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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 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 and 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 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 and 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.


Element-Centric or Document-Centric Interoperability

Posted on February 17, 2015 I Written By

John Lynn is the Founder of the 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 and 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 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 and 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?

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 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 and 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.