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Value Based Reimbursement Research Results in Time for #AHIPInstitute

Posted on June 15, 2016 I Written By

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

McKesson Health Solutions has commissioned a new National Research study on Value Based Reimbursement. Here’s a quick summary of some of the findings:

The rapid pace of change in healthcare payment continues unabated, with payers reporting they are 58% along the continuum towards full value-based reimbursement, a 10% leap since 2014. Hospitals aren’t far behind, reporting they’re now 50% along the value continuum, up 4% in the past two years.

Those numbers were a bit shocking to me. It doesn’t feel like we’ve gotten that far in the shift to value based reimbursement. Does it feel like it to you? I knew we were headed that direction, but definitely thought we had just begun. These numbers paint a much different story.

This week I’m excited to attend my first AHIP Institute. I’ll be exploring this shift in all its gory details.

Along with this study and with AHIP starting tomorrow, McKesson has been sharing a number of cartoons about the healthcare industry. Here are a few of them they tweeted out:

Healthcare Costs

Healthcare Payment Pathway

A Great Look Into Healthcare Quality Improvement

Posted on June 14, 2016 I Written By

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

As I think back on the evolution of EHR software and healthcare IT, it’s been incredible to see how EHR has moved from being something that could help improve your billing to now trying to be something to improve the quality of healthcare that’s being provided. In fact, I’ve long argued that the expectation of EHR was far ahead of the EHR reality. EHRs weren’t designed for quality and so it was a mistake for many to believe that it would improve quality.

While that’s the reality of history, going forward the new EHR reality is that they better figure out how to improve healthcare quality. In fact, the ones that are able to do this are going to be the most successful.

As we shift our focus to healthcare quality, I was intrigued by this video animation by Doc Mike Evans describing healthcare quality. It’s fascinating to look at the history and consider healthcare quality going forward.

What do you think of Doc Mike Evans’ thoughts on Healthcare Quality Improvement? Is he spot on? Is there something he’s missing?

Don’t Blame HIPAA: It Didn’t Require Orlando Regional Medical Center To Call the President

Posted on June 13, 2016 I Written By

The following is a guest blog post by Mike Semel, President of Semel Consulting. As a Healthcare Scene community, our hearts go out to all the victims of this tragedy.

Orlando Mayor Buddy Dyer said the influx of patients to the hospitals created problems due to confidentiality regulations, which he worked to have waived for victims’ families.

“The CEO of the hospital came to me and said they had an issue related to the families who came to the emergency room. Because of HIPAA regulations, they could not give them any information,” Dyer said. “So I reached out to the White House to see if we could get the HIPAA regulations waived. The White House went through the appropriate channels to waive those so the hospital could communicate with the families who were there.”    Source: WBTV.com

I applaud the Orlando Regional Medical Center for its efforts to help the shooting victims. As the region’s trauma center, I think it could have done a lot better by not letting HIPAA get in the way of communicating with the patients’ families and friends.

In the wake of the horrific nightclub shooting, the hospital made things worse for the victim’s families and friends. And it wasn’t necessary, because built into HIPAA is a hospital’s ability to share information without calling the President of the United States. There are other exemptions for communicating with law enforcement.

The Orlando hospital made this situation worse for the families when its Mass Casualty Incident (MCI) plan should have anticipated the situation. A trauma center should have been better prepared than to ask the mayor for help.

As usual, HIPAA got the blame for someone’s lack of understanding about HIPAA. Based on my experience, many executives think they are too busy, or think themselves too important, to learn about HIPAA’s fundamental civil rights for patients. Civil Rights? HIPAA is enforced by the US Department of Health & Human Services’ Office for Civil Rights.

HIPAA compliance and data security are both executive level responsibilities, although many executives think it is something that should get tasked out to a subordinate. Having to call the White House because the hospital didn’t understand that HIPAA already gave it the right to talk to the families is shameful. It added unnecessary delays and more stress to the distraught families.

Doctors are often just as guilty as hospital executives of not taking HIPAA training and then giving HIPAA a bad rap. (I can imagine the medical practice managers and compliance officers silently nodding their heads.)

