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The Rise Of mHealth And EHR Use, And The World Of Telehealth – Around Healthcare Scene

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mHealth is on the rise, and it looks like usage of smart phones among physicians is following that same trend. A recent study shows that usage rose about nine percent in 2012, which shows that it is becoming more accepted in the medical world. It will be interesting to see if it increases even more this year (I have a feeling it might.)

Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

Even though 90 percent of doctors are using an EMR at one point or another, only about 55 percent have actually adopted an EHR into their practice. It can be nerve-racking trying to find the perfect EHR. If you are finding yourself at that crossroad, be sure to read these five tips from ADP AdvancedMD on how to have a successful EHR implementation.

Still, some of you may be hesitant to implement an EHR. You may ask, is it worth it? Does it takeaway from healthcare? There is debate from both sides, each with compelling arguments. John believes that technology is overall positive in any industry, and discusses his thoughts, and some of the challenges that faces the industry.

Telehealth and medicine is so huge, it can be hard to digest. Neil Versel recently attended the American Telemedicine Association’s annual conference in Austin, Texas, and saw just how huge this market was. Be sure to check out this video he created from his experience, and to perhaps get a better idea about the many types of telehealth. Similar to the increase in doctors using smartphones, there has been a jump in EMR and HIE use as well. A survey from Accenture found that over 90 percent of doctors are using an EMR in either their practice or at a hospital, and over 50 percent are using an HIE. This increase was highest among doctors in the United States. Be sure to read more of the interesting facts this survey found about EMR and HIE use in the U.S., and around the world.

With summer quickly approaching, it’s more important than ever to stay hydrated. But if you need a little reminder, be sure to look into the Jomi Band.  It gives you warnings when you might be on the brink of dehydration, and makes it easy to keep track of how much water you’ve consumed in a day’s time.

May 12, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and Health IT Development – Interview with Chetu

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Craig Schmidt - Chetu
Craig Schmidt is the Director of Global Sales for Healthcare & Pharmaceuticals at Chetu. Craig’s focus at Chetu is understanding the top healthcare industry challenges, creating relationships with HIT leaders and developing Information Technology solutions to address those challenges. Craig has, for over 15 years, held a variety of Sales and Sales Management positions with increasing responsibility in the Healthcare and Information Technology Industries.

Tell us more about Chetu and your work in the healthcare market.

It would not be an exaggeration to say that Chetu has experience in nearly every section of Healthcare IT. In our 13 years we have developed solutions for Providers, Payers, HIT Vendors and others. Just a few of the things with which we have helped customers include: complete EMR and Practice Management design and development, ePrescribing, Drug Database integration, Revenue Cycle Management (835/837 & 270/275 engines).

When does someone in healthcare look to Chetu versus doing the work in house?

The two main reasons are: they do not have the particular HIT experience in-house & they do not have enough “bandwidth” to develop in-house and do not want to hire and train permanent staff.

What’s the most challenging thing about developing applications in healthcare?

Healthcare in general and Healthcare IT are bound by many Federal, State and other rules and regulations, e.g., Meaningful Use, Affordable Care Act, HIPAA, etc. There are also a variety of standards for interoperability such as HL7, CCD/CCR.

Do you mostly do one off projects or long term contracts with your clients?

We strive to be the “Back End, Long-term” IT Partner for our clients. We offer complete solutions from application development and support to maintenance and management of applications and systems. In Healthcare we have many (over 60%) clients that have been working with Chetu for multiple years. Many of these have been with Chetu for over 5 years – which is very long-term in this market

What’s your view on SaaS vs. in house client server applications? Do you have a preferred technology stack? What do you see being used most in healthcare?

For the past several years organizations have been rapidly moving to the “Cloud.” And, there are obvious advantages for being cloud based. However, client server applications have advantages of speed and stability that can’t always be achieved with SaaS. We are now seeing a slight movement to applications that are hybrids – combining the best of both approaches.

In healthcare, there is no clear preferred technology stack. It is all over the place. We have worked in .NET, HTML5, Java, PHP, Native Mobile Apps (iOS, Android), Python, C++, Foxpro, VB, Mirth. Cobol, MUMPS and many more. Healthcare IT has traditionally seen a very fragmented approach. Chetu has the great advantage of being agnostic. We can and will work with nearly any platform or tool.

EMR usability (or lack thereof) has been a major topic of discussion. How do you manage this with your EHR clients?

