’s impossible. #hitexpo

13/ @GraceCordovano asked the perfect question and I wish there had been a whole session dedicated to answering it: (paraphrasing) What’s the difference between your institutional definition of interop and what the patients are talking about? #hitexpo

14/ The answer to that question is the crux of our issue. The thing patients want and need is for everyone who cares for them to be on the same page. Interop is very relevant to that issue, obviously, but there’s a lot of friction and it goes way beyond tech. #hitexpo

15/ Also, despite common misconception, no other industry has solved this either. Sure, my credit card works in Europe and Asia and gets back to my bank in the US, but that’s just a use case. There is no ubiquitous semantic interop between JP Morgan Chase and HSBC.

16/ There are lots of use cases that work in healthcare too. E-Prescribing, claims processing and all the related HIPAA transactions, etc. #hitexpo

17/ Also worth noting… Canada has single payer system and they also don’t have clinical interoperability.

This is not a problem unique to healthcare nor the US. #hitexpo

18/ So healthcare needs to pick its use cases and do the hard work. That’s what Rasu described on stage. That’s what Paul was saying has been accomplished. They are both right. And you can do it too. #hitexpo

19/ So good news: #interoperability is solved in #healthcare.

Bad news: It’s a ton of work and everyone needs to do it.

More bad news: You have to keep doing it forever (it breaks, new partners, new sources, new data to care about, etc). #hitexpo

19/ Some day there will be patient mediated exchange that solves the patient side of the problem and does it in a way that works for everyone. Maybe on a #blockchain. Maybe something else. But it’s 10+ years away. #hitexpo

20/ In the meantime my recommendation to clinical orgs – support your regional #HIE. Even UPMC’s very good solution only works for data sources they know about. Your patients are getting care outside your system and in a growing # of clinical and community based settings. #hitexpo

21/ the regional #HIE is the only near-term solution that even remotely resembles semantic, ubiquitous #interoperability in #healthcare.
#hitexpo

22/ My recommendation to patients: You have to take matters into your own hands for now. Use consumer tools like Apple health records and even Dropbox like @ShahidNShah suggested in another #hitexpo session. Also, tell your clinicians to support and use the regional #HIE.

23/ So that got long. I’ll end it here. What do you think?

P.S. the #hitexpo was very good. You should check it out in 2019.

A big thank you to Don Lee for sharing these perspectives and diving in much deeper than we can do in 45 minutes on stage. This is what makes the Health IT Expo community special. People with deep understanding of a problem fleshing out the realities of the problem so we can better understand how to address them. Plus, the sharing happens year round as opposed to just at a few days at the conference.

Speaking of which, what do you think of Don’s thoughts above? Is he right? Is there something he’s missing? Is there more depth to this conversation that we need to understand? Share your thoughts, ideas, insights, and perspectives in the comments or on social media using the #HITExpo hashtag.

Is EMR Use Unfair To Patients?

Posted on April 24, 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.

As we all know, clinicians have good reasons to be aggravated with their EMRs. While the list of grievances is long — and legitimate — perhaps the biggest complaint is loss of control. I have to say that I sympathize; if someone forced me to adopt awkward digital tools to do my work I would go nuts.

We seldom discuss, however, the possibility that these systems impose an unfair burden on patients as well. But that’s the argument one physician makes in a recent op-ed for the American Council on Science and Health.

The author, Jamie Wells, MD, calls the use of EMRs “an ethical disaster,” and suggests that forced implementation of EMRs may violate the basic tenets of bioethics.

Some of the arguments Dr. Wells makes apply exclusively to physicians. For one thing, she contends that penalizing doctors who don’t adapt successfully to EMR use is unfair. She also suggests that EMRs create needless challenges that can erode physicians’ ability to deliver quality care, add significant time to a physician’s workday and force doctors to participate in related continuing education whether or not they want to do so.

Unlike many essays critiquing this topic, Wells also contends that patients are harmed by EMR use.

For example, Wells argues that since patients are never asked whether they want physicians to use EMRs, they never get the chance to consider the risks and benefits associated with EHR data use in developing care plans. Also, they are never given a chance to weigh in on whether they are comfortable having less face time with their physicians, she notes.

