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The “Disconnects” That Threaten The Connected World

Posted on January 11, 2017 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.

I’m betting that most readers are intimately familiar with the connected health world. I’m also pretty confident that you’re pretty excited about its potential – after all, who wouldn’t be?  But from what I’ve seen, the health IT world has paid too little attention to problems that could arise in building out a connected health infrastructure. That’s what makes a recent blog post on connected health problems so interesting.

Phil Baumann, an RN and digital strategist at Telerx, writes that while the concept of connecting things is useful, there’s a virtually endless list of “disconnects” that could lead to problems with connected health. Some examples he cites include:

  • The disconnect between IoT hardware and software
  • The disconnect between IoT software and patches (which, he notes, might not even exist)
  • The disconnect between the Internet’s original purpose and the fast-evolving purposes created in the Connected World
  • The disconnects among communication protocols
  • The disconnect between influencers and reality (which he says is “painfully wide”)
  • The disconnects among IoT manufacturers
  • The disconnects among supply chains and vendors

According to Baumann, businesses that use IoT devices and other connected health technologies may be diving in too quickly, without taking enough time to consider the implications of their decisions. He writes:

Idea generation and deployment of IoT are tasks with enormous ethical, moral, economic, security, health and safety responsibilities. But without considering – deeply, diligently – the disconnects, then the Connected World will be nothing of the sort. It will be a nightmare without morning.

In his piece, Baumann stuck to general tech issues rather than pointing a finger at the healthcare industry specifically. But I’d argue that the points he makes are important for health IT leaders to consider.

For example, it’s interesting to think about vulnerable IoT devices posing a mission-critical security threat to healthcare organizations. To date, as Baumann rightly notes, manufacturers have often fallen way behind in issuing software updates and security patches, leaving patient data exposed. Various organizations – such as the FDA – are attempting to address medical device cybersecurity, but these issues won’t be addressed quickly.

Another item on his disconnect list – that connected health deployment goes far beyond the original design of the Internet – also strikes me as particularly worth taking to heart. While past networking innovations (say, Ethernet) have led to rapid change, the changes brought on by the IoT are sprawling and almost unmanageable under current conditions. We’re seeing chaotic rather than incremental or even disruptive change. And given that we’re dealing with patient lives, rather than, for example, sensors tracking packages, this is a potentially dangerous problem.

I’m not at all suggesting that healthcare leaders should pull the plug on connected health innovations. It seems clear that the benefits that derive from such approaches will outweigh the risks, especially over time. But it does seem like a good idea to stop and think about those risks more carefully.

FDA Weighs In On Medical Device Cybersecurity

Posted on January 5, 2017 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.

In the past, medical devices lived in a separate world from standard health IT infrastructure, typically housed in a completely separate department. But today, of course, medical device management has become much more of an issue for health IT managers, given the extent to which such devices are being connected to the Internet and exposed to security breaches.

This has not been lost on the FDA, which has been looking at medical device security problems for a long time. And now – some would say “at long last” – the FDA has released final guidance on managing medical device cybersecurity. This follows the release of earlier final guidance on the subject released in October 2014.

While the FDA’s advice is aimed at device manufactures, rather than the health IT managers who read this blog, I think it’s good for HIT leaders to review. (After all, you still end up managing the end product!)

In the guidance, the FDA argues that the best way to bake cybersecurity protections into medical devices is for manufacturers to do so from the outset, through the entire product lifecycle:

Manufacturers should build in cybersecurity controls when they design and develop the device to assure proper device performance in the face of cyber threats, and then they should continuously monitor and address cybersecurity concerns once the device is on the market and being used by patients.

Specifically, the agency is recommending that manufacturers take the following steps:

  • Have a way to monitor and detect cybersecurity vulnerabilities in their devices
  • Know assess and detect the level of risk vulnerabilities pose to patient safety
  • Establish a process for working with cybersecurity researchers and other stakeholders to share information about possible vulnerabilities
  • Issue patches promptly, before they can be exploited

The FDA also deems it of “paramount” importance that manufacturers and stakeholders consider applying core NIST principles for improving critical infrastructure cybersecurity.

