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The Many Faces and Facets of EHR Interoperability

Posted on December 5, 2014 I Written By

The following is a guest blog post by Thanh Tran, CEO, Zoeticx, Inc.
Thanh Tran, CEO, Zoeticx
Interoperability is the ability to make sub-systems and organizations work together (inter-operate) for attainment of a common goal. In healthcare, implementation and connection of EHR systems and the data they collect allows for us to impact patient care to become a value-driven one for all patients.

The opposite of interoperability is not the lack of connecting EHR systems, but instead the failure of healthcare systems and organizations to collaborate in an efficient, effective, safe and consistent way to support patient care. To better understand the ecosystem of healthcare, we need to look at this redefined concept of interoperability in greater depth while also considering the needs of various stakeholders and their views of the system.

Care Providers Want Care Continuum

Care Providers are not a single entity whose needs can be fulfilled with a single solution. The focus of all providers is on the patient care continuum and their role in it. The lack of EHR interoperability is fundamentally defined as the inability to share patient medical records across this continuum.

Each provider brings a unique view and delivers specialized, customized care to the patient over different time periods. The care delivered by each provider is interdependent on other providers taking care of the patient for a current encounter. To deliver care, healthcare providers must have the ability to access not only summary information about a patient, or the outcome of a prior intervention, but also be able to drill down into the specific data where they can provide meaning and insight for the patient and the rest of the care team.

Collaborative healthcare, care delivered by specialized and focus teams of providers, has become standard in medicine. Access to the information and meaning provided by various providers is essential. It must be delivered in near time, to the proper provider on the team.

For care providers it is about the ability to see the whole care spectrum; to drill into details with on-demand and near time access.

IT Pros Need Information Flow

With healthcare IT pros, interoperability begins with patient medical information flow.  As the patient transits through healthcare facilities, they are treated by different care providers using different systems. Care providers depend on the above medical flow to ensure effective and quality care delivery. Proprietary patient medical records from diverse EHR systems prohibit that flow, leaving healthcare IT crippled, along with care providers, in enabling a seamless workflow across the system.

Healthcare IT organizations impacted by merger and acquisition face the lack of EHR interoperability under another major challenge, IT integration of disparate EHR systems. Rip and replace is a costly solution to achieving integration and overcoming EHR interoperability among diverse EHR systems.

Furthermore, healthcare IT faces the continued demand for solutions to patient care effectiveness, efficiency and improving patient care quality. However, healthcare IT application developers have been bogged down by the lack of EHR interoperability as well. The EHR agnostic environment is required to seal off applications from the EHR infrastructure. Without this layer, the development would be focused on addressing infrastructure challenges instead of innovative solutions for care providers.

As any other IT organization, healthcare IT faces the challenge of doing more with less. EHR systems share a number of characteristics as its siblings, enterprise applications from other IT industries. EHR systems form the backbone of healthcare systems, but they are also complex, slow to react to care providers’ requirements and costly to maintain. That cost is already in place, leaving healthcare IT with a smaller budget to address the lack of interoperability. Any solutions to EHR interoperability must be low total cost of ownership, lightweight to deploy and portable to a variety of healthcare IT applications.

Administrators Require Compliance and Data Protection

Healthcare administration is charged with complying with patient privacy requirements (HIPAA). Solutions for EHR interoperability with additional copies of patient medical records are not optimal since they represent additional compliance activities and agreements (such as Data Service Agreement) between the data source and destination. These additional compliance activities represent complexity, cost and risk of non-compliance that would result in potential penalties, legal and IT maintenance costs. For healthcare administration, simplicity and practicability of the solution are critical.

Patients Suffer Most

The greatest impact to all stakeholders in EHR interoperability is on the patient. Being at the center of the healthcare delivery model, patients must be brought into the interoperability equation. A vital component for gaining control of increasing healthcare expenditures is engagement of patients.

Not only do we need patient engagement, but patients are demanding security and control over who accesses their medical data. These two are not independent, but are intimately connected. Without control and understanding of who accesses the data, patients will lose trust in the system leading to disengagement and disempowerment.