We have had the opportunity to work with dozens of different EMRs; ambulatory and hospital based. Many of these EMRs are the product of individual physicians or physician groups that are unhappy with their current EMR and have not seen any existing EMRs that meet their usability needs. They have come to us with their ideas about developing an EMR from scratch. We have developed ENT, Ophthalmology, Plastic Surgery and other specialty focused EMRs stemming from this issue.

What are you seeing happening with mobile in healthcare?

There is a tremendous rush to mobile in Healthcare right now. Over the past several years our Healthcare mobile development has grown tenfold. There are many, many great mobile applications developed with patients, physicians, nurses, home health providers and others in mind. These apps have been and will continue to make providers, payers and patients lives easier and make delivering healthcare more efficient and productive.

You’ve worked with a lot of the various healthcare standards. How do they compare to the standards you work with in other industries?

There really is no parallel to the standards that guide healthcare in other industries. From my limited experience I would say that the Banking/Financial industry comes closest. But even then the amount and complexity of the standards are a fraction of what is found in Healthcare and Pharma.

Tell us about some of your work on the major hospital platforms like Siemens Soarian, Meditech and Epic. Is it a challenge working with these large companies?

These large companies have invested millions of dollars building and improving the very complex systems. So, they are rightfully concerned and selective about how and who is allowed to work in their systems. It can be a challenge, but not impossible to work with these companies. An added challenge comes from the hospitals themselves. There is the attitude that these systems are so unique that only company trained personnel have the capability to work in them.

Chetu, having worked in the Soarian, Meditech, Epic, Cerner, McKesson and other hospital platforms understands that the underlying technology in all of these systems are the same or very similar. Although each system may have unique capabilities – we recognize that the goal is the same for each. And, in getting past the UI or getting “under the hood” so to speak, we see mostly the same technologies at work.

What are the most innovative healthcare IT projects you see out there that you like working on?

Right now we are seeing a rush to capitalize on the tremendous amount of data that EMRs are generating. Data analytics using this great resource is helping pharmaceutical companies, scientists and researchers, Accountable Care Organizations – nearly everyone on the healthcare continuum provide better and less expensive patient care. This is an area that is in its infancy but we see growing rapidly.

What types of data analytics projects have you done in healthcare? Do you do just the programming component or can you do every part of a data analytics project?

Chetu has been involved in numerous healthcare analytics projects. We have helped our customers with data warehousing, data mining, OLAP, business analysis, automated report generation, multi-dimensional information “cubes”, custom reporting solutions using tools like Informatica, DTS / SSIS, Datastage and SSRS, SSAS, Cognos, Microstrategy, Crystal, OBIEE.

We have developed solutions across the complete data analytics process. From data mining and ETL to data cube and data modeling and report generation we have the experience and the people that can handle nearly any healthcare analytics project.

Full Disclosure: Chetu is an advertiser on EMR and HIPAA.

April 25, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

User-friendly EMRs, Meaningful Use Fraud, and DietBet – Around Healthcare Scene

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Many are concerned with the user experience in Health IT – particularly regarding the user-friendliness of EMRs. While it is easy to be overwhelmed by the negative reports, there are businesses and providers working hard to resolve these issues. McKesson is one of those companies, and they were recently recognized for their work at HIMSS13. Will more companies start making efforts like this? 

One step toward making EMRs more user-friendly is, well, making them accessible to patients. Unfortunately, according to a recent Accenture study, 65 percent of doctors believe patients should only have limited access to their health records, and 4 percent believe records should be totally closed. Reasons range from self-consciousness of what a doctor says in a record, to being uncomfortable with using digital records. Allowing patient-access may very well be a huge cultural shift for doctors everywhere.

In order to pass Meaningful Use stage 1, one must indicate which EMR was adopted. But, according to BuildYourEMR.com’s CEO, Mike Jensen, 74 percent of the providers who stated they were using his EMR…weren’t. If this is similar across the board, around 5.4 billion dollars were paid in error for incentives. While this isn’t likely to be the case, it’s pretty sad the lengths people will go to in order to get some extra money. EMR vendors need to start going over their CMS data in order to help prevent this fraudulent behavior.

If money was at stake for you to lose weight, would that motivate you? For most people, it probably would. DietBet takes the desire people have to lose weight and pairs it with the innate desire to have money, and creates a weight-loss game. If you lose 4 percent of your body weight in four weeks, you get part of the money pot for the group you are in. If you don’t, you lose the amount you paid to participate in the first place.