In addition, she says that since EMRs prompt physicians to ask questions not relevant to that patient’s care, adding extra steps to the process, they create unfair delays in a patient’s getting relief from pain and suffering.

What’s more, she argues that since EMR systems typically aren’t interoperable, they create inconveniences which can ultimately interfere with the patient’s ability to choose a provider.

Folks, you don’t have to convince me that EMR implementations can unfairly rattle patients and caregivers. As I noted in a previous essay, my mother recently went to a terrifying experience when the hospital where my brother was being cared for went through an EMR implementation during the crucial point in his care. She was rightfully concerned that staff might be more concerned with adapting to the EMR and somewhat less focused on her extremely fragile son’s care.

As I noted in the linked article above. I believe that health executives should spend more time considering potentially negative effects of their health IT initiatives on patients. Maybe these execs will have to have a sick relative at the hospital during a rollout before they’ll make the effort.

Hospital Patient Identification Still A Major Problem

Posted on April 18, 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.

A new survey suggests that problems with duplicate patient records and patient identification are still costing hospitals a tremendous amount of money.

The survey, which was conducted by Black Book Research, collected responses from 1,392 health technology managers using enterprise master patient index technology. Researchers asked them what gaps, challenges and successes they’d seen in patient identification processes from Q3 2017 to Q1 2018.

Survey respondents reported that 33% of denied claims were due to inaccurate patient identification. Ultimately, inaccurate patient identification cost an average hospital $1.5 million last year. It also concluded that the average cost of duplicate records was $1,950 per patient per inpatient stay and more than $800 per ED visit.

In addition, researchers found that hospitals with over 150 beds took an average of more than 5 months to clean up their data. This included process improvements focused on data validity checking, normalization and data cleansing.

Having the right tools in place seemed to help. Hospitals said that before they rolled out enterprise master patient index solutions, an average of 18% of their records were duplicates, and that match rates when sharing data with other organizations averaged 24%.

Meanwhile, hospitals with EMPI support in place since 2016 reported that patient records were identified correctly during 93% of registrations and 85% of externally shared records among non-networked provider.

Not surprisingly, though, this research doesn’t tell the whole story. While using EMPI tools makes sense, the healthcare industry should hardly stop there, according to Gartner Group analyst Wes Rishel.

“We simply need innovators that have the vision to apply proven identity matching to the healthcare industry – as well as the gumption and stubbornness necessary to thrive in a crowded and often slow-moving healthcare IT market,” he wrote.

Wishel argues that to improve patient matching, it’s time to start cross-correlating demographic data from patients with demographic data from third-party sources, such as public records, credit agencies or telephone companies, what makes this data particularly helpful is that it includes not just current and correct attributes for person, but also out-of-date and incorrect attributes like previous addresses, maiden names and typos.

Ultimately, these “referential matching” approaches will significantly outperform existing probabilistic models, Wishel argues.

It’s really shocking that so many healthcare organizations don’t have an EMPI solution in place. This is especially true as cloud EMPI has made EMPI solutions available to organizations of all sizes. EMPI is needed for the financial reasons mentioned above, but also from a patient care and patient safety perspective as well.

Reasonable and Unreasonable Healthcare Interoperability Expectations

Posted on February 12, 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.

Other than EMR and EHR, I don’t think there’s any topic I’ve written about more than healthcare interoperability. It’s a challenging topic with a lot of nuances. Plus, it’s a subject which would benefit greatly if we could make it a reality. However, after all these years I’m coming to some simple conclusions that I think often get lost in most discussions. Especially those in the healthcare IT media.

First, we all know that it would be wonderful for all of your healthcare records to be available to anyone who needs them at any time and in any place and not available to those who shouldn’t have access to them. I believe that in the next 15 years, that’s not going to happen. Sure, it would be great if it did (we all see that), but I don’t see it happening.

The reasons why are simple. Our healthcare system doesn’t want it to happen and there aren’t enough benefits to the system to make it happen.

Does that mean we should give up on interoperability? Definitely not!

Just because we can’t have perfect healthcare interoperability doesn’t mean we shouldn’t create meaningful interoperability (Yes, I did use the word meaningful just to annoy you).

