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Don’t Yell FHIR in a Hospital … Yet

Posted on November 30, 2016 I Written By

The following is a guest blog post by Richard Bagdonas, CTO and Chief Healthcare Architect at MI7.
richard-bagdonas
The Fast Healthcare Interoperability Resource standard, commonly referred to as FHIR (pronounced “fire”) has a lot of people in the healthcare industry hopeful for interoperability between the electronic health record (EHR) systems and external systems — enabling greater information sharing.

As we move into value-based healthcare and away from fee-for-service healthcare, one thing becomes clear: care is no longer siloed to one doctor and most certainly not to one facility. Think of the numerous locations a patient must visit when getting a knee replaced. They start at their general practitioner’s office, then go to the orthopedic surgeon, followed by the radiology center, then to the hospital, often back to the ortho’s office, and finally to one or more physical therapists.

Currently the doctor’s incentives are not aligned with the patient. If the surgery needs to be repeated, the insurance company and patient pay for it again. In the future the doctor will be judged and rewarded or penalized for their performance in what is called the patient’s “episode of care.” All of this coordination between providers requires the parties involved become intimately aware of everything happening at each step in the process.

This all took off back in 2011 when Medicare began an EHR incentive program providing $27B in incentives to doctors at the 5,700 hospitals and 235,000 medical practices to adopt EHR systems. Hospitals would receive $2M and doctors would receive $63,750 when they put in the EHR system and performed some basic functions proving they were using it under what has been termed “Meaningful Use” or MU.

EHR manufacturers made a lot of money selling systems leveraging the MU incentives. The problem most hospitals ran into is their EHR didn’t come with integrations to external systems. Integration is typically done using a 30 year old standard called Health Level 7 or HL7. The EHR can talk to outside systems using HL7, but only if the interface is turned on and both systems use the same version. EHR vendors typically charge thousands of dollars and sometimes tens of thousands to turn on each interface. This is why interface engines have been all the rage since they turn one interface into multiple.

The great part of HL7 is it is standard. The bad parts of HL7 are a) there are 11 standards, b) not all vendors use all standards, c) most EHRs are still using version 2.3 which was released in 1997, and d) each EHR vendor messes up the HL7 standard in their own unique way, causing untold headaches for integration project managers across the country. The joke in the industry is if you have seen one EHR integration, you’ve seen “just one.”

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HL7 versions over the years

HL7 version 3.0 which was released in 2005 was supposed to clear up a lot of this integration mess. It used the Extensible Markup Language (XML) to make it easier for software developers to parse the healthcare messages from the EHR, and it had places to stick just about all of the data a modern healthcare system needs for care coordination. Unfortunately HL7 3.0 didn’t take off and many EHRs didn’t build support for it.

FHIR is the new instantiation of HL7 3.0 using JavaScript Object Notation (JSON), and optionally XML, to do similar things using more modern technology concepts such as Representation State Transfer (REST) with HTTP requests to GET, PUT, POST, and DELETE these resources. Developers love JSON.

FHIR is not ready for prime time and based on how HL7 versions have been rolled out over the years it will not be used in a very large percentage of the medical facilities for several years. The problem the FHIR standard created is a method by which a medical facility could port EHR data from one manufacturer to another. EHR manufacturers don’t want to let this happen so it is doubtful they will completely implement FHIR — especially since it is not a requirement of MU.

And FHIR is still not hardened. There have been fifteen versions of FHIR released over the last two years with six incompatible with earlier versions. We are a year away at best from the standard going from draft to release, so plan on there being even more changes.

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15 versions of FHIR since 2014 with 6 that are incompatible with earlier versions

Another reason for questioning FHIR’s impact is the standard has several ways to transmit and receive data besides HTTP requests. One EHR may use sockets, while another uses file folder delivery, while another uses HTTP requests. This means the need for integration engines still exists and as such the value from moving to FHIR may be reduced.

Lastly, the implementation of FHIR’s query-able interface means hospitals will have to decide if they must host all of their data in a cloud-based system for outside entities to use or become a massive data center running the numerous servers it will take to allow patients with mobile devices to not take down the EHR when physicians need it for mission-critical use.

While the data geek inside me loves the idea of FHIR, my decades of experience performing healthcare integrations with EHRs tell me there is more smoke than there is FHIR right now.