John recently had the opportunity to go to TEDMED as a guest of the Breakaway Group (A Xerox company)
. It was a great experience for him, and highlights can be found @ehrandhit or searching #simplehealth on Twitter. John recounts some of key takeaways from TEDMED, and suggests some of the major themes that will likely be seen in healthcare.

April 21, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Effortless EHR Interaction

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I recently came across the really interesting device called MYO. I really can’t do the device justice, so I’ll just share this video which will do a much better job showing the gesture controls that are possible with the MYO.

I love how it senses even changes in the muscle. I love when description that says that the response sometimes feels like it responds before you even move since it senses your muscle before the movement is even done. Pretty amazing.

There are has to be so many possible uses for a next generation gesture device like MYO in healthcare. I’ve been thinking a lot about effortless EHR interaction and where it could go. I wonder if MYO and other gesture control systems can dramatically improve a physician’s interaction with an EHR.

Plus, the most exciting thing of all is that I think we’re still in the very early days of what’s going to be possible with gesture control and human computer interaction in general. Pair this with always on ubiquitous computing like is being shown with Google Glass and we’re just at the very beginning of the computing revolution.

I guess we’ll see if healthcare decides to lag behind these new technologies or whether we’ll ride the wave of transformation.

April 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

EHR Debates and The Growth of mHealth – Around Healthcare Scene

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With the dissatisfaction that many have felt from EMR, providers and patients alike, outside healthcare companies are coming up with new ideas on how to help. Healthpons, a healthcare version of Groupon, recently launched and aims to help people find affordable care, and allow providers to market themselves. Is this “cash for care” model a trickle down effect of EMR Dissatisfaction?

Among the debates related to EHRs, one of the biggest is about purging data. On one side, people believe that all data from a person’s life in order to give the best care possible. Another camp believes that keeping EHR data opens up the door for the institution being held liable. What do you think?

Hospitals are implementing EMRs left and right. However, who is it that pays for it? Some argue that it’s the consumer, others sometimes even say it’s the insurance companies. In the end, it’s the hospitals themselves.

How do you measure the quality of a doctor? In same ways, it’s impossible. Ideally, there would be a way to determine whether the quality of care a doctor provides is worth the cost they charge. However, there are risks involved in this, and really, it’s hard.  Don’t we all want the best doctor possible, for the lowest price? How can we keep doctor’s accountable for the care they provide?

If you have a hard time deciding the quality of a doctor, why not take matters into your own hands? Most people know that Google contains a plethora of health information, and that smartphones have a variety of health-related apps. The digital health market is growing at a fast rate and more technology is being released each day. What do you think the future holds for mHealth?

The past few weeks, some well-known names in health IT have lost dear family members. Remember these people in your thoughts.

April 7, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

The Health IT Tablet Shift and Some Hope for Windows 8

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One of the most amazing shifts that we’ve seen in healthcare is the acceptance of the tablet form factor. I’ve been fascinated with tablets since they first came out. The idea was always great, but in implementation the idea always fell apart. Many a sales rep told me how the tablet was going to be huge for healthcare. Yet, everyone that I know that got one of the really early tablets stopped using it.

Of course, the tablets that I’m referring to our the pre-iPad tablets. As one Hospital CTO told me at HIMSS, “the iPad changed tablets.

It’s so true. Now there isn’t even a discussion of whether the tablet is the right form factor for healthcare. The only question I heard asked at HIMSS was if a vendor had a tablet version of their application. In fact, I’m trying to remember if I saw a demo of any product at HIMSS that wasn’t on a tablet. Certainly all of the EHR Interface Improvements that I saw at HIMSS were all demonstrated on a tablet.

As an extension of the idea of tablets place in healthcare, I was also interested in the healthcare CTO who suggested to me that it’s possible that the Windows 8 tablet could be the platform for their health systems mobile approach. Instead of creating one iPad app that had to integrate all of their health system applications, he saw a possibility that the Windows 8 tablet could be the base for a whole suite of individual applications that were deployed by the health system.

I could tell that this wasn’t a forgone conclusion, but I could see that this was one path that he was considering seriously when it came to how they’d approach mobile. I’m sure that many have counted out Microsoft in the tablet race. However, I think healthcare might be once place where the Windows 8 tablet takes hold.

When you think about the security needs of healthcare, many hospital IT professionals are familiar with windows security and so they’ll likely be more comfortable with Windows 8. Now we’ll just have to see if Windows 8 and the applications on top of it can deliver the iPad experience that changed tablets as we know them.

