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Sansoro Hopes Its Health Record API Will Unite Them All

Posted on June 20, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

After some seven years of watching the US government push interoperability among health records, and hearing how far we are from achieving it, I assumed that fundamental divergences among electronic health records at different sites posed problems of staggering complexity. I pricked up my ears, therefore, when John Orosco, CTO of Sansoro Health, said that they could get EHRs to expose real-time web services in a few hours, or at most a couple days.

What does Sansoro do? Its goal, like the FHIR standard, is to give health care providers and third-party developers a single go-to API where they can run their apps on any supported EHR. Done right, this service cuts down development costs and saves the developers from having to distribute a different version of their app for different customers. Note that the SMART project tries to achieve a similar goal by providing an API layer on top of EHRs for producing user interfaces, whereas Sansoro offers an API at a lower level on particular data items, like FHIR.

Sansoro was formed in the summer of 2014. Researching EHRs, its founders recognized that even though the vendors differed in many superficial ways (including the purportedly standard CCDs they create), all EHRs dealt at bottom with the same fields. Diagnoses, lab orders, allergies, medications, etc. are the same throughout the industry, so familiar items turn up under the varying semantics.

FHIR was just starting at that time, and is still maturing. Therefore, while planning to support FHIR as it becomes ready, Sansoro designed their own data model and API to meet industry’s needs right now. They are gradually adding FHIR interfaces that they consider mature to their Emissary application.

Sansoro aimed first at the acute care market, and is expanding to support ambulatory EHR platforms. At the beginning, based on market share, Sansoro chose to focus on the Cerner and Epic EHRs, both of which offer limited web services modules to their customers. Then, listening to customer needs, Sansoro added MEDITECH and Allscripts; it will continue to follow customer priorities.

Although Orosco acknowledged that EHR vendors are already moving toward interoperability, their services are currently limited and focus on their own platforms. For various reasons, they may implement the FHIR specification differently. (Health IT experts hope that Argonaut project will ensure semantic interoperability for at least the most common FHIR items.) Sansoro, in contrast can expose any field in the EHR using its APIs, thus serving the health care community’s immediate needs in an EHR-agnostic manner. Emissary may prevent the field from ending up again the way the CCD has fared, where each vendor can implement a different API and claim to be compliant.

This kind of fragmented interface is a constant risk in markets in which proprietary companies are rapidly entering an competing. There is also a risk, therefore, that many competitors will enter the API market as Sansoro has done, reproducing the minor and annoying differences between EHR vendors at a higher level.

But Orosco reminded me that Google, Facebook, and Microsoft all have competing APIs for messaging, identity management, and other services. The benefits of competition, even when people have to use different interfaces, drives a field forward, and the same can happen in healthcare. Two directions face us: to allow rapid entry of multiple vendors and learn from experience, or to spend a long time trying to develop a robust standard in an open manner for all to use. Luckily, given Sansoro and FHIR, we have both options.

Prescription Benefits’ Information Silos Provide Feedstock for RxEOB

Posted on June 7, 2016 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

In health care, silos between industries prevent synergies like in the travel industry, where you can order your hotel, flight, rental car, and tourist sights all in one place. Interoperability–the Holy Grail of much health care policy, throughout the Meaningful Use and MACRA eras–is just one sliver of the information hoarding problem. There is much more to integrated care, and prescriptions illustrate the data exchange problems in spades. Pharmacist Robert Oscar recognized the business possibilities inherent in breaking through the walls, and formed RxEOB 15 years ago to address them.

RxEOB helps patients and their physicians make better decisions about medications, taking costs and other interests into account. Sold to health insurance plans and benefits managers, it’s an information management platform and a communication platform, viewing patients, health plans, physicians, pharmacists, and family members as team members.

It’s instructive to look at the various players in the prescription space, what data each gives to RxEOB, and what RxEOB provides to each in return.

Payers

These organizations have lots of data that’s useful in the RxEOB ecosystem: costs, formularies, and coverage information. What payers often lack is information such as price, benefit status, and tier for drugs “similar to” one that is being prescribed.