My best advice when it comes to FHIR is to keep using the technologies you have today and if you are not retired by the time FHIR hits its adoption curve, look at it with fresh eyes at that time. I will be eagerly awaiting its arrival, someday.

About Richard Bagdonas
Richard Bagdonas has over 12 years integrating software with more than 40 electronic health record system brands. He is an expert witness on HL7 and EDI-based medical billing. Richard served as a technical consultant to the US Air Force and Pentagon in the mid-1990’s and authored 4 books on telecom/data network design and engineering. Richard is currently the CTO and Chief Healthcare Architect at MI7, a healthcare integration software company based in Austin, TX.

A Look At Nursing Home Readiness For HIE Participation

Posted on October 12, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

A newly released study suggests that nursing homes have several steps to go through before they are ready to participate in health information exchanges. The study, which appeared in the AHIMA-backed Perspectives in Health Information Management, was designed to help researchers understand the challenges nursing homes faced in health information sharing, as well as what successes they had achieved to date.

As the study write up notes, the U.S. nursing home population is large — nearly 1.7 million residents spread across 15,600 nursing homes as of 2014. But unlike other settings that care for a high volume of patients, nursing homes haven’t been eligible for EMR incentive programs that might have helped them participate in HIEs.

Not surprisingly, this has left the homes at something of a disadvantage, with very few participating in networked health data sharing. And this is a problem in caring for residents adequately, as their care is complex, involving nurses, physicians, physicians’ offices, pharmacists and diagnostic testing services. So understanding what potential these homes have to connect is a worthwhile topic of study. That’s particularly the case given that little is known about HIE implementation and the value of shared patient records across multiple community-based settings, the study notes.

To conduct the study, researchers conducted interviews with 15 nursing home leaders representing 14 homes in the midwestern United States that participated in the Missouri Quality Improvement Initiative (MOQI) national demonstration project.  Studying MOQI participants helped researchers to achieve their goals, as one of the key technology goals of the CMS-backed project is to develop knowledge of HIE implementations across nursing homes and hospital boundaries and determine the value of such systems to users.

The researchers concluded that incorporating HIE technology into existing work processes would boost use and overall adoption. They also found that participation inside and outside of the facility, and providing employees with appropriate training and retraining, as well as getting others to use the HIE, would have a positive effect on health data sharing projects. Meanwhile, getting the HIE operational and putting policies for technology use were challenges on the table for these institutions.

Ultimately, the study concluded that nursing homes considering HIE adoption should look at three areas of concern before getting started.

  • One area was the home’s readiness to adopt technology. Without the right level of readiness to get started, any HIE project is likely to fail, and nursing home-based data exchanges are no exception. This would be particularly important to a project in a niche like this one, which never enjoyed the outside boost to the emergence of the technology culture which hospitals and doctors enjoyed under Meaningful Use.
  • Another area identified by researchers was the availability of technology resources. While the researchers didn’t specify whether they meant access to technology itself or the internal staff or consultants to execute the project, but both seem like important considerations in light of this study.
  • The final area researchers identified as critical for making a success of HIE adoption in nursing homes was the ability to match new clinical workflows to the work already getting done in the homes. This, of course, is important in any setting where leaders are considering major new technology initiatives.

Too often, discussions of health data sharing leave out major sectors of the healthcare economy like this one. It’s good to take a look at what full participation in health data sharing with nursing homes could mean for healthcare.

ONC Announces Winners Of FHIR App Challenge

Posted on August 3, 2016 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The ONC has announced the first wave of winners of two app challenges, both of which called for competitors to use FHIR standards and open APIs.

As I’ve noted previously, I’m skeptical that market forces can solve our industry’s broad interoperability problems, even if they’re supported and channeled by a neutral intermediary like ONC. But there’s little doubt that FHIR has the potential to provide some of the benefits of interoperability, as we’ll see below.

Winners of Phase 1 of the agency’s Consumer Health Data Aggregator Challenge, each of whom will receive a $15,000 award, included the following:

  • Green Circle Health’s platform is designed to provide a comprehensive family health dashboard covering the Common Clinical Data Set, using FHIR to transfer patient information. This app will also integrate patient-generated health data from connected devices such as wearables and sensors.
  • The Prevvy Family Health Assistant by HealthCentrix offers tools for managing a family’s health and wellness, as well as targeted data exchange. Prevvy uses both FHIR and Direct messaging with EMRs certified for Meaningful Use Stage 2.
  • Medyear’s mobile app uses FHIR to merge patient records from multiple sources, making them accessible through a single interface. It displays real-time EMR updates via a social media-style feed, as well as functions intended to make it simple to message or call clinicians.
  • The Locket app by MetroStar Systems pulls patient data from different EMRs together onto a single mobile device. Other Locket capabilities include paper-free check in and appointment scheduling and reminders.