March 20, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

HIMSS Analytics Clinical & BI Maturity Model

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While the theme of HIMSS 2013 may have been, “How Great Is Interoperability,” the effectiveness of the many facets of interoperability are only as good as the actionable value of the shared data. The clinical insights that should be enabled by Meaningful Use Stage 2+ are expected to drive market trends in myriad areas of the healthcare system: chronic disease management, targeted member interventions, quality measures. In order to assess organizational readiness to capitalize on the promise of Meaningful Use, HIMSS Analytics began measuring the implementation and adoption of EMR and clinical documentation using a maturity model called EMRAM.

EMRAM

But, in analytics terms, EMRAM’s results are simply targeted foundational reporting, answering the question, “WHAT happened with Meaningful Use EMR adoption criteria.” So, you’ve got your clinical data in an EMR. Now what are you able to DO with it?

In 2013, HIMSS Analytics is taking a broader approach with the introduction of a new Clinical Business Intelligence maturity model, creating a framework to benchmark participating providers’ analytics maturity level.

I’ve been fortunate to know James Gaston, Senior Director of HIMSS Analytics Clinical & Business Intelligence, for many years, going back to his days with Arkansas Blue Cross. His appreciation for BI initiatives is matched only by his enthusiasm for the first day of turkey hunting season. When I ran into him at TDWI’s BI World summit in Orlando in November, he acted like a kid on Christmas morning, telling me about the brave new world of clinical data management that he was about to tackle. The excitement continued to build in the months leading up to HIMSS. James was practically glowing when we spoke about the upcoming C&BI Maturity Model release.

“Our customers are interested in not just understanding how to deploy IT applications, but how effectively they’re using those applications to support clinical business intelligence, as well as analytical pursuits,” James said. “So, HIMSS Analytics partnered with IIA to create and present a Clinical & BI Maturity Model that helps healthcare organizations measure that level of effectiveness.”

Sarah Gates, the VP of Research for IIA (the International Institute of Analytics), elaborated. “The HIMSS Analytics C&BI Maturity Model leverages the Competing on Analytics DELTA model, developed by Tom Davenport, which measures not only how well you’re using data and technology, but how well you’re building an analytical organization.” There are 5 core competency measurements in the DELTA model that will inform the HIMSS Analytics C&BI analysis: Data, Enterprise, Leadership, Targets, and Analysts. The methodology is holistic, touching on the cultural aspects of the organization as well as the technical, allowing a longitudinal view of the organization’s analytics program. A yardstick value from 1-5 will be assigned to each respondent based on Davenport’s criteria for each core competency.

Although HIMSS Analytics will eventually offer Level 1-5 certification program for those organizations with observed results for analytics, James and Sarah agreed that it is not appropriate for every provider to reach for the Level 5 gold star. Per Sarah, “Healthcare is an industry just starting to discover analytics. We’re expecting to see lots of practitioners that are emerging in use of analytics, so we believe it (survey results) will be heavy on the lower end of the maturity scale. Data warehouse capabilities and staffing career paths for data analysts will be key differentiators for mature programs.” Not all providers have the resources – financial, human, and/or technical – to attain advanced analytics nirvana, and James wants to insure that these providers don’t feel as if they’ve “failed”; the goal is to baseline against the peer group, identify opportunities for improvement, and focus on what is possible for each individual organization, working within their constraints.

What can we expect to see at next year’s C&BI survey results presentation? James said, “We want to be able to talk about benchmarking the industry as a whole, helping healthcare find its way with clinical business intelligence and begin to understand how important it is, and where opportunities lie Everyone’s talking about clinical and BI – it is the opportunity to realize savings in healthcare, to use information to empower people to make better decisions.”

So, it’s up to you, providers and technology partners. You’ve implemented your EMR, achieved a high adoption rate across your organization’s core clinical processes, attested to Meaningful Use Stage 2, achieved Stage 7 on the HIMSS EMRAM scale, perhaps even participated in multi-HIE CCD medical records sharing with other provider networks. You’ve got the data in-house and availabe. It’s time to see how ready you are to rise to the analytics challenge and maximize your return on those EMR and HIE investments.

Attempt to beat your previous Doug Fridsma long jump.

Note: for the complete HIMSS 2013 Leadership Survey Results, please download PDF here.

March 14, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who 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.

Bringing Long Term Care Into HIEs Without An EMR

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HIEs will never achieve their full potential if all players in the healthcare process aren’t included in the network. But without an EMR to connect to the HIE, how can a provider participate?

A new software package developed by Geisinger Health System and the Keystone Beacon Community Program offers a new option allowing nursing homes, home health agencies and other long-term care facilities without EMRs to upload data to HIEs, reports EHR Intelligence.