All of this sounds good. But considering the immensity of the medical device infrastructure – and the rate of its growth – don’t expect these guidelines to make much of an impact on the device cybersecurity problem.

After all, there are an estimated 10 million to 15 million medical devices in US hospitals today, according to health tech consultant Stephen Grimes, who spoke on biomedical device security at HIMSS ’16. Grimes, a past chair of the HIMSS Medical Device Security Task Force, notes that one 500-bed hospital could have 7,500 devices on board, most of which will be networked. And each networked monitor, infusion pump, ventilator, CT or MRI scanner could be vulnerable to attack.

Bottom line, we’re looking at some scary risks regardless of what manufacturers do next. After all, even if they do a much better job of securing their devices going forward, there’s a gigantic number of existing devices which can be hacked. And we haven’t even gotten into the vulnerabilities that can be exploited among home-based connected devices.

Don’t get me wrong, I’m glad to see the FDA stepping in here. But if you look at the big picture, it’s pretty clear that their guidance is clearly just a small step in a very long and complicated process.

Patient Engagement Platforms Are 2017’s Sexiest Tech

Posted on January 3, 2017 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.

Over the last few months, I’ve become convinced that the predictable star of 2017 — population health management — isn’t going to be as hot as people think.

Instead, I’d argue that the trend to watch is the emergence of new technologies that guide, reach out to and engage with patients at key moments in their care process. We’re at the start of a period of spectacular growth for patient engagement platforms, with one analyst firm predicting that the global market for these solutions will hit $34.94 billion by 2023.

We all seem to agree already that we need to foster patient engagement if we want to meet population health goals. But until recently, most of the approaches I’ve seen put in place are manual, laborious and resource-intensive. Yes, the patient portal is an exception to that rule – and seems to help patients and clinicians connect – but there’s only so much you can do with a portal interface. We need more powerful, flexible solutions if we hope to make a dent in the patient engagement problem.

In the coming year, I think we’ll see a growing number of providers adopt technology that helps them interact and engage with patients more effectively. I’m talking about initiatives like the rollout of technology by vendor HealthGrid at ColumbiaDoctors, a large multispecialty group affiliated with Columbia University Medical Center, which was announced last month.

While I haven’t used the technology first hand, it seems to offer the right functions, all available via mobile phone. These include pre- and post-visit communications, access to care information and a clinically-based rules engine which drives outreach regarding appointments, educations, medications and screening. That being said, HealthGrid definitely has some powerful competitors coming at the same problem, including the Salesforce.com Health Cloud.

Truth be told, it was probably inevitable that vendors would turn up to automate key patient outreach efforts. After all, unless providers boost their ability to target patients’ individual needs – ideally, without hiring lots of costly human care managers – they aren’t likely to do well under value-based payment schemes. One-off experiments with mobile apps or one-by-one interventions by nurse care coordinators simply don’t scale.

Of course, these technologies are probably pretty expensive right now – as new tech in an emerging market usually is — which will probably slow adoption somewhat. I admit that when I did a Google search on “patient engagement solutions,” I ran into a vendor touting a $399 a month option for doctors, which isn’t too bad if it can actually deliver. But enterprise solutions are likely to be a big investment, and also, call for a good deal of integration work. After all, if nothing else, health systems will want to connect patient engagement software to their back-office systems and EMR, at minimum, which is no joke.

Still, to my mind there’s little question that patient engagement technologies are going to be the sexiest health IT niche to watch in 2017, one which will generate major buzz in healthcare boardrooms across the country. Whether you invest or not, definitely watch this space.

ONC Takes Another Futile Whack At Interoperability

Posted on January 2, 2017 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.

With the New Year on its way, ONC has issued its latest missive on how to move the healthcare industry towards interoperability. Its Interoperability Standards Advisory for 2017, an update from last year’s version, offers a collection of standards and implementation specs the agency has identified as important to health data sharing.

I want to say at the outset that this seems a bit, well, strange to me. It really does seem like a waste of time to create a book of curated standards when the industry’s interoperability take changes every five minutes. In fact, it seems like an exercise in futility.

But I digress. Let’s talk about this.

