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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.

ePrescribing and Combating the Opioid Crisis

Posted on December 15, 2017 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.

Healthcare Scene recently sat down with Paul Uhrig, Chief Administrative, Legal and Privacy Officer for Surescripts, to talk about the Opioid Crisis and how technology like ePrescribing including electronically prescribing controlled substances (EPCS) can help deal with the opioid crisis.

We cover a lot of ground with Paul in this interview including some of the core problems with the opioid crisi. Plus, we talk about the evolution of ePrescribing including adoption rates across regular ePrescribing and EPCS (ePrescribing of Controlled Substances) and what’s holding adoption back. We dive into how technology and ePrescribing can help with the opioid abuse problem. I also ask Paul about what lessons we’ve learned from states like New York and Vermont that have already passed legislation that required ePrescribing of controlled substances. Finally, I couldn’t help but also ask Paul about Surescripts work to help during the recent natural disasters.

Check out the full interview with Paul Uhrig from Surescripts embedded below or on YouTube.

If you like this content, be sure to subscribe to Healthcare Scene on YouTube and browse through our other Healthcare IT interviews.

Surescripts Deal Connects EMR Vendors And PBMs To Improve Price Transparency

Posted on November 22, 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.

I’m no expert on the pharmacy business, but from where I sit as a consumer it’s always looked to me as though pharmaceutical pricing is something of a shell game. It makes predicting what your airline ticket will cost seem like child’s play.

Yes, in theory, the airlines engage in demand-oriented pricing, while pharma pricing is based on negotiated prices spread among multiple contracted parties, but in either case end-users such as myself have very little visibility into where these numbers are coming from.  And in my opinion, at least, that’s not good for anyone involved. You can say “blah blah blah skin in the game” all you want, but co-pays are a poor proxy for making informed decisions as a patient as to what benefits you’ll accrue and problems you face when buying a drug.

Apparently, Surescripts hopes to change the rules to some degree. It just announced that it has come together with two other interest groups within the pharmacy supply chain to offer patient-specific benefit and price information to providers at the point of care.

Its partners in the venture include a group of EMR companies, including Cerner, Epic, Practice Fusion and Aprima Medical Software, which it says represent 53% of the U.S. physician base. It’s also working with two pharmacy benefit managers (CVS Health and Express Scripts) which embrace almost two-thirds of US patients.

The new Surescripts effort actually has two parts, a Real-Time Prescription Benefit tool and an expanded version of its Prior Authorization solution.  Used together, and integrated with an EHR, these tools will clarify whether the patient’s health insurance will cover the drug suggested by the provider and offer therapeutic alternatives that might come at a lower price.

If you ask me, this is clever but fails to put pressure on the right parties. You don’t have to be a pharmaceutical industry expert to know that middlemen like PBMs and pharmacies use a number of less-than-visible stratagems jack up drug prices. Patients are forced to just cope with whatever deal these parties strike among themselves.

If you really want to build a network which helps consumers keep prices down, go for some real disclosure. Create a network which gathers and shares price information every time the drug changes hands, up to and including when the patient pays for that drug. This could have a massive effect on drug pricing overall.

Hey, look at what Amazon did just by making costs of shipping low and relatively transparent to end-users. They sucked a lot of the transaction costs out of the process of shipping products, then gave consumers tools allowing them to watch that benefit in action.

Give consumers even one-tenth of that visibility into their pharmacy supply chain, and prices would fall like a hot rock. Gee, I wonder why nobody’s ever tried that. Could it be that pharmaceutical manufacturers don’t want us to know the real costs of making and shipping their product?