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Should We Even Need to Debate EHR Interoperability?

Posted on June 26, 2017 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 saw this tweet from Former AMA president and emergency Physician, Steven J. Stack, and the way he phrased it really struck me:

Do we really need to debate EHR interoperability? A debate would assume that some people think that interoperability is a bad idea. I have yet to meet someone that says that healthcare shouldn’t have EHR data interoperability. Unlike a lot of things happening in healthcare, everyone can see the value of sharing healthcare data.

The only arguments I’ve ever seen against EHR data sharing come from privacy and security advocates that suggest that sharing EHR data can go to far. Reminds me of the cartoon I saw that said something like “How come every hacker can get my health information, but my doctor can’t?” No doubt there are privacy and security concerns related with EHR data sharing, but they can all be solved. Healthcare interoperability is not being impeded by the need for privacy and security.

I’d suggest that the debate on healthcare interoperability is over. We know it’s the right thing to do. The only question is which organization is going to embrace it first and make it a reality. Format, standard, protocols, etc will matter little once we have organizations that have the will to share data.

Let’s stop debating healthcare interoperability and let’s start sharing.

Study: “Information Blocking” By Vendors And Providers Persists

Posted on April 6, 2017 I Written By

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

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

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

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

Forms of Blocking:

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

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

Frequency of blocking:

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

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

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

Motivations for blocking:

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

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

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

Solutions:

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

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

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

Are We Waiting For An Interoperability Miracle?

Posted on December 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.

Today, in reading over some industry news, my eyes settled on an advertising headline that gave me pause: “Is Middleware The Next Interoperability Miracle?”  Now, I have to admit a couple things: 1) that vendors have to pitch the latest white paper with all the fervor they can command, and 2) that it never hurts to provoke conversation with a strong assertion. But seeing a professional advertisement include the word “miracle” — an expostulatory term which you might use to sell dishwashers — still took me back a bit.

And then I began to think about what I had seen. I wondered whether it will really take a miracle to achieve health data interoperability sometime in our lifetime. I asked myself whether health IT insiders like you, dear readers, are actually that discouraged. And I wondered if any vendor truly believes that they can produce such a miracle, if indeed one is needed.

First, let’s ask ourselves about whether we need a Hail Mary pass or even a miracle to salvage industry hopes for data interoperability. I’m afraid that in my view, the answer is quite possibly yes. In saying this, I’m assuming that interoperability must arrive soon to meet our current needs, at least within the next several years.

Unfortunately, nothing I’ve seen suggests that we can realistically achieve robust interoperability within the next say, 5 to 10 years, despite all appearances to the contrary. I know some readers may disagree with me, but as I see it the combination of technical and behavioral obstacles to interoperability are just too profound to be addressed in a timely manner.

Okay, then, on to whether health IT rank and file are so burned out on interoperability efforts that they just want the problem taken off of their hands. If they did, I would certainly sympathize, as the forces in play here are beyond the control of any individual IT staffer, consultant, hospital or health system. The forces holding back interoperability are interwoven with technical, financial, policy and operational issues which can’t be addressed without a high level of cooperation between competing entities — and perhaps not even then.

So, back to where we started. Headline aside, does the vendor in question or any other truly believe that they can engineer a solution to such an intractable problem, conquer world interoperability issues and grow richer than Scrooge McDuck? Probably not. Interoperability is a set of behaviors as much as a technology, and I doubt even the cockiest startup thinks it can capture that many hearts and minds.

Ultimately, though, whoever wrote that headline is probably keying into something real. While the people doing the hard work of attempting health data sharing aren’t exactly desperate, I think there’s a growing sense that we’re running out of time to get this thing done. Obviously, other than artificial ones imposed by laws and regulations, we aren’t facing any actual deadline, but things can’t go on like this forever.

In fact, I’d argue that if we don’t create a useful interoperability model soon, a window of opportunity for doing so will be lost for quite some time. After all, we can’t keep spending on this infrastructure if it’s never going to offer a payback.