About the ISA

The Advisory includes four technical  sections, covering a) vocabulary/code sets/terminology, b) content/structure standards and implementation specs, c) standards and implementation specs for services and d) models and profiles, plus a fifth section listing ONC’s questions and requesting feedback. This year’s version takes the detailed feedback the ONC got on last year’s version into account.

According to ONC leader Vindell Washington, releasing the ISA is an important step toward achieving the goals the agency has set out in the Shared Nationwide Interoperability Roadmap, as well as the Interoperability Pledge announced earlier this year. There’s little doubt, at minimum, that it represents the consensus thinking of some very smart and thoughtful people.

In theory ONC would appear to be steaming ahead toward meeting its interoperability goals. And one can hardly disagree that it’s overarching goal set forth in the Roadmap, of creating a “learning health system” by 2024 sounds attractive and perhaps doable.

Not only that, at first glance it might seem that providers are getting on board. As ONC notes, companies which provide 90% of EHRs used by hospitals nationwide, as well as the top five healthcare systems in the country, have agreed to the Pledge. Its three core requirements are that participants make it easy for consumers to access their health information, refrain from interfering with health data sharing, and implement federally recognized national interoperability standards.

Misplaced confidence

But if you look at the situation more closely, ONC’s confidence seems a bit misplaced. While there’s much more to its efforts, let’s consider the Pledge as an example of how slippery the road ahead is.

So let’s look at element one, consumer access to data. While agreeing to give patients access is a nice sentiment, to me it seems inevitable that there will be as many forms of data access as there are providers. Sure, ONC or other agencies could attempt to regulate this, but it’s like trying to nail down jello given the circumstances. And what’s more, as soon as we define what adequate consumer access is, some new technology, care model or consumer desire will change everything overnight.

What about information blocking? Will those who took the Pledge be able to avoid interfering with data flows? I’d guess that if nothing else, they won’t be able to support the kind of transparency and sharing ONC would like to see. And then when you throw in those who just don’t think full interoperability is in their interests – but want to seem as though they play well with others – you’ve pretty much got a handful o’ nothing.

And consider the third point of the Pledge, which asks providers to implement “federally recognized” standards. OK, maybe the ISA’s curated specs meet this standard, but as the Advisory is considered “non-binding” perhaps they don’t. OK, so what if there were a set of agreed-upon federal standards? Would the feds be able to keep up with changes in the marketplace (and technology) that would quickly make their chosen models obsolete? I doubt it. So we have another swing and a miss.

Given how easy the Pledge is to challenge, how much weight can we assign to efforts like the ISA or even ONC’s long-term interoperability roadmap? I’d argue that the answer is “not much.” The truth is that at least in its current form, there’s little chance the ONC can do much to foster a long-term, structural change in how health organizations share data. It’d be nice to think that, but thinking doesn’t make it so.

Top EMR and HIPAA Blog Posts of 2016

Posted on December 30, 2016 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.

At the end of each year, it’s fun to pull up the stats and see which blog posts were the most popular blog posts and pages on EMR and HIPAA. What’s shocking to me is how many older posts on EMR and HIPAA are still generating a ton of traffic. Here’s a look at the top 10 blog posts and a bit of commentary on each.

1. Healthcare IT and EHR Conferences and Events – This page has gotten 10 times more traffic than pretty much all of the other posts on this list.  I’m biased, but it’s a great resource.  It also illustrates to me that I should spend more time creating these types of deep resources that are useful to readers.  It also illustrates that I traveled too much in 2016, but I’ve enjoyed every moment of those trips.

2. 6 Healthcare Incubators Growing the Future of HealthTech – This post probably needs to be updated with which incubators are still around and new healthcare incubators that have launched.  Might also be interesting to look at how well companies from the various incubators have done since being in the incubator.

3. Benefits of EMR or EHR Over Paper Charts – This was one of the first pages I ever created on EMR and HIPAA.  The sad part is that it looks like I still had plenty left to complete on that page.  However, it still highlights many of the benefits of EMR and EHR.  I’m glad it’s still getting visits since far too often we love to complain about EMR and EHR and take for granted all the benefits that an EHR provides.