ONC also announced winners of the Provider User Experience Challenge, each of whom will also get a $15,000 award. This part of the contest was dedicated to promoting the use of FHIR as well, but participants were asked to show how they could enhance providers’ EMR experience, specifically by making clinical workflows more intuitive, specific to clinical specialty and actionable, by making data accessible to apps through APIs. Winners include the following:

  • The Herald platform by Herald Health uses FHIR to highlight patient information most needed by clinicians. By integrating FHIT, Herald will offer alerts based on real-time EMR data.
  • PHRASE (Population Health Risk Assessment Support Engine) Health is creating a clinical decision support platform designed to better manage emerging illnesses, integrating more external data sources into the process of identifying at-risk patients and enabling the two-way exchange of information between providers and public health entities.
  • A partnership between the University of Utah Health Care, Intermountain Healthcare and Duke Health System is providing clinical decision support for timely diagnosis and management of newborn bilirubin according to evidence-based practice. The partners will integrate the app across each member’s EMR.
  • WellSheet has created a web application using machine learning and natural language processing to prioritize important information during a patient visit. Its algorithm simplifies workflows incorporating multiple data sources, including those enabled by FHIR. It then presents information in a single screen.

As I see it, the two contests don’t necessarily need to be run on separate tracks. After all, providers need aggregate data and consumers need prioritized, easy-to-navigate platforms. But either way, this effort seems to have been productive. I’m eager to see the winners of the next phase.

A 10 Year Old Child Shows Us Why A Direct Project Directory Is Unnecessary

Posted on December 15, 2015 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.

I recently hosted a panel of direct project experts. During the panel, Greg Meyers (@greg_meyer93) talked about why the need for a Direct Address directory was overstated. He argued that doctors could collect the direct addresses for the network of providers they refer to on their own quite easily. A directory would be nice, but you could still easily get value from direct without one.

To prove this point, Greg sent over this great story about his niece.

This past weekend, my wife’s family held their Christmas dinner and gift exchange, and the actions from my 10 year old niece were the highlight of my day. She has been desperately wanting a iPod Touch for quite some time for simple tween workflows such as taking pictures/video, downloading apps, and emailing/video chatting with her friends. With me being the corruptive spoiler of my sister-in-law’s children, I got permission a few months back to get her daughter the prized iTouch as a Christmas present.

From the moment she opened it, her excitement almost exploded out of her face. She spent the first hour asking Siri silly little girl questions, but the next hour was a display of simple intuition and what appears to achieve what some in the Health IT domain describe as almost impossible.

The tasks was simple: setup her email and FaceTime so she could start communicating with her family and friend immediately. Keep in mind this a child whose only electronic presence is her GMail account mandated via her 5th grade class; no Facebook, no SnapChat, no Twitter, no WhatsApp, and no access to a repository of electronic endpoints other than what she could find with a google search.

We went down the path of getting FaceTime associated with an AppleId and configuring the email app with access to her GMail account. What happened next was my moment of the year. She went around asking all her family members for email addresses and entering them into her contacts list. Anybody that had an apple device, she asked if they were on FaceTime and tried to initiate a test video conversation. If she had issues connecting to them, she would ask them to initiate a conversation by giving them her address and added them into her contacts after terminating a test chat. She tried adding some her classmates via the email addresses she knew, but when she failed, she said she would just call them or ask when she went back to school on Monday. By the time the day was over, she had built a respectable network (with validated endpoints) with her closest contacts and formed solid plan of how to continue to build her network. Oh, and she did this without the assistance of a directory; just plain old simple leg work.

I’m kicking myself for not following her with a video camera, but I think this poetically demonstrated the ability to build useful networks via the trivial thought processes of a tween girl.

Thanks Greg for sharing the story. Sometimes we seem to forget that not all solutions have to be technical and we don’t have to be hand fed everything. Here’s the video interview with Greg Meyers, Julie Mass and Mark Hefner for those that want to learn more about Direct Project:

EMR Vendors Struggle With Meaningful Use Stage 2

Posted on October 29, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

CCHIT head Alisa Ray, clearly, is trying to put it delicately. EMR vendors are “struggling a little bit” when it comes to meeting 2014 criteria. “It  has been a slow start,” Ray told Healthcare IT News.

