Facilitating Interoperability

October 18th, 2013

Cross-Posted 10/18/13 from The Health Affairs Blog

A Health Affairs report on health information interoperability by staffers of the Office of the National Coordinator for Health Information Technology (ONC) provides a good enough summary of the situation. But it also is not news, and falls under the Bob Dylan Rule: You don’t need a weatherman to know which way the wind blows. From the article: “In general, limited interoperability across vendors, low motivation to share information in a fee-for-service payment environment, and the high cost of interfaces remain substantial barriers to widespread health information sharing.”

Two difficult but solvable structural problems block our exchange of health care information. The first is the “transport protocol.” Most health care data transport approaches lack the strong privacy and security safeguards that other industries now consider essential. The same industry that is moving toward clinical applications of mobile health, genomics, and nanotechnology still primarily relies on cumbersome, expensive faxes to transmit clinical information between organizations.

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Why EHRs Really Haven’t Made Us Healthier: A Response To Glen Tullman

Brian Klepper

Recently-fired Allscripts CEO Glen Tullman waxed progressive in a self-promotional Forbes article last week, describing the ways past and forward for electronic health records (EHRs) and health information technology (HIT). He may have been trying to recover from a damning New York Times article that clearly illustrated the relationships between campaign contributions, influence over health information technology policy, and business success.

Tullman recalls building EHRs that moved many physicians away from paper and the errors it fosters. He calls out David C. Kibbe, MD as an example of the forces wanting to preserve paper and opposing EHRs, with quotes from a 2008 blog post suggesting that the current crop are “notoriously expensive,” “difficult to implement” and unable to demonstrate care quality improvements. He predicts that, in the future, the industry will leverage open platforms and interoperability, yielding new monitoring and management utilities that can facilitate better care at lower cost.

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An Archipelago of Health Information Islands

Brian Klepper

Posted 12/27/12 on Medscape Connect’s Care and Cost Blog

My wife Elaine was hospitalized for 6 days recently with an array of ailments related to her advancing cancer, so diagnosing and addressing her problems required a multidisciplinary approach. In addition to the nursing and support staffs, she was tended by an emergency physician, two hospitalists, three gastroenterologists, a pulmonologist, an infectious disease physician and an interventional radiologist. With the exception of one specialist who had performed a procedure on her two weeks earlier, this episode was the first time any had met Elaine.

Each clinician was familiar with her status before visiting her, because the health system has an enterprise-wide electronic health record (EHR) that aggregates information into each patient’s chart. The hospitalists coordinated the care process and also touched base with Elaine’s primary care physician and her oncologist.

In other words, the system worked exactly like we hoped it would but often doesn’t. Especially in complex cases like this, the likelihood of a positive result is enhanced if the team members have access to the same complete information, and if someone – in this case the hospitalists – quarterbacks the activity.

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Putting Physician Practices Into Context

Brian Klepper

Posted 12/11/12 on Medscape Connect’s Care & Cost Blog

An organization’s ability to learn, and translate that learning into action rapidly, is the ultimate competitive advantage.

Jack Welch

Physicians and medical societies in all specialties would do well to take a look at this article, published in the November issue of The Journal of Oncology Practice. Authored by Elaine Towle, Thomas Barr and James Senese of Oncology Metrics (a subsidiary of the oncology electronic health record firm Altos Solutions), this year’s National Oncology Practice Benchmark Report aggregates and analyzes data on a wide variety of clinical, operational and financial business metrics. There are 89 charts in categories – work units, patient visits, revenue, practice expense, pharmacy operations, clinical trials, and staffing/productivity – from oncology practices around the country. The focus here is on the practice. The report does not delve into relative patient quality or cost.

The authors have deep experience with oncology practice, and they note that the cornerstone of their firm’s approach is “to promote the discovery and adoption of best practices.” Towle and Barr previously ran oncology practices in New Hampshire and Ft. Worth. This is their 7th annual report, meaning they have had the benefit of years of immersing in and refining their work product.

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Nothing About Me Without Me: Participatory Medicine, Meaningful Use and the American Hospital Association

David Harlow

Posted 5/6/12 on Health Blawg

Meaningful Use Stage 2 regulations were released in March by CMS and ONC. Over the past month or so, I’ve been working with other members of the Society for Participatory Medicine (thank you, all) to prepare comments on these regulations from the patient perspective. Last Friday, we filed two comment letters on the proposed regulations. One letter to the ONC on Meaningful Use Stage 2, and one letter to CMS on Meaningful Use Stage 2. Each letter opens like this:

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Will Regina Holiday Become Health Care’s Rosa Parks?

Michael Millenson

Posted 5/5/12 on The Health Care Blog

The protest organized by Regina Holliday over a patient’s right to access their medical information is not quite the same magnitude as agitating for integration in 1950s-era Alabama. Yet there are intriguing similarities between the crusade Rosa Parks launched then and what Holliday is attempting today. Both involve a refusal to accept second-class status and a resolve to push back against entrenched institutions.