I think one of the major failures of most interoperability efforts is that they’re too ambitious. They try to do everything and since that’s not achievable, they end up doing nothing. There are plenty of reasonable interoperability efforts that make a big difference in healthcare. We can’t let the perfect be the enemy of better. That’s been exactly what’s happened with most of healthcare interoperability.

At the HIMSS conference next month, they’re going to once again have an intereroperability showcase full of vendors that can share data. If HIMSS were smart, they’d do away with the showcase and instead only allow those vendors to show dashboards of the amount of data that’s actually being transferred between organizations in real time. We’d learn a lot more from seeing interoperability that’s really happening as opposed to seeing interoperability that could happen but doesn’t because organizations don’t want that type of interoperability to happen.

Interoperability is a challenging topic, but we make it harder than it needs to be because we want to share everything with everyone. I’m looking for companies that are focused on slices of interoperability that practically solve a problem. If you have some of these, let us know about them in the comments.

When It Comes To Meaningful Use, Some Vendors May Have An Edge

Posted on December 1, 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.

A new article appearing in the Journal of the American Medical Informatics Association has concluded that while EHRs certified under the meaningful use program should perform more or less equally, they don’t.

After conducting an analysis, researchers found that there were significant associations between specific vendors and level of hospital performance for all six meaningful use criteria they were using as a yardstick. Epic came out on top by this measure, demonstrating significantly higher performance on five of the six criteria.

However, it’s also worth noting that EHR vendor choice by hospitals accounted for anywhere between 7% and 34% of performance variation across the six meaningful use criteria. In other words, researchers found that at least in some cases, EHR performance was influenced as much by the fit between platform and hospital as the platform itself.

To conduct the study, researchers used recent national data on certified EHR vendors hospitals and implemented, along with hospital performance on six meaningful use criteria. They sought to find out:

  • Whether certain vendors were found more frequently among the highest performing hospitals, as measured by performance on Stage 2 meaningful use criteria;
  • Whether the relationship between vendor and hospital performance was consistent across the meaningful use criteria, or whether vendors specialized in certain areas; and
  • What proportion of variation in performance across hospitals could be explained by the vendor characteristics

To measure the performance of various vendors, the researchers chose six core stage two meaningful use criteria, including 60% of medication orders entered using CPOE;  providing 50% of patients with the ability to view/download/transmit their health information; for 50% of patients received from another setting or care provider, medication reconciliation is performed; for 50% of patient transitions to another setting or care provider, a summary of care record is provided; and for 10% of patient transitions to another setting or care provider, a summary of care record is electronically transmitted.

After completing their analysis, researchers found that three hospitals were in the top performance quartile for all meaningful use criteria, and all used Epic. Of the 17 hospitals in the top performance quartile for five criteria, 15 used Epic, one used MEDITECH and one another smaller vendor. Among the 68 hospitals in the top quartile for four criteria, 64.7% used Epic, 11.8% used Cerner and 8.8% used MEDITECH.

When it came to hospitals that were not in the top quartile for any of the criteria, there was no overwhelming connection between vendor and results. For the 355 hospitals in this category, 28.7% used MEDITECH, 25.1% used McKesson, 20.3% used Cerner, 14.4% used MEDHOST and 6.8% used Epic.

All of this being said, the researchers noted that news the hospital characteristics nor the vendor choice explained were then a small amount of the performance variation they saw. This won’t surprise anybody who’s seen firsthand how much other issues, notably human factors, can change the outcome of processes like these.

It’s also worth noting that there might be other causes for these differences. For example, if you can afford the notably expensive Epic systems, then your hospital and health system could likely afford to invest in meaningful use compliance as well. This added investment could explain hospitals meaningful use performance as much as EHR choice.

Database Linked With Hospital EMR To Encourage Drug Monitoring

Posted on March 31, 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.

According to state officials, Colorado occupies the unenviable position of second worst in the US for prescription drug misuse, with more than 255,000 Coloradans misusing prescribed medications.

One way the state is fighting back is by running the Colorado Prescription Drug Monitoring Program which, like comparable efforts in other states, tracks prescriptions for controlled medications. Every regular business day, the state’s pharmacists upload prescription data for medications listed in Schedules II through V.

While this effort may have value, many physicians haven’t been using the database, largely because it can be difficult to access. In fact, historically physicians have been using the system only about 30 percent of the time when prescribing controlled substances, according to a story appearing in HealthLeaders Media.