Patient control over medical record access must be dynamic, secure and able to occur in near time. Above all, patients have full control of who has the full access of their medical records. Current concepts of Opt-In or Opt-Out choice for medical data duplication does not address these dynamic and secure requirements and give patients the control of who has access.

The Optimal EHR Interoperability Solution

EHR systems are database oriented. To address EHR interoperability by creating an additional centralized database layer is not an optimal approach, let alone the failure to satisfy the stakeholders impacted.

The next wave of healthcare challenges needs to be addressed by innovative applications aimed at supporting care providers. The best approach is a middleware infrastructure, supporting open architecture for healthcare, capable of performing data switching and value added data redistribution capabilities from various EHR systems. The middleware solution must be lightweight, embedded as part of healthcare applications supporting on-demand, near time access to diverse EHR systems. It is where interoperability must be implemented.

Thanh Tran is CEO of Zoeticx, Inc., a medical software company located in San Jose, CA. He is a 20 year veteran of Silicon Valley’s IT industry and has held executive positions at many leading software companies. Zoeticx offers a middleware infrastructure supporting on-demand, near time access to diverse EHR systems.

Healthcare Interoperability Series Outline

Posted on November 7, 2014 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.

Interoperability is one of the major priorities of ONC. Plus, I hear many doctors complaining that their EHR doesn’t live up to its potential because the EHR is not interoperable. I personally believe that healthcare would benefit immeasurably from interoperable healthcare records. The problem is that healthcare interoperability is a really hard nut to crack

With that in mind, I’ve decided to do a series of blog posts highlighting some of the many challenges and issues with healthcare interoperability. Hopefully this will provide a deeper dive into what’s really happening with healthcare interoperability, what’s holding us back from interoperability and some ideas for how we can finally achieve interoperable healthcare records.

As I started thinking through the subject of Healthcare Interoperability, here are some of the topics, challenges, issues, discussions, that are worth including in the series:

  • Interoperability Benefits
  • Interoperability Risks
  • Unique Identifier (Patient Identification)
  • Data Standards
  • Government vs Vendor vs Healthcare Organization Efforts and Motivations
  • When Should You Share The Data and When Not?
  • Major Complexities (Minors, Mental Health, etc)
  • Business Model

I think this is a good start, but I’m pretty sure this list is not comprehensive. I’d love to hear from readers about other issues, topics, questions, discussion points, barriers, etc to healthcare interoperability that I should include in this discussion. If you have some insights into any of these topics, I’d love to hear it as well. Hopefully we can contribute to a real understanding of healthcare interoperability.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

Posted on June 30, 2014 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.

July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?

This Geek Girl’s Singing: HIMSS 14 Social Media Finale

Posted on March 14, 2014 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.

As one of the inaugural crop of HIMSS Social Media Ambassadors, a second-generation native Floridian, and a former Orlando resident, it is my sworn duty to summarize, recap, and perhaps satirize the last group of Blog Carnival posts, to metaphorically sing the HIMSS opera finale. And you folks submitted some doozies! I’m very grateful to the HIMSS (@HIMSS) and SHIFT Communications (@SHIFTComm) team for providing me with links to all entries. Y’all have been BUSY!

A man after my own heart, and a frequent #HITsm participant who weathers harsh criticism with witty aplomb: Dan Haley’s (from athenahealth, @DanHaley5) piece on 3 Takeaways From HIMSS – Policy And Otherwise caught my attention with the line, “Regulators are from Mars…” He stole my favorite blog entry prize with the line: “Orlando is magical when you are a kid. Kids don’t attend HIMSS.”

First-time attendee Jeffrey Ting (from Systems Made Simple) outlined his experiences with some of my favorite topics in his piece, HIMSS Reflections By A First-Time Attendee: HIEs and interoperability. I agree with him: the Interoperability Showcase’s “Health Story” exhibit was one of the best presentations of the whole conference.

