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Study: “Information Blocking” By Vendors And Providers Persists

Posted on April 6, 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.

A newly-released study suggests that both EHR vendors and providers may still be interfering with the free exchange of patient healthcare data. The researchers concluded that despite the hearty disapproval of both Congress and healthcare providers, the two still consider “information blocking” to be in their financial interest.

To conduct the study, which appears in this month’s issue of The Milbank Quarterly, researchers conducted a national survey between October 2015 and January 2015. Researchers reached out to leaders driving HIE efforts among provider organizations. The study focused on how often information blocking took place, what forms it took and how effective various policy strategies might be at stopping the practice.

It certainly seems that the practice continues to be a major issue of concern to HIE leaders. Eighty-three percent of respondents said they were very familiar with information blocking, while just 12 percent reported having just some familiarity with the practice and 5 percent said they had minimal familiarity. On average, the respondents offered a good cross-industry view, having worked with 18 EHR vendors and with 31 hospitals or health systems on average.

Forms of Blocking:

If the research is accurate, information blocking is a widespread and persistent problem.

When questioned about specific forms of information by EHR vendors, 29 percent of respondents said that vendors often or routinely roll out products with limited interoperability capabilities. Meanwhile, 47 percent said that vendors routinely or often charge high fees for sharing data across HIEs, and 42 percent said that the vendors routinely or often make third-party access to standardized data harder than it needs to be. (For some reason, the study didn’t mention what types of information blocking providers have instituted.)

Frequency of blocking:

It’s hardly surprising that most of the respondents were familiar with information blocking issues, given how often the issue comes up.

In fact, a full fifty percent said that EHR vendors routinely engaged in information blocking, 33 percent said that the vendors blocked information occasionally, with only 17 percent stating that EHR vendors rarely did so.

Interestingly, the HIE managers said that providers were also engaged in information blocking, though fewer did so than among the vendor community. Twenty-five percent reported that providers routinely engage in information blocking, and 34 percent saying that providers did so occasionally. Meanwhile, 41 percent said information blocking by providers was rare.

Motivations for blocking:

Why do HIE participants block the flow of health data? It seems that at present they get something important out of it, and unless somebody stops them it makes sense to continue.

When it came to EHR vendors, the respondents felt that their motivations included a desire to maximize short-term revenue, with 41 percent reporting that this was a routine motivation and 28 percent that it was an occasional motivation. They also felt EHR vendors blocked information to improve the chances that providers would choose their platform over competing products, with 44 percent of respondents saying this was routine and 11 percent that it was occasional.

Meanwhile, they believed that hospitals and health systems, the most common motivation was to improve revenue by strengthening their competitive advantage, with 47 percent seeing this as routine and 30 percent occasional. Also, respondents said providers wanted to accommodate priorities other than data exchange, with 29 percent seeing this as routine and 31 percent occasional.

Solutions:

So what can be done about vendor and provider information blocking? There are a number of ways policymakers can get involved, but few have done so as of yet.

When given a choice of policy-based strategies, 67 percent said that making this practice illegal would be very effective. Meanwhile, respondents said that three strategies would be very or moderately effective. They included prohibiting gag clauses and encouraging public reporting and comparisons of vendors and their products (93 percent); requiring stronger demonstrations of product interoperability (92 percent) and national policies defining policies and standards for core aspects of information exchange.

Meanwhile, when it came to reducing information blocking by providers, respondents recommended that CMS roll out stronger incentives for care coordination and risk-based contracts (97 percent) and public reporting or other efforts shining a spotlight on provider business practices (93 providers).

Healthcare Industry Leads In Blockchain Deployment

Posted on January 19, 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.

A new study by Deloitte concludes that healthcare and life sciences companies stand out as planning the most aggressive blockchain deployments of any industry. That being said, healthcare leaders are far from alone in paying close attention to blockchain, which seems to be coming into its own as corporate technology.