Usually, hearing this would lead to an inside baseball discussion of vendor operations, which wouldn’t be very exciting. But the thing is, meeting 2014 certification criteria is necessary to allow providers to meet Meaningful Use Stage 2. So vendor struggles in complying with CCHIT’s criteria should concern providers a great deal.

There are three areas of Stage 2 that are proving to be an issue for vendors: clinical quality measures, interoperability and automated measure calculation for reporting metrics, Ray said.

This has led to a real lag in certifications. About 40 companies had listed products with the CCHIT in 2011, but a scant 21 percent of those have stepped up and gotten certified in the 2014 criteria.

According to Ray’s chat with Healthcare IT News, “almost everyone has struggled and been surprised by the complexities” of meeting 2014 standards.  Despite having gone through the process yearly since 2006 with CCHIT, several have had to go through repeated certification trials to meet criteria.

ICSA Labs’ Amit Trivedi, meanwhile, noted that while there were close to 3,000 listings, with many having multiple listings — Cerner alone had 800 — so far there less than 300 on ONC’s Certified Health IT Products list.

There are signs that EMR vendors will catch up, the HIT story suggests. For example, vendors have been working particularly hard to offer Continuity of Care Documents or Direct messaging, a capability providers must demonstrate for Meaningful  Use Stage 2, said Matt Kohler, vice president of Network Infrastructure Services at Surescripts.

But vendors clearly have some serious development challenges ahead if they want to keep up with the pace set by Meaningful Use Stage 2.  If I were a provider reading this, I’d call my vendor right away and see where they were at in the certification process.

Eyes Wide Shut – Managing Multi-EMR Meaningful Use Stage 2 Is Hard

Posted on October 2, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Most discussions on Meaningful Use (MU) seem to focus on a single healthcare provider organization (acute or ambulatory), with a single EMR, and a single Medical Record Number (MRN) pool generating unique patient identifiers. Even in that context, the complaints of the difficulties of successfully implementing the technology and obtaining the objectives are deafening. How daunting might those challenges seem, multiplied across a large integrated delivery network (IDN), attempting to make enterprise-wide technology and operational process decisions, in alignment with MU incentive objectives?

Imagine you are an IDN with 9 hospital facilities, sharing a single EMR. You also have 67 ambulatory practices, with 7 additional EMRs. You’ve made the progressive choice to implement a private health information exchange (HIE) to make clinical summary data available throughout the IDN, creating a patient-centric environment conducive to improved care coordination. To properly engage patients across the IDN and give them the best user experience possible, you’ve purchased an enterprise portal product that is not tethered to an EMR, and instead sources from the HIE. And because you’ve factored the MU incentive dollars into the budget which enabled these purchasing decisions, there is no choice but to achieve the core and select menu measures for 2014.

It is now October 2013. The first quarter you’ve chosen to gather Stage 2 attestation data starts on April 1, 2014. All your technology and process changes must be ready by the data capture start date, in order to have the best opportunity to achieve the objectives. Once data capture begins, you have 90 days to “check the box” for each MU measure.

Tech check: are all the EMRs in your IDN considered Certified Electronic Health Records Technology (CEHRT) for the 2014 measures?

Your acute EMR is currently 2 versions behind the newly-released MU 2014-certified version; it is scheduled to complete the upgrade in November 2013. Your highest-volume ambulatory EMR is also 2 versions behind the 2014-certified version, and it cannot be upgraded until March 2014 due to vendor resource constraints. Your cardiology EMR cannot be upgraded until June due to significant workflow differences between versions, impacting those providers still completing Stage 1 attestation. One of your EMRs cannot give you a certification date for its 2014 edition, and cannot provide an implementation date for the certified version. The enterprise portal product has been 2014-certified as a modular EMR, but the upgrade to the certified version is not available until February 2014.

Clearly, your timeline to successfully test and implement the multitude of EMR upgrades required prior to your attestation date is at risk.

Each EMR might be certified, but will it be able to meet the measures out of the box?

Once upgraded to the 2014 version, your acute EMR must generate Summary of Care C-CDA documents and transmit them to an external provider, via the Direct transfer protocol. Your ambulatory EMRs must generate Transition of Care C-CDA documents and use the same Direct protocol to transmit. But did you purchase the Direct module when you signed your EMR contract, or maintenance agreement?

