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HIE, RHIO, and Direct Project on Google Plus

Posted on February 9, 2012 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.

The past couple days, a deep and thoughtful conversation has been happening on Google Plus around the idea of HIE, RHIO and the Direct Project. As of this posting, the G+ discussion has generated 80 comments from a broad spectrum of people. If you’re interested in HIE, RHIO, Direct Project or any related healthcare data exchange you’ll want to go read the entire thread.

I’ll just bring out a comment made today by David C. Kibbe that I believe does a pretty good job summarizing a good portion of the conversation. Plus, I think he does a good job describing the various methods of healthcare data exchange. I look forward to hearing from readers about Kibbe’s comments and the other comments in the thread which stand out for others.

Without further ado….David C. Kibbe’s comments:

After re-reading many of these comments, I feel compelled to attempt a few generalizations that (I hope) are based on some observations from the real world of patients, doctors, and hospitals.

First, the majority of health care in the majority of communities in this country is highly fragmented. Sometimes that fragmentation takes the shape of two or three large systems competing with one another. More often there are dozens of small, independent practices of different kinds arrayed near one or more hospitals.

Ownership of these practices, imaging centers, outpatient centers, etc. is in fairly constant transition, with perhaps a slight trend overall towards consolidation. But, in general, most of these communities will face diversity and multiple ownership, and therefore significant fragmentation that is both physical and reflected in information technology systems.

For the patient, this reality is epitomized by having to fill out similar, redundant insurance and medical history forms for each provider visited in the community. Yes, there are exceptions where a particular health care provider is very dominant, and where the “system knows me” wherever I go as a patient. But that is still not the norm, and even those highly integrated systems have their boundaries outside of which communications devolve to paper, mail, telephone, and fax.

As a generalization, there have been two health IT strategies that have dominated the discussion of how to de-fragment community health care systems. One is some version of the community health information network, CHIN. RHIOs, HIEs, and so on. This model seeks to aggregate data from multiple provider enterprises, organize it, and make it available to members. The other is the mega-EHR, which, it is assumed by proponents, will extend its tentacles out into a critical mass of providers, usually from a hospital or group of hospitals, and therefore connect everyone.

The US is a large enough society that it can accommodate both of these “solutions” to the problems inherent in diversity and fragmentation in health care resources. Both of these models are likely to persist well in to the future.

However, what we are now seeing gain some popularity and mindshare is a third model for information and data de-fragmentation in health care, one that is based upon the standards, protocols, and specifications of the Internet, the web, and a network-of-networks architecture. Unlike the other two models, this new model does not require a controlling and centralized (and probably “rent-seeking”) intermediary on the network. This new model, like the Internet, is relatively neutral with respect to operating systems and pre-existing applications. Directed exchange, essentially secure e-mail mediated by a federated trust framework using PKI for point-to-point “push” communications between known participants, is an example of this third model reaching operational status.

To a great many technologists and others involved in health care IT, instances of the new model — let’s call it the Health Internet just to have a name — seems overly simple, even toylike or retrograde, and hardly robust by engineering or health informatics standards. “Why would you want secure e-mail?” I hear every day from health IT experts. “It seems almost stupidly limited and under-powered given the complexity of health care!”

The answer to that kind of question is “Yes, you’re right, Directed exchange, for example, is not very complicated or robust compared to an HIE or an EPIC install. But it might be incredibly low-cost to use and fast-and-easy to deploy; it doesn’t require sophisticated expertise by users, and quite the contrary looks and feels like familiar software, e.g. gmail; and for a whole lot of people who are part of fragmented health care systems it may be “good enough” and their only real alternative for secure health data exchange and connectivity.”

The Health Internet isn’t a substitute for HIEs or for enterprise EHRs. Directed exchange is a “good enough,” better-than-fax solution for the enormous volumes of health information moving across geographical boundaries, outside of EHRs or billing systems. It’s uses will be at the bottom of the health data food chain, the least sexy but still critical exchanges that move data across practices and between hospitals and doctors via fax because they can’t get there any other way cheaply and with minimal technical complexity.