The cold reality is that eventually, the data sharing system we have — such as it is — will fall apart of its own weight, as organizations simply stop paying for their part of it. So while we might not need a miracle as such, being granted one wouldn’t hurt. If this effort fails us, who knows when we’ll have the time and money to try again.

Top Ten Reasons for EHR’s to Use Middleware for Connectivity

Posted on March 10, 2015 I Written By

The following is a guest blog post by Thanh Tran, CEO, Zoeticx, Inc.
Thanh Tran, CEO, Zoeticx
Where should CIOs and IT professionals look to address EHR interoperability?  Middleware!

A middleware architecture has been shown to be the best technological solution for addressing the problem of EHR interoperability. The middleware platform facilitates the transparent, yet secure, access of patient health data, directly from the various databases where it is stored. A server-based middleware framework supporting access to the various patient health data stores allows for a scalable, unified and standardized platform for applications to be developed upon. The middleware architectural design has been successfully used to link data from multiple databases, irrespective to the database platform or where the database is located.

Don’t take my word for it.  Here are ten good reasons to consider middleware.

  • Application Developers Can Focus on Healthcare Apps—Enables medical record app developers to focus on their healthcare solution by freeing them from dealing with a diverse, complex EHR infrastructure.
  • Inspires the Next Generation of Healthcare Innovative Solutions—These solutions are inspired by expanding the market for the next generation of healthcare applications rather than being tied down to a stack approach, depending on the particular EHR vendor.
  • Improves Patient Care OutcomesPatients will receive better healthcare outcomes when application developers can inspire more Patients will also benefit from the next generation of applications as they will address providers’ specific needs in diverse operational care environments.
  • Saves Healthcare IT Dollars—Focuses the healthcare IT budget on addressing providers’ needs instead of building and re-building the patient record infrastructure.
  • Proven Technology—A proven technology used for decades in many industries such as financial, retail, manufacturing and other markets.
  • Easy Integration—Enables healthcare integration with diverse, deployed legacy systems, including EHR systems. It addresses EHR interoperability as part of overall integration challenges.
  • Passive to Active Healthcare IT Environment—It turns passive healthcare IT environments into active ones to enhance communication and collaboration among care providers.
  • Avoids Data Duplication—Cost efficient, simplified administration. Offers a better privacy protection solution than HIEs by addressing EHR interoperability while fulfilling the demand to support the patient care continuum in an operational care environment.
  • Eliminates Wastefulness—Addressing healthcare IT integration is much more cost efficient than the “Rip-and-Replace” approach.
  • Extends EHR Usefulness—Protects and extends healthcare IT investments in EHR and EMR systems.

About Thanh Tran
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.

Top 4 HIT Challenges and Opportunities for Healthcare Organizations in 2015 – Breakaway Thinking

Posted on January 15, 2015 I Written By

The following is a guest blog post by Mitchell Woll, Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Mitchell Woll - The Breakaway Group
Healthcare organizations face numerous challenges in 2015: ICD-10 implementation, HIPAA compliance, new Meaningful Use objectives, and the Office of the National Coordinator’s (ONC) interoperability road map.  To adapt successfully, organizations must take advantage of numerous opportunities to prepare.

Healthcare leaders must thoroughly assess, prioritize, prepare, and execute in each area:

  1. Meaningful Use Stage 2 objectives require increased patient engagement and reporting for a full year before earning incentives.
  2. The ONC’s interoperability road map demands a new framework to achieve successful information flow between healthcare systems over the next ten years.
  3. There are 10 months left in which to prepare for the October 1 ICD-10 deadline.
  4. HIPAA compliance will be audited.

1. Meaningful Use
For those who have already implemented an EHR, Meaningful Use Stage 2 focuses new efforts on patient access to personal health data and emphasizes the exchange of health information between patient and providers. Stage 2 also imposes financial penalties for failure to meet requirements.

CMS’s latest deadline for Stage 2 extends through 2016, so healthcare organizations have additional time to fulfill Stage 2 requirements. Stage 3 requirements begin in 2017, so healthcare organizations should take the extra time to build interoperability and foster an internal culture of collaboration between providers and patients. For Stage 3, Medicare incentives will not apply in 2017 and EHR penalties will rise to 3 percent.

