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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.

Open Source Tool Offers “Synthetic” Patients For Hospital Big Data Projects

Posted on September 13, 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.

As readers will know, using big data in healthcare comes with a host of security and privacy problems, many of which are thorny.

For one thing, the more patient data you accumulate, the bigger the disaster when and if the database is hacked. Another important concern is that if you decide to share the data, there’s always the chance that your partner will use it inappropriately, violating the terms of whatever consent to disclose you had in mind. Then, there’s the issue of working with incomplete or corrupted data which, if extensive enough, can interfere with your analysis or even lead to inaccurate results.

But now, there may be a realistic alternative, one which allows you to experiment with big data models without taking all of these risks. A unique software project is underway which gives healthcare organizations a chance to scope out big data projects without using real patient data.

The software, Synthea, is an open source synthetic patient generator that models the medical history of synthetic patients. It seems to have been built by The MITRE Corporation, a not-for-profit research and development organization sponsored by the U.S. federal government. (This page offers a list of other open source projects in which MITRE is or has been involved.)

Synthea is built on a Generic Module Framework which allows it to model varied diseases and conditions that play a role in the medical history of these patients. The Synthea modules create synthetic patients using not only clinical data, but also real-world statistics collected by agencies like the CDC and NIH. MITRE kicked off the project using models based on the top ten reasons patients see primary care physicians and the top ten conditions that shorten years of life.

Its makers were so thorough that each patient’s medical experiences are simulated independently from their “birth” to the present day. The profiles include a full medical history, which includes medication lists, allergies, physician encounters and social determinants of health. The data can be shared using C-CDA, HL7 FHIR, CSV and other formats.

On its site, MITRE says its intent in creating Synthea is to provide “high-quality, synthetic, realistic but not real patient data and associated health records covering every aspect of healthcare.” As MITRE notes, having a batch of synthetic patient data on hand can be pretty, well, handy in evaluating new treatment models, care management systems, clinical support tools and more. It’s also a convenient way to predict the impact of public health decisions quickly.

This is such a good idea that I’m surprised nobody else has done something comparable. (Well, at least as far as I know no one has.) Not only that, it’s great to see the software being made available freely via the open source distribution model.

Of course, in the final analysis, healthcare organizations want to work with their own data, not synthetic substitutes. But at least in some cases, Synthea may offer hospitals and health systems a nice head start.

Mount Sinai Uses AI To Manage CHF Cases

Posted on October 31, 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.

New York-based Mount Sinai Hospital has begun a project which puts it in the vanguard of predictive analytics, working with a partner focused on artificial intelligence. Mount Sinai plans to use the Cloud Medx Clinical AI Platform to predict which patients might develop congestive heart failure and care better for those who’ve already done so.

As many readers will know, CHF is a dangerous chronic condition, but it can be managed with drugs, proper diet and exercise, plus measurement of blood pressure and respiratory function by remote monitoring devices. And of course, hospitals can mine their EMR for other clinical clues, as well as rifling through data from implantable medical devices or health tracking bands or smartwatches, to see if a patient’s condition is going south.

But using AI can give a hospital a more in-depth look at patterns that might not be visible to the unaided clinician. In fact, CloudMedx is already helping Sacramento-based Sutter Physician Services improve its patient care by digging out unseen patterns in patient data.

To perform its calculations, CloudMedx runs massive databases on public clouds such as Amazon Web Services and Microsoft Azure, then layers its specialized analytics and algorithms on top of the data, allowing physicians or researchers to query the database. The analytics tools use natural language processing and machine learning to track patients over time and derive real-time clinical insights.

In this case, the query tools let clinicians determine which patients are at risk of developing CHF or seeing their CHF status deteriorate. Factors the system evaluates include medical notes, a patient’s family history, demographics and past medical procedures, which are rolled up into a patient risk score.

In moving ahead with this strategy, Mount Sinai is rolling out what is likely to be a common strategy in the future. Going forward, expect to see other providers engage the growing number of AI-based healthcare analytics vendors, many of whom seem to have significant momentum.

For example, there’s Lumiata, a developer of AI-based productive health analytics whose Risk Matrix tool draws on more than 175 million patient-record years. Risk Matrix offers real-time predictions for 20 chronic conditions, including CHF, chronic kidney disease and diabetes.

Risk Matrix bases its predictions on its customers’ datasets, including labs, EHR data claims information and other types of data organized using FHIR. Once data is mapped out into FHIR, Risk Matrix generates output for more than 1 million records in less than three hours, the company reports. Users access Risk Matrix analyses using a FHIR-compatible API, which in turn allows for the results to be integrated into the output of the existing workflows.