At least that’s the idea….If I were Epic, or the health plans, or a leader of an HIE, I’d embrace the Health Internet for the innovation and efficiency it can offer that part of the health care market that can’t afford your more sophisticated and expensive products. And, in the process, find very large numbers of new customers. Won’t a lot of those be patients and consumers?

EHR, HIE and Meaningful Use Conference in Las Vegas

Posted on August 12, 2010 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’m really excited about a meaningful use and EHR conference that’s being held literally in my backyard. It’s the Inaugural Digital Medical Office of the Future: Driving Toward Meaningful Use Conference and Exhibition. The conference is scheduled for September 9-10, 2010 at Green Valley Ranch in Las Vegas, NV. You can see more details at the EHR conference website.

The whole conference seems really well done and should have a great mix of EHR, EMR, Meaningful Use and HIE topics. I’m personally most excited to hear the famous Mark Anderson from the AC Group speak in person. Our paths have crossed a number of times in the digital world, and so I’m excited to meet him in the physical world. I also noticed that David Kibbe is on the agenda. Both are legends in the EMR and EHR world which should make for an extraordinary time.

If any EMR and HIPAA readers plan to attend, it would be fun to meet you in person. Maybe we could do an EMR and HIPAA dinner or something. It’s always fun to meet readers of the site in person.

Full Disclosure: I’ve been given press access to the conference and exchanged the ad you see in the right sidebar for EMR and HIPAA listed in the conference materials.

ONC Standards Make CCHIT Process Irrelevant

Posted on February 22, 2010 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.

FierceEMR has really hit the healthcare IT arena in force over the past 6 months. They even have a big party planned for HIMSS. I’ll probably be stopping by since it’s the day after the New Media Meetup at HIMSS. Well, one of my favorite healthcare IT writers, Neil Versel wrote an article for FierceEMR that really caught my eye. It was titled, “Kibbe: New ONC standards make CCHIT process ‘irrelevant'”

If you’ve read this blog for any time you know that I’m an enormous fan of CCHIT (that was in the sarcasm font in case you couldn’t tell). I even declared the Marginalization of CCHIT back in July of last year. So, obviously I agree with David Kibbe’s assertion that the CCHIT process is irrelevant thanks to the HITECH act. A section of the article linked above describes some of the major problems with CCHIT:

Kibbe long has said the CCHIT certification process discourages innovation by being too complicated and costly for new, small companies that otherwise might shake up the EHR market with lower-priced, easier-to-use products. He also has held that the certification body was too closely tied to the health IT establishment. “CCHIT in effect acted as judge and jury for its own industry’s definition of EHR software, inhibiting alternative approaches that would embrace component or modular architectures, web-based delivery also known as ‘software-as-a-service,’ and practical means of achieving interoperable data exchange between applications from different vendors,” he says in a recent blog post.

No doubt the CCHIT criteria is no longer meaningful. The only problem is that a question still haunts my mind, “Did we just move the flawed process from CCHIT to ONC?”

Comparison of CCR and CCD

Posted on November 5, 2009 I Written By

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

In response to my previous post about CCR and CCD, I’ve learned a whole bunch about the two different standards for healthcare data exchange. Although, I must admit that it’s all a bit messy right now.

Since I know that many of you don’t read all the comments on the site, nor do you get to read the emails I receive, I think you’ll find some of the following links about CCR and CCD quite interesting.

First is a description of the difference between CCR and CCD. This is written by David Kibbe who helped create the CCR specifications. So, keep that in perspective, but it’s a really interesting write up comparing the two standards.

Dr. Jeff also put together this interesting “summary” of CCR and CCD. It’s a little scattered, but has some good nuggets in it that expanded my knowledge of the various standards.

The other good thing that came out of my previous post is an interview with Dr. David Kibbe which I’ll be posting next week. He ducks some of the politically charged questions, but I think you’ll really enjoy the interview. If you don’t, I’m sure you’ll be willing to let me know that too.