“HIPAA interferes with patient care” is something I hear often from doctors. When I ask how, I am told by the doctors that they can’t communicate with specialists, call for a consult, or talk to their patients’ families. These are ALL WRONG.

I ask those doctors two questions that are usually met with a silent stare:

  1. When was the last time you received HIPAA training?
  2. If you did get trained, did it take more than 5 minutes or was it just to get the requirement out of the way?

HIPAA allows doctors to share patient information with other doctors, hospitals, pharmacies, and Business Associates as long as it is for a patient’s Treatment, Payment, and for healthcare Operations (TPO.) This is communicated to patients through a Notice of Privacy Practices.

HIPAA allows doctors to use their judgment to determine what to say to friends and families of patients who are incapacitated or incompetent. The Orlando hospital could have communicated with family members and friends.

From Frequently Asked Questions at the HHS website:

Does the HIPAA Privacy Rule permit a hospital to inform callers or visitors of a patient’s location and general condition in the emergency room, even if the patient’s information would not normally be included in the main hospital directory of admitted patients?

Answer: Yes.

If a patient’s family member, friend, or other person involved in the patient’s care or payment for care calls a health care provider to ask about the patient’s condition, does HIPAA require the health care provider to obtain proof of who the person is before speaking with them?

Answer: No.  If the caller states that he or she is a family member or friend of the patient, or is involved in the patient’s care or payment for care, then HIPAA doesn’t require proof of identity in this case.  However, a health care provider may establish his or her own rules for verifying who is on the phone.  In addition, when someone other than a friend or family member is involved, the health care provider must be reasonably sure that the patient asked the person to be involved in his or her care or payment for care.

Can the fact that a patient has been “treated and released,” or that a patient has died, be released as part of the facility directory?

Answer: Yes.

Does the HIPAA Privacy Rule permit a doctor to discuss a patient’s health status, treatment, or payment arrangements with the patient’s family and friends?

Answer: Yes. The HIPAA Privacy Rule at 45 CFR 164.510(b) specifically permits covered entities to share information that is directly relevant to the involvement of a spouse, family members, friends, or other persons identified by a patient, in the patient’s care or payment for health care. If the patient is present, or is otherwise available prior to the disclosure, and has the capacity to make health care decisions, the covered entity may discuss this information with the family and these other persons if the patient agrees or, when given the opportunity, does not object. The covered entity may also share relevant information with the family and these other persons if it can reasonably infer, based on professional judgment, that the patient does not object. Under these circumstances, for example:

  • A doctor may give information about a patient’s mobility limitations to a friend driving the patient home from the hospital.
  • A hospital may discuss a patient’s payment options with her adult daughter.
  • A doctor may instruct a patient’s roommate about proper medicine dosage when she comes to pick up her friend from the hospital.
  • A physician may discuss a patient’s treatment with the patient in the presence of a friend when the patient brings the friend to a medical appointment and asks if the friend can come into the treatment room.

Even when the patient is not present or it is impracticable because of emergency circumstances or the patient’s incapacity for the covered entity to ask the patient about discussing her care or payment with a family member or other person, a covered entity may share this information with the person when, in exercising professional judgment, it determines that doing so would be in the best interest of the patient. See 45 CFR 164.510(b).

Thus, for example:

  • A surgeon may, if consistent with such professional judgment, inform a patient’s spouse, who accompanied her husband to the emergency room, that the patient has suffered a heart attack and provide periodic updates on the patient’s progress and prognosis.
  • A doctor may, if consistent with such professional judgment, discuss an incapacitated patient’s condition with a family member over the phone.
  • In addition, the Privacy Rule expressly permits a covered entity to use professional judgment and experience with common practice to make reasonable inferences about the patient’s best interests in allowing another person to act on behalf of the patient to pick up a filled prescription, medical supplies, X-rays, or other similar forms of protected health information. For example, when a person comes to a pharmacy requesting to pick up a prescription on behalf of an individual he identifies by name, a pharmacist, based on professional judgment and experience with common practice, may allow the person to do so.