But Lumiata is just the tip of the iceberg. CB Insights has identified more than 90 companies applying machine learning algorithms and predictive analytics to important problems in healthcare.

While many startups have flocked into the imaging and diagnostics space, expect to see AI-related activity in drug discovery, remote monitoring and oncology. Also, market watchers say companies founded to do AI work outside of healthcare see many opportunities there as well.

Now, at least at this stage, high-end AI tools are likely to be beyond the budget of mid-sized to small community hospitals. Nonetheless, they’re likely to be deployed far more often as value-based reimbursement hits the scene, so they might end up in use at your hospital after all.

What If EMR Interoperability Was Mandatory?

Posted on June 5, 2013 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.

For decades, industries have haggled and coded and bargained their way into shared data standards.  Each agreement has made great technical advances possible and grown markets into forms which could hardly have been imagined before.

Traditionally, the idea has been agreeing on interoperable standards is a form of enlightened self-interest.  The equasion “interoperability=larger markets=more pie for everyone” has nearly always managed to take root even in industries as brutally competitive as networking.  Consider where we’d be without 802.11 for WiFi, for example. If WiFi manufacturers had staged a prolonged battle over standards, and the reach of WiFi didn’t blossom everywhere, the Internet as we know it might not exist.

Well, here in EMR vendor land, we’ve somehow passed the exit marked “coopetition” and wandered off into interoperability nowhere land.  Sure, tell me about the CommonWell Alliance, which looks, on the surface, something like industry cooperation, and I’ll retort, “too little, too late.”  And do I even have to say that the idea that Epic supports everybody is something of a laughing matter?

Maybe, after seeing how miserably the EMR vendor industry has failed to come together to share data, it’s time to force the matter.  I read that ONC  honcho Farzad Mostashari has occasionally threatened to do just that, but hasn’t followed through with any proposed regs on the subject.

What if the FCC, the FDA and the ONC (which are now taking comments on a regulatory framework for health IT) decide to look at standards, pick a winner and shove it down the ever-living throat of every uncooperative vendor hoping to create dependency on their way of doing things?  That would include Epic, of course, which today, hears countless hospital CIOs say they had to buy their product because everybody else did.

Don’t get me wrong, this is a very, very serious matter; any regs that attempted to force interoperability would impose untold billions in costs on vendors, not to mention their customers. But if interoperability is the real prize we’re ultimately hoping to gain — the big EMR enchilada — is it possible that it’s time to take the risk anyway?  I don’t know, but I certainly wonder.  How about you, readers?

Adolescent Data Needs Stronger EMR Protections, Group Says

Posted on November 13, 2012 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.

The American Academy of Pediatrics is calling for changes to EMRs to protect the privacy of adolescent patients, whom, it says, don’t currently get the same level of protection as adults.

According to the AAP, there are several reasons adolescents don’t enjoy the same privacy protections as adults.

For one thing, there are the legal issues. HIPAA doesn’t provide specific guidance on adolescent privacy, and the medical industry hasn’t put clear standards in place outlining when adults can access an adolescent’s health records either.

What’s more, states vary in how they handle this issue, according to the AAP report. State laws typically allow minors to consent for their healthcare on the basis of their status — for example, if they’re a pregnant or parenting teen — and on the basis of the services they seek  — such as STI diagnosis and treatment or contraception. However, while state and federal laws provide protection of privacy when minors  consent for their own care, privacy protections differ widely.

To make sure adolescent privacy is protected across all data platforms, the AAP is recommending a set of principles that it feels should ideally govern not only EMRs, but also PHRs and HIEs. These include :

*  Creation of a set of criteria for EMRs that meet adolescent privacy standards

*  Creating and implementing technology for EMRs which would allow determination of who has access to, or ability to control access to, any part of the adolescent medical record.

* Making it possible for adolescents to record consents and authorizations according to privacy laws using the HL-7 Child Health Profile DC.1.3.3 standard

*  Flexibility within standards to allow for protection of privacy for diagnoses, associated lab tests, problem lists and any other documentation containing confidential data.

* EMR systems must be able to apply state and federal confidentiality rules when assembling aggregate data to prevent identification of individuals.

The AAP has a lot more to say, but in summary, it seems to be putting the burden for protecting adolescent privacy largely on EMR vendors, though I believe it’s hoping members will advocate for these changes as well.

Either way, it doesn’t work well if there’s a protected class (certain adolescents) whose rights simply can’t be protected adequately with today’s technology.  Time to get on this issue, I’d say.

