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Report Champions API Use To Improve Interoperability

Posted on 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.

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.

Do We Need Another Interoperability Group?

Posted on 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.

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.

Within Two Years, 20% Of Healthcare Orgs Will Be Using Blockchain

Posted on August 16, 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.

I don’t know about you, but to me, blockchain news seems to be all over the map. It’s like a bunch of shiny objects. Here! Look at the $199 zillion investment this blockchain company just picked up! Wow! Giant Hospital System is using blockchain to automate its cafeteria! And so on. It gets a bit tiring.

However, I’m happy to say that the latest piece of blockchain news to cross my desk seems boring (and practical) in comparison. The news is that according to a Computerworld piece, 20% of healthcare organizations should be using blockchain for operations management and patient identity by 2020, or in other words within two years. And to be clear, we’re talking about systems in day-to-day use, not pilot projects.

The stats come from a report by analyst firm IDC Health Insights, which takes a look at, obviously, blockchain use in the healthcare industry. In the report, researchers note that healthcare has been slower out of the blockchain gate than other industries for reasons that include regulatory and security concerns and blockchain resource availability. Oh, and while the story doesn’t spell this out, good ol’ conservative decision-making has played its part too.

But now things are changing. IDC predicts that in addition to supporting internal operations, blockchain could form the basis for a new health information exchange architecture. Specifically, blockchain could be used to create a mesh network capable of sharing information between stakeholders such as providers, pharmacies, insurance payers and clinical researchers, the report suggests. This architecture could be far more useful than the existing point-to-point approach HIEs use now, as it would be more flexible, more fault-tolerant and less prone to bottlenecks.

As part of the report, IDC offers some advice to healthcare organizations interested in taking on blockchain options. It includes recommendations that they:

  • See to it that any blockchain-related decisions are evidence-based and informed and that stakeholders share information about the pros and cons of blockchain interoperability freely
  • Develop a blockchain interoperability proof of concept which demonstrates how decentralized, distributed and immutable properties could make a contribution
  • Pitch the benefits of blockchain interoperability to providers and patients, letting them know that it could eliminate barriers to getting the data they need when and where they need it
  • Adopt blockchain interoperability early if at all, as this can offer benefits even prior to implementation, and gives leaders a chance to tackle concerns privately if need be

Of course, these suggestions and factoids barely scratch the surface of the blockchain discussion, which is why IDC gets $4,000 a copy for the full report. (Though I should note that the article goes into a lot more depth than I have here.)

Regardless, what came across to me from the article was nonetheless worth thinking about when kicking around possible blockchain strategies. Broadly speaking, providers should get in early, keep everyone involved (including patients and providers ), work out differences over its use privately and see to it that your rollout meets concrete needs. You may want to also read this article on 5 blockchain uses for healthcare. It may not be in places you’d have thought previously.

And now, back to silly blockchain news. I’ll let you know when another set of practical ideas shows up.

Hospitals That Share Patients Don’t Share Patient Data

Posted on August 7, 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.

If anyone in healthcare needs to catch up on your records, it’s another provider who is treating mutual patients. In this day and age, there’s no good reason why clinicians at one hospital should be guessing what the other would get (or not get as the case is far too often).

Over the last few years, we’ve certainly seen signs of data sharing progress. For example, in early August the marriage between health data sharing networks CommonWell and Carequality was consummated, with providers using Cerner and Greenway Health going live with their connections.

Still, health data exchange is far more difficult than it should be. Despite many years of trying, hospitals still don’t share data with each other routinely, even when they’re treating the same patient.

To learn more about this issue, researchers surveyed pairs of hospitals likely to share patients across the United States. The teams chose pairs which referred the largest volume of patients to each other in a given hospital referral region.

After reaching out to many facilities, the researchers ended up with 63 pairs of hospitals. Researchers then asked them how likely they were to share patient health information with nearby institutions with whom they share patients.

The results, which appeared in the Journal of the American Medical Informatics Association, suggest that while virtually all of the hospitals they studied could be classified as routinely sharing data by federal definitions, that didn’t tell the whole story.

For one thing, while 97% of respondents met the federal guidelines, only 63% shared data routinely with hospitals with the highest shared patient (HSP) volume.

In fact, 23% of respondents reported that information sharing with their HSP hospital was worse than with other hospitals, and 48% said there was no difference. Just 17% said they enjoyed better sharing of patient health data with their HSP volume hospital.

It’s not clear how to fix the problem highlighted in the JAMIA study. While HIEs have been lumbering along for well more than a decade, only a few regional players seem to have developed a trusted relationship with the providers in their area.

The techniques HIEs use to foster such loyalty, which include high-touch methods such as personal check-ins with end users, don’t seem to work as well for some HIE they do for others. Not only that, HIE funding models still vary, which can have a meaningful impact on how successful they’ll be overall.

Regardless, it would be churlish to gloss over the fact that almost two-thirds of hospitals are getting the right data to their peers. I don’t know about you, but this seems like a hopeful development.

Important Patient Data Questions Hospitals Need To Address

Posted on July 13, 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.

Obviously, managing and protecting patients’ personal health information is very important already.  But with high-profile incidents highlighting questionable uses of consumer data — such as the recent Facebook scandal – patients are more aware of data privacy issues than they had been in the past, says Dr. Oleg Bess, founder and CEO of clinical data exchange company 4medica.

According to Bess, hospitals should prepare to answer four key questions about personal health information that patients, the media and regulators are likely to ask. They include:

  • Who owns the patient’s medical records? While providers and EHR vendors may contend that they own patient data, it actually belongs to the patient, Bess says. What’s more, hospitals need to be sure patients should have a clear idea of what data hospitals have about them. They should also be able to access their health data regardless of where it is stored.
  • What if the patient wants his or her data deleted? Unfortunately, deleting patient data may not be possible in many cases due to legal constraints. For example, CMS demands that Medicare providers retain records for a fixed period, and many states have patient record retention laws as well, Bess notes. However, if nothing else, patients should have the ability to decline having their personally-identifiable data shared with third parties other than providers and payers, he writes.
  • Who is responsible for data integrity? Right now, problems with patient data accuracy are common. For example, particularly when patient matching tools like an enterprise master patient index aren’t in place, health data can end up being mangled. To this point, Bess cites a Black Book Research survey concluding that when records are transmitted between hospitals that don’t use these tools, they had just a 24% match rate. Hospital data stewards need to get on top of this problem, he says.
  • Without a national patient ID in place, how should hospitals verify patient identities? In addition to existing issues regarding patient safety, emerging problems such as the growing opioid abuse epidemic would be better handled with a unique patient identifier, Bess contends. According to Bess, while the federal government may not develop unique patient IDs, commercially developed master patient index technology might offer a solution.

To better address patient matching issues, Bess recommends including historical data which goes back decades in the mix if possible. A master patient index solution should also offer enterprise scalability and real-time matching, he says.

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.