Other examples of hospital executives’ lack of HIPAA knowledge include:

  • Shasta Regional Medical Center, where the CEO and Chief Medical Officer took a patient’s chart to the local newspaper and shared details of her treatment without her permission.
  • NY Presbyterian Hospital, which allowed the film crew from ABC’s ‘NY Med’ TV show to film dying and incapacitated patients.

To healthcare executives and doctors, many of your imagined challenges caused by HIPAA can be eliminated by learning more about the rules. You need to be prepared for the 3 a.m. phone call. And you don’t have to call the White House for help.

About Mike Semel
Mike Semel, President of Semel Consulting,  is a certified HIPAA expert with over 12 years’ HIPAA experience and 30 years in IT. He has been the CIO for a hospital and a K-12 school district; owned and managed IT companies; ran operations at an online backup provider; and is a recognized HIPAA expert and speaker. He can be reached at mike@semelconsulting.com or 888-997-3635 x 101.

10 Years of Blogging – The HealthBlawg

Posted on June 10, 2016 I Written By

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

My friend and colleague, David Harlow, is celebrating an important milestone on his blog. It’s the 10th anniversary of his HealthBlawg. That’s a long time in blog years. I know since I just passed my 10 year anniversary last year as well. It’s amazing for me to think back on all those years and the things I’ve learned from David’s posts on HealthBlawg.

In true David Harlow fashion, he’s doing a great 10 year celebration of HealthBlawg with what he’s calling the Festschrift of the Blogosphere. As part of that celebration, he’s invited other bloggers (including myself) to write posts in the HealthBlawg’s Tenth Blogiversary. I loved the idea since in many ways it took me back to the early days of blogging (before Twitter and other social media) where we all connected with each other on blogs.

I think David still has a number of other posts coming from guest bloggers, but I thought I’d highlight a few of them which I found extremely interesting.

First up is Dr. Nick van Terheyden’s post called “Channeling Churchill to deal with innovation, impatience and chaos in healthcare“. The whole post is great and worth a read, but this part stood out to me in particular:

Everything you thought you knew about how to make your organization financially successful will change. Profit centers like radiology and diagnostic imaging will become cost centers; the more high-end expensive care you give, which once supported all the more mundane services you provide, the lower your profits will be. Instead of filling beds, your job will be to keep them empty.

It’s a big challenge, but the same kind of augmented intelligence systems that will help physicians keep patients healthy can help you keep your organization healthy. Analytics can help you identify and stratify risk, so that you can contract with payers at rates that won’t kill your bottom line. And it can help you identify gaps in care that could lead to the need for expensive treatments and procedures.

It’s going to take a while for organizations to really process what Dr. Nick is saying. In fact, I don’t think most will and they’ll be blindsided when it happens. Talk about a dramatic shift in thinking and Dr. Nick described it so well. Combine this with Dr. Nick’s opening comments about the shifting consumer expectations and we’re in for some big changes.

Another post honoring the HealthBlawg that stood out to me was e-Patient Dave’s post called “Gimme my DaM Data: liberating to patients, scary to some.” I’d heard most of Dave’s story before, but he offered a few insights into it that I’d never heard before. However, his message is still just as compelling today as it was when he first blogging about his data issues back in 2009.

It’s too bad these things are still issues because I wish we could put e-Patient Dave out of business. Ok, that might sound harsh, but I think he wants to be put out of business too. No one would be happier than him if the culture around our health data were changed. I’m sure he’d find something else worth advocating for if we solved the problem of patient access to data.

If you’re not familiar with e-Patient Dave, here’s a section of his post which illustrates the problem and his goal:

Some old-schoolers are threatened by patients seeing the chart; some even think it’s none of your business. Twenty years ago Seinfeld episode 139 showed Elaine looking at her chart and seeing she’d been marked “difficult.” The doctor took the chart from her hands: back then she had no legal right to see it… so she sent Kramer to get it, impersonating a doctor.

You should get your data – all of it. It may not be easy – some providers are severely out of date about your legal rights, and some resist for other reasons: some feel threatened, some know there are gross errors in the chart, some charts contain insults, and some contain flat-out billing fraud: conditions you don’t have, but they’ve been billing your insurance for.