4. 10 Ways Many Dental Offices Are Breaching HIPAA – This was a great guest post by Trevor James.  It was targeted at Dental Offices, but most of the items apply to any healthcare organization.  It’s amazing how many people still don’t understand HIPAA and what it requires.

5. Meaningful Use Is Going to Be Replaced – #JPM16 – This announcement was a bit of a surprise when it happened and I’m trying to understand why we didn’t know this was coming.  I also find it quite interesting that Andy Slavitt chose to make this announcement at JP Morgan’s annual healthcare conference and not at HIMSS or some other event.  Maybe it was just timing, but I think that says a lot about the JP Morgan event.

6. 2014 EHR Mandate – One of the top searches that refers traffic to EMR and HIPAA are related to the question of whether there’s an EHR mandate.  That’s likely why this post is so popular even though it was written back in 2011.  It’s amazing how well this content still applies almost 6 years later.  There is no EHR mandate and I don’t think there ever will be.  However, there are forces and reasons to use EHR.

7. Crazy and Funny ICD-10 Codes – These are still funny today.  Although, I’m a bit surprised that the post is still so popular.  It would be interesting to see a report from an EHR vendor or someone on how many of these funny codes actually get used in practice.  My guess is not very many times, but I’m open to being surprised.

8. The Impact of the 2016 Election on Healthcare IT – This was a prediction post.  We’ll need another year or two to see if my predictions were accurate.  I’m still pretty confident in them.

9. Examples of HIPAA Privacy Violations – More HIPAA Lawsuits Coming? – This post is amazing since it was written back in 2006.  That makes it almost 10 years old.  What can I say?  Concern over HIPAA lawsuits is a big deal and people can’t help to look when a wreck (ie. HIPAA violation) happens.

10. Has Electronic Health Record Replacement Failed? – Props to Justin Campbell from Galen Healthcare on this great piece.  I think we’re just at the beginning of the EHR replacement market.  So, I have a feeling this piece and others like it are going to continue in popularity.

11. Don’t Yell FHIR in a Hospital … Yet – I’m a little shocked to find this on the list since it was only posted a month ago. I guess the topic of FHIR is a good one and Richard’s post throwing some words of caution on the FHIR train was of interest to many.

12. EMR Templates – I think this was the only post on the list that I didn’t remember without looking.  No surprise, the post was from 2012.  I’m always a little scared to read some of my early blog posts.  However, this one was pretty good.  The challenge of template documentation in EHR software versus other methods is still an important discussion, but one that’s not really happening now.

13. Practice Fusion Violates Some Physicians’ Trust in Sending Millions of Emails to Their Patients – This post kind of needs no explanation.  I worked for probably a month writing it, so I’m glad that it’s still getting read.  It probably got an extra bump this year because the FTC finally closed the case against Practice Fusion that came out of this article.  It’s still an astounding story.

14. EMR Companies Holding Practice Data for “Ransom” – Wow!  Another post from 2011.  This is still a problem today, but the dynamics have changed for most companies.  Although, the challenge is likely to get even harder since many EHR vendors are now SaaS based EHR which make it even harder to get your data and easier for the EHR vendor to hold that data for “ransom.”

15. Securing Your HIPAA Controlled Computer Workstations – This post is from 2006.  My how things have changed in 10 years.  It’s an interesting look into where I started with this blog.  I’ve wondered lately if I should get back into more practical posts like this one.

16. Best Scanners for High Volume Scanning in a Doctor’s Office – A good scanner is still essential in every healthcare organization even if you have an EHR.  These Fujitsu’s are still good options, but I’ve also seen great success with the Ambir and Canon imageFormula scanners as well.

17. Don’t Blame HIPAA: It Didn’t Require Orlando Regional Medical Center To Call the President – This was a great reality check from Mike Semel on the salacious news that the President had got involved in the HIPAA issues related to the Orlando shootings.  Mike did this a number of times in 2016, so check out all his HIPAA blog posts.

18. HIPAA Cloud Bursts: New Guidance Proves Cloud Services Are Business Associates – Another great example of Mike Semel dropping HIPAA knowledge bombs.  It’s no surprise that his posts are on this list multiple times.