The “similar to” concept is central to the pharmaceutical field, from the decision made by drug companies to pursue research, through FDA approval (they want proof that a new medication is substantially better than ones it is similar to), to physician choices and payer coverage. There may be good reasons to prescribe a medication that costs more than ones to which it is similar: the patient may not be responding to other drugs, or may be suffering from debilitating side effects. Still, everyone should know what the alternatives are.

Physicians

One of RxEOB’s earliest services was simply to inform doctors about the details of the health care coverage their patients had. This is gradually becoming an industry function, but is still an issue. Nowadays, thanks to electronic health records, most physicians theoretically have access to all the information they need to prescribe thoughtfully. But the information they want may be buried in databases or unstructured documents, jumbled together with irrelevant details. RxEOB can extract and combine information on available drugs, formularies, authorization requirements, coverage information, and details such as patient drug histories to help the doctor make a quick, accurate decision.

Pharmacies

These can use RxEOB’s information on the benefits and cost coverage offered by health insurance for the patients they serve.

Benefits managers

These staff know a lot about patients’ benefits, which they provide to RxEOB. In return, RxEOB can help them set up portals and use text messaging or mobile apps to communicate to patients.

Consumers

Finally we come to the much-abused patients, who have the greatest stake in the whole system and are the least informed. The consumer would like to know everything that the rest of the system knows about pricing, alternatives, and coverage. And the consumer wants to know more: why they should take the drug in the first place, for instance, how to deal with side effects. RxEOB provides communication channels between the patient and all the other players. Thus, the company contributes to medication adherence.

RxEOB is a member of the National Council of Prescription Drug Programs (NCPDP) which works on standards for such things as prior authorizations and communications. Thus, while carving out a successful niche in a dysfunctional industry, it is helping to move the industry to a better place in data sharing.

More Patient Demand, More Communications

Posted on May 31, 2016 I Written By

The following is a guest blog post by Andy Nieto, IT Strategist for DataMotion Health.
Andy Nieto
Nearly every news outlet does an annual recap about what has changed over the past 12 months. In recent years, we’ve learned we are now more connected, more aware, traveling more, doing more and so on. The role of the local family doctor being the only caregiver has also changed, giving way to more specialists, more providers and more needs. A survey by GfK Roper showed Americans over 65 saw an average of 28 doctors – and that was five years ago. There are now 8,000 of us reaching age 65 every day. By 2029, the 65+ group will comprise more than 20 percent of the population.

This is just the tip of the iceberg. Healthcare is encountering numerous problems, fueled by an aging population. For the industry to adapt, move forward, and produce better health outcomes, one particular change is critical.

Problem One: More People Seeing More Doctors

A 2014 Journal of the American Medical Association article, “Finding the Missing Link for Big Biomedical Data” (jama.2014.4228), identified there are a tremendous number of data elements which affect a patient’s health, wellness, and ultimately, their outcomes from treatment.

There are two concurrent efforts underway to manage and control this data. The first was the HITECH Act and move to digitization, management and aggregation of patient data. This push for electronic health records (EHRs) has resulted in more than 3,000 certified healthcare technology products on the market. There are 900,000 active physicians, more than 5,700 hospitals, 60,000 pharmacies and 100,000 physical therapy entities. And this doesn’t include countless caregivers, ancillary staff, labs, etc.

That said, the volume of information is staggering and will only increase.

The second effort underway is to define care needs and create communities to effectively address these. The Health Information Management System Society (HIMSS) has created the Health Story Project in an effort to understand the scope of these needs. The Office of the National Coordinator for Health Information Technology (ONC) has patient rights and wellness acts. And virtually every insurance and health system has some type of health outreach management plan.

All of these communities are empowered by access to, and utilization of, information about the patients under their care. Most importantly, it is imperative that the “left hand understand what the right hand is doing” in order to treat patients more effectively and safely, control costs, create greater efficiencies and much more.

Problem Two: So Much Information in So Many Places
“Americans are sicker” is a blanket statement that the media now seems to report daily. Obesity, chronic conditions and increased costs for healthcare are constantly in the headlines. At least one report has stated that 45 percent of all Americans suffer from at least one chronic condition. What’s more, by 2025 one half of all Americans will suffer from chronic conditions.