When your doctor hesitates to give you your data, which reasons do they have? Only one way to find out.

I have to admit that reading Dave’s story again has me inspired to spend more time and effort in that space myself and on this blog.

If you’d like to see the post I did, it’s called “Integrated Health – People Finally Caring About Their Health and Not Even Realizing It.” Here’s an excerpt from my post:

While most people will tell you they care about their health, their actions say otherwise. The reality is that the rest of our life is full of bright shiny objects and so it’s really easy for us to get distracted. However, there’s a coming revolution of health care that is totally integrated into your life that’s going to help us care about our health and we won’t even realize it is happening.

If you were to ask someone if they cared about their health, 100% of people would say they do. In fact, you’d likely hear the majority of people go on to say that if they didn’t have their health, then they wouldn’t have anything. While we are happy to publicly proclaim our desire for health, our actions often send a very different message.

Thanks David for inspiring us all with your work at HealthBlawg. You’re a good man (which can be hard to say for a lawyer…sorry I had to have at least one lawyer joke) that is working hard to make a difference in healthcare. I look forward to another decade of blogging alongside you.

Can Online Self-Scheduling Really Change the ER and Urgent Care Experience? – Communication Solutions Series

Posted on June 9, 2016 I Written By

The following is a guest blog post by Laura Alabed-Olsson, Marketing Manager of Stericycle Communication Solutions, as part of the Communication Solutions Series of blog posts. Follow and engage with them on Twitter:@StericycleComms
Laura Alabed-Olsson
As a part of the team behind online self-scheduling solution InQuicker, I am asked this question a lot. When you’re dealing with the sickest of the sick of patients, can online self-scheduling really make a difference? Yes, it can. Let’s begin by looking at things from a patient’s perspective.

Imagine you’re sick. Really sick. You haven’t showered in a day or so. You’re in your pajamas and buried under the covers in your bed. Even if your favorite ER or urgent care is the best of the best – think big-screen TV, a beverage bar and a tall stack of your favorite magazines – wouldn’t you rather wait from home than this palace of a waiting room? Online self-scheduling makes this possible. You simply go to your preferred provider’s website. Select an estimated treatment time. Provide some basic information. And then you wait from home until it’s time to be seen. It’s that easy. (You still feel crummy, but at least a little bit happy that you won’t have to wait long when you get there, right?)

Now, let’s look at it from a provider’s perspective. With online self-scheduling, you have the benefit of knowing who’s coming in, why they’re seeking care, and when they’ll arrive – giving you plenty of time to prepare space and allocate resources. Online self-scheduling supports operational efficiency, big time.

Running behind and fearful that you can’t see a self-scheduled patient at their estimated treatment time? No problem. Just let them know when you’ll be ready, so that they can adjust their timing. Then, bask in the glow of knowing that when they do arrive, they’re certain to be happier than they would have been had they been sitting in the waiting room the entire time. Talk about getting the patient-provider relationship off on the right foot!

Today’s patients want – and increasingly expect – a patient-centric approach to healthcare. Online self-scheduling supports this (along with patient acquisition and retention, operational efficiency and care coordination). In fact, across the clients that use InQuicker for their online scheduling needs, we see patient satisfaction rates that average 90 percent.

Yes, online self-scheduling really can change (and improve) the ER/urgent care experience. Do you want happy patients and happy providers? Online self-scheduling could be the answer.

The Communication Solutions Series of blog posts is sponsored by Stericycle Communication Solutions, a leading provider of high quality telephone answering, appointment scheduling, and automated communication services. Stericycle Communication Solutions combines a human touch with innovative technology to deliver best-in-class communication services. Connect with Stericycle Communication Solutions on social media: @StericycleComms

Securing IoT Devices Calls For New Ways Of Doing Business

Posted on June 8, 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.

While new Internet-connected devices can expose healthcare organizations to security threats in much the same way as a desktop PC or laptop, they aren’t always procured, monitored or maintained the same way. This can lead to potentially major ePHI breaches, as one renowned health system recently found out.