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A Doctor’s Appointment on your Phone: Out of Beta and Into Your Pocket

Jane Sarasohn-Kahn

Posted 5/1/12 on Health Populi

You can now carry a doctor with you in your pocket. Two top telehealth companies that support online physician-patient visits have gone mobile. This upgrade was announced this week at the 2012 American Telemedicine Association conference, being held in San Jose, CA.

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Of Zombies, Emperor’s New Clothes, Documentation Inertia: LIngering Untrue Diagnoses That Persist in the Electronic Health Record

Jaan Sidorov

Posted 4/04/12 on The Disease Management Care Blog

Every practicing physician using an electronic health record (EHR) has seen them. Past diagnosis zombies that stumble endlessly through every encounter record. “Coronary heart disease” that the patient never really had, “diabetes” that was only one possibility among many and a “fracture” that never appeared on any x-ray.

These undead conditions clutter the technology-enabled health system basically because of two EHR value propositions:

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Will the Quantified Self Movement Take Off in Health Care?

Kent Bottles

Posted 4/02/12 on Kent Bottles Private Views

“If you cannot measure it, you cannot improve it.” Lord Kelvin

“Asking science to explain life and vital matters is equivalent to asking a grammarian to explain poetry.” Nassim Nicholas Taleb

Of course the quantified self movement with its self-tracking, body hacking, and data-driven life started in San Francisco when Gary Wolf started the “Quantified Self” blog in 2007. By 2012, there were regular meetings in 50 cities and a European and American conference. Most of us do not keep track of our moods, our blood pressure, how many drinks we have, or our sleep patterns every day. Most of us probably prefer the Taleb to the Lord Kelvin quotation when it comes to living our daily lives. And yet there are an increasing number of early adopters who are dedicated members of the quantified self movement.

“They are an eclectic mix of early adopters, fitness freaks, technology evangelists, personal-development junkies, hackers, and patients suffering from a wide variety of health problems. What they share is a belief that gathering and analysing data about their everyday activities can help them improve their lives.”

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What’s the Difference Between ACOs and “AC-Like” Arrangements?

Vince Kuraitis

Posted 3/09/12 on the e-CareManagement Blog

A lot. AC-Like arrangements will be MUCH simpler to create and maintain.

The health care market is moving toward accountable care. There are at least two broad paths forward:

1) Formal Accountable Care Organizations (ACOs) by which care providers contract with Medicare

2) Informal Accountable Care-Like (AC-Like) arrangements between care providers and commercial health plans

What are the differences between these routes? I see at least 5 factors at play:

Transaction costs
Timing
Incrementalism
Flexibility
Capital cost

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Job #1 in Health Care Data Analytics: Get the Data, and Make Sure You Can Trust It

The ability to get the data is the #1 obstacle that will slow the adoption of data analytics in health care, according to IBM’s report, The value of analytics in healthcare: from insights to outcomes.

Healthcare “high performers,” as IBM calls them, use data analytics for guiding future strategy, product research and development, and sales and marketing functions. 90% of healthcare CIOs told IBM that developing “insight and intelligence” were key focuses of their organizations over the next 3 to 5 years.

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Data Breach: How Much Will One Cost You?

David Harlow

Posted 3/06/12 on Health Blawg

MP900440914 The going rate for a compromised medical record seems to be $1000 (well, at least that’s the asking price) as seen in papers filed in the eleven class action lawsuits against Sutter Health following the theft of a desktop computer last fall. The computer contained unencrypted protected health information on about 4.24 million members. The eleven class action suits are likely to be consolidated for ease of handling by the courts.

For an outfit whose most recently reported year-end financials show just under $900 million in income on just over $9 billion in revenue, a $4.24 billion claim certainly qualifies as a big deal. The data breach claims against Sutter Health were filed last year following its self-reporting of the computer theft, and are in the news again due to the potential consolidation.

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Technology, Aetna, iTriage, and the Future of Medicine

Kent Bottles

Posted 3/06/12 on Kent Bottles Private Views

Somehow I got invited to an Aetna coming out party for their Care Pass Platform. The corporate event complete with chocolate covered strawberries, wine, and beef and chicken on a stick was an opportunity to meet some of my longest twitter colleagues: @MatthewBrowning @unitystoakes @stevenkreinmd @paulomachado @sjdmd @boltyboy @hjluks @PJMachado @shwen

Mark Bertolini, the CEO of Aetna, first appeared on my radar when he spoke at HIMSS on the challenges that health care insurance companies face: “The end of insurance companies, the way we’ve run the business, is here.” Finally, an insurance executive who gets it. I am reminded of another CEO who told me, “I am more scared about our business model than ever before.”

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Fewer Than 10% of People Manage Health via Mobile: a HIMSS Reality Check on Remote Health Monitoring

Jane Sarasohn-Kahn

Posted 2/28/12 on Health Populi

With mobile health consumer market projections for ranging from $7 billion to $43 billion, according to PricewaterhouseCoopers, a casual reader might think that a plethora of health citizens are tracking their health, weight, food intake, exercise, and other observations of daily living by smartphones and tablets.

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