Dr. Geeta Nayyar’s perspective as a board member of HIMSS and CMIO for PatientPoint gave her a unique vantage point for her post, HIMSS 14: A Truly Inspiring Event. Take note, HIMSS conference planners – your monumental efforts were recognized, as was the monumental spirit of the closing keynote speaker, Erik Weihenmayer.

HIMSS Twitter recaps permeated the blogosphere, with my favorite being the inimitable Chuck Webster’s (@wareflo) HIMSS14 Turned It Up To 11 On And Off-Line!. Chuck also periodically provided trend analysis results of year-over-year #HIMSS hashtag traffic for each period of the conference, complete with memes for particular shapes: Loch Ness monster humped-back, familiar faces of frequent tweeters.

Health IT guru Brian Ahier’s (@ahier) wrapped up the “Best In Show” of HIMSS Blog Carnival , complete with Slideshare visuals awarding Ed Parks of Athenahealth “Best Presentation” and providing an excellent summation of must-read posts.

Interoperability was one of the most prevalent themes of HIMSS, and a plethora of posts discussing the healthcare industry’s progress on the path to Dr. Doug Fridsma’s (@Fridsma) High Jump Of Interoperability (Semantic-Level) were submitted to the Blog Carnival. Notable standouts included: Shifting to a Culture of Interoperability by Rick Swanson from Deloitte, and Dr. Summarlan Kahlon’s (of Relay Health), Diagnosis: A Productive HIMSS 2014, which posited that, “this year’s conference was the first one which convinced me that real, seamless patient-level interoperability is beginning to happen at scale.”

And who could forget about patient engagement, the belle of the HIMSS ball? Telehealth encounters, mobile health apps and implications, patient portals, and the Connected Patient Gallery dominated the social media conversation. Carolyn Fishman from DICOM Grid called it, HIMSS 2014: The Year of the Patient, and discussed trepidation patients feel about portal technologies infringing on face-time.

Quantified-self wearable-tech offered engagement opportunities, as well. Having won one such gadget herself, Jennifer Dennard (@SmyrnaGirl) gave props to organizations like Patientco and Nuance for their use (and planned use) of wearable tech in support of employee wellness programs, and posited on the applications of such tech in the monitoring and treatment of chronic disease in her piece, Watching for Wearables at HIMSS14.

Finally, if you’re able to read Lisa Reichard’s (from Billians Health Data) @billians) highlights piece,Top 10 Tales and Takeaways, without busting out into Beatles tunes, you probably wouldn’t have had nearly as much fun as she and I did at HISTalkapalooza, dancing to Ross Martin’s smooth parodies. You also probably don’t have your co-workers frantically purchasing noise-canceling headphones.

I did say I’d be singing to bring HIMSS to a virtual close.

Can’t wait to get back to the metaphorical microphone for HIMSS 2015 in Chicago!

#HIMSS14 Day 1 – Interoperability, HIE and Social Media

Posted on February 24, 2014 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.

Well, this is technically my second or third day, but this is the first official day of HIMSS. It’s a mad house like you can imagine and the vendor hall is as big as you’d expect. You need about 3 weeks to go through it. I actually decided to do a walking meeting with someone and we basically walked the whole exhibit floor twice. Luckily, the conversation was good and we dove into some interesting topics. I also told them about my future mobile strategy for Healthcare Scene. She liked it. Hopefully I can roll it out in the next few months.

My day happened to start off with a lot of discussion on interoperability and HIE with MAeHC and then Orion Health. I think it’s really interesting to see the progress we’ve made when it comes to interoperability and HIE, but I also found it interesting that Micky Tripathi from MAeHC still described healthcare interoperability as being in its infancy. I largely agree with him and it’s really too bad. Although, it was also interesting to compare that to Orion Health talking about how they’ve proven that HIE can work. Plus, they also noted something I’ve written multiple times: Private HIEs are growing faster than the Public HIEs.

I’m still really torn on the business model for interoperability and HIEs. I don’t see a clear model in most situations. I even saw one tweet yesterday that talked about taxing on a per patient basis to pay for the HIE. I heard that in NY they’re actually literally working on a tax to fund it. However, I really think that calling it a per patient tax is a really bad way to describe the funding. I’ll certainly be covering more of my interoperability and HIE discussions in the future. Watch for those blog posts in the coming weeks.