According to Deloitte, 39% of senior executives at large US companies had little or no knowledge of blockchain technology, but the other 61% reported their blockchain knowledge level as broad to expert. The execs who were well-informed about blockchain told Deloitte that it would be crucial for both their company and industry. In fact, 55% of the knowledgeable group said their company would be at a competitive disadvantage if they failed to adopt blockchain, and 42% believed it would disrupt their industry.

Given this level of enthusiasm, it’s not surprising that respondents have begun to invest in blockchain internally. Twenty-eight percent of respondents said their company had invested $5 million of more in blockchain tech to date, and 10% reported investing $10 million or more. Not only that,  25% of respondents expected to invest more than $5 million in blockchain technology this year.

While the level of blockchain interest seems to be pronounced across industries studied by Deloitte, healthcare and life science companies lead the pack when it came to deployment, with 35% of industry respondents saying that their company expects to put blockchain into production during 2017.

All that being said, aggressive deployment may or may not be a good thing just yet. According to research by cloud-based blockchain company Tierion, the majority of blockchain technology isn’t ready for deployment, though worthwhile experiments are underway.

Tierion argues that analysts and professional experts are overselling blockchain, and that most of blockchain technology is experimental and untested. Not only that, its research concludes that at least one healthcare application – giving patients the ability to manage their health data – is rather risky, as blockchain security is shaky.

It seems clear that health IT leaders will continue to explore blockchain options, given its tantalizing potential for sharing data securely and flexibly. And as the flurry of interest around ONC’s blockchain research challenge demonstrates, many industry thought leaders take this technology seriously. If the winning submissions are any indication, blockchain may support new approaches to health data interoperability, claims processing, medical records, physician-patient data sharing, data security, HIEs and even the growth of accountable care.

If nothing else, 2017 should see the development of some new and interesting healthcare blockchain applications, and probably the investment of record new amounts of capital to build them. In other words, whether blockchain is mature enough for real time deployment or not, it’s likely to offer an intriguing show.

A Look At Nursing Home Readiness For HIE Participation

Posted on October 12, 2016 I Written By

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

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

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

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

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

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

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

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

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

Please, No More HIE “Coming Of Age” Stories

Posted on September 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.

Today I read a Modern Healthcare story suggesting that health information exchanges are “coming of age,” and after reading it, I swear my eyes almost rolled back into my head. (An ordinary eye roll wouldn’t do.)

The story leads with the assertion that a new health data sharing deal, in which Texas Health Resources agreed to share data via a third-party HIE, suggests that such HIEs are becoming sustainable.

Author Joseph Conn writes that the 14-hospital system is coming together with 32 other providers sending data to Healthcare Access San Antonio, an entity which supports roughly 2,400 HIE users and handles almost 2.2 million patient records. He notes that the San Antonio exchange is one of about 150 nationwide, hardly a massive number for a country the size of the U.S.

In partial proof of his assertion that HIEs are finding their footing, he notes that that from 2010 to 2015, the number of HIEs in the U.S. fluctuated but saw a net gain of 41%, according to federal stats. And he attributes this growth to pressure on providers to improve care, lower costs and strengthen medical research, or risk getting Medicare or Medicaid pay cuts.

I don’t dispute that there is increased pressure on providers to meet some tough goals. Nor am I arguing that many healthcare organizations believe that healthcare data sharing via an HIE can help them meet these goals.

But I would argue that even given the admittedly growing pressure from federal regulators to achieve certain results, history suggests that an HIE probably isn’t the way to get this done, as we don’t seem to have found a business model for them that works over the long term.

As Conn himself notes, seven recipients of federal, state-wide HIE grants issued by the ONC — awarded in Connecticut, Illinois, Montana, Nevada, New Hampshire, Puerto Rico and Wyoming — went out of business after the federal grants dried up. So were not talking about HIEs’ ignoble history of sputtering out, we’re talking about fairly recent failures.

He also notes that a commercially-funded model, MetroChicago HIE, which connected more than 30 northeastern Illinois hospitals, went under earlier this year. This HIE failed because its most critical technology vendor suddenly went out of business with 2 million patient records in its hands.