For many businesses and industries, there’s long been an 80/20 rule where 80% of the cost was from 20% of materials, 80% of revenue from 20% of customers, etc.  For healthcare though, there are many who feel the situation with chronic care patients is much worse.

Of course, effective treatment means a need for more specialists, more providers and more information to handle those with such conditions. But that vital information is now in so many places.

Problem Three: The Communication Crisis
When I was growing up, my mother always told me to “use my words” to address conflict. Unfortunately, our healthcare crisis has an even larger and more fundamental conflict – a lack of communication. How do we deal with any of these problems if we cannot communicate?

Communication in healthcare is a multi-pronged issue. Information must be exchanged. Care, providers, resources and schedules must be coordinated. Amidst this, we cannot forget the patient, and that today as a country we are less healthy and demands have increased.

One study found patients with chronic conditions as a result of poor lifestyle choices, obesity for example, are significantly less likely to be compliant with treatment plans. The fact is, patients that have regular and interactive communication with their providers are significantly more likely to be compliant with care plans and demonstrate better outcomes.

Communication, including feedback with the patient, is critical to addressing patient compliance

A Single Solution
Communication is the foundation of coordinating the volume of care providers, specialists and services needed to address patient health, wellness and outcomes. HIPAA, HITECH, Omnibus rulings, as well as the ongoing work of the ONC and HIMSS, all support interoperability and connected healthcare. Opening the lines of communication is the first step, though with this progress, the problem of data becomes clear.

Communication exists in many forms. Healthcare is both a science of medicine and an art of care, which means various types of information must be exchanged. To achieve the “holy grail” of interoperability, obstacles for clinical information exchange must be removed. Barriers around data types and formats are a blockade to progress. Conversation, consultation, planning and discussion are as critical to the delivery of care as discrete and diagnostic data elements. Therefore, messaging must be used that is open and empowered to ALL types of data – from structured digital data to images and unstructured documents – and security is obviously imperative.

Simple communication is a conversation between providers. So, why is it, then, that many “so called” clinical messaging solutions do not support the simple process of person-to-person dialogue? A communications solution must support both “science and art.” Care coordination, facilitating provider-to-provider and provider-to-patient interaction removes barriers, simplifies and improves care delivery, and by extension, improves health and wellness.

With this in mind, the themes of “more” must be extended to healthcare to move forward. And that means more communication, more coordination and more care.

About Andy Nieto
Andy Nieto is the IT Strategist for DataMotion Health, a provider of secure health information delivery services and solutions. An accredited HISP (health information service provider) of Direct Secure Messaging, the DataMotion Direct service enables efficient interoperability and sharing of a person’s data across the continuum of care and their broader lives. For more information, please visit http://www.datamotionhealth.com.

Healthcare Data Standards Tweetstorm from Arien Malec

Posted on May 20, 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.

If you don’t follow Arien Malec on Twitter, you should. He’s got strong opinions and an inside perspective on the real challenges associated with healthcare data interoperability.

As proof, check out the following Healthcare Standards tweetstorm he posted (removed from the tweet for easy reading):

1/ Reminder: #MU & CEHRT include standards for terminology, content, security & transport. Covers eRx, lab, Transitions of Care.

2/ If you think we “don’t have interop” b/c no standards name, wrong.

3/ Standards could be ineffective, may be wrong, may not be implemented in practice, or other elts. missing

4/ But these are *different* problems from “gov’t didn’t name standards” & fixes are different too.

5/ e.g., “providers don’t want 60p CCDA documents” – data should be structured & incorporated.

6/ #actually both (structured data w/terminology & incorporate) are required by MU/certification.

7/ “but they don’t work” — OK, why? & what’s the fix?

8/ “Government should have invested in making the standards better”

9/ #actually did. NLM invested in terminology. @ONC_HealthIT invested in CCDA & LRU projects w/ @HL7, etc.

10/ “government shouldn’t have named standards unless they were known to work” — would have led to 0 named

11/ None of this is to say we don’t have silos, impediments to #interoperability, etc.

12/ but you can’t fix the problem unless you understand it first.