The package, KeyHIE Transform, extracts data from the Minimum Data Set and Outcome and Assessment Information Set that nursing homes already submit to CMS. It turns that information into a Continuity of Care Document usable by any EMR which is HL7-compatible.

This approach provides a bridge to a wide range of data which currently gets left behind by most HIEs. And as EHR Intelligence rightly notes, with telehealth and remote monitoring becoming more popular ways of managing senior  health, as well as assisted living, it will be increasingly important for other providers to have access to all of the seniors’ data via the HIE.

Geisinger’s KeyHIE has already run several  pilot programs using t his technology in long-term care facilities and home health agencies. It expects to launch the technology to the market in April of this year.

As is often the case, Geisinger seems to be ahead of the market with a solution that makes great sense.  After all, finding a way to integrate new data into an HIE — especially one that draws on existing data — is likely to add significant value to that HIE.  I’m eager to see whether this technology actually works as simply as it sounds.

March 13, 2013 I Written By

Katherine Rourke 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 Marvelous Land of Oz: The HIMSS Interoperability Showcase

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As I walked the floor of the HIMSS Interoperability Showcase, listening to the tour guide’s carnie-esque pitch on the wonders awaiting me with each successive use case encounter, I ALMOST wished I hadn’t worked with so many of the organizations hawking their wares. It’s a bit sad to know the man behind the curtain, to realize that The Great and Powerful Oz is simply a man with a highly mechanized presentation. But that knowledge gives me insight that others attending the Showcase may not have had – and validation that, in the end, Oz IS Great and Powerful, even though he’s just a man.

There were 20 specific interoperability use cases represented at HIMSS this year, collectively, by 101 vendors. In order to qualify to participate, each of the organizations had to successfully demonstrate proficiency with their chosen use case at the Connectathon event in Chicago. In January. In a basement the size of a football field. Packed shoulder-to-shoulder with your closest competitors at high school-cafeteria tables. Talk about a frigid atmosphere!

Perhaps to stay warm, perhaps to pass the time, perhaps in the pursuit of the patient-centric design principles the healthcare industry espouses publicly yet so seldom seems to put into practice, cross-company collaboration occurs. Competitors converge on each others’ laptops, debugging code, refining business rules and algorithms. Functional use cases emerge, success stories are shared, everyone goes home happy with a list of enhancements to incorporate before the main event at HIMSS. The frantic rush to prep for Connectathon is amplified by the urgency and importance of HIMSS. The ONC is watching! Your competitors are watching! The 40K HIMSS attendees will be watching!

Invariably, the use cases are perfected in the weeks leading up to HIMSS, each click carefully orchestrated, each transition scripted, all parties putting forth their best effort to insure success for the spectators – many of whom are clients, prospects, regulatory officials, or journalists seeking The Next Big Healthcare Thing to go viral in the blogosphere. The yellow brick road is constructed, and as one walks its length, the carefully choreographed demonstrations come to life with compelling tales: “Keeping a Newborn Safe,” “Improving Pediatric Care,” “Optimizing Cancer Care,” “Beneficiary Enrollment.” The show goes on, and it’s a good one – albeit with the occasional glimpse of the man behind the curtain.

The perfectly nice gentleman manning the Federal Health Architecture booth seemed eager to demonstrate the capability to request and retrieve a patient’s medical record from multiple HIEs and disparate EMRs. He walked me through the provider portal view, showed me how he could see that there were multiple medical records available for this patient across providers, and talked me through each click up until the print button. Print?

“Aren’t you importing the records into the requesting EMR?” I asked.

“No. Right now, they have to print each set of records.”

“So, each time this scenario presents itself, the provider has to click on each available external record, print multiple pages, compare notes across screen and paper, and later choose whether to manually update his own EMR with the other information?”

The perfectly nice gentleman suddenly seemed uncomfortable. The Great and Powerful Oz, exposed as mere mortal, Oscar Zoroaster Diggs. You’d think I’d know when to quit.

“The standards and technology exist to do CCD discrete data import, and a couple of the large EMR vendors are implementing that capability for high Medicare population IDNs. How does it make the provider more efficient, and give the patient more face-time with his doctor, if we’re still printing and no data consolidation or reconciliation is happening prior to point-of-care? Why didn’t you extend the use case to show end state?”

He assured me that they’re working on it, and we made a deal that NEXT year, I’ll come back and he’ll walk me through their progress towards discrete data import. No printing, he promised. I’m going to hold him to it.

