I have to admit, I’ve really enjoyed going through and making lists looking back on EMR and Health IT in 2011 and thinking about what is going to happen in EMR and Health IT in 2012. Thanks for everyone who has joined and added to the discussion. It’s been really great!

This next list might actually be the hardest one for me to create. I call it the 2012 EHR and Health IT Noise. You know what I’m talking about. The topics that are going to get talked to death, tweeted everywhere, but won’t really have any major impact on healthcare (at least in 2012). Some would call these distractions.

HIE – Yes, we’re going to hear more and more about HIE’s and their potential. 2012 will still enjoy all that federal grant money that was given to HIE’s. What will we see from it? Maybe a couple books describing lessons learned from all the money spent on trying to set up an HIE. If one or two HIE’s are successful and start sharing patient data with doctors I’ll be really impressed.

EHR Usability – In 2012 I predict we’re going to hear story after story about the lack of usability with EHR software. The complaints will start to pile up, but I don’t think any of that noise will do much to shift the usability of EHR software. It’s a really hard task to dramatically shift the usability of EHR software after the fact. I can’t see many of the legacy EHR accomplishing that shift.

Some new EMR startups may start to come into their own in 2012 with usable EHR software, but they likely won’t be heard above the noise of the other legacy EHR software that’s practically unusable. We’re in a selling spree cycle for EHR software, maybe 2013 will change that.

Mobile Health Apps – This is a little different noise than the others above. This will be noise because there will be so many mobile health apps out there in 2012 and none of them will really consolidate market share yet. I believe that a number of mobile health apps will start to differentiate themselves in 2012, but most people won’t know the difference. They’ll just hear all the noise and try and ignore it.

Meaningful Use – Oh wait, I already wrote about that one here. If you haven’t read the comments of that post, you should. Some good discussion.

Any other things you think will make noise in EMR and Health IT in 2012? I’d love to hear your additions.

While attending the EHR Summit by HBMA, I got the chance to learn more about the AZ REC and HIE. Here are some tweets about the things they said that worth noting with my own comments:

Arizona REC

AZ REC had trouble getting vendors to take their free EHR interns. #EHRSummit11

This was pretty interesting since they said that doctors were more than willing to take on their student interns, but vendors were reticent to take them on. I do love the education program that the AZ REC put together. Internships like this are valuable.

Biggest complaint the HIT students had was access to actual EHR software. AZ REC created a EHR software lab to solve it. #EHRSummit11

This is a really common complaint by the RECs. In fact, I just helped a REC get access to some EHR software to solve this problem. It’s amazing to me that more EHR vendors aren’t happy to provide their software for these education programs.

AZ REC has a list serv of 2500 doctors and a list for vendors. See: http://www.arizonarec.org/? #EHRSummit11

I found it interesting that they had a doctor list and a vendor list. Makes sense.

AZ REC looking at optimizing health IT for ACO’s to be sustainable. I think this will be a common strategy. #EHRSummit11

The idea of REC sustainability is an important one. I think many are looking towards the ACO requirements as one pathway to sustainability. Of course, how stable are ACO’s? One thing seems certain, the relationships the RECs create with doctors could be leveraged for good if done right.

Arizona HIE

The case for the benefits of good information from something like a HIE is easy. The problem is making it actually happen. #EHRSummit11

This was my gut response when the AZ HIE was talking about the benefits of having the information an HIE provides. I don’t think I’ve heard anyone say that exchanging information would be a bad thing and produce worse clinical outcomes. Sure, they want to ensure privacy of the data when it’s done, but the benefits of having the best information are completely apparent.

HINAz (AZ HIE) didn’t depend on grants to create the HIE. They focused on the benefits of the HIE to users. #EHRSummit11

This seems like something that’s a bit unique to AZ. Most HIE’s are so focused on the grant funding. In this sense, I think that this might give the AZ HIE a chance to be successful. Plus, I loved that they did actual research into which users benefited from the HIE.

AZ HIE, Hospitals pay 50% of costs, Plans pay 50% of costs. Physicians pay nominal fee to participate (cause nominal benefit). #EHRSummit11

This is where the real fun begins. The hospitals and plans are paying for the HIE since the AZ HIE found that they’re the ones that would benefit from it. They found that doctors received nominal benefits from using the HIE and so they shouldn’t be charged to use it. Of course, the other beneficiaries not mentioned here is the benefit to the patients. I’m sure hospitals and plans will pass the cost on to patients, so I guess that works out in the end.

I recently got a message from Jerry Theis of MyCrisisRecords. He sent me a story that I thought was a great way to start off the new year. It talks about the value of health care data interoperability and in this case a device and PHR with a person’s health information. Enjoy the story!

Yesterday, one of my members called me to tell me she was taken to the emergency room suffering combinations of complications caused by a rare condition, Polymorphous along with a flare up of fibromyalgia which caused to her go into cardiac arrest. The ER doctors were able to effectively treat her because she had her digital device which provided them all of her medications, conditions, allergies (she is allergic to latex). Because of this rare condition and her acute distress she was told by the doctors had she not had this device there would have been adverse events, medical errors and it would have been fatal.

The ER doctors read the article I had downloaded in the device about Polymorphous. She, the patient educated the doctors who said they had never treated or seen this rare condition. The ER doctors consulted with Mayo Clinic and an expert on Polymorphous consulted with them and spoke to the patient while reviewing the transmittal of her PHR sent to him. She consented to be injected with a drug that had to be sent from Mayo (2hrs). It relieved her of the severe pain and swelling in her throat.