CMS has also proposed a 2015 EHR certification, which requests interoperability enhancement to support transitions of care.  Complying with this certification is voluntary, but provides the opportunity to become certified for Medicare and Medicaid EHR incentive programs at the same time.

Meaningful Use Stage 2 and the ONC roadmap require that 2015 efforts concentrate on interoperability. Healthcare organizations should prepare for health information exchange by focusing efforts on building patient portals and integrating communications by automating phone, text, and e-mail messages. After setting up successful exchange methods, healthcare organizations should train staff how to use patient portals. The delay in Stage 2 means providers have more time to become comfortable using the technology to correspond with patients. Hospitals should also educate patients about these resources, describing the benefits of collaboration between providers and patients. Positive collaboration and successful data exchange helps achieve desired health outcomes faster.

2. Interoperability
The three-year goal of the ONC’s 10-year roadmap is for providers and patients to be able to send, receive, find, and use basic health information. The six and ten-year goals then build on the initial objectives, improving interoperability into the future.

Congress has also shown initiative on promoting interoperability asking the ONC to investigate information blocking by EHRs. Most of the ONC’s roadmap for the next three years is similar to Meaningful Use Stage 2 goals.

Sixty-four percent of Americans do not use patient portals, so for 2015 healthcare organizations should focus on creating them, refining their workflows, and encouraging patients to use them. Additionally, 35 percent of patients said they are unaware of patient portals, while 31 percent said their physician has never mentioned them. Fifty-six percent of patients ages 55-64, and 46 percent of patients 65 and older, said they would access medical information more if it were available online. Hospitals need their own staff to use and promote patient portals in order to conquer the challenges of interoperability and Stage 2.

3. HIPAA Compliance
In 2015, the Office of the Inspector General (OIG) will audit EHR use, looking closely at HIPAA security, incentive payments, possible fraud, and contingency plan requirements. Also during the HIPAA compliance audit, the Office of Civil Rights (OCR) will confirm whether hospitals’ policies and procedures meet updated security criteria.  Healthcare organizations should take this opportunity to verify compliance with 2013 HIPAA standards to prepare for upcoming audits. Many helpful resources exist, including HIPAA compliance toolkits, available from several publishers. These kits include advice on privacy and security models. Healthcare organizations and leaders can also take advantage of online education, or hire consultants to help review and implement the necessary measures. It’s important that action be taken now to educate staff about personal health information security and how to remain HIPAA compliant.

4. ICD-10 Deadline
The new ICD-10 deadline comes as no surprise now that it was delayed several times. In July 2014, the US Department of Health and Human Services (HHS) implemented the most recent delay and set a new date of Oct. 1, 2015, giving hospitals a 10-month window to prepare for the eventual ICD-10 rollout. Because healthcare organizations are more adaptable than ever, they can use their practiced flexibility and experience to meet these demands successfully.

As Health Information and Management Systems Society (HIMSS) suggests, communication, education and testing must be part of an ICD-10 implementation plan. Informing internal staff and external partners of the transition is a crucial first step. ICD-10 should be tested internally and externally to verify the system works with the new codes before the transition. Healthcare organizations should outline and develop an ICD-10 training program by selecting a training team and assessing the populations who need ICD-10 education. They should perform a gap analysis to understand the training needed and utilize role-based training to educate the proper populations. Finally, organizations should establish the training delivery method, whether online, in the classroom, one-on-one, or some combination of these to teach different topics or levels of proficiency. In my experience at The Breakaway Group, I’ve seen that the most effective and efficient education is role-based, readily-accessible, and offers learners hands-on experience performing tasks essential to their role. This type of targeted education ensures learners are proficient before the implementation. As with any go-live event, healthcare organizations must prepare and deliver the new environment, providing support throughout the event and beyond.

Facing 2015
These challenges require the same preparation, willingness, and audacity needed for prior HIT successes, including EHR implementation and meeting Meaningful Use Stage 1 requirements. ICD-10, HIPAA compliance, Stage 2, and interoperability all have the element of education in common. Healthcare organizations and leaders should apply the same tenacity and discipline to inform, educate, and prepare clinicians for upcoming obligations.