As for HASA, the San Antonio exchange discussed above, it’s not just a traditional HIE. Conn’s piece notes that most of the hospitals in the Dallas-Fort Worth area have already implemented or plan to use an Epic EMR and share clinical messages using its information exchange capabilities. Depending on how robust the Epic data-sharing functions actually are, this might offer something of a solution.

But what seems apparent to me, after more than a decade of watching HIEs flounder, is that a data-sharing model relying on a third-party platform probably isn’t financially or competitively sustainable.

The truth is, a veteran editor like Mr. Conn (who apparently has 35 years of experience under his belt) must know that his reporting doesn’t sustain the assertion that HIEs are coming into some sort of golden era. A single deal undertaken by even a large player like Texas Health Resources doesn’t prove that HIEs are seeing a turnaround. It seems that some people think the broken clock that is the HIE model will be right at least once.

P.S.  All of this being said, I admit that I’m intrigued by the notion of  “public utility” HIE. Are any of you associated with such a project?

Engaging Patients With Health Data Cuts Louisiana ED Overuse

Posted on September 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.

Maybe I’m misreading things, but it seems to me that few health IT pros really believe we can get patients to leverage their own health data successfully. And I understand why. After all, we don’t even have clear evidence that patient portals improve outcomes, and portals are probably the most successful engagement tool the industry has come up with to date.

And not to be a jerk about it, but I bet you’d be hard-pressed to find HIT gurus who believed the state of Louisiana would lead the way, as the achingly poor southern state isn’t exactly known for being a healthcare thought leader.  As it so happens, though, the state has actually succeeded where highfalutin’ health systems have failed.

Over one year, the state has managed to generate a 23% increase in health IT use among at-risk patients, and also, a 10.2% decrease in non-emergent use of emergency departments by Medicaid managed care organization members, thank you very much.

So how did Louisiana’s top healthcare brass accomplish this feat? Among other things, they launched a HIE-enabled ED data registry, along with a direct-to-consumer patient engagement campaign. These efforts were done in partnership with the Louisiana Health Care Quality Forum, which developed statewide marketing plans for the effort (See John’s interview with the Louisiana Health Care Quality Forum for more details).

They must have created some snazzy marketing copy. As Healthcare IT News noted, between August 2015 and May 2016, patient portal use shot up 31%, consumer EHR awareness rose 23% and opt-in to the state’s HIE grew by 3%, Quality Forum marketer Jamie Martin told HIN.

Not only that, the number of patients asking for access to or copies of electronic health data increased by 12%, and the number of patients with current copies of their health information grew by 9%, Martin said.

This is great news for those who want to see patients buy in to the digital health paradigm. Though it’s hard to tell whether the state will be able to maintain the benefits it gained in its initial effort, it clearly succeeded in getting a substantial number of patients to rethink how they manage their care.

But (and I’m sorry to be a bit of a Debbie Downer), I was a bit disappointed when I saw none of the gains cited related to changing health behaviors, such as, say, an increase in diabetics getting retinal exams.

I know that I should probably be focused on the project’s commendable successes, and believe it or not, I do find them to be exciting. I’m just not sure that these kinds of metrics can be used as proxies for health improvement measures, and let’s face it, that’s what we need, right?

The Downside of Interoperability

Posted on May 2, 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.

It’s hard to argue that achieving health data interoperability is not important — but it comes with risks. And I’ve seen little discussion of the fact that interoperability may actually increase the chance that a major attack could hit a wide swath of healthcare providers. It might be extreme to suggest that we put off such efforts until we step up the industry’s security status, but the problem shouldn’t be ignored either.

Sure, data interoperability is a critical goal for healthcare providers of all stripes. While there’s room to argue about how it should be accomplished, particularly over whether providers or patients should drive health data management, there’s no question it needs to get done. There’s little doubt that most efforts to coordinate care will fall flat if providers are operating with incomplete information.

And what’s more, with the demand for interoperability baked into MACRA, we pretty much have no choice but to make it happen anyway. To my knowledge, HHS has proposed neither carrot nor stick to convince providers to come on board – nor has it defined “widespread” interoperability to my knowledge — but the agency has to achieve something by 2018, and that means change will come.