Senators Join Initiative To Scrutinize Meaningful Use

Posted on October 23, 2012 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 weeks ago, four House GOP leaders wrote a letter to HHS head Katherine Sebelius demanding that she account for perceived failures in the Meaningful Use program.

The four congressmen had written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

Politics being what it is, the other shoe had to drop, and now a group of senators have offered their own objections.

Sens. John Thune and Dr. Tom Coburn of the Finance Committee, and Richard Burr and Pat Roberts of the Health, Education, Labor and Pensions Committee have formally requested that CMS and ONC staffers meet with the latter committee regarding the final rule for Stage 2 of Meaningul Use.

In a letter to HHS, the senators raise several questions:

* Do EMRs sometimes increase utilization of diagnostic tests, and if so, how should the government respond?

* Have some providers gotten subsidies for EMR systems they had in place prior to the kickoff of  Meaningful Use? If so, what is HHS doing to claw back such payments and prevent future outlays of this kind?

* Has the use of EMRs boosted providers’ billing of Medicare, and thereby raised the cost of the program?

* What is HHS’s strategy for “meaningful interoperability”?

Interestingly, the senators’ letter stops short of demanding a halt on MU payments, which the congressmen did in no uncertain terms.  But they’re clearly antsy about the future of the Meaningful Use program, which has paid out $6.6+ billion in incentives to date.

And you know what?  It’s about time that Congress got interested in the future of EMRs and Meaningful Use specifically.  Better to have them breathing down HHS’ neck now than further down the line when there’s far less opportunity to turn the MU battleship.

Congressmen Want Halt On Meaningful Use Payments

Posted on October 8, 2012 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.

Four congressmen have thrown what could be a monkey wrench into the rollout of Meaningful Use Stage 2 regulations, arguing that Meaningful Use rules are weak and ineffective and that MU incentives have gone awry.

The four have written a letter to HHS head Kathleen Sebelius to recommend that until MU Stage 2 rules require “comprehensive interoperability,” and hospitals can prove they’re capable of exchanging data, the agency shouldn’t hand out incentive payments.

In the letter, the congressmen somewhat spitefully quote the recent piece from The New York Times which suggests that EMRs are raising costs by encouraging upcoding. “Perhaps not surprisingly, your EHR incentive program appears to be doing more harm than good,” the letter says. (Oh, snap!)

What do the congressmen want? A) To see CMS suspend all incentive payments until “universal interoperable standards” are promulgated, B) to require higher level of performance from Meaningful Users (upping percentages of, for example, transfers that need to be done electronically) and C) to see HHS “take steps to eliminate the subsidization of business practices that block the exchange of information between providers.”

Of course, the health IT leaders of the world are aghast. HIMSS, for example, has already issued a statement opposing the incentive payment halt.

But there is a nuanced conversation to be had here. While I admit I’ve ridiculed the tone of the congressional letter a bit, I think there’s some merit in the complaints. Interestingly enough, the most substantial complaint (letter “C”) in the missive is discussed the least in the text.

Let’s think about what John rightly calls “Jabba the Hutt” EMR vendors. What incentive do they have to change their business practices and make their products interoperable if the only threat to their business is academic discussions about Blue Buttons, The Direct Project and 17 flavors of HL7?

No, my friends, while I disliked the nasty, hectoring tone of the letter, I think we should take the authors’ objections seriously. We are at an interoperability crossroads and there’s no immediate end in sight.

What Won’t Happen In #HIT By September 2013

Posted on September 7, 2012 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 part of the upcoming National Health IT Week (#NHITWeek), which takes place September 10 through 14th) my august colleague John has written up a list of ways in #HIT is likely to make a difference over the next 12 months.  (He makes some great guesses; definitely give the post a look.)

For my part, being the naughty contrarian that I am, I thought It’d turn John’s blog post on its head and answer the question “What Won’t Come Together In Health IT Over the Next 12 Months?”  Here’s some of my predictions:

* EMR-to-EMR interoperability:  Folks, from what I see we’re definitely more than a year from having a workable form of interoperability between systems or even routine high-volume data sharing. Really, do I even have to debate this one?

High penetration by HIEs:  With funding mechanisms and goals ranging all over the map — and players including health plans, broadband network providers like Verizon, hospital coalitions and more — I just can’t see the HIE picking up a lot more market share over the next 12 months. Too many organizations involved, and too much to figure out.

Major uptick in open-source HIT  use:  Time and again, I’m reminded that far too many hospital leaders, government CIOs and medical practice leaders aren’t ready to take open-source tools seriously despite the myriad of good reasons to do so. I don’t think this is poised to change in the near term, sadly.