Aside from this specific use case, across the Marvelous Land of Oz, what I’d REALLY love to see next year: the basement Connectathon advancements made to support the use cases for HIMSS actually incorporated into the products. As part of the qualifying criteria for repeat showcase exhibitors, have them demonstrate the capabilities developed in prior years actually functioning in the marketplace under general release. That would be a substantial improvement on this year’s long jump attempt for the Interoperability Showcase.

I want to fall in love with the hard-working man behind the curtain, not the showy pyrotechnics.

March 11, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who 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.

Interoperability: The High Jump and The Long Jump with ONC’s Doug Fridsma

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I’ll admit, I was incredibly nervous about interviewing Dr. Doug Fridsma, the Chief Science Officer for the Office of the National Coordinator and the face of both the Standards and Interoperability (S&I) Framework and the Federal Health Architecture initiative. Not only do I consider him a key luminary, but his overarching responsibility for the future of interoperability and standards-based programs is incredibly alluring. I swoon over those who have the power and desire to effect meaningful, positive change on a grand scale. I wasn’t disappointed.

Doug explained his philosophy towards fulfilling the promise of interoperability with a sports metaphor: the high jump and the long jump.

“I don’t like high jumps,” he said. “High jumps, if you knock down the bar, you’re done and you get no points. Long jumps, you get points for each increment. The high jump for interoperability is ubiquitous data liquidity. The long jump is Meaningful Use.”

The S&I Framework project is tracking progress towards standardization and standards adoption across 5 areas of Meaningful Use and interoperability:

  1. Meaning – shared vocabularies across continuum of care
  2. Structure of messages shared across continuum of care
  3. Transport of messages
  4. Security of transport and messages
  5. Services for accessing messages

All of these categories are exemplified in the flagship project for Meaningful Use and interoperability: the Automate Blue Button Initiative, affectionately known as ABBI. For those not familiar with ABBI, do an experiment: ask your primary care provider whether you can visit a patient portal and download your medical records by clicking the “Blue Button.” If your PCP can provide you the website link to request the download, you should be able to receive your entire medical record (from that provider) in a vaguely huma-readable format (Excel, Word, PDF, etc.). The medical and clinical jargon may not make a lot of sense; however, it’s certainly an incremental hop in the long jump towards interoperability and standards adoption. The standard vocabularies, structure, transport mechanism, security protocol, and web-enabled access are foundational building blocks which enable the Blue Button program’s adoption.

Doug’s goal with the ABBI program was three-fold: get it OUT there, have providers and patients start USING it, and structure it so that it can be repeatable and scalable. Patient engagement advocates across the Twittersphere applaud the sentiment that we, patients, should have ownership of our health data, and many recognize the ONC’s efforts as instrumental in turning the tide for patient access. Several notable bloggers have covered the ABBI project in detail, analyzing its value to healthcare IT development professionals, providers, and patients, including:
Keith Boone @motorcycle_guy – the ABBI Pitch, with a quick overview of the goals for the program, and humorous insight into providers’ qualms about adoption

Greg Meyer @greg_meyer – Scalable Trust and Trust Bundles, with developer-focused details on the structure and transport categories of interoperability

For the next incremental long jump beyond ABBI and Meaningful Use Stage 2, Doug Fridsma and the ONC have several new initiatives tackling the atomic-level data governance and quality of clinical information. In order to communicate between disparate EHR systems, across multiple facilities and potentially multiple payers, it isn’t just the structure of the container and transport of the message that must be consistent: it’s the individual data elements, themselves, which comprise the meat of the message that must be standardized.

The ONC recently announced the Structured Data Capture Initiative with the goal of creating a technical infrastructure to support “structurally sound” standard data elements with support for “unique semantics”, to capture EHR and supplemental clinical data for use across the continuum of care. This effort officially kicked off the week of HIMSS 2013; its progress will be instrumental in broadening the effectiveness of interoperability and Meaningful Use.

So, as I walk the Interoperability Showcase at HIMSS13, watch the use case demonstrations, and ask the participants the tough questions like, “How are you incorporating the use case development you’re exhibiting here into consideration for your next product full release,” I’ll be taking note of those organizations that seem focused on the next incremental jump towards patient-centric, data-driven healthcare systems. And I’ll be wondering what Doug Fridsma and the ONC will do to get to the next incremental jump on the way to the nirvana of ubiquitous data liquidity.

…I’ll also be kicking myself for not taking the opportunity to get a fan photo with Doug while I had the chance.

March 5, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who 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.