Health Information Exchange

What Would ONC’s Dr. Doug Fridsma Do? (THIS Geek Girl’s Guide to HIMSS)

I know you’ve all been wondering how I’m planning to spend my mad crazy week at HIMSS in New Orleans. Well, maybe not ALL of you, but perhaps at least one – who is most likely my blog boss, the master John Lynn. Given the array of exciting developments in healthcare IT across the spectrum, from mobile and telehealth to wearable vital sign monitoring devices, EMR consolidation to cloud-based analytics platforms, it’s been extraordinarily difficult to keep myself from acting like Dori in “Finding Nemo”: “Oooooh! Shiny!” I’ve had to remind myself daily that I will have an opportunity to play with everything that catches my eye, but that I am only qualified to write and speak intelligently on my particular areas of expertise. And so, I’m proud to say I’ve finally solidified my agenda for the entire week, and I cannot WAIT to go ubergeek fan girl on so many industry luminaries and fascinating up-and-comers making great strides towards interoperability, deriving the “meaning” in “Meaningful Use” from clinical data, and leveraging the power of big data analytics to improve quality of patient experience and outcomes.

On Sunday, I’m setting the stage for the rest of the week with a sit-down with ONC’s Director of Standards and Interoperability and Acting Chief Scientist, Dr. Doug Fridsma. His groundbreaking work in interoperability spans multiple initiatives, including: the Nationwide Health Information Network (NwHIN) and the CONNECT project, as well as the Federal Health Architecture. For insight into his passion for transforming the healthcare system through health IT, check out his blog: From The Desk of the Chief Science Officer.

Through the rest of the week, I aspire to see the world through Dr. Fridsma’s eyes, focusing on how each of the organizations and individuals contribute to the standards-based processes and policies that form the foundation for actionable analytics – and improved health. I’ve selected interviews with key visionaries from companies large and small, who I feel are representative of positive forward movement:

Health Care DataWorks piques my interest as an up-and-comer to watch, empowering healthcare systems to improve outcomes and reduce medical costs by providing accelerated EDW design and implementation, whether on-premise or via SaaS solution. Embedded industry analytics models supporting alternative network models, population-based payment models, and value-based purchasing allow for rapid realization of positive ROI.

Emdeon, is the single largest clinical, financial, and administrative network, connecting over 400,000 providers and executing more than seven billion health exchanges annually. And if that’s not enough to attract keen attention, they recently announced a partnership with Atigeo to provide intelligent analytics solutions with Emdeon’s PETABYTES of data.

Serving an area near and dear to my heart, Clinovations provides healthcare management consulting services to stakeholders at each link in the chain, from providers to payers and supporting trading partners – in areas from EMR implementation (and requisite clinical data standards) to market and vendor assessments, and data management activities throughout. With the dearth in qualified SME resources in the clinical data field, I look forward to learning about how Clinovations plans to manage their growth and retain key talent.

Who doesn’t love a great legacy decommissioning story? Mediquant proports adopting their DataArk product can result in an 80% reduction in legacy system costs through increased interoperability across disparate source systems and consolidated access. The “active archiving” solution allows for a centralized repository and consolidated accounting functions out of legacy data without continuing to operate (and support) the legacy system. Longitudinal clinical records? Yes, please!

Those are just a few on my must-see list, and I think Dr. Doug Fridsma would be proud of their vision, and find alignment to his ONC program goals. But will he be proud of their execution?

Can’t wait to find out, on the exhibit hall floor – and in the hallway conversations, and the client case study sessions, and the general scuttlebutt – at HIMSS!

HIE as Avenue for New Patient Acquisition

Written by: John Lynn

I’ve mostly taken a bit of time off to enjoy Thanksgiving with the family. I hope you’re doing the same and enjoying the start of the holidays.

For those of you still grinding away, I thought I’d throw out a thought that one of my readers told me in an email discussion we were having. They suggested that at some point they believed that the HIE (Health Information Exchange) would be a way to get new patients. They admitted that it wasn’t the original intent of the HIE, but was still a likely outcome.

I’ve been thinking quite a bit lately about how to drive new patients to a doctors office for my new Physia venture. Although, I have to admit that I hadn’t been thinking about HIE as a way to get new patients. I’ll be chewing on that a little bit this holiday weekend. I’d love to hear other non-traditional ways you’re using to find new patients.