I also did a lot of social media talk today. Together with Shahid Shah and Cari McLean we had a discussion about Social Media and Influence. It was great to see so many friendly faces in the audience. I feel lucky every chance I get to hear Shahid talk. He’s really good at reframing things in interesting ways. Plus, Cari has a unique perspective to offer from her perch on top of the HIMSS Social Media tower. I previously noted that social media has just become an integral part of HIMSS. What’s interesting is that most of the companies at HIMSS haven’t created it as an integral part of their company. Many are still learning, but it’s great to see them learn. I hope many will attend the Health IT Marketing and PR Conference where we dive in a lot deeper on these topics.

As I said to someone today, social media can provide value to every company, but not every company should do social media. Some companies aren’t ready to commit to doing social media the right way. Other companies aren’t ready to be that open and transparent. Social media is just one tool in the kit. Although, it’s a really powerful one if used properly. I’ve also been touched by the power of social media to help individuals. Social media has connected me to people that would have no doubt been back at their rooms or in the corner of the event wondering why they were there, but instead they’re out having a good time and connecting with other interesting people.

There you go. I talked about a number of other things today, but I’ll cover that over the weeks and months ahead. For now I’m calling my day today HIMSS HIE, Interoperability and Social Media day.

Be sure to also check out my #HIMSS14 Twitter Roundup and my post on Hospital EMR and EHR about the real cause of hospital readmissions. I think the later post will be a post I reference over and over as people continue to talk about solutions that reduce hospital readmissions.

Making the Case for Healthcare Data Interoperability

Posted on November 4, 2013 I Written By

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

My post titled “Patient Controlled Records Could Work Internationally” has driven a lot of interesting conversation in both the comments and my email inbox. I want to highlight some of the responses in a few future posts. The responses do a really good job extending the conversation around a patient controlled health record.

One example of this is from regular reader and commenter R Troy (Ron). As I mention in my post, I think that the patient controlled medical record can work for chronic patients, because they care about their care. R Troy’s comment does a good job explaining a couple examples of why chronic patients can really benefit from having and controlling their patient record:

I am sure that you are quite correct; people in good health have far less interest in maintaining their own health records, except perhaps for those who are fanatics who want to track everything.

As you may have guessed, I have chronic problems – in my case asthma and allergies primarily. And one family member is T1D, and another has a serious auto immune disorder. The latter in particular is part of my passion for EHR’s – I believe that treatment would be far better handled and the results understood with EHR’s with analytical capabilities. Same reason I want a good PHR capability – because that illness plus my issues demand having good data when an emergency occurs, or you move to a new doctor.

A few years ago, the family member with the immune disorder had been scheduled for outpatient treatment at Hospital X. The night before, that person needed to get to an ER ASAP. We wanted the ambulance to go to the ER at X. But there was a bad winter storm, and the ambulance took the person to Hospital Y, in a separate hospital system.

It took Y a few days to get sufficient paper records faxed over from X and from the treating doctor to properly care for the patient, making the situation even worse, and very wasteful cost wise. While HIE would greatly have helped, so would a viable PHR that was well populated and very readily and quickly accessible at Y. BTW, I’m not sure if X and Y are yet able to communicate (the doctor is still not live on an EHR), but I am quite sure that the EHR used in the ER at X (which the patient uses from time to time) has only minimal connections to the EHR used by the rest of hospital X.

One of my HealthIT instructors had orthopedic work done at hospital Z, with lots of imaging. A short time later, he found himself in the ER of hospital X – which could not access any of the imaging from Z, which now had to be completely repeated. Both wasteful and dangerous.

If HIE’s were ‘universal’, at least in the US, the need for a PHR would mainly revolve around the patient’s need to see all their info in one container, plus to get at it from outside the US if the need came up. But it would still exist.

We won’t go into all the challenges of the universal HIE here, but until those challenges are solved. You can see the value of a chronic patient having their universal health record that they can share no matter where they go for healthcare.