According a piece in SearchHealtlhIT, executives at Intermountain Healthcare recently went through something of a panic when connected audiology device went missing. According to Intermountain CISO Karl West, the device had come into the hospital via a different channel than most of the system’s other devices. For that reason, West told the site, his team couldn’t verify what operating system the audiology device had, how it had come into the hospital and what its lifecycle management status was.

Not only did Intermountain lack some key configuration and operating system data on the device, they didn’t know how to prevent the exposure of stored patient information the device had on board. And because the data was persistent over time, the audiology device had information on multiple patients — in fact, every patient that had used the device. When the device was eventually located, was discovered that it held two-and-a-half years worth of stored patient data.

After this incident, West realized that Intermountain needed to improve on how it managed Internet of Things devices. Specifically, the team decided that simply taking inventory of all devices and applications was far from sufficient to protect the security of IoT medical devices.

To prevent such problems from occurring again, West and his team created a data dictionary, designed to let them know where data originates, how it moves and where it resides. The group is also documenting what each IoT device’s transmission capabilities are, West told SearchHealthIT.

A huge vulnerability

Unfortunately, Intermountain isn’t the first and won’t be the last health system to face problems in managing IoT device security. Such devices can be a huge vulnerability, as they are seldom documented and maintained in the same way that traditional network devices are. In fact, this lack of oversight is almost a given when you consider where they come from.

Sure, some connected devices arrive via traditional medical device channels — such as, for example, connected infusion pumps — but a growing number of network-connected devices are coming through consumer channels. For example, though the problem is well understood these days, healthcare organizations continue to grapple with security issues created by staff-owned smart phones and tablets.

The next wave of smart, connected devices may pose even bigger problems. While operating systems running mobile devices are well understood, and can be maintained and secured using enterprise-level processes,  new connected devices are throwing the entire healthcare industry a curveball.  After all, the smart watch a patient brings into your facility doesn’t turn up on your procurement schedule, may use nonstandard software and its operating system and applications may not be patched. And that’s just one example.

Redesigning processes

While there’s no single solution to this rapidly-growing problem, one thing seems to be clear. As the Intermountain example demonstrates, healthcare organizations must redefine their processes for tracking and securing devices in the face of the IoT security threat.

First and foremost, medical device teams and the IT department must come together to create a comprehensive connected device strategy. Both teams need to know what devices are using the network, how and why. And whatever policy is set for managing IoT devices has to embrace everyone. This is no time for a turf war — it’s time to hunker down and manage this serious threat.

Efforts like Intermountain’s may not work for every organization, but the key is to take a step forward. As the number of IoT network nodes grow to a nearly infinite level, healthcare organizations will have to re-think their entire philosophy on how and why networked devices should interact. Otherwise, a catastrophic breach is nearly guaranteed.

Prescription Benefits’ Information Silos Provide Feedstock for RxEOB

Posted on June 7, 2016 I Written By

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

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

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

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

Payers

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

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

Physicians

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

Pharmacies

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

Benefits managers

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

Consumers

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

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

FHIR Product Director Speaks Out On FHIR Hype

Posted on June 6, 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.

To date, all signs suggest that the FHIR standard set has tremendous promise, and that FHIR adoption is growing by leaps and bounds. In fact, one well-connected developer I spoke with recently argues that FHIR will be integrated into ONC’s EHR certification standards by 2017, when MACRA demands its much ballyhooed “widespread interoperability.”

However, like any other new technology or standard, FHIR is susceptible to being over-hyped. And when the one suggesting that FHIR fandom is getting out of control is Grahame Grieve, FHIR product director, his arguments definitely deserve a listen.

In a recent blog post, Grieve notes that the Gartner hype cycle predicts that a new technology will keep generating enthusiasm until it hits the peak of inflated expectations. Only after falling into te trough of disillusionment and climbing the slope of enlightenment does it reach the plateau of productivity, the Gartner model suggests.

Now, a guy who’s driving FHIR’s development could be forgiven for sucking up the praise and excitement around the emerging standard and enjoying the moment. Instead, though, it seems that Grieve thinks people are getting ahead of themselves.