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November 23, 2012 I Written By John Lynn

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Filed Under: Healthcare HealthCare IT HIE

Tags:Health Information Exchange HIE New Patient Acquisition Patients Physia Thanksgiving

HIE Waste

Written by: John Lynn

In a post on LinkedIn, David Angove offered this comment on government HIE funding:

The biggest waste of the new program I’ve seen is the HIE (Health Information Exchange) part. It got much more money than the EHR/MU part (5-10 times) and much of it ended up in the pockets of universities who just absorbed it as personal funding. Just look to see how many HIEs are actually functional in the US now almost 4 years after the grants were awarded. Most of the working HIEs were done by private groups who got tired of waiting for the groups who got all the grant money to do something.

It should be clear that David’s comparing the money spent on HIE’s as compared with RECs (he refers to it as EHR/MU). If you take in the larger EHR incentive money that doctors will receive, then it blows the HIE portion of the funding away.

Instead of focusing on the comparable amounts, I think the question of whether the HIE money the government put out as part of ARRA and the HITECH Act has been generally a waste. I started to think through the successful HIE projects out there. David’s right that the most successful ones I know of (see Indiana’s HIE, Maine’s HIE, and Arizona’s HIE) would have happened regardless of whether the government money came. Does anyone know of government funded HIEs that are seeing success and wouldn’t have without the government money?

The hard part of this question is that we’re not likely to know exactly how well the HIE funding has gone until we see how many HIEs survive post government funding.

Related to this was how many hospital CIOs I’ve talked to that don’t believe that HIE is the future of health information exchange. As one hospital CIO told me, he didn’t think that the HIE was a viable model. Instead he suggested that point to point exchange of information is going to be the winner when it comes to exchanging health information. Considering the issues related to HIE, I have a hard time arguing against that thought.

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October 30, 2012 I Written By John Lynn

Filed Under: ARRA EHR Electronic Health Record Electronic Medical Record EMR HealthCare IT HIE HITECH

Tags:Arizona HIE ARRA David Angove Health Information Exchange HIE HITECH Hospital CIO Indiana HIE Maine HIE

Enterprise HIE vs Public HIE

Written by: John Lynn

I was recently listening to an interview with a hospital CIO talking about their move to becoming an ACO and the various ACO initiatives. As part of the interview the hospital CIO was asked about HIEs and how they were approaching the various HIE models. His answer focused on their internal efforts to create what he called an Enterprise HIE.

I think it’s telling that even within a hospital system they haven’t figured out how to exchange health information. They control the end points (at least in large part) and yet they still have a challenge of exchanging information between their own provider organization.

One trend that is causing the above challenge has to do with hospitals acquiring medical practices. As you acquire a practice or even acquire a hospital there’s often a challenge associated with getting everyone on the same IT system. Plus, even within one hospital they use hundreds of different applications to capture clinical content. Thus the need to create an enterprise HIE.

I think that the idea of hospitals building enterprise HIEs puts some context on public HIE efforts. First, if hospital organizations are having a challenge putting together an internal enterprise HIE, it’s no wonder that public HIEs are having such a challenge. If hospitals don’t have their own houses in order, how could they export that to a public HIE?

In that same interview I mentioned above, the hospital CIO said that he was monitoring the other HIE initiatives in his area. However, he said that he believed that we were far from seeing HIEs really take off and be used widely. Obviously each HIE is very regional in nature since healthcare is mostly regional in nature. However, it was a telling message about the slow pace of HIE.

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September 28, 2012 I Written By John Lynn

Filed Under: HealthCare IT HIE

Tags:Enterprise HIE Health Information Exchange Hospital CIO Hospital Mergers Public HIE

HIEs And Health Data Ownership

Written by: Katherine Rourke

Without a doubt, patient consent for release of medical data is going to be an immense headache for HIEs. Though they’re poised to extend their tentacles into hospitals and practices across the U.S., we’re still far from sure how we’re going to keep the walls firm between what data patients have released and what they haven’t.

As Forbes contributor Doug Pollack notes, it’s still not clear whether you can limit access to say, just the psychiatric notes in your chart while releasing the rest of the content. Even if you can, setting such minute permissions within each e-chart is an IT nightmare.

That being said, there’s a bigger problem afoot, one which Pollack dismisses but I do not. My question is this: who owns the data that travels across an HIE? While IANALADWTB (I am not a lawyer and don’t wish to be), my research suggests that an already fuzzy issue is just going to get fuzzier.

While it may be beyond dispute that a patient owns the right to access their health data and control who gets to see it, who owns the patient data if an HIE breaks up? The hospitals involved? The doctor? The patient? Do they engage in a country-fair rope pull to see who wrestles down ownership?