Targeted role-based education will best ensure proficiency and avoid comprehensive, costly, and time-consuming system training. Through role-based education, healthcare organizations gain more knowledgeable personnel who are up to speed on new applications. These organizations probably already have at least a foundation for 2015 expectations, and they should continue to recall the strategies used for prior go-live events. What was successful? It’s important to plan to replicate successful strategies, alleviating processes that caused problems.  This is great opportunity to capitalize efforts for organizational improvements. Healthcare leaders must let the necessity of 2015 government requirements inspire invention and innovation, ultimately strengthening their organizations.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Are Client Server EHR Holding Back Healthcare?

Posted on December 19, 2014 I Written By

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

The number one topic of debate on this blog has definitely been Client Server EHR versus SaaS EHR. There are staunch parties on both sides of this aisle. No doubt both sides have a case to make and we’ll see both in healthcare for a long time to come. Although, I think that long term the SaaS EHR will win out.

As I was thinking about this recently, I realized that while client server EHR can do everything a SaaS EHR can do, it definitely makes a lot of things much harder to accomplish.

It’s much harder to create an API that connects to 2000 client server EHR installs.

It’s much harder to make 2000 client server EHR installs interoperable.

It’s much harder to evaluate data across 2000 client server EHR installs.

I’m sure I could keep going with this list, but you get the point. Even though something is possible, it doesn’t mean that they’re actually going to do it. In fact, if it’s hard to do, then it takes extreme pressure for them to do it.

All of this has me begging the question of whether client server installs are holding back the EHR industry. Up until now, many of the things I mention above haven’t been that important. Going forward I think that all three of the things I mention above are going to be very important.

The good thing is that I see many client server EHR moving to some kind of hosted EHR solution. That solves some of the problems mentioned above. At least if it’s a hosted EHR solution, they can control the environment and more easily implement things like API access and interoperability. That’s much harder in the client server world where if you have 2000 EHR installs, you have 2000 unique setups.

Of course, as soon as a large SaaS EHR has a massive breach, healthcare will go running after the client server EHR. The battle lines are drawn and each side knows each other very well. Although, I think the SaaS EHR have the high ground right now. We’ll see how that continues over time. Client server EHR have done an amazing job battling.

The Future of Electronic Health Records in the US: Lessons Learned from the UK – Breakaway Thinking

Posted on December 17, 2014 I Written By

The following is a guest blog post by Carrie Yasemin Paykoc, Senior Instructional Designer / Research Analyst at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Carrie Yasemin Paykoc
With 2014 coming to a close, there is a natural tendency to reflect on the accomplishments of the year. We gauge our annual successes through comparison with expected outcomes, industry standards, and satisfaction with the work done. To continue momentum and improve outcomes in the coming years we look for fresh ideas. For example, healthcare organizations can compare their efforts with similar types of organizations both locally and abroad. In the United States, looking beyond our existing borders toward the international community can provide valuable insight. Many other nations such as the UK, are further down the path of providing national healthcare and adopting electronic health records. In fact, the National Health Service (NHS) of UK has started plans to allow access of  Electronic Health Records (EHR) on Smartphones through approved health apps. Although healthcare industry standards appear to be in constant flux, these valuable international lessons can help local healthcare leaders develop strategies for 2015 and beyond.

By the year 2024, the Office of the National Coordinator (ONC) aims to improve population health through the interoperable exchange of health information, and the utilization of research and evidence-based medicine. These bold and inspiring goals are outlined in their 10 Year Vision to Achieve Interoperable Health IT Infrastructure, also known as ONC’s interoperability road map. This document provides initial guidance on how the US will lay the foundation for EHR adoption and interoperable Healthcare Information Technology (HIT) systems. ONC has also issued the Federal Health IT Strategic Plan 2015-2020. This strategy aims to improve national interoperability, patient engagement, and expansion of IT into long-term care and mental health. Achieving these audacious goals seems quite challenging but a necessary step in improving population health.