Did you check to see whether the Direct module that has been certified with the EMR is also an accredited member of DirectTrust?

Did you know that some EMRs have Direct modules that can ONLY transmit data to DirectTrust-accredited modules?

You determine your acute EMR will only send to EMRs with DirectTrust-accredited modules, and that you only have a single ambulatory EMR meeting this criteria. That ambulatory EMR is not the primary target for post-acute care referral.

You have no control over the EMRs of providers outside the IDN, who represent more than 20% of your specialist referrals.

Your 10% electronic submission of Summary of Care C-CDA documents via Direct protocol measure is at risk.

Is your organization prepared to manage the changes required to support the 2014 measures?

This is a triple-legged stool consideration: people, process, and technology must all align for change to be effective. To identify the process changes required, and the people needed to support those processes, you must understand the technology that will be driving this change. Of all the EMRs in your organization, only 2 have provided product specifications, release notes, and user guides for their 2014-certified editions.

Requests for documentation about UI, data, or workflow changes in the 2014 versions are met with vague responses, “We will ask product management and get back to you on that.” Without information on the workflow changes, you cannot identify process changes. Without process change recognition, you cannot properly identify people required to execute the processes. You are left completely in the dark until such time as the vendors see fit to release not only the product, but the documentation supporting the product.

Clearly, your enterprise program for Meaningful Use Stage 2 health IT implementation and adoption is at risk.

What is the likelihood that your Meaningful Use Stage 2 attestation will be a successful endeavor for the enterprise?

As a program manager, I would put this effort in flaming red status, due to the multitude of risks and external dependencies over which the IDN organization has zero control. I’d apply that same stoplight scorecard rating to the MU Stage 2 initiative. There is simply too much risk and too many variables outside the provider’s control to execute this plan effectively, without incurring negative impacts to patient care.

The ONC never said Meaningful Use would be easy, but does it have to be this hard?

Eyes Wide Shut – Is This Meaningful Use?

Posted on September 25, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

Again and again, I find myself expounding upon the need to differentiate between the “letter of the law” and the “spirit of the law” of Meaningful Use Stage 2. I believe whole-heartedly in the transformative power of health IT, and support the future vision of the Meaningful Use objectives of patient empowerment and nationwide standards for records transmission and interoperability. The spirit of the “law” is a revolutionary movement towards a technology-enabled, patient-centric healthcare system, where clinical data can be shared and consumed instantly, whenever patient desires or requires it.

The letter of the “law” is daunting, and its implementation could be seen as not only counter-revolutionary, but detrimental to the very patient population it is designed to engage and empower.

Consider this acute care scenario:

You’re a hospital healthcare provider, discharging a patient, in compliance with the patient-specific education and Summary of Care measures. You log in to your EMR, complete the discharge instructions in the correlated workflow, print the discharge summary and any condition-specific educational information for the patient, revisit their room to insure that they can review the instructions and ask any questions, and you’re on to assessing the condition of the next patient in need of care. Right?

How many times did you have to close the “patient-specific education” suggestion windows that popped up, alerting you to available materials for download, keyed off diagnosis codes or lab results?

How many minutes did you spend looking for the HISP address of the patient’s cardiologist, so you could transmit the Summary of Care document to them via the Direct module of your EMR? How many clicks did you have to use to FIND the Direct module in your EMR? And how many minutes did you spend cursing the ONC for requiring Direct for Summary of Care transmission for 10% of your discharged patient population when the cardiologist’s address was rejected by the Direct module, giving you a message that the receiver is not DirectTrust-accredited?

How much time did the discharge process take you before your facility decided to attest to Meaningful Use Stage 2? How much time does it take you now?
Consider this ambulatory care scenario:

You’re support staff for a general practitioner, who is deploying a patient portal in support of patient engagement measures. At check-in (or check-out), you provide the patients with the URL for enrollment and access, give them information on the benefits of having their medical records available electronically, encourage them to communicate electronically with their provider with questions or concerns, and you send them on their empowered and engaged way.

How many minutes did you spend validating each portal account owner’s identity once their enrollment request came? How many minutes did you spend validating the relationship of the portal account owner to each of the patients he/she requests to associate with the account? How did you document the due diligence done to insure no medical records are improperly released per HIPAA and other federal guidelines, as in the case of custodial disputes, behavioral health patients, or emancipated minors?