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

Posted on October 2, 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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A Biometrically Controlled Healthcare System

Posted on September 6, 2013 I Written By

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

I recently had a nice conversation with Brian Dubin, VP at CERTIFY, where we discussed biometrics in healthcare. Brian got me interested when he described CERTIFY as a biometrics based “big data” company. When I first started this blog, I fell completely in love with all the various biometric options. Check out one of my first posts on Facial Recognition back in April 2006. Shortly after that I even made this EMR and biometrics contribution to a healthcare IT wiki as part of a “blogposium”. [Excuse my moment of nostalgia]

While CERTIFY works with all of the major biometric fingerprints: Finger, Palm, Iris, Facial, Voice, and Signature, I was even more intrigued by a discussion we had around a healthcare system that was biometrically controlled (my word not CERTIFY’s). I realize that the word “controlled” might have negative connotations surrounding it, but I think it is fascinating to consider all of the ways that your biometric identity could be incorporated into healthcare.

Here are some examples I’m considering (some are a reality today and others will be in the future):
Arrive at the office – Imagine that when you arrive at the hospital or medical practice and a video camera grabs your image and the front desk already knows who you are and can say, “Hi John, glad to have you hear today.” Yes, this freaks out some people, but many of the front desk people remember the faces of the patients. Now they can know your name and check you in much quicker.

Positive patient identification – If you don’t like the video camera identification of a patient, you can also do positive identification of the patient using biometrics in a less big brother’s watching you way. When they sit down at the desk to check in, the patient can use a biometric device to identify themselves. Technology like the one I talk about in my post Retina Scanning vs. Iris Recongition are what can be used for this approach.

Voice recognition for a call center – Imagine when you call into a call center they used voice recognition to identify you. This could be used to access your information more quickly. Although, it could also be used to make sure that whoever the person in the call center pulled up matches the voice on the phone. This could solve them pulling up the wrong “John Smith.”

Single sign on – If your biometric identity is stored in the cloud, then that should make that identity available on any system. Plus, I’ve always been fond of single sign on with Facial recognition. The camera is always watching if you’re there or not and so if you open a new application it can immediately authenticate you since it’s constantly authenticating your biometric identity.

I’m really intrigued by the idea of using biometric identities across multiple systems. I’ve heard many hospital CIOs talk about the hundreds of IT systems they have to support. I’ve also heard doctors and nurses complain about the number of logins and passwords they have to remember. Could biometrics be the solution to this problem? Could a biometric identity be shared between systems or would each system need to do more of the traditional single sign on integration?

Unattended computer – Related to the single sign on, facial recognition can also identify when you’re no longer at a computer. If you leave the computer it can automatically lock the computer to ensure that the health data is kept private. You have to balance how quickly the device locks, but this can be great for security.

Location access – A lot of places already do this with fingerprint or palm scans to access private areas. Plus, this prevents the sharing of keys. You can’t really share your fingerprint very well.

Signatures – There’s certainly an art and identity in someone’s signature. However, why don’t we incorporate even more biometrics into someone’s signature? The combination of a signature plus some other biometric identity would be even more powerful. Plus, when I sign to pick up a prescription, if the pharmacy knew my fingerprint, they could indeed verify that I was the right patient.

HIE identification – I don’t know anyone that’s doing this, but I wonder if instead of trying to make a unique patient identifier, using social security numbers, or some other convoluted method of identity management, could we just use someone’s biometric identity? If we aren’t there today, I think we’ll get there eventually. I’m sure there could be mismatches when it comes to matching two biometric identities that were captured by two separate systems. However, we have plenty of mismatches using ssn, name, birthdate, etc. Maybe the real answer is a combination of biometrics and name, birthdate, etc.

A Biometric Healthcare Experience
Those are some general examples. Now let’s imagine a patient visit where they walk into the hospital and are immediately recognized as a patient seeing Dr. Jones for a surgery. The front desk knows who you and has you sign any forms using your biometrics and then directs you to room 315. When you arrive at room 315 you gain access to the room using your biometric identity. The nurse arrives to prep you for surgery and knows she’s working on the right patient because of your biometric identity.