I share this with you because it meant so much to me to hear her testimonial and how thankful she was and how grateful she said the doctors were about what I created. I am a psychotherapist and she is a patient of mine who has a Bi Polar condition. The doctors said they may have had discarded her presentation because of her psychiatric condition had they not had the complete PHR. Another primary reason why I relentlessly developed this technology, for the special needs populations.

I recently heard Arien Malec from ONC summarize the biggest challenge of Healthcare Information Exchange (HIE) in one simple phrase:

There’s no @ sign for healthcare

It’s a really basic idea, but sadly cuts straight to one of the core reasons HIE isn’t happening. We don’t have a great way to authenticate, verify and address health information to another provider.

Twitter has created this interesting concept of using @ to specify people. For example, you can find me @techguy and @ehrandhit. It’s amazing how quickly Twitter has created a whole new set of addresses where we can communicate with other people. Certainly it’s not designed for healthcare, but it’s amazing that they could create this whole new address system for people and organizations. And trust me when I say that Twitter is a great communication and collaboration mechanism.

One of the main reasons the fax machine is so successful in healthcare is that each clinic has a unique identifier, their fax phone number. I’ll be writing more about the fax machine in the future, but HIE needs to solve the problem of a verifiable address that’s unique to each healthcare provider if we want to move beyond the fax machine.

It seems like the people behind NHIN are trying to address this challenge, but they still have a ways to go. Does anyone else know of other ways people are trying to address the missing @ sign in healthcare?

If you’ve been reading my blog, then you know that I’ve started a pretty interesting and complicated discussion about EHR and EMR sharing of patient data. I first posted an example of sharing data with an EHR and then followed it up with some challenges associated with sharing of EHR data.

In my interoperability challenges post, Bjorn from Health Xcel posted a lengthy comment discussing some challenges of data sharing and made the case for RHIO (Regional Health Information Organizations) and HIE (Health Information Exchanges) as a means for sharing patient data between hospitals and doctors offices.

His comment was so well done that I’m copying it below for more people to see and read it. I don’t personally agree with everything that was said. I also think he didn’t address the funding challenges of RHIO and the policy problems. Maybe Bjorn will return with some comments on how those might work. Enjoy Bjorn’s take on RHIO and HIE (emphasis added):

I think Google Health and MS HealthVault will be good awareness catalysts for the quiet e-health revolution that is taking place. However, I do not think the defining change we need lies with their business model. A patient-centric model sounds good but we’d be assuming that everyone has an account with one of these systems and that they know how to use them. How will the data about a patient that is stored in a hospital be reconciled with Google Health? Which of course leads to interoperability concerns.

Web 2.0 does not lend itself to creating a reliable e-health solution either as service A is dependent on service B and if service B is down, service A won’t function and has no power to fix it by their own volition.

I think so far the industry, aka hospitals, has been trying to solve the problem by adding a patient interface to large hospital systems so patients can see their records. It’s also a step in the right direction but again it is not the golden calf we are looking for.

So what is the ideal system of the future?
A patient should be able to enter any hospital in the world, conscious or unconscious, and the hospital should have all the information they need about the patient to administer correct treatment and to notify the right people.

How do we do this?
I am a believer in the HIE / RHIO model. In the [not too distant] future, hospitals should concern themselves with healing people and not how to spend their IT budget. Hospitals, insurance agencies, smaller providers and patients will all be connected to an RHIO (Region Health Information Organization) where they will have a wealth of services; either to enter sensitive data or to discover data about one patient or the entire population. RHIOs will be connected to a larger e-health backbone consisting of HIEs that are the great data aggregators of the world. RHIOs would be responsible for conforming to regional regulations. This model is similar to how we connect to the Internet today. We don’t jack directly into one of the main Internet hubs of the world but go through an ISP that can provide us with an email address, a web page AND connect us to the rest of the world.

HIEs and RHIOs run on a software platform where health IT vendors can deploy their software applications. Some required components:

- User discovery
o Any one node on the system should be able to query the other nodes to find a user and her data
- Portable user
o This goes with the first bullet point in that a user should be able to log in to the system anywhere in the world and even though the user does not have an account with the RHIO she is directly interfacing with, RHIO should know how to authenticate her correctly
- Interoperability / Standards / Data aggregation and discovery
o The key to any successful e-health venture. Services need to be able to talk to each other. It shouldn’t matter whether the services reside within the same application or in different parts of the world. I believe the semantic web (web 3.0) will be a key facilitator of making this possible.
- Federated security
o If we take the previous examples of Google Health and MS HealthVault, they would all have to have their own security scheme and user authentication and access control. Multiply that by a dozen and suddenly a lot of money is being spent on recreating the wheel over and over. We need a unified system for this.
- Updates
o All applications should reside server side and users should have thin-client access only. When the applications are being updated, it should happen across the board overnight. If something goes wrong, there should be a way to undo the upgrade without hospitals or anyone else having to do anything.
- Data sharing
o The patient-centric network will definitely happen as users become more educated. But hospitals still need to be able to have access to patient data even though they have not been granted access, in case of emergency.

Ok, this suddenly got really long ;-) There is a lot of work to do for everyone in order to get true e-health solutions to work. The biggest obstacles aren’t technical but political and also the willingness to adopt a new way of interfacing with your health.

Cheers
bjorn