And that’s only the tip of the iceberg. Consider that networking giants like Verizon Enterprise Solutions are planting their humungous stake in the HIE arena, and things only get more complicated.

Verizon just signed a deal under which it will manage the HIE infrastructure for Pennsylvania-based managed care giant Highmark, one which embraces more than a dozen hospitals. If the HIE contract were to go sour, would Verizon just turn over its data backups to the hospitals, Highmark and affiliated physicians without a fight? Or would it be to its legal advantage to stall, stall, stall while patients waited and hospitals fumed?

Regardless of how the law evolves on the matter, there are going to reasons for spats when partners representing different interests come together on an HIE. I’m betting data control will lead to some of the biggest ones.

Things may go smoothly in the new era of HIEs, but if they don’t, the whole darned “sharing” thing could come crashing to the ground. And hospitals that try to stand up to deep-pockets giants like Verizon and Highmark may live to regret it.

Where is the Value in Health IT?

Written by: John Lynn

What a powerful question that I think hasn’t got enough attention. Everyone seems to be so enamored with EHR thanks to the $36 billion in EHR incentive money. I seem to not be an exception to that rule as well. Although, at least I was in love with EHR well before the government started spending money on it.

While so many are distracted by the government money I think it’s worth asking the question of where the value is in healthcare IT.

Practice Management software has a ton of billing benefits. Is there a practice out there that doesn’t use some sort of practice management software? I don’t know of any.

Health Information Exchange (HIE) has a ton of value for reducing duplicate tests. Certainly we have challenges actually implementing an HIE, but the value in reducing healthcare costs and improving patient care seems quite clear. Having the best information about someone clearly leads to better healthcare.

Data Warehouse and Revenue Cycle Management (RCM) has tremendous value. RCM is not really sexy, but after attending a conference like ANI you can see how much money is on the table if you deal with revenue integrity. I add data warehouse in this category since they’re often very closely tied together.

Since this is an EHR site, where then does EHR fit into all this? What are the really transparent benefit of using an EHR. I know there are a whole list of EHR benefits. However, I think it is a challenge for many doctors to see how all of those benefits add up. EHR adoption would be much higher if there was one big hair benefit to EHR adoption. Unfortunately, I don’t yet think there’s one EHR benefit that’s yet reached that level of impact. I hope one day it will. Not that it matters right now anyway. Most practices wouldn’t see the benefit between the EHR incentive weeds.

PHR Are Like Early Email

Written by: John Lynn

In response to Anne Zieger’s post on PHR, John Tempesco offered this powerful insight that’s worth sharing:

PHRs will become popular when the patients don’t have to enter most of the data themselves. As more and more EHRs and HIEs begin to automatically interact with PHRs and patients have one central place to go for all their health information, they’ll catch on. Having a PHR now is like the early adopters of cell phones or email – there are few people to have conversations with.

It’s a really interesting comparison to email in the early days. I unfortunately wasn’t on email early on so I can’t say exactly what it was like, but I’ve heard stories. The interesting thing is that HIE’s seem to be suffering some of the same problem. HIE’s are often like early email since only a few people are on board with it. Plus, imagine if email required some sort of third party agreement to let you email each other?

EHR software on the other hand could become widely adopted and connected to a PHR. The biggest problem there is the major lack of standards for sending that health information. Until we solve the standards problem, I don’t think a PHR will be able to connect to the hundreds of EHR software vendors.

Is Lack of EHR the Real HIE Problem?

Written by: John Lynn

HIE (Health Information Exchange) is a really interesting thing. It’s something we all know we want to have happen and so far millions and millions of dollars later no one has been able to crack the code on how to make an HIE a reality.

The benefits of having an HIE are real and apparent. I’ve never heard anyone argue about whether an HIE would bring benefits to healthcare. It’s simple to see that having all of your health information available to a doctor at the point of care is valuable and useful. We don’t need a study to show that. We know it’s the case. Having the information could be the difference between life or death.

We all know that if a doctor can get the lab or radiology information from the HIE, then they don’t have to order another duplicate lab or x-ray. They might still order another one (for a bunch of perverse and maybe some legitimate reasons), but in many cases they wouldn’t have to order one since they’d already have the info they need.

Why then isn’t HIE a reality today?

For the longest time I’ve argued that there are two main barriers to HIE: governance and funding. By governance I mean, “How are we going to make sure that the right people get the right information and that the wrong people don’t get the information they shouldn’t have?” Funding is really about finding a sustainable revenue model for an HIE.