As things stand, it can take physicians up to three minutes to access the data, given that they have to sign out of their EMR, visit the PDMP site, log in using separate credentials, click through to the right page, enter patient information and sort through possible matches before they got to the patient’s aggregated prescription history. Given the ugliness of this workflow, it’s no surprise that clinicians aren’t searching out PDMP data, especially if they don’t regard a patient as being at a high risk for drug abuse or diversion.

But perhaps taking some needless steps out of the process can make a difference, a theory which one of the state’s hospitals is testing. Colorado officials are hoping a new pilot program linking the PDMP database to an EMR will foster higher use of the data by physicians. The pilot, funded by a federal grant through the Bureau of Justice Assistance, connects the drug database directly to the University of Colorado Hospital’s Epic EMR.

The project began with a year-long building out phase, during which IT leaders created a gateway connecting the PDMP database and the Epic installation. Several months ago, the team followed up with a launch at the school of medicine’s emergency medicine department. Eventually, the PDMP database will be available in five EDs which have a combined total of 270,000 visits per year, HealthLeaders notes.

Under the pilot program, physicians can access the drug database with a single click, directly from within the Epic EMR system. Once the PDMP database was made available, the pilot brought physicians on board gradually, moving from evaluating their baseline use, giving clinicians raw data, giving them data using a risk-stratification tool and eventually requiring that they use the tool.

Researchers guiding the pilot are evaluating whether providers use the PDMP more and whether it has an impact on high-risk patients. Researchers will also analyze what happened to patients a year before, during and a year after their ED visits, using de-identified patient data.

It’s worth pointing out that people outside of Colorado are well aware of the PDMP access issue. In fact, the ONC has been paying fairly close attention to the problem of making PDMP data more accessible. That being said, the agency notes that integrating PDMPs with other health IT systems won’t come easily, given that no uniform standards exist for linking prescription drug data with health IT systems. ONC staffers have apparently been working to develop a standard approach for delivering PDMP data to EMRs, pharmacy systems and health information exchanges.

However, at present it looks like custom integration will be necessary. Perhaps pilots like this one will lead by example.

Many Providers Still Struggle With Basic Data Sharing

Posted on February 15, 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.

One might assume that by this point, virtually every provider with a shred of IT in place is doing some form of patient data exchange. After all, many studies tout the number of healthcare data send and receive transactions a given vendor network or HIE has seen, and it sure sounds like a lot. But if a new survey is any indication, such assumptions are wrong.

According a study by Black Book Research, which surveyed 3,391 current hospital EMR users, 41% of responding medical record administrators find it hard to exchange patient health records with other providers, especially if the physicians involved aren’t on their EMR platform. Worse, 25% said they still can’t use any patient information that comes in from outside sources.

The problem isn’t a lack of interest in data sharing. In fact, Black Book found that 81% of network physicians hoped that their key health system partners’ EMR would provide interoperability among the providers in the system. Moreover, the respondents say they’re looking forward to working on initiatives that depend on shared patient data, such as value-based payment, population health and precision medicine.

The problem, as we all know, is that most hospitals are at an impasse and can’t find ways to make interoperability happen. According to the survey, 70% of hospitals that responded weren’t using information outside of their EMR.  Respondents told Black Book that they aren’t connecting clinicians because external provider data won’t integrate with their EMR’s workflow.

Even if the data flows are connected, that may not be enough. Researchers found that 22% of surveyed medical record administrators felt that transferred patient information wasn’t presented in a useful format. Meanwhile, 21% of hospital-based physicians contended that shared data couldn’t be trusted as accurate when it was transmitted between different systems.

Meanwhile, the survey found, technology issues may be a key breaking point for independent physicians, many of whom fear that they can’t make it on their own anymore.  Black Book found that 63% of independent docs are now mulling a merger with a big healthcare delivery system to both boost their tech capabilities and improve their revenue cycle results. Once they have the funds from an acquisition, they’re cleaning house; the survey found that EMR replacement activities climbed 52% in 2017 for acquired physician practices.

Time for a comment here. I wish I agreed with medical practice leaders that being acquired by a major health system would solve all of their technical problems. But I don’t, really. While being acquired may give them an early leg up, allowing them to dump their arguably flawed EMR, I’d wager that they won’t have the attention of senior IT people for long.

