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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.

Apple Trials Tech Offering Patient Access To Their Health Records

Posted on January 29, 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.

In recent times, tech giants have been falling over themselves in a race to offer consumers the best access to their health data, including even dark horses like Amazon. And it’s little wonder – it’s become increasingly obvious that he who controls patient health data access controls a critical sector of the entire healthcare industry.

The most recent stake in the ground comes from Apple, whose latest update to its Health app allows customers to see their medical records on their iPhone. The Health Records section of the Health app, which comes with the release of the iOS 11.3 beta, collects FHIR-based records from multiple sources and makes them available through its Health Records section.

The patient data display will pull together patient data from various healthcare organizations into a single view. The data will include lists of allergies, conditions and medications taken, immunizations records, lab results on procedures and vital sign information. When providers published new information, iPhone users will be notified.

To conduct its Health Records beta test, Apple has partnered with a number of high-profile health systems and hospitals, including Johns Hopkins Medicine; Cedars-Sinai; Penn Medicine; Geisinger Health System; UC San Diego Health; UNC Health Care; Rush University Medical Center; Dignity Health; Ochsner Health System; MedStar Health and OhioHealth.

As part of its launch, Apple told the New York Times that unless consumers specifically choose to share it with the company, it will never see the data, which will be encrypted and stored locally on the iPhone.  A recent (if unscientific) poll suggests that consumers trust Apple with their health data more than other top tech vendors, so this reassurance may be enough to ease their fears.

But security is hardly Apple’s biggest concern. How does the tech colossus expect to profit from its health data investments?  When I break the issues down, it looks like this:

  • Unlike hospitals and clinics, which can expect medium- to long-term ROI when patients manage their health better, Apple doesn’t deliver care.
  • Apple might want to sell anonymized aggregated patient data, but as far as I know, the company would still have to get patient permission, and that would be an administrative and legal nightmare.
  • If Apple or its competitors have some vision of selling access to the patient, good luck with that. Providers have a hard time attracting and keeping patients with nifty technology even if those patients live in their backyard.

While I could be missing something major, from what I see, Apple, Google, Samsung, Amazon and the rest are engaging in a series of preemptive patient data land grabs. My sense is that none of them know exactly what to do with this data, they’ll be damned if they’re going to let their competitors get there first.

That said, many in the industry are suggesting that this move is just another effort by Apple to sell more iPhones. The question I ask is how valuable will the information be to the patients? Certainly the beta hospitals and health systems are large and have a lot of data, but how is this going to scale down to the smaller providers? If you don’t have these smaller providers, then you’re going to be missing some of the most important health data.

Rush Sues Patient Monitoring Vendor, Says System Didn’t Work

Posted on August 25, 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.

Rush University Medical Center has filed suit against one of its health IT vendors, claiming that its patient monitoring system didn’t work as promised and may have put patients in danger.

According to a story in the Chicago Tribune, Rush spent $18 million installing the Infinity Acute Monitoring Solution system from Telford, PA-based Draeger Inc. between 2012 and early 2016.  The Infinity system included bedside monitors, larger data aggregating monitors at central nursing stations, battery-powered portable monitors and M300 wireless patient-worn monitors.

However, despite years of attempting to fix the system, its patient alarms were still unreliable and inaccurate, it contends in the filing, which accuses Draeger of breach of contract, unjust enrichment and fraud.

In the suit, the 664-bed hospital and academic medical center says that the system was dogged by many issues which could have had an impact on patient safety. For example, it says, the portable monitors stopped collecting data when moved to wireless networks and sometimes stole IP addresses from bedside monitors, knocking the bedside monitor off-line leaving the patient unmonitored.

In addition, the system allegedly sent out false alarms for heart arrhythmia patients with pacemakers, distracting clinicians from performing their jobs, and failed monitor apnea until 2015, according to the complaint. Even then, the system wasn’t monitoring some sets of apnea patients accurately, it said. Near the end, the system erased some patient records as well, it contends.

Not only that, Draeger didn’t deliver everything it was supposed to provide, the suit alleges, including wired-to-wireless monitoring and monitoring for desaturation of neonatal patients’ blood oxygen.

As if that weren’t enough, Draeger didn’t respond effectively when Rush executives told it about the problems it was having, according to the suit. “Rather than effectively remediating these problems, Draeger largely, and inaccurately, blamed them on Rush,” it contends.

While Draeger provided a software upgrade for the system, it was extremely difficult to implement, didn’t fix the original issues and created new problems, the suit says.

According to Rush, the Draeger system was supposed to last 10 years. However, because of technical problems it observed, the medical center replaced the system after only five years, spending $30 million on the new software, it says.

Rush is asking the court to make Draeger pay that the $18 million it spent on the system, along with punitive damages and legal fees.

It’s hard to predict the outcome of such a case, particularly given that the system’s performance has to have depended in part on how Rush managed the implementation. Plus, we’re only seeing the allegations made by Rush in the suit and not Draeger’s perspective which could be very different and offer other details. Regardless, it seems likely these proceedings will be watched closely in the industry. Regardless of whether they are at fault or not, no vendor can afford to get a reputation for endangering patient safety, and moreover, no hospital can afford to buy from them if they do.