That being said, I’m struck by how little industry concern there seems to be about the extent to which interoperability can multiply the possibility of a breach occurring. Unfortunately, security is only as good is the weakest link in the chain, and data sharing increases the length of the chain exponentially. Of course, the risk varies a great deal depending on who or what the data-sharing intermediary is, but the fact remains that a connected network is a connected network.

The problem only gets worse if interoperability is achieved by integrating applications. I’m no software engineer, but I’m pretty sure that the more integrated providers’ infrastructure is, the more vulnerabilities they share. To be fair, hospitals theoretically vet their partners, but that defeats the purpose of universal data sharing, doesn’t it?

And even if every provider in the universal data sharing network practices good security hygiene, they can still get attacked. So it’s not a matter of requiring participants to comply with some network security standard, or meet some certification criteria. Given the massive incentives these have to steal health data (and lock it up with ransomware), nobody can hold out forever.

The bottom line is that I believe we should discuss the matter of security in a fully-connected health data sharing network more often.

Yes, we almost certainly need to press ahead and simply find a way to contain the risks. We simply can’t afford our fragmented healthcare system, and data interoperability offers perhaps the best possible chance of pulling it back together.

But before we plunge into the fray, it only makes sense to stop and consider all of the risks involved and how they should be addressed. After all, universal interconnection exposes a virtually infinite number of potential points of failure to cybercrooks. Let’s put some solutions on the table before it’s too late.

We Share Health Data with Marketing Companies, Why Not with Healthcare Providers? Answer: $$

Posted on November 20, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

For those who don’t realize it, your health data is being shared all over the place. Yes, we like to think that our health care data is being stored and protected and that laws like HIPAA keep them safe, but there are plenty of ways to legally share health care data today. In fact, many EHR vendors sell your health care data for a pretty penny.

Of course, many would argue that it’s shared in a way that complies with all the laws and that it’s done in a way that your health record isn’t individually identified. They’re only sharing your health data in a de-identified manner. Others would argue that you can’t deidentify the health data and that there are ways to reidentify the data. I’ll leave those arguments for another post. We’ll also leave the argument over whether all this sharing of health data (usually to marketing, pharma and insurance companies) is safe or not for a future post as well.

What’s undeniable is that health data for pretty much all of us is being bought and sold all over health care. If you don’t believe it’s so, take a minute to look at the work of Deborah Peel from Patient Privacy Rights and learn about her project theDataMap. She’ll be happy to inform you of all the ways data is currently being bought and sold. It’s a really big business.

Here’s where the irony comes in. We have no trouble sharing health data (Yes, even EHR vendors have no problem sharing data and lets be clear that not all EHR vendors share data with these outside companies but mare are sharing data) with marketing companies, payers and pharma companies that are willing to pay for access to that data. Yet, when we ask EHR vendors to share health data with other EHR vendors or with an HIE, they balk at the idea as if it’s impossible. They follow that up with a bunch of lame excuses about HIPAA privacy or the complexity of health care data.

Let’s call a spade a spade. We could pretty easily be interoperable in health care if we wanted to be interoperable. We know that’s true because when the money is there from these third party companies, EHR vendors can share data with them. The problem has been that the money has never been there before for EHR vendors to be motivated enough to make interoperability between EHR vendors possible. In fact, you could easily argue that the money was instructing EHR vendors not to be interoperable.

However, times are changing. Certainly the government pressure to be interoperable is out there, but that doesn’t really motivate the industry if there’s not some financial teeth behind it. Luckily the financial teeth are starting to appear in the form of value based reimbursement and the move away from fee for service. That and other trends are pushing healthcare providers to want interoperable health records as an important part of their business. That’s a far cry from where interoperability was seen as bad for their business.

I heard about this shift first hand recently when I was talking with Micky Tripathi, President & CEO of the Massachusetts eHealth Collaborative. Micky told me that his organization had recently run a few RFPs for healthcare organizations searching for an EHR. As part of the EHR selection process Micky recounted that interoperability of health records was not only included in the RFP, but was one of the deciding factors in the healthcare organizations’ EHR selections. The same thing would have never been said even 3-5 years ago.