My sense is that hospital and health system leaders are focused externally rather than internally. Most of the big threats and opportunities – like ACO integration – are coming at leaders from the outside.

True, if a practice is a valuable ally, but independent of the health system, CIOs and VPs may spend lots of time and money to link arms with them technically. But once they get in house, it’s more of a “get in line” situation from what I’ve seen.  Readers, what is your experience?

Boston Children’s Benefits From the Carequality and CommonWell Agreement

Posted on February 3, 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.

Recently two of the bigger players working on health data interoperability – Carequality and the CommonWell Health Alliance – agreed to share data with each other. The two, which were fierce competitors, agreed that CommonWell would share data with any Carequality participant, and that Carequality users would be able to use the CommonWell record locator service.

That is all well and good, but at first I wasn’t sure if it would pan out. Being the cranky skeptic that I am, I assumed it would take quite a while for the two to get their act together, and that we’d hear little more of their agreement for a year or two.

But apparently, I was wrong. In fact, a story by Scott Mace of HealthLeaders suggests that Boston Children’s Hospital and its physicians are likely to benefit right away. According to the story, the hospital and its affiliated Pediatric Physicians Organization at Children’s Hospital (PPOC) will be able to swap data nicely despite their using different EMRs.

According to Mace, Boston Children’s runs a Cerner EMR, as well as an Epic installation to manage its revenue cycle. Meanwhile, PPOC is going live with Epic across its 80 practices and 400 providers. On the surface, the mix doesn’t sound too promising.

To add even more challenges to the mix, Boston Children’s also expects an exponential jump in the number of patients it will be caring for via its Medicaid ACO, the article notes.

Without some form of data sharing compatibility, the hospital and practice would have faced huge challenges, but now it has an option. Boston Children’s is joining CommonWell, and PPOC is joining Carequality, solving a problem the two have struggled with for a long time, Mace writes.

Previously, the story notes, the hospital tried unsuccessfully to work with a local HIE, the Mass Health Information HIway. According to hospital CIO Dan Nigrin, MD, who spoke with Mace, providers using Mass Health were usually asked to push patient data to their peers via Direct protocol, rather than pull data from other providers when they needed it.

Under the new regime, however, providers will have much more extensive access to data. Also, the two entities will face fewer data-sharing hassles, such as establishing point-to-point or bilateral exchange agreements with other providers, PPOC CIO Nael Hafez told HealthLeaders.

Even this step upwards does not perfect interoperability make. According to Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, providers leveraging the CommonWell/Carequality data will probably customize their experience. He contends that even those who are big fans of the joint network may add, for example, additional record locator services such as one provided by Surescripts. But it does seem that Boston Children’s and PPOC are, well, pretty psyched to get started with data sharing as is.

Now, back to me as Queen Grump again. I have to admit that Mace paints a pretty attractive picture here, and I wish Boston Children’s and PPOC much success. But my guess is that there will still be plenty of difficult issues to work out before they have even the basic interoperability they’re after. Regardless, some hope of data sharing is better than none at all. Let’s just hope this new data sharing agreement between CommonWell and Carequality lives up to its billing.

Some Projections For 2017 Hospital IT Spending

Posted on January 4, 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.

A couple of months ago, HIMSS released some statistics from its survey on US hospitals’ plans for IT investment over the next 12 months. The results contain a couple of data points that I found particularly interesting:

  • While I had expected the most common type of planned spending to be focused on population health or related solutions, HIMSS found that pharmacy was the most active category. In fact, 51% of hospitals were planning to invest in one pharmacy technology, largely to improve tracking of medication dispensing in additional patient care environments. Researchers also found that 6% of hospitals were planning to add carousels or packagers in their pharmacies.
  • Eight percent hospitals said that they plan to invest in EMR components, which I hadn’t anticipated (though it makes sense in retrospect). HIMSS reported that 14% of hospitals at Stage 1-4 of its Electronic Medical Record Adoption Model are investing in pharmacy tech for closed loop med administration, and 17% in auto ID tech. Four percent of Stage 6 hospitals plan to support or expand information exchange capabilities. Meanwhile, 60% of Stage 7 hospitals are investing in hardware infrastructure “for the post-EMR world.”