13/ & “gov’t didn’t name standards” isn’t the problem.

14/ So describe the problems, let’s work on fixing them, & abandon magical thinking & 🦄. The End.

Here was my immediate response to the tweetstorm:

I agree with much of what Arien says about their being standards and the government named the standards. That isn’t the reason that exchange of health information isn’t happening. As he says in his 3rd tweet above, the standards might not be effective, they may be implemented poorly, the standards might be missing elements, etc etc etc. However, you can’t say there wasn’t a standard and that the government didn’t choose a standard.

Can we just all be honest with ourselves and admit that many people in healthcare don’t want health data to be shared? If they did, we’d have solved this problem.

The good news is that there are some signs that this is changing. However, changing someone from not wanting to share data is a hard thing and usually happens in steps. You don’t just over night have a company or individual change their culture to one of open data sharing.

Vice President Joe Biden Speaks at Health Datapalooza

Posted on May 10, 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.

I’ve always wanted to attend Health Datapalooza. It seems like a great event and has a really amazing group of people. However, it’s always in DC (at least so far) and I didn’t want to travel. So, I’ve had to follow along from home watching the #hdpalooza hashtag. There’s been a lot of great insights into healthcare and what’s happening with healthcare.

One session I really wanted to see was Vice President Joe Biden’s keynote. The good thing is that ePatient Dave recorded it on his iPad and made it available:

Considering Biden’s involvement in the Cancer Moonshot and his own personal experience in the healthcare system taking care of his son, he provides some great perspective.

Health Data Sharing and Patient Centered Care with DataMotion Health

Posted on April 13, 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.

Now that the HIMSS Haze has worn off, we thought we’d start sharing some of the great video interviews we did at HIMSS 2016. In this case, we did a 3 pack of interviews at the DataMotion Health booth where we got some amazing insights into health data sharing, engaging patients, and providing patient centered care.

First up is our chat with Dr. Peter Tippett, CEO of Healthcelerate and Co-Chairman of DataMotion Health, about the evolution of healthcare data sharing. Dr. Tippett offers some great insights into the challenge of structured vs unstructured data. He also talks about some of the subtleties of medicine that are often lost when trying to share data. Plus, you can’t talk with Dr. Tippett without some discussion of ensuring the privacy and security of health data.

Next up, we talked with Dennis Robbins, PHD, MPH, National Thought Leader and member of DataMotion Health’s Advisory Board, about the patient perspective on all this technology. He provides some great insights into patients’ interest in healthcare and how we need to treat them more like people than like patients. Dr. Robbins was a strong voice for the patient at HIMSS.

Finally we talked with Bob Janacek, Co-Founder and CTO of DataMotion Health, about the challenges associated with coordinating the entire care team in healthcare. The concept of the care team is becoming much more important in healthcare and making sure the care team is sharing the most accurate data is crucial to their success. Learn from Bob about the role Direct plays in this data sharing.

Thanks DataMotion Health for having us to your booth and having your experts share their insights with the healthcare IT community. I look forward to seeing you progress in your continued work to make health data sharing accessible, secure, and easy for healthcare organizations.

The Challenge of Patient Identification and Patient Matching

Posted on March 11, 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.

A little bit before HIMSS, Healthcare Scene had the chance to sit down with a panel of experts on patient identification and patient matching, but I wasn’t able to post that interview until now. This is such an important topic, so I was happy to learn from some real experts in the space.

In this interview we talk over the challenges associated with matching patients in healthcare and the damage that’s done when you don’t match the right patient. We also talk about the solutions to the patient identification and matching problem including the impact a national patient identifier would have on the problem. Finally, we talk over CHIME’s $1 million National Patient ID challenge.

Here’s a look at those who participated in the discussion:

If you’re interested in the challenge of patient identification and patient matching in healthcare, then you’ll enjoy this discussion:

Also, after the more formal discussion we take some questions from the live audience in what we call the “after party.” Plus we even dusciss Beth Just’s new alter ego. Finally, we dive in deeper on the topic of patient identification and matching:

Communal Themes Between Behavioral Health and General Healthcare – #NatCon16

Posted on March 7, 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.