No doubt interoperability of health records has a long way to go, but there are signs that times are changing. The economics are starting to make sense for organizations to embrace interoperablity. That’s a great thing since we know they can do it once the right economic motivations are present.

Flow – A Spoken Word HIE Piece by Ross Martin

Posted on August 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Want to see brilliance in action? Check out this spoken word piece about HIEs by Ross Martin.

Here’s the background Ross Martin shares about the piece:

On Monday, August 17th, 2015 I begin a new chapter as Program Director for the new Integrated Care Network initiative at CRISP, Maryland’s health information exchange. We will be providing data to healthcare providers to enhance their care coordination efforts and providing additional care coordination tools to some of those providers who don’t already have these capabilities in place.

To mark the transition, I decided to make a video of this spoken word piece I wrote in 2012 (originally entitled “A Man among Millions”) for my last day consulting for the Office of the National Coordinator for Health IT while I was working at Deloitte Consulting. This piece explains why I am so passionate about making health information exchange work for all of us.

I am grateful for the opportunity to make a difference with an amazing team of collaborators and look forward to providing updates on our progress over the coming months and years.

Words: http://rossmartinmd.blogspot.com/2015/08/flow.html

Element-Centric or Document-Centric Interoperability

Posted on February 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

A recent Chilmark blog post on national healthcare interoperability mentioned two approaches to healthcare interoperability: element-centric interoperability and document-centric exchange.

As I think back on the thousands of discussions I’ve had on interoperability, these two phrases do a great job describing the different approaches to interoperability. Unfortunately, what I’ve seen is that many people get these two approaches to interoperability mixed up. In fact, I think it’s fair to say that meaningful use’s CDA requirement is an attempt to mix these two concepts into one. It’s one part element data and one part document.

Personally, I think we should be attacking one approach or the other. Trying to mix the two causes issues and confusion for those involved. The biggest problem with mixing the two is managing people’s perception. Once doctors get a small slice of cake, they want the rest of it too. So, it’s very unsatisfying to only get part of it.

Document-Centric Exchange
The argument for document-centric exchange of healthcare data is a good one. There are many parts of the patient record that can’t really be slimmed down into a nice element-centric format. Plus, there’s a wide variation in how and what various doctors document. So, the document format provides the ultimate in flexibility when it comes to outputting and sharing this data with another provider.

Those who are against document-centric exchange highlight that this is really just a modernization of the fax machine. If all we’re doing is exchanging documents, then that’s basically replicating what we’ve been doing for years with the fax machine. Plus, they highlight the fact that you can’t incorporate any of the granular data elements from the documents into the chart for any sort of clinical decision support. It might say your allergies on the document, but the EHR won’t know about those allergies if it’s stored on a document you received from another system.

While certainly not ideal, document-centric exchange can still be a nice improvement over the fax machine. In the fax world, there was still a lot of people required to get the documents faxed over to another provider. In the document-centric exchange world this could happen in real time with little to no interaction from the provider or their staff. The fact that this is possible is exciting and worrisome to many people. However, it would facilitate getting the right information (even if in document form) to the right people at the right time.

Element-Centric Exchange
We all know that the nirvana of health information exchange is element-centric exchange. In this exchange, your entire health record is available along with a series of meta data which tells the receiving system what each data element represents. This solves the allergy problem mentioned above since in an element-centric exchange the allergy would be stored in a specific field which notes it as an allergy and the receiving system could process that element and include it in their system as if it was entered natively.

This last line scares many people when it comes to element-centric exchange. Their fear is that the information coming from an external system will not be trustworthy enough for them to include in their system. What if they receive the data from an external system and it’s wrong. This could cause them to make an incorrect decision. This fear is important to understand and we need our systems to take this into account. There are a lot of ways to solve this problem starting with special notation about where the information was obtained so that the provider can evaluate that information based on the trustworthiness of the source. As doctors often do today with outside information about a patient, they have to trust but verify the information. If it says No Known Drug Allergy, the doctor or other medical staff can verify that information with the patient.