EHR Adoption in UK
The US is not alone in their EHR adoption and interoperability goals. Many nations in our international community are years ahead of the US in terms of EHR implementation and utilization. Just across the Atlantic Ocean, the United Kingdom has already begun addressing opportunities and challenges with EHR adoption and interoperability. In their latest proposal the NHS has outlined their future vision for personalized health care in 2020. This proposal discusses the UK’s strategy for integrating HIT systems into a national system in a meaningful way. This language is quite similar to Meaningful Use and ONC’s interoperability roadmap in the United States. With such HIT parallels much could be learned from the UK as the US progresses toward interoperability.

The UK began their national EHR journey in the 1990s with incentivizing the implementation of EHR systems. Although approximately 96 percent of all general provider practices use EHRs in the UK, only a small percentage of practices have adopted their systems. Clinicians in the UK are slow to share records electronically with patients or with their nation’s central database, the Spine.

Collaborative Approach
In the NHS’s Five Year Forward View they attempt to address these issues and provide guidance on how health organization can achieve EHR adoption with constrained resources. One of the strongest themes in the address is the need for a collaborative approach. The EHRs in the UK were procured centrally as part of their initial national IT strategy. Despite the variety of HIT systems, this top-down approach caused some resentment among the local regions and clinics. So although these HIT systems are implemented, clinicians have been slow to adopt the systems to their full potential. (Sarah P Slight, et al. (2014). A qualitative study to identify the cost categories associated with electronic health record implementation in the UK. JAMIA, 21:e226-e231) To overcome this resistance, the NHS must follow their recommendations and work collaboratively with clinical leadership at the local level to empower technology adoption and ownership. Overcoming resistance to change takes time, especially on such a large national scale.

Standard Education Approach
Before the UK can achieve adoption and interoperability, standardization must occur. Variation in system use and associated quality outcomes can cause further issues. EHR selection was largely controlled by the government, whereas local regions and clinics took varied approaches to implementing and educating their staff. “Letting a thousand flowers bloom” is often the analogy used when referring to the UK’s initial EHR strategy. Each hospital and clinic had the autonomy of deciding on their own training strategy which consisted of one-on-one training, classroom training, mass training, or a combination of training methods. They struggled to back-fill positions to allow clinicians time to learn the new system. This process was also expensive. At one hospital £750 000 (over $1.1 million US) was spent to back-fill clinical staff at one hospital to allow for attendance to training sessions. This expensive and varied approach to training makes it difficult to ensure proficient system use, end-user knowledge and confidence, and consistent data entry. In the US we also must address issues of consistency in our training to increase end-user proficiency levels. Otherwise the data being entered and shared is of little value.

One way to ensure consistent training and education is to develop a role-based education plan that provides only the details that clinicians need to know to perform their workflow. This strategy is more cost-effective and quickly builds end-user knowledge and confidence. In turn, as end-user knowledge and confidence builds, end users are more likely to adopt new technologies. Additionally, as staff and systems change, plans must address how to re-engage and educate clinicians on the latest workflows and templates to ensure standardized data entry. If the goal is to connect and share health information (interoperability), clinicians must follow best-practice workflows in order to capture consistent data.  One way to bridge this gap is through standardized role-based education.

Conclusion
Whether in the US or UK, adopting HIT systems require a comprehensive IT strategy that includes engaged leadership, qualitative and quantitative metrics, education and training, and a commitment to sustain the overall effort.  Although the structure of health care systems in the US and UK are different, many lessons can be learned and shared about implementing and adopting HIT systems. The US can further research benefits and challenges associated with the Spine, UK’s central database as the country moves toward interoperability. Whereas the UK can learn from education and change management approaches utilized in US healthcare organizations with higher levels of EHR adoption. Regardless of the continent, improving population health by harnessing available technologies is the ultimate goal of health IT.  As 2015 and beyond approaches, collaborate with your stakeholders both locally and abroad to obtain fresh ideas and ensure your healthcare organization moves toward EHR adoption.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

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.