The nurse signs into the EMR using facial recognition and that biometric identity is captured so the EMR knows exactly who is entering the data into the system. The lab arrives and attached your biometric identity to the blood draws and the results will automatically be sent to the EHR matching on your biometrics.

Your doctor writes a prescription for you which gets sent to the pharmacy. The pharmacy knows that he is indeed a doctor based on the biometric identity of the doctor. Once you go to pickup the prescription they verify your biometric identity to ensure you’re in fact the right patient for that prescription. You later go to your family doctor who’s received all of the information and reports from your surgery which were easily matched to you thanks to your biometric identity.

I could keep going, but I think you get the idea. I’m sure there are major holes in the above example, but I think it’s interesting to consider what a biometrically controlled healthcare experience would look like. Plus, to take a line from Google’s Founder, maybe I’m still thinking too small. It’s possible that biometrics will be able to do so much more. It’s not going to happen tomorrow or all at once, but I’m certain that biometrics will play a big part in the future of healthcare.

I’d love to hear your thoughts on this. Are we on the path to a biometric controlled healthcare system?

Bring Your Own EHR (BYOEHR)

Posted on July 23, 2013 I Written By

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

Nerd Doc recently offered a new term I’d never heard called Bring Your Own EHR (BYOEHR). Here’s the explanation:

As a tech nerd doc, the best advice I can give to CIOs/CMIOs is to find a framework for ambulatory practices that embraces a BYOEHR (Bring your own EHR) in the same vein of BYOD (Bring your own device). What I mean by that is allow providor choice in purchasing and implementing their own EHR while insuring that a framework is set up for cross communication to interlink records.

This is to fend off the trend to a one size (Epic) fits all approach in which no one is happy. C-level management needs to realize that if users (providers) are not happy, the promises of savings via efficiency simply will not happen.

I think we’re starting to hear more and more examples like this. We saw evidence of this in my previous post called “CIO Reveals Secrets to HIE.” That hospital organization had created an HIE that connected with 36 different EMRs. Think about the effort that was required there. However, that CIO realized that there was a benefit to creating all of those connections. The results have paid off with a highly used HIE.

I’m sure we’ll still see hospitals acquiring practices and forcing an enterprise EHR down their throats for a while. However, don’t be surprised if the cycle goes back to doctors providing independent healthcare on whatever EHR they see fits them best. Those hospitals that have embraced a BYOEHR approach will be well positioned when this cycle occurs.

CIO Reveals Secrets to HIE

Posted on July 3, 2013 I Written By

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

Inspira Health Network is a community health system comprising three hospitals in southern New Jersey, with more than 5,000 employees and 800 affiliated physicians. It is an early adopter of health information exchange technology. In this Q&A-style paper their CIO and Director of Ambulatory Informatics share secrets to their successful Health Information Exchange implementation.

One of the most impressive numbers from their HIE implementation is that they were able to get 600 providers using the portal and 36 EMRs connected. Plus, they were able to get their HIE up and running in 4 months while many of the public HIEs were still working on their implementations. As I’ve written about previously, I see a lot of potential in the Private HIE. So, it’s great to see a first hand account from a CIO about their private HIE implementation.

Here are some of the other benefits the CIO identifies in the paper:

  • Ties the Physician Community to the Organization
  • Helps Meet the Meaningful Use Patient Engagement Requirements
  • Helps Address Care Coordination Requirements
  • Paper, Postage, and Staff Resource Savings
  • Improve Patient Length of Stay

Check out the full Q&A for a lot of other insights including rolling out the HIE to doctors who have an EMR and those who don’t. I also love that the CIO confirmed that the biggest technical challenge is that every EHR vendor has interpreted the HL7 standard differently based on the technical limitations of the application. This is why I’m so impressed that they were able to get 36 EMRs connected.

I hope more CIOs will share their stories of success. We’ve heard enough bad news in healthcare IT. I want to cover more health IT success stories.