19. Quality Reporting: A Drain on Practice Resources, New Study Shows –  This chart from Steven’s post has really stuck with me.  The administrative bloat in healthcare is brutal.  The challenge is that I’m not sure how we get back to the more reasonable levels of the past.  Every doctor I know feels this and it’s an awful thing for patients.

20. Health Plans Need Your Records: Know What’s Driving Requests and How to Be Prepared – I’d known Craig Mercure for years and across multiple companies.  It was great to meet up with him again in 2016 at his new position at CIOX Health.  He certainly opened my eyes to the new world of health plan records requests.  CIOX has a great business doing this for health plans.

There’s a quick run down of the top blog posts on EMR and HIPAA for 2016.  Seeing all my old posts is fun and sometimes embarrassing.  I guess it does highlight the powerful long tail of great content.

Did you have a favorite EMR and HIPAA post?  We’d love to hear about it.

CVS Launches Analytics-Based Diabetes Mgmt Program For PBMs

Posted on December 29, 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.

CVS Health has launched a new diabetes management program for its pharmacy benefit management customers designed to improve diabetes outcomes through advanced analytics.  The new program will be available in early 2017.

The CVS program, Transform Diabetes Care, is designed to cut pharmacy and medical costs by improving diabetics’ medication adherence, A1C levels and health behaviors.

CVS is so confident that it can improve diabetics’ self-management that it’s guaranteeing that percentage increases in spending for antidiabetic meds will remain in the single digits – and apparently that’s pretty good. Or looked another way, CVS contends that its PBM clients could save anywhere from $3,000 to $5,000 per year for each member that improves their diabetes control.

To achieve these results, CVS is using analytics tools to find specific ways enrolled members can better care for themselves. The pharmacy giant is also using its Health Engagement Engine to find opportunities for personalized counseling with diabetics. The counseling sessions, driven by this technology, will be delivered at no charge to enrolled members, either in person at a CVS pharmacy location or via telephone.

Interestingly, members will also have access to diabetes visit at CVS’s Minute Clinics – at no out-of-pocket cost. I’ve seen few occasions where CVS seems to have really milked the existence of Minute Clinics for a broader purpose, and often wondered where the long-term value was in the commodity care they deliver. But this kind of approach makes sense.

Anyway, not surprisingly the program also includes a connected health component. Diabetics who participate in the program will be offered a connected glucometer, and when they use it, the device will share their blood glucose levels with a pharmacist-led team via a “health cloud.” (It might be good if CVS shared details on this — after all, calling it a health cloud is more than a little vague – but it appears that the idea is to make decentralized patient data sharing easy.) And of course, members have access to tools like medication refill reminders, plus the ability to refill a prescription via two-way texting, via the CVS Pharmacy.

Expect to see a lot more of this approach, which makes too much sense to ignore. In fact, CVS itself plans to launch a suite of “Transform Care” programs focused on managing expensive chronic conditions. I can only assume that its competitors will follow suit.

Meanwhile, I should note that while I expect to see providers launch similar efforts, so far I haven’t seen many attempts. That may be because patient engagement technology is relatively new, and probably pretty expensive too. Still, as value-based care becomes the dominant payment model, providers will need to get better at managing chronic diseases systematically. Perhaps, as the CVS effort unfolds, it can provide useful ideas to consider.

Connected Health is Like Going from Printed Maps to Waze

Posted on December 28, 2016 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.

At the Connected Health Summit this year, I had a chance to talk with Chris Nicholson, CEO of mPulse Mobile. I was really impressed with what mPule Mobile was doing and I loved that they were actually doing things and not just talking about things that they could do. Sure was a refreshing experience from many other meetups with startups in this space.

During our discussion, Chris offered an interesting comparison between healthcare before connected health and healthcare after. I wasn’t recording our discussion, but here’s the gist of his comparison.

In the past health tech was kind of like a static map that was outdated as soon as it was printed. New tech is like Waze which is being constantly updated. Waze evolves based on a variety of factors and data to be able to create a custom experience for the user.