Hospital App Helps Patients After Surgery

Posted on March 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.

Patients are very vulnerable after surgery. If they don’t follow post-surgical instructions, they may be readmitted (never a good thing for hospitals these days), and far worse, may suffer real harm.

Unfortunately, many patients don’t retain or follow doctors’ instructions on how to best recover from surgery, particularly if these instructions aren’t documented well.  For example, a 2015 study appearing in Anesthesiology concluded that only 60% of 519 surgery patients who got verbal post-operative instructions or annotated EMR records complied with medication instructions.

In an effort to improve stats like these, Chicago’s Rush University Medical Center has introduced an app designed to support patients in their post-surgical recovery process. The app, SeamlessMD, prompts patients to ask for reminders about their surgeon’s instructions, according to a HIMSS Future Care article.

Anthony Perry, MD, vice president for ambulatory care and population health at Rush, told the publication that his facility had already implemented protocols for enhanced recovery after surgery before the app was created. But the app has potential to move patients’ post-surgical recovery to the next level, Perry said. “It’s not only a neat technology, but a neat technology that’s truly aligned with our own goals,” he noted.

Dr. Perry believes that presenting prompts and reminders via a personal mobile device offers benefits traditional care instructions can’t, particularly when the app is placed on a patient’s phone. “There’s a bridge that a smartphone gives us into a person’s everyday life that we don’t have when they come visit us in the office,” he said.

Rush’s initiative comes as hospitals around the world consider the benefits of rolling out patient-oriented apps. For example, four National Health Services hospitals serving the United Kingdom are testing apps that monitor patient health at home.

The hospitals are testing two apps, one focused on managing gestational diabetes treatment and the other addressing COPD monitoring and care. (As one might expect, the diabetes app collects blood glucose readings and the COPD app oxygen saturation levels.) The pilot, which is still in its initial stages, has already seen some success. For example, the number of office visits by patients with gestational diabetes has fallen 25% since the app was released to such patients.

This may be the dawn of a new age for hospital use of mHealth apps, which has been at best at a trial-and-error stage for several years. While most hospitals and health systems have toyed with apps to some degree, in the past there was neither a clinical nor technical approach for them to adopt. So many initial app projects went nowhere.

But with evidence piling up that at least some approaches work – such as remote patient monitoring for chronic disease management, as described above – hospitals are beginning to see apps as a practical tool for improving outcomes. Meanwhile, as they’ve adopted mobile-friendly infrastructures, hospitals have become more capable of supporting hospital-developed apps effectively.

Of course, there’s probably a number of functions apps can perform which nobody’s pursued just yet. But with some early successes in place, my guess is that hospitals will try lots of new app projects going forward.

Rush University Medical Center Rolls Out OpenNotes

Posted on November 18, 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.

Back in 2010, a group of primary care doctors from three different healthcare organizations across the US came together to launch a project in which they’d begin sharing their clinical notes directly with their patients. The doctors involved were part of a 12-month study designed to explore how such sharing would affect healthcare. The project was a success, and today, 10 million patients have access to their clinicians’ notes via OpenNotes.

Now, Rush University Medical Center has joined the party. The 664-bed academic hospital, which is based in Chicago, now allows patients to see all of their doctor’s notes through a secure web link which is part of Epic’s MyChart portal. According to Internet Health Management, Rush has been piloting OpenNotes since February and rolled it out across the system last month.  Patients could already use MyChart to review physician instructions, prescriptions and test orders online.

If past research is any indication, the new service is likely to be hit with patients. According to a study from a few years ago, which looked at 3,874 primary care patients at Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center, 99% of study participants wanted continued access to clinician notes after having it for one year. This was true despite the fact that almost 37% of patients reported being concerned about privacy after using the portal during that time.

Dr. Allison Weathers, Rush associate chief medical information officer, told the site that having access to the notes can help individuals with complex health needs and under the care of multiple providers. “Research shows that when patients can access their physicians’ notes, they better understand the medical issues and treatment plan as active partners in their care,” she said. “When a patient is sick, tired or stressed during a doctor’s visit, they may forget what the doctors said or prescribed.”

I think it’s also apparent that giving patients access to clinician notes helps them engage further with the process of care. Ordinarily, for many patients, medical notes from their doctor are just something that they hand along to another doctor. However, when they have easy access to their notes, alongside of the test results, appointment scheduling, physician email access and other portal functions, it helps them become accustomed to wading through these reports.

Of course, some doctors still aren’t OpenNotes-friendly. It’s easy to see why. For many, the idea of such sharing private notes — and perhaps some unflattering conclusions — has been out of the question. Many have suggested that if patients read the notes, they can’t feel free to share their real opinion on matters of patient care and prognosis. But the growth of the OpenNotes program suggests to me that the effect of sharing notes has largely been beneficial, giving patients the opportunity not only to correct any factual mistakes but to better understand their provider’s perspective. As I see it, only good can come from this over the long run.