Other data from the HIMSS report included news of new analytics and telecom plans:

  • Researchers say that recent mergers and acquisitions are triggering new investments around telephony. They found that 12% of hospitals with inpatient revenues between $25 million and $125 million – and 6% of hospitals with more than $500 million in inpatient revenues — are investing in VOIP and telemedicine. FWIW, I’m not sure how mergers and acquisitions would trigger telemedicine rollouts, as they’re already well underway at many hospitals — maybe these deals foster new thinking and innovation?
  • As readers know, hospitals are increasingly spending on analytics solutions to improve care and make use of big data. However (and this surprised me) only 8% of hospitals reported plans to buy at least one analytics technology. My guess is that this number is small because a) hospitals may not have collected their big data assets in easily-analyzed form yet and b) that they’re still hoping to make better use of their legacy analytics tools.

Looking at these stats as a whole, I get the sense that the hospitals surveyed are expecting to play catch-up and shore up their infrastructure next year, rather than sink big dollars into future-looking solutions.

Without a doubt, hospital leaders are likely to invest in game-changing technologies soon such as cutting-edge patient engagement and population health platforms to prepare for the shift to value-based health. It’s inevitable.

But in the meantime it probably makes sense for them to focus on internal cost drivers like pharmacy departments, whose average annual inpatient drug spending shot up by more than 23% between 2013 and 2015. Without stanching that kind of bleeding, hospitals are unlikely to get as much value as they’d like from big-idea investments in the future.

A Look At Geisinger’s Big Data Efforts

Posted on December 28, 2016 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.

This week I got a look at a story appearing in a recent issue of Harvard Business Review which offers a description of Geisinger Health System’s recent big data initiatives. The ambitious project is designed not only to track and analyze patient outcomes, but also to visualize healthcare data across cohorts of patients and networks of providers and even correlate genomic sequences with clinical care. Particularly given that Geisinger has stayed on the cutting edge of HIT for many years, I think it’s worth a look.

As the article’s authors note, Geisinger rolled out a full-featured EMR in 1996, well ahead of most of its peers. Like many other health systems, Geisinger has struggled to aggregate and make use of data. That’s particularly the case because as with other systems, Geisinger’s legacy analytics systems still in place can’t accommodate the growing flood of new data types emerging today.

Last year, Geisinger decided to create a new infrastructure which could bring this data together. It implemented Unified Data Architecture allowing it to integrate big data into its existing data analytics and management.  According to the article, Geisinger’s UDA rollout is the largest practical application of point-of-care big data in the industry. Of particular note, Geisinger is crunching not only enterprise healthcare data (including HIE inputs, clinical departmental systems and patient satisfaction surveys) and consumer health tools (like smartphone apps) but even grocery store and loyalty program info.

Though all of its data hasn’t yet been moved to the UDA, Geisinger has already seen some big data successes, including:

* “Close the Loop” program:  Using natural language processing, the UDA analyzes clinical and diagnostic imaging reports, including free text. Sometimes it detects problems that may not be relevant to the initial issue (such as injuries from a car crash) which can themselves cause serious harm. The program has already saved patient lives.

* Early sepsis detection/treatment: Geisinger uses the UDA to bring all sepsis-patient information in one place as they travel through the hospital. The system alerts providers to real-time physiologic data in patients with life-threatening septic shock, as well as tracking when antibiotics are prescribed and administered. Ninety percent of providers who use this tool consistently adhere to sepsis treatment protocols, as opposed to 40% of those who don’t.

* Surgery costs/outcomes: The Geisinger UDA tracks and integrates surgical supply-chain data, plus clinical data by surgery type and provider, which offers a comprehensive view of performance by provider and surgery type.  In addition to offering performance insight, this approach has also helped generate insights about supply use patterns which allow the health system to negotiate better vendor deals.

To me, one of the most interesting things about this story is that while Geisinger is at a relatively early stage of its big data efforts, it has already managed to generate meaningful benefits from its efforts. My guess is that its early successes are more due to smart planning – which includes worthwhile goals from day one of the rollout — than the technology per se. Regardless, let’s hope other hospital big data projects fare so well. (Meanwhile, for a look at another interesting hospital big data project, check out this story.)