How many minutes did you spend walking patients through the enrollment, login, medical records view, and secure message functions? How much time did you spend answering questions from patients about the portal, rather than the health concerns that prompted the visit?

How much time did the check-out process take before your GP decided to attest to Meaningful Use Stage 2? How much time does it take you now?

In both of these scenarios, did you or the patient see any measurable difference in care as a result of the EMR’s new functionality?

Now, consider the aggregate of these scenarios over an entire day – dozens of encounters, dozens of clicks, dozens of minutes spent engaging the EMR to record requisite “clicks” for attestation numerator reporting, rather than engaging the patient.

Is this meaningful use of a healthcare provider’s time and energy? Is this meaningful use of health IT, meeting very specific targets to obtain finite objectives rather than enabling innovation and deriving best practice long-term solutions?

Is this what the ONC intended?

Health IT Tweet Roundup – Neil Versel Edition

Posted on July 21, 2013 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.

As you know, each weekend I like to do a roundup of interesting tweets and add a bit of commentary. This time I thought it would be fun to grab some tweets from just one person, Neil Versel. Neil has been doing a number of really great posts on his blog Meaningful Health IT News lately (Full Disclosure: Neil’s blog is part of the Healthcare Scene blog network). The following tweets highlight some of Neil’s recent blog posts.


I agree that Blue Button Plus is a great step forward for Blue Button. This post is particularly interesting because Neil didn’t see the promise of Blue Button before the changes were made and it was called plus.


This is a great discussion on the meaningful use requirements and Blue Button’s role in them. Join in if you have some knowledge on the area about what your EHR is doing.


Neil’s right about people who don’t cover healthcare regularly not understanding many of the true dynamics at play. I do find it interesting that Neil is such a fan of clinical decision support. I still think it’s in such an infant state. I can’t wait for much more advanced clinical decision support.

Cerner Supports Blue Button +

Posted on July 5, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

Cerner has announced plans to support and participate in the Blue Button + initiative, marking a small step towards freer sharing of patient health information by its clients.

Blue Button +, launched as the Automate Blue Button Plus Initiative, is the next generation version of the Blue Button technology for consumer download of health information. This next gen Blue Button is intended to provide a blueprint for better-structured and secure transmission of personal health data.

What this announcement means in practical terms, according to an entry in Cerner’s blog, is that the EMR giant will make it possible for its Cerner Direct clients to securely zap information to any personal health record participating in Blue Button +.  Cerner Direct users will also be able to send automated reminders to people managing specific health conditions or who need age/gender-specific check-ups, plus send out summaries of care and instructions following a health visit.

Cerner Direct, as readers probably guessed, uses standards drawn from the Direct Project, a set of standards and documentation allowing providers to push data from one point to another. Cerner has obtained accreditation from the Direct Trusted Agent Accreditation Program offered by DirectTrust and the Electronic Healthcare Network Accreditation Commission.

And why is Cerner taking this step? “The primary goal we have for our clients is to help create a trusted, reliable group of participants with which to securely exchange health care information using Direct protocols over the open internet, helping them reduce their liabilities by creating an efficient, secure method of communication based on best practices,” writes Andy Heeren of Cerner.

This sounds like a reasonable move toward greater data interoperability, if not an earthshaking one. It will be interesting to see where Cerner takes this.

The Path to Healthcare Interoperability Standards

Posted on June 24, 2013 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.

I’ve been thinking a lot about the issues associated with healthcare interoperability. One of the biggest excuses/problems out there is the idea of interoperability standards. Healthcare certainly has plenty of interoperability standards, but adoption and implementation of the actual standards has been the major issue.

I do think that meaningful use and EHR certification is making some difference in regards to standards. I think that Direct Project is likely going to become a pretty solid standard for exchanging some healthcare documents. However, it’s limited in it’s scope.

Instead, I think we’re going to see a different path to healthcare interoperability. It’s going to be led by a few prominent organizations that start sharing info. Once those organizations start sharing data, whatever standard they use will start to spread and will become the standard for interoperability in healthcare.

Which organization or group of organizations will be the ones that break out and establish the standard? I still think the jury is out on that one, but a couple prime candidates are: CommonWell and Healtheway.

I’d love to hear if you see another path to healthcare interoperability or other initiatives that could break through and be successful.