For those not familiar with Waze (Now owned by Google), it uses everyone’s driving information in order to make sure you’re taking the fastest route possible. The app has been so successful, it has caused new traffic problems in neighborhoods when Waze would reroute drivers through a neighborhood most people wouldn’t have thought to take to avoid a trouble area. It caused so much traffic in these neighborhoods, a lot of neighbors got really upset.

While there are challenges with any application, I think that Chris’ comparison is a good one. The EHR is essentially a static map of a person’s visit to the doctor. That information is outdated almost immediately after the patient leaves the doctor’s office. It’s great for historical understanding, but certainly isn’t a real time look at what could most benefit a patient’s health.

As I prepare for CES next week, I’m excited to see the slew of health sensors and health applications that will be at the conference. These combinations of technology will get us closer to the Waze of healthcare where our health status and the status of where our health is headed is updated in real time. I haven’t seen the Waze of healthcare yet. Have you?

Connected Wearables Pose Growing Privacy, Security Risks

Posted on December 26, 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.

In the past, the healthcare industry treated wearables as irrelevant, distracting or worse. But over that last year or two, things have changed, with most health IT leaders concluding that wearables data has a place in their data strategies, at least in the aggregate.

The problem is, we’re making the transition to wearable data collection so quickly that some important privacy and security issues aren’t being addressed, according to a new report by American University and the Center for Digital Democracy. The report, Health Wearable Devices in the Big Data Era: Ensuring Privacy, Security, and Consumer Protection, concludes that the “weak and fragmented” patchwork of state and federal health privacy regulations doesn’t really address the problems created by wearables.

The researchers note that as smart watches, wearable health trackers, sensor-laden clothing and other monitoring technology get connected and sucked into the health data pool, the data is going places the users might not have expected. And they see this as a bit sinister. From the accompanying press release:

Many of these devices are already being integrated into a growing Big Data digital health and marketing ecosystem, which is focused on gathering and monetizing personal and health data in order to influence consumer behavior.”

According to the authors, it’s high time to develop a comprehensive approach to health privacy and consumer protection, given the increasing importance of Big Data and the Internet of Things. If safeguards aren’t put in place, patients could face serious privacy and security risks, including “discrimination and other harms,” according to American University professor Kathryn Montgomery.

If regulators don’t act quickly, they could miss a critical window of opportunity, she suggested. “The connected health system is still in an early, fluid stage of development,” Montgomery said in a prepared statement. “There is an urgent need to build meaningful, effective, and enforceable safeguards into its foundation.”

The researchers also offer guidance for policymakers who are ready to take up this challenge. They include creating clear, enforceable standards for both collection and use of information; formal processes for assessing the benefits and risks of data use; and stronger regulation of direct-to-consumer marketing by pharmas.

Now readers, I imagine some of you are feeling that I’m pointing all of this out to the wrong audience. And yes, there’s little doubt that the researchers are most worried about consumer marketing practices that fall far outside of your scope.

That being said, just because providers have different motives than the pharmas when they collect data – largely to better treat health problems or improve health behavior – doesn’t mean that you aren’t going to make mistakes here. If nothing else, the line between leveraging data to help people and using it to get your way is clearer in theory than in practice.

You may think that you’d never do anything unethical or violate anyone’s privacy, and maybe that’s true, but it doesn’t hurt to consider possible harms that can occur from collecting a massive pool of data. Nobody can afford to get complacent about the downside privacy and security risks involved. Plus, don’t think the nefarious and somewhat nefarious healthcare data aggregators aren’t coming after provider stored health data as well.

The Case For Accidental Interoperability

Posted on December 22, 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.

Many of us who follow #HITsm on Twitter have encountered the estimable standards guru Keith Boone (known there as @motorcycle_guy). Keith always has something interesting to share, and his recent article, on “accidental” interoperability, is no exception.

In his article, he describes an aha moment: “I had a recent experience where I saw a feature one team was demonstrating in which I could actually integrate one of my interop components to supply additional functionality,” he writes. “When you build interop components right, this kind of accidental interop shows up all the time.”

In his piece, he goes on to argue that this should happen a lot more often, because by doing so, “you can create lot of value through it with very little engineering investment.”