To his way of thinking, the rate of hype speech around FHIR continues to expand. As he sees it, people are “[making] wildly inflated claims about what is possible, (wilfully) misunderstanding the limitations of the technology, and evangelizing the technology for all sorts of ill judged applications.”

As Grieve sees it, the biggest cloud of smoke around FHIR is that it will “solve interoperability.” And, he flatly states, it’s not going to do that, and can’t:

FHIR is two things: a technology, and a culture. I’m proud of both of those things…But people who think that [interoperability] will be solved anytime soon don’t understand the constraints we work under…We have severely limited ability to standardise the practice of healthcare or medicine. We just have to accept them as they are. So we can’t provide prescriptive information models. We can’t force vendors or institutions to do things the same way. We can’t force them to share particular kinds of information at particular times. All we can do is describe a common way to do it, if people want to do it.

The reality is that while FHIR works as a means of sharing information out of an EHR, it can’t force different stakeholders (such as departments, vendors or governments) to cooperate successfully on sharing data, he notes. So while the FHIR culture can help get things done, the FHIR standard — like other standards efforts — is just a tool.

To be sure, FHIR seems to have legs, and efforts like the Argonaut Project — which is working to develop a first-generation FHIR-based API and Core Data Services specification — are likely to keep moving full steam ahead.

But as Grieve sees it, it’s important to keep the pace of FHIR work deliberate and keep fundamentals like solid processes and well-tested specifications in mind: “If we can get that right — and it’s a work in process — then the trough of despair won’t be as deep as it might.”

5 Reasons Why Canada Could Be a Hotbed for EHR innovation

Posted on June 4, 2016 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

From June 5th to 8th thousands of Canadian HealthIT professionals, government representatives, hospital leaders and policy consultants will gather for the annual eHealth Conference (#eHealth2016) in Vancouver. This event is like HIMSS, but smaller and focused on Canada.

Full disclosure: I am Canadian, but I spend about 80% of my time focused on US Healthcare. I manage to stay informed about the happenings in my home country through the tweets and posts of people like Glenn Lanteigne @GlennLanteigne, Mark Casselman @markcasselman, Michael Martineau @eHealthMusings, Colleen Young @colleen_young and Pat Rich @pat_health

Ahead of the #eHealth2016 conference Pat Rich sent out this tweet:

This tweet got me thinking about the state of EHRs in my home country. After hours of catching up on the latest Canadian EHR news – a light bulb went off – Canada could be the ideal test bed for new EHR innovations.

Here’s 5 reasons why

Reason 1 – No Meaningful Use, MACRA or MIPS

Like the US, Canada did allocate government dollars to help encourage the adoption of EHRs by physician practices and healthcare institutions. However, the dollars given out to Canadians paled in comparison to the US $34B CMS program. In fact, in some provinces (like Quebec) the incentive payments were so insignificant that many choose not to fill out the paperwork to receive their funding.

As well, none of the incentive programs have attestation requirements similar to the US Meaningful Use criteria. Nor do Canadian programs have penalties for not adopting an EHR.

This combination of relatively low incentive dollars, lack of MU-style adherence programs and zero penalties means that EHR vendors in Canada are relatively free to pursue their own product roadmaps. There is less government and end-user pressure to build functionality simply to meet funding criteria. Instead, EHR vendors can focus more on what end-users really want (better user interfaces anyone?)

Reason 2 – PIPEDA vs HIPAA

Canada does have privacy legislation. It’s called PIPEDA and it places the onus on healthcare organizations to protect the personal identifiable health information of patients. At a high level the protections for health information under PIPEDA is similar to that of the US HIPAA laws.

The biggest difference, however, is in the attitude of healthcare providers towards PIPEDA vs HIPAA. In Canada PIPEDA is not thought of as a barrier to information sharing. Privacy is definitely a concern, but PIPEDA isn’t used as often as an excuse to prevent access to information.