While I still think that both of these issues are real challenges for HIE, I recently started to wonder if the real challenge for an HIE is that not enough doctors and hospitals are using EHR. We want HIE’s to be successful, but can an HIE be really successful for doctors and hospitals that don’t have an EHR?

The lack of EHR adoption might be the biggest impediment to HIE.

ONC is More Focused on HIE than EMR

Written by: John Lynn

I can’t remember where I heard or read this, but I remember that when I did it stuck with me and I knew I had to write about it. Here’s the comment someone made (sorry I can’t attribute it properly):

Frankly, ONC is more focused on info exchange than EMR in the long run.

That’s a pretty strong statement, and one I really can’t argue against. In fact, if ONC didn’t have $36 billion out there hanging on the terms meaningful use of a certified EHR, they’d probably be doing even more with HIE and less with EHR.

I think ONC should actually be applauded for many of the health information exchange initiatives that it’s been pushing forward. I think that the Direct Project (which I broadly include in health information exchange) is one of the most exciting things in healthcare exchange right now and ONC should take a lot of credit for making it happen. I’m still waiting for my friends who happen to be physicians to talk to me about using direct project. Then, I’ll know it’s really gone mainstream, but I think it shows such promise that one day they will be telling me about it.

Yes, as most of you know, I still somewhat begrudgingly wish that the EHR incentive money would have gone towards exchange of healthcare information instead of EHR. It would have incentivized something that doesn’t have natural physician incentives to adopt. Plus, an EHR would have been essential to really exchanging information if the “healthcare data exchange stimulus” money was executed properly. Then, market dynamics would determine EHR adoption to a much larger extent. Water under a bridge it seems, but maybe someone at ONC could scrape some money together to prove me wrong.

With all of that said, I think ONC wants the healthcare information flowing. They see EHR as a step towards that end, but that’s the end goal. We’ll just see if they have the tools and resources needed to see it through a midst all the other healthcare IT distractions.

Good Luck With That HIE Tech Purchase

Written by: Katherine Rourke

Want to buy HIE technology? It’ll cost you. But more importantly, you’ll still be dealing with a bewildering array of choices, if a new report from KLAS has it right.

According to KLAS, which asked 95 providers about their HIE buying plans, there were a few clear leaders in the field. Providers surveyed by KLAS reviewed 38 HIE vendor offerings. Of those, five HIE vendors were considered in more than 10 percent of the providers’ buying plans, researchers found.

If there was a clear leader, it was Medicity, which was considered in 23 percent of HIE buying decisions, according to a report from Healthcare IT News. Next was Axolotl, with 22 percent; RelayHealth, with 16 percent; ICA, with 11 percent, and Epic, also with 11 percent. (Note: Epic was only being considered seriously when providers want to tie together multiple Epic installations.)

Looked at another way — by vendors mentioned most frequently by providers — the leaders were Axolotl, Cerner, dbMotion (part owned by the University of Pittburgh Medical Center), Epic, GE, ICA, InterSystems, Medicity, Orion and RelayHealth.

If you want to really fit the HIE to your situation, consider the following criteria, the HIN story suggests:

Public HIEs – A public exchange may belong to official state agencies or may be semi-independent with direct and typically temporary government backing. Public HIEs demand solutions with strong potential scalability and need standards-based technology.
Cooperative HIEs – In this model, otherwise-competitive hospitals work together to form independent HIE organizations, generally with an open invitation to other hospitals, clinics and physician practices. These HIEs often struggle to establish long-term funding and look for vendor solutions that offer flexible and affordable cost alternatives while best adapting diverse EMR technologies.
Private HIEs – In some respects, private HIEs are designed to enhance relationships as well as exchange data. Often, a single hospital or IDN creates an HIE hoping to draw in community physicians while protecting or increasing revenues. Funding is less complicated and these HIEs are more likely to be satisfied with solutions that best work with their existing technology.

The truth is, though, that whatever model best fits your HIE purchase, narrowing things down to your short-list isn’t as easy as just picking from KLAS’s top contenders. Even these leaders have a moderate to tenuous grip on the market, and may or may not have the solution that fits your model. (Note: I’m familiar with Axolotl and Orion, both of which have what may be some of the longest-deployed tech out there, but I can’t vouch that they’re exactly better than anyone else.)

If it were me, I’d look at lesser-known, strongly-backed folks focused directly on the problem. Then, I’d do a co-development program with them so both win. Got other ideas to share readers?

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June 21, 2012 I Written By Katherine Rourke

Filed Under: EHR Electronic Health Record Electronic Medical Record EMR HealthCare IT HIE