A Look Back on My 2012 Christmas Wish List

Posted on December 26, 2013 I Written By

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

Last year, I posted a healthcare IT Christmas Wish list. A year later, I thought it would be fun if I got what I wanted for Christmas last year or not (yes, it takes healthcare at least a year to grant wishes).

Here’s the list and my thoughts on how far we’ve come on each wish:

1. Open EHR Systems – We’re certainly not there yet, but I think there has been a sea change when it comes to opening up EHR software. I’m sure some could appropriately argue that we still have a long way to go, but let me give you some examples from Epic that give me cause for hope. First, this Epic Interoperability chart that Judy shared. Second, Kaiser joined the Epic network. Third, the Epic API.

It’s fun to use Epic as a proxy for openness because they’ve been so closed for so long. Judy Faulkner was after all the one that suggested that open EHR was an issue for patients. I’d love to see EHR more open, but I’m excited by the possibilities of open EHR. I believe this will have to happen and vendors who fight against it will be left behind.

2. Remove Healthcare’s Perverse Incentives – Sadly, I’ve seen almost no change to this yet. One area where I think this could be starting to change is around price transparency. There’s been a strong push to make healthcare pricing more transparent. As more and more patients have high deductible plans (like me), we start to shop around a lot more and be more interested in price. When we’re footing the bill, that price translates to our cost. This will cause companies to change how they do business.

3. Beautiful EHR User Interfaces – I’ve seen very little change in this regard. Sure, a few have rolled out an iPad interface, but I think they’ve missed out on the iPad Opportunity. Although, I recently saw the Modernizing Medicine iPad interface again in person. It’s so fundamentally different than every other EHR interface I’ve seen. While it demonstrates well the opportunity, it’s so fundamentally different that I’m not sure any existing EHR vendors can replicate it. I ask myself if we’ve spent billions of dollars on EHR user interfaces that can’t be what they should become.

4. More Empowered and Trusted Patients – I’m sure we’ll be battling this one for a long time to come. Although, the empowered patient is happening. Health information is available to everyone at the click of the mouse or a swipe of the finger. This shift is going to happen. There is nothing anyone can do to stop it. It’s more a question of whether people will embrace it or “kick against the pricks.”

Overall I’d say that we’re generally trending towards my wish list, but as is usually the case there is plenty more to do. I’d love to hear your thoughts on the above items.

One Government EHR for All of Healthcare

Posted on August 26, 2013 I Written By

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

Over and over I hear some doctor or EHR industry person say, “Why doesn’t the government just provide one EHR for all of healthcare?” Usually this is followed by some suggestion that the government has invested millions (or is it billions?) of dollars in the Vista EHR software and they should just make that the required national EHR.

You can see where this thinking comes from. The government has invested millions of dollars in the Vista EHR software. It’s widely used across the country. It’s used by most (and possibly all) of the various medical specialties. Lots of VA users love the benefit of having one EHR system where their records are always available no matter where in the VA system you go for health care. I’m sure there are many more reasons as well.

While the idea of a single EHR for all of healthcare is beautiful in theory, the reality of our healthcare system is that it’s impossible.

I’ve always known that the idea of a single government EHR was impossible, but I didn’t have a good explanation for why I thought it was impossible. Today, I saw a blog post called “Health IT Down the Drain” on Bobby Gladd’s blog. The blog post refers to the $1.3 billion over the last 4 years (their number) that has been spent trying to develop a single EHR system between the Department of Defence (DoD) and Veterans Affairs (VA). Congress and the President have demanded an “integrated” and “interoperable” solution between the two departments and we yet to see results. From Bobby’s post comes this sad quote:

“The only thing interoperable we get are the litany of excuses flying across both departments every year as to why it has taken so long to get this done,” said Miller, the chairman of the Veterans Affairs Committee…

The government can’t even bring together two of its very own departments around a single EHR solution. Imagine how it would be if the government tried to roll out one EHR system across the entire US healthcare system.

I hope those people who suggest one government EHR can put that to bed. This might work in a much smaller country with a simpler healthcare system. It’s just never going to happen in the US.