Reason 3 – Single Payer

Each provincial government in Canada is the single payer for healthcare for its citizens. If you live in Ontario and you go to the hospital, the hospital bills the Ontario government for the care you received. There are no other payers involved, no co-pays, nothing.

For EHR vendors this makes payment processing and collection a lot simpler – giving them more time to focus on other areas of EHR functionality.

Reason 4 – Patient Identifiers

A beneficial consequence of the single-payer system is that every person in Canada has a unique patient identifier. Consolidating health information from multiple healthcare organizations is therefore much easier since every lab result, prescription, requisition and image has this unique identifier. It’s Canada’s built-in unique key.

Reason 5 – Sorry, eh.

Canadians by nature are very apologetic. We say “sorry” when people bump into us. We apologize when we feel we are inconveniencing someone else. It’s something in the water.

I’ve personally found Canadian end-users to be very tolerant and understanding of new technologies. It’s not in our nature to complain so things have to go REALLY wrong before we make it an issue. Admittedly I have a small sample size, but when I speak to HealthIT vendors doing business in Canada, I hear similar stories.

Conclusion

In combination, the 5 reasons above create an innovation-friendly environment for EHR vendors. Instead of having product functionality dictated by government legislation and financial incentives, vendors are free to incorporate real end-user feedback into their EHR platforms. They can push the usability envelop in a tolerant environment where privacy isn’t used as a blocker to progress.

Maybe I’m delusional, but I’m really hoping to see signs of EHR innovation at the upcoming #eHealth2016 conference. If you are an EHR vendor that’s doing business in Canada and you are doing something innovative with user experience or functionality I want to hear from you!

Vendors Bring Heart And Lung Sounds To EHR

Posted on June 3, 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.

In what they say is a first, a group of technology vendors has teamed up to add heart and lung sounds to an EMR. The current effort extends only to the drchrono EHR, but if this rollout works, it seems likely that other vendors will follow, as adding multimedia content to patient medical records is a very logical step.

Urgent care provider Direct Urgent Care, a Berkeley, CA-based urgent care provider with 30,000 patients, is rolling out the Eko Core Digital Stethoscope for use by physicians. The heart and lung sounds will be recorded by the digital stethoscope, then transmitted wirelessly to a phone- or tablet-based mobile app. The app, in turn, uploads the audio files to the drchrono HR.

Ordinarily, I’d see this as an early experiment in managing multimedia health data and leave it at that. But two things make it more interesting.

One is that the Eko Core sells for a relatively modest $299, which is not bad for an FDA-cleared device. (Eko also sells an attachment for $199 which digitizes and records sounds captured by traditional analog stethoscopes, as well as streaming those files to the Eko app.) The other is that the recorded sounds can be shared with remote specialists such as cardiologists and pulmonologists, which seems valuable on its face even if the data doesn’t get stored within an EMR.

Not only that, this rollout underscores a problem just been given too little attention. At present, what I’ve seen, few EMRs incorporated anything beyond text. Even radiology images, which have been digital for ages (and managed by sophisticated PACS platforms) typically aren’t accessible to the EMR interface. In fact, my understanding is that PACS data is another silo that needs to be broken down.

Meanwhile, medical practices and hospitals are increasingly generating data that doesn’t fit into the existing EMR template, from sources such as wearables, health apps and video consults. Neither EMR developers nor standards organizations seem to have kept up with the influx of emerging non-text data, so virtually none of it is being integrated into patient records yet.

In other words, not only is it interesting to note that an EMR vendor is incorporating audio into medical records, at a modest cost, it’s worth taking stock of what it can teach us about enriching digital patient records overall.

Eventually, after all, patients will be able to capture — with some degree of accuracy — multimedia content that includes not only audio, but also ultrasound recordings, EKG charts and more. Of course, these self-administered tests and will never replace a consult by a skilled clinician, but there certainly are situations in which this data will be relevant.

When you also bear in mind that the number of telemedicine consults being conducted is growing dramatically, and that these, too, offer insights that could become part of a patient’s chart, the need to go beyond text-based EMRs becomes even more evident.

So maybe the Eko/drchrono partnership will work out, and maybe it won’t. But what they’re doing matters nonetheless.