The other major challenge with element-centric exchange is that medical information is really complex. Trying to narrow a record down to specific elements is a real challenge. It’s taken us this long to get element-centric exchange of prescription information. We’re getting pretty close there and prescriptions are relatively easy in the healthcare information world. We’re still working on labs and lab results and anyone whose worked on those interfaces understand why it’s so hard to do element-centric exchange of health information.

This doesn’t even address the challenge of processing these elements and inputting them into a new system. It’s one thing to export the data out of the source system in an element-centric format. It’s an even bigger challenge to take that outputted document and make sure it imports properly into the destination system. Now we’re talking about not only knowing which element should go where, but also the integrity and format of the data in that field. Take something as simple as a date and see the various formats which all say the same thing: 2/17/15, 2/17/2015, 02/17/2015, February 17 2015, Feb 17 2015, 17/2/2015 etc.

Where Is This Heading?
As I look into the future of interoperability, I think we’ll see both types of exchange. Document-centric exchange will continue with things like Direct Project. I also love these initiatives, because they’re connecting the end points. Regardless of what type of exchange you do, you need to trust and verify who is who in the system so that you’re sending the information to the right place. Even if document exchange using Direct isn’t the end all be all, it’s a step in a good direction. Plus, once you’re able to send your documents using direct, why couldn’t an HIE of sorts receive all of your documents? We’re still very early in the process of what Direct could become in the document-centric exchange world.

I think we have a long ways to go to really do element-centric exchange well. One challenge I see in the current marketplace is that companies, organization, and our government are trying to bite off more than they can chew. They are trying to make the entire patient chart available for an element-centric exchange. Given the current environment, I believe this is a failed strategy as is illustrated by the hundreds of millions of dollars that the government has spent on this goal.

I look forward to the day when I see some more reasonable approaches to element-centric exchange which understand the realities and complexities associated with the challenge. This reminds me of many organizations’ approach to big data. So many organizations have spent millions on these massive enterprise data warehouses which have yet to provide any value to the organization. However, lately we’ve seen a move towards small data that’s tied directly to results. I’d like to see a similar move in the element-centric exchange world. Stop trying to do element based exchange with the entire health record. Instead, let’s focus our efforts on a smaller set of meaningful elements that we can reasonable exchange.

While the idea of document-centric exchange and element-centric exchange simplify the challenge, I think it’s a great framework for understanding healthcare interoperability. Both have their pros and cons so it’s important to understand which approach you want to take. Mixing the two often leaves you with the problems of both worlds.

6 Healthcare Interoperability Myths

Posted on February 9, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

With my new fascination with healthcare interoperability, I’m drawn to anything and everything which looks at the successes and challenges associated with it. So, it was no surprised that I was intrigued by this whitepaper that looks at the 6 Healthcare Interoperability Myths.

For those who don’t want to download the whitepaper for all the nitty gritty details, here are the 6 myths:

  1. One Size Fits All
  2. There Is One Standard to Live By
  3. I Can Only “Talk” to Providers on the Same EHR as Mine
  4. If I Give Up Control of My Data, I’ll Lose Patients
  5. Hospitals Lead in Interoperability
  6. Interoperability Doesn’t Really “Do” Anything. It’s Just a Fad like HMOs in the 90s

You can read the whole whitepaper if you want to read all the details about each myth.

The first two hit home to me and remind me of my post about achieving continuous healthcare interoperability. I really think that the idea of every health IT vendor “interpreting” the standard differently is an important concept that needs to be dealt with if we want to see healthcare interoperability happen.

Another concept I’ve been chewing on is whether everyone believes that healthcare interoperability is the right path forward. The above mentioned whitepaper starts off with a strong statement that, “It’s no tall tale. Yes. We need interoperability.” While this is something I believe strongly, I’m not sure that everyone in healthcare agrees.

I’d love to hear your thoughts. Do we all want healthcare interoperability or are there are a lot of people out there that aren’t sure if healthcare interoperability is the right way forward?