Instead of getting a break after HIMSS, I’m doing back to back conferences as I attend the National Council for Behavioral Health’s NatCon Conference in Las Vegas. If you’re following along at home, the twitter stream for the event is #NatCon16 and is full of a ton of gems from the conference.
Chris Matthews and John Lynn at NatCon
Today I got the chance to hear and meet two of the keynote speakers: Chris Matthews and @KevinMD. Chris Matthews provided a lot of great insights into the political environment and a lot of amazing insider stories. My biggest takeaway from his talk is that we’re stuck in a massive quagmire and I don’t see much of that changing in the future. Presidential candidates can make all the promises they want, but they mean nothing if they don’t have the political support and finances to pay for it. @KevinMD was great to meet and hear talk about the benefits of using social media. Of course, he was mostly preaching to the choir for me. However, I’m sure that his comments were extremely eye opening for many in the audience.
KevinMD and John Lynn
Besides these two keynotes, I attended a few different sessions in the tech track of the conference. The most surprising thing to me was how similar these sessions were to any sessions you might have in any healthcare IT conference. This wasn’t really shocking, but it was a surprise that the messages and challenges were so much the same. Here are a few examples:

Third Party App Integration with EHRs
In one session, the vendors were talking about their inability to integrate their behavioral health apps into the various EHR software. They all said it was on the roadmap, but that there wasn’t an easy way for them to make it a reality. One of them appropriately called for EMR customers to start demanding that their EHR vendors open up their systems to be able to integrate with these third party apps.

Fear of Social Media
I usually find at conferences that this breaks out into two groups. One group loves social media, embraces it and benefits from it. The other group is totally afraid of the repercussions of using it. @KevinMD offered some great insights on how to overcome this fear. First, don’t say anything on social media that you wouldn’t say in a crowded hospital hallway. Second, start by using something like LinkedIn or Doximity which is a more private type of social media and are both professional networks. The real key I’d suggest is that you should own your brand. Don’t leave your brand image up to other people.

Business Models
There was a lot of discussion around various uses of technology in behavioral health and the need for the business models to catch up with the technology. Many would love to use all these technological advances, but they aren’t sure how they’re going to get paid for doing so.

I’m sure I could go on and on. I know that many in the general medical field look at behavioral health as a totally different beast. No doubt there are some differences in behavioral health, but I think that we’re more alike than we are different. Looking forward to learning even more over the next two days.

Will the Disconnected Find Interoperability at HIMSS 2016? Five Scenarios for Action!

Posted on February 28, 2016 I Written By

The following is a guest blog post by Donald Voltz, MD.
Donald Voltz - Zoeticx

With the yearly bluster and promise of HIMSS, I still find there have been few strides in solving interoperability. Many speakers will extol the next big thing in healthcare system connectivity and large EHR vendors will swear their size fits all and with the wave of video demo, interoperability is declared cured.  Long live proprietary solutions, down with system integration and collaboration. Healthcare IT, reborn into the latest vendor initiative, costing billions of dollars and who knows how many thousands of lives.

Physicians’ satisfaction with electronic health record (EHR) systems has declined by nearly 30 percentage points over the last five years, according to a 2015 survey of 940 physicians conducted by the American Medical Association (AMA) and American EHR Partners. The survey found 34% of respondents said they were satisfied or very satisfied with their EHR systems, compared with 61% of respondents in a similar survey conducted five years ago.

Specifically, the survey found:

  • 42% of respondents described their EHR system’s ability to improve efficiency as difficult or very difficult;
  • 43% of respondents said they were still addressing productivity challenges related to their EHR system;
  • 54% of respondents said their EHR system increased total operating costs; and
  • 72% of respondents described their EHR system’s ability to decrease workload as difficult or very difficult.

Whether in the presidential election campaign or at HIMSS, outside of the convention center hype, our abilities are confined by real world facts.  Widespread implementation of EHRs have been driven by physician and hospital incentives from the HITECH Act with the laudable goals of improving quality, reducing costs, and engaging patients in their healthcare decisions. All of these goals are dependent on readily available access to patient information.