In an ideal world, such unplanned instances of interoperability would happen often, allowing developers and engineers to connect solutions with far less trouble and effort. And the more often that happened, the more resources everyone involved would have to invest in solving other types of problems.

But in his experience, it can be tough to get dev teams into the “component-based” mindset that would allow for accidental interoperability. “All too often I’ve been told those more generalized solutions are ‘scope expansions,’ because they don’t fit the use case,” and any talk of future concerns is dropped, he says.

While focusing on a particular use case can save time, as it allows developers to take shortcuts which optimize their work for that use case, this approach also limits the value of their work, he argues. Unfortunately, this intense focus prevents developers from creating more general solutions that might have broader use.

Instead of focusing solely on their short-term goals, he suggests, health IT leaders may want to look at the bigger picture. “My own experience tells me that the value I get out of more general solutions is well worth the additional engineering attention,” he writes. “It may not help THIS use case, but when I can supply the same solution to the next use case that comes along, then I’ve got a clear win.”

Keith’s article points up an obstacle to interoperability that we don’t think much about right now. While most of what I read about interoperability options — including on this blog — focus on creating inter-arching standards that can tie all providers together, we seldom discussed the smaller, day-to-day decisions that stand in the way of health data sharing.

If he’s right (and I have little doubt that he is) health IT interoperability will become a lot more feasible, a lot more quickly, if health organizations take a look at the bigger purposes an individual development project can meet. Otherwise, the next project may just be another silo in the making.

Columbia-Affiliated Physician Group Plans Rollout Of Mobile Engagement Platform

Posted on December 15, 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 massive multispecialty medical practice associated with Columbia University has decided to implement a mobile patient engagement platform, as part of a larger strategy aimed at boosting patient satisfaction and ease of access to care.

The vendor behind the technology, HealthGrid, describes its platform as offering the physicians the ability to “provide actionable care coordination, access to critical health information and to enable [patient] self-care management.” HealthGrid also says that its platform will help the group comply with the requirements of Meaningful Use and MIPS.

The group, ColumbiaDoctors, includes more than 1,700 physicians, surgeons, dentists and nurses, and offers more than 230 specialty and subspecialty areas of care. All of the group’s clinicians are affiliated with New York-Presbyterian hospital and serve as faculty at Columbia University Medical Center.

The group is investing heavily in making its services more accessible and patient-friendly. In April, for example, ColumbiaDoctors agreed to roll out the DocASAP platform, which is designed to offer patients advanced online scheduling capabilities, including features allowing patients to find and book patients via mobile and desktop channels, tools helping patients find the best provider for their needs and analytics tools for business process improvement.

HealthGrid, for its part, describes itself as a CRM platform whose goal is to “meet patients where they are.” The vendor has developed a rules engine, based on clinical protocols, that connects with patients at key points in the care process. This includes reaching out to patients regarding needed appointments, education, medications and screening, both before and after they get care. The system also allows patients to pay their co-pays via mobile channels.

Its other features include automated mobile check-in – with demographic information auto-populated from the EMR – which patients can update from their mobile phones. The platform allows patients to read, update and sign off on forms such as HIPAA documentation and health information using any device.

While I’d never heard of HealthGrid before, it sounds like it has all the right ideas in place for consumer engagement. Clearly it impressed ColumbiaDoctors, which must be spending a fair amount on its latest addition. I’m sure the group’s leaders feel that if it increases patient alignment with treatment goals and improves the condition of the population it serves, they’ll come out ahead.

But the truth is, I don’t think anyone knows yet whether health organizations can meet big population health goals by interacting more with patients or spending more time in dusty back rooms fussing over big data analytics. To be sure, if you have enough money to spend they can both reach out directly to patients and invest heavily in next-generation big data infrastructure. However, my instinct is that very few institutions can focus on both simultaneously.

Without a doubt, sophisticated health IT leaders know that it pays to take smart chances, and ColumbiaDoctors is probably wise to pick its spot rather than play catch-up. Still, it’s a big risk as well. I’ll be most eager to see whether tools like HealthGrid actually impact patients enough to be worth the expense.