Epic controls the hospital EMR world for good:  Yes, hospitals are still switching over to Epic. And yes, hospital cutovers to Epic probably haven’t even hit their all-time peak.  But the smaller to medium-sized hospitals that just can’t afford Epic are still in play, and there’s a lot of them. Let’s see who comes riding in to put the lock on this niche before we crown Epic world heavyweight champ.

* Major growth in remote monitoring:  Mobile technologies are becoming more critical daily to the practice of medicine. But somehow, that doesn’t translate to a hunger for home-monitoring patients using, say, wireless glucose monitors. I’ve been watching this sector for years and it still seems like it could explode, but I’m not seeing critical mass this year.

Having been Scrooge for a bit, I certainly have to join John in saying that yes, this is likely to be a pivotal year for the EMR industry, and for #HIT entrepreneurs.  I just think we’re going to remain stuck with some of these legacy issues for some time to come.

Are Best Of Breed EMRs Going Out Of Fashion?

Posted on September 4, 2012 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 visited a hospital which belonged to a health system going with Epic. This hospital, one of the smaller facilities in the chain, was running Picis in the ED and (I think) Cerner throughout, but the decision had been made to convert everything to Epic sometime soon, a tech told me.

I can’t say the news was surprising, but it was disappointing nonetheless. The community hospital in question has given me excellent service, and my guess is that when Epic barrels in, it will lose its way — at least for a while — frazzling the staff and decreasing the quality of their interaction with me.

However, I ‘d better get used to this trend. As Healthcare Technology Online editor in chief Ken Congdon notes in an excellent editorial, the pendulum is definitely swinging toward enterprise-wide EMR implementations, a direction encouraged by the standardized demands imposed nationwide by Meaningful Use.

If interoperability was easier to pull off, things might be different. But with HL7 and other integration standards and languages still not quite up to the job, one can see the sense of going with an enterprise option.

Here’s the story one CIO told Congdon as to why he’s deploying Siemens Soarian solution:

Michael Mistretta, CIO of MedCentral Health System  [said:]  “Vendor management was a key consideration in our decision to use a single vendor approach to EMR implementation,” says Mistretta. “With a single vendor, I only have one finger to point at. It simplifies my environment because I don’t have Siemens telling me it’s McKesson’s problem and vice versa. Also, the built-in interoperability is key. There is a trade-off in the fact that the system does not provide prime functionality to certain departments or specialties within our health system, but at this point in time, it’s much more beneficial for our organization to have the ability to share data across the continuum of care quickly and easily.” 

CIOs of large hospitals also told Congdon that enterprise system replacements were much cheaper than going through a long-term, highly-complex integration effort.

In an interesting twist, however, hospital IT leaders from mid-sized to smaller hospitals have reached the opposite conclusion, Congdon reports. They’ve been telling him that buying an enterprise system would be much more expensive than sticking with what they had and making it interoperate.

I see a market opening here. If enterprise EMR vendors can get their pricing in line for smaller hospitals, they may have a lot more wins coming their way than they expected.  Interesting stuff.

Group Develops EMR-Less HIE Technology

Posted on August 22, 2012 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 pair of major tech players and a group led by Geisinger have come together to create tools making health information exchanges accessible to providers who don’t have an EMR in place. The tools are aimed at skilled nursing facilities, but from what I can see, the approach would work for other providers too.

Federal standards already require SNFs to submit MDSs — which are electronic patient assessments — to both the Medicare and Medicaid programs. The thing is, MDS data doesn’t conform to the Continuity of Care standard, so it can’t be shared amongst various providers across an HIE.

What’s happening is that Geisinger’s Keystone Beacon Community and GE-Microsoft joint venture Caradigm have created a MDS (minimum data set)-to-CCD transformer which turns patient care data into a Continuity of Care Document.  Providers can then take their CCD document and transfer it to  an HIE.

The Keystone Beacon Community, which is part of an HHS-backed program established in 2009, was launched to speed up the ability of health IT to transform local healthcare systems.  Keystone includes a network of 17 central Pennsylvania providers, including medical practices, hospitals, long-term care communities and others.

I’m not surprised to see Geisinger driving this train, as it’s been ahead of the EMR curve for many years. Geisinger is also large enough to conduct a real test of new technologies, as its network single-handedly serves more than 2.6 million residents of 42 area counties.

Still, I’ve got to wonder whether efforts like the Direct Project aren’t a better place to invest energy at the moment. It seems to me that Direct Project technologies are far simpler to deal with and still get a great deal done. But then again, maybe I’m just being a party pooper.  Nonetheless, I can’t help feeling that in this situation, less (complicated technology) is more.