Whether the access is required by a health professional or a computers’ algorithm generating alerts concerning data, potential adverse events, medication interactions or routine health screenings, healthcare systems have been designed to connect various health data stores. The design and connection of various databases can become the limiting factor for patient safety, efficiency and user experiences in EHR systems.

Healthcare Evolving

Healthcare, and the increasing amount of data being collected to manage the individual as well as patient populations, is a complex and evolving specialty of medicine. The health information systems used to manage the flow of patient data adds additional complexity with no one system or implementation being the single best solution for any given physician or hospital. Even within the same EHR, implementation decisions impact how healthcare professional workflow and care delivery are restructured to meet the constraints and demands of these data systems.

Physicians and nurses have long uncovered the limitations and barriers EHR’s have brought to the trenches of clinical care. Cumbersome interfaces, limited choices for data entry and implementation decisions have increased clinical workloads and added numerous additional warnings which can lead to alert fatigue. Concerns have also been raised for patient safety when critical patient information cannot be located in a timely fashion.

Solving these challenges and developing expansive solutions to improve healthcare delivery, quality and efficiency depends on accessing and connecting data that resides in numerous, often disconnected health data systems located within a single office or spanning across geographically distributed care locations including patients’ homes. With changes in reimbursement from a pay for procedure to a pay for performance model, an understanding of technical solutions and their implementation impacts quality, finances, engagement and patient satisfaction.

Moving from a closed and static framework to an open and dynamic one holds great potential while requiring an innovative look at how technology is used as a tool to connect the people, processes and data. Successful application and integration of technology will determine future healthcare success. Although the problems with healthcare data exchange have not been solved, numerous concepts have been proposed on how to solve these challenges.

Connecting the Disconnected

Currently, healthcare data flow is disconnected. Understanding the current and future needs of patients and healthcare professionals along with how we utilize the technology tools available to integrate data into a seamless stream can bring about an enhanced, high-quality, efficient care delivery model.  One successful integration example, middleware, has been used for years to integrate data in financial and retail organizations with its simple open technology.

One of the leaders in middleware integration is Zoeticx, a healthcare IT system integrator who integrates the data traffic and addresses, adding the missing components to connect, direct and act upon the healthcare data flow.  This technology helped one hospital struggling with the typical EHR interoperability plaguing most healthcare facilities connect multiple EHR systems.  In addition, the health-care facility used middleware to identify a new revenue stream from CMS reimbursements for patient wellness visits while also improving patient care.

Accessing patient information from EHR’s and other patient health data repositories is critical for patient care. The development of tools and strategies to enhance the patient experience, improve quality and innovation of the care delivery model requires an understanding of how data is accessed and shared.  Current EHR’s have employed numerous ways to extract patient data, each of which brings opportunities and challenges. Here are a few examples to ask about at HIMSS.

The Critical Care Team – Distributed Care

The critical care environment is a challenging one with numerous healthcare professionals teaming up to manage and care for patients. Delays in addressing critical issues, lab values or other studies can negatively impact these patients or lead to redundancy and inefficiencies which increase costs without impacting outcomes. Coordinating care between the various care team members can be a challenge.

The medical record and the nursing flow sheet had traditionally been the platform for communication and understanding the trajectory of care. With the incorporation of the electronic medical record, things have changed. EHR’s bring along new constraints in caring for critical patients while at the same time bring about potential to enhance care delivery through the improvement in communication and management of these patients.

Chronic Care Management

There is a growing prevalence of US adult patients who are managing two or more chronic medical conditions. Governmental and commercial insurance providers have embraced this trend by introducing chronic care management (CCM) programs in an effort to better manage these patients so as to limit costly hospital admissions and improve quality of life.

There are numerous barriers to engaging physicians and patients in the management of chronic health conditions. One of the findings from a recent survey of chronic care management by health plan was how improvement in coordination of care between multiple physicians and other healthcare professionals can positively impact the care received and improve utilization. With commercial and governmental incentives, development and implementation of CCM management tools that interface with EHR’s and connect patients and professionals can enhance care delivery in this expanding population of patients.

Care Transitions

Patients admitted to the hospital for scheduled procedures or the unexpected management of a medical issue are at risk of being readmitted for preventable issues that develop following discharge.  For aging patients with multiple chronic conditions, enhanced communication to limit misunderstandings, conflicts in disease management and compliance with medications are critical as they move from hospitals to intermediate care settings and ultimately back home. Management of these critical care transitions depend on communication of patient data, the meaning ascribed to this data by the primary care physician along with those who managed these patients in the hospital becomes a critical component in care quality, patient satisfaction and to address preventable readmissions.

Healthcare professionals have emerged to manage many aspects of patient care and are dependent on access to patient data which is often spread between EHR’s and other health data systems. Connecting and sharing this information plays a role in how these patients are managed. Development of clinical pathways that integrate and translate evidenced-based medicine into the care delivery model is a critical component to the management of care across transitions.

Patient data, treatment plans and monitoring approaches to chronic conditions and underlying risks must be integrated and communicated between patients and healthcare professionals. The complexity of healthcare and the distributed care-team model makes this more critical now than ever before. Understanding data flow between all members of the care team, including patients and their family, becomes key in the development of strategies to achieve high quality, cost effective and engaging solutions that ultimately impact outcomes.

The Annual Health Screen

Preventative care is an expanding area of medicine with the goal of trying to control US healthcare costs. In 2011, The Affordable Care Act established the Annual Wellness Visit for Medicare beneficiaries. The purpose of this initiative is to perform an annual health risk assessment and identify all of the healthcare professionals caring for a beneficiary. By identifying risks and care professionals, coordination of care and risk mitigation can be put in place.

The Centers for Medicare & Medicaid Services (CMS) is promoting this service in an effort to enhance patient care, reduce unexpected care and reduce healthcare costs. With an expansive list of healthcare professionals who can perform the Annual Wellness Visit, a critical component in implementing this service hinges on communication and the sharing of the information obtained. Understanding and connecting patients, professionals, and their health data into a unified, accessible system must be managed.

Personalized Health

The landscape of patient health data is expanding. Personalized health and wellness trackers, genetic variants influencing risks for chronic conditions and pharmacogenetics, are all revealing new biologic pathways that will impact how care is delivered in the future. Systematically integrating these disparate pieces of data is becoming critical to translate individual disease risk and treatment recommendations. Emerging uses of personalized data will impact how we store, access and use this data for personalized diagnosis and management of disease.

Solving the technical challenge of accessing the data, development of decision-support tools and visually displaying the results to physicians and patients who will ultimately act upon the findings is being actively developed. How these new technologies are integrating into clinical medicine will impact their use and the engagement of all those involved. Exploring the potential ways to integrate emerging technologies into current EHR’s becomes critical to the future of healthcare delivery.

The process of healthcare delivery, use of data to drive decisions and employing various technological tools have become interdependent components that hold great potential for impacting quality of care. Gaining an understanding of the clinical needs, designing processes that meet these patient needs while incorporating evidence-based decision support has become a critical component of healthcare delivery. Understanding the current thinking, available technology and emerging solutions to the challenges we face with data flow and communication is the first step to developing innovative and impactful solutions.

Step up at HIMSS and ask the presenter how they plan to address these needs. Then reach out to the authors at Donald.voltz@gmail.com or Thanh.tran@zoeticx.com for a reality check.

About Donald Voltz, MD
Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.

Board-certified in anesthesiology and clinical informatics, Dr. Voltz is a researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

What’s Next in the World of Healthcare IT and EHR?

Posted on February 24, 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.

In the following video, Healthcare Scene sits down with Dana Sellers, CEO of Encore, a Quintiles Company. Dana is an expert in the world of healthcare IT and EHR and provides some amazing expertise on what’s happening in the industry. We talk about where healthcare IT is headed now that meaningful use has matured and healthcare CIOs are starting to look towards new areas of opportunity along with how they can make the most out of their previous EHR investments.

As we usually do with all of our Healthcare Scene interviews, we held an “After Party” session with a little more informal discussion about what’s happening in the healthcare IT industry. If you don’t watch anything else, skip to this section of the video when Dana tells a story about a CIO who showed the leadership needed to make healthcare interoperability a reality.