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Making the Case for Healthcare Data Interoperability

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My post titled “Patient Controlled Records Could Work Internationally” has driven a lot of interesting conversation in both the comments and my email inbox. I want to highlight some of the responses in a few future posts. The responses do a really good job extending the conversation around a patient controlled health record.

One example of this is from regular reader and commenter R Troy (Ron). As I mention in my post, I think that the patient controlled medical record can work for chronic patients, because they care about their care. R Troy’s comment does a good job explaining a couple examples of why chronic patients can really benefit from having and controlling their patient record:

I am sure that you are quite correct; people in good health have far less interest in maintaining their own health records, except perhaps for those who are fanatics who want to track everything.

As you may have guessed, I have chronic problems – in my case asthma and allergies primarily. And one family member is T1D, and another has a serious auto immune disorder. The latter in particular is part of my passion for EHR’s – I believe that treatment would be far better handled and the results understood with EHR’s with analytical capabilities. Same reason I want a good PHR capability – because that illness plus my issues demand having good data when an emergency occurs, or you move to a new doctor.

A few years ago, the family member with the immune disorder had been scheduled for outpatient treatment at Hospital X. The night before, that person needed to get to an ER ASAP. We wanted the ambulance to go to the ER at X. But there was a bad winter storm, and the ambulance took the person to Hospital Y, in a separate hospital system.

It took Y a few days to get sufficient paper records faxed over from X and from the treating doctor to properly care for the patient, making the situation even worse, and very wasteful cost wise. While HIE would greatly have helped, so would a viable PHR that was well populated and very readily and quickly accessible at Y. BTW, I’m not sure if X and Y are yet able to communicate (the doctor is still not live on an EHR), but I am quite sure that the EHR used in the ER at X (which the patient uses from time to time) has only minimal connections to the EHR used by the rest of hospital X.

One of my HealthIT instructors had orthopedic work done at hospital Z, with lots of imaging. A short time later, he found himself in the ER of hospital X – which could not access any of the imaging from Z, which now had to be completely repeated. Both wasteful and dangerous.

If HIE’s were ‘universal’, at least in the US, the need for a PHR would mainly revolve around the patient’s need to see all their info in one container, plus to get at it from outside the US if the need came up. But it would still exist.

We won’t go into all the challenges of the universal HIE here, but until those challenges are solved. You can see the value of a chronic patient having their universal health record that they can share no matter where they go for healthcare.

November 4, 2013 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.

Bring Your Own EHR (BYOEHR)

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Nerd Doc recently offered a new term I’d never heard called Bring Your Own EHR (BYOEHR). Here’s the explanation:

As a tech nerd doc, the best advice I can give to CIOs/CMIOs is to find a framework for ambulatory practices that embraces a BYOEHR (Bring your own EHR) in the same vein of BYOD (Bring your own device). What I mean by that is allow providor choice in purchasing and implementing their own EHR while insuring that a framework is set up for cross communication to interlink records.

This is to fend off the trend to a one size (Epic) fits all approach in which no one is happy. C-level management needs to realize that if users (providers) are not happy, the promises of savings via efficiency simply will not happen.

I think we’re starting to hear more and more examples like this. We saw evidence of this in my previous post called “CIO Reveals Secrets to HIE.” That hospital organization had created an HIE that connected with 36 different EMRs. Think about the effort that was required there. However, that CIO realized that there was a benefit to creating all of those connections. The results have paid off with a highly used HIE.

I’m sure we’ll still see hospitals acquiring practices and forcing an enterprise EHR down their throats for a while. However, don’t be surprised if the cycle goes back to doctors providing independent healthcare on whatever EHR they see fits them best. Those hospitals that have embraced a BYOEHR approach will be well positioned when this cycle occurs.

July 23, 2013 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.

CIO Reveals Secrets to HIE

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Inspira Health Network is a community health system comprising three hospitals in southern New Jersey, with more than 5,000 employees and 800 affiliated physicians. It is an early adopter of health information exchange technology. In this Q&A-style paper their CIO and Director of Ambulatory Informatics share secrets to their successful Health Information Exchange implementation.

One of the most impressive numbers from their HIE implementation is that they were able to get 600 providers using the portal and 36 EMRs connected. Plus, they were able to get their HIE up and running in 4 months while many of the public HIEs were still working on their implementations. As I’ve written about previously, I see a lot of potential in the Private HIE. So, it’s great to see a first hand account from a CIO about their private HIE implementation.

Here are some of the other benefits the CIO identifies in the paper:

  • Ties the Physician Community to the Organization
  • Helps Meet the Meaningful Use Patient Engagement Requirements
  • Helps Address Care Coordination Requirements
  • Paper, Postage, and Staff Resource Savings
  • Improve Patient Length of Stay

Check out the full Q&A for a lot of other insights including rolling out the HIE to doctors who have an EMR and those who don’t. I also love that the CIO confirmed that the biggest technical challenge is that every EHR vendor has interpreted the HL7 standard differently based on the technical limitations of the application. This is why I’m so impressed that they were able to get 36 EMRs connected.

I hope more CIOs will share their stories of success. We’ve heard enough bad news in healthcare IT. I want to cover more health IT success stories.

July 3, 2013 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.

Private HIE’s Will Make Nationwide HIE Possible

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We’ve been working for a long time on creating a nationwide HIE. I still remember when I first started blogging about EMR 7.5 years ago we were talking about implementing RHIO’s. I’m sure someone reading this blog can talk about what the exchange of health data was before RHIO’s. The irony is that we keep talking about creating this beautiful exchange of information, but it never really becomes a reality.

As I look at the landscape, there are very few HIEs that are showing a viable business model. The two leaders I think are probably the Indiana HIE and the Maine HIE. They seem to be the two making the most progress. I think there’s also something going on in Massachusetts, but it’s so complicated of a healthcare environment that I’m not sure how much is reality and hyperbole.

With those exceptions, I’m mostly seeing a lot of talk about some sort of community HIE and not very much action. However, I am seeing quite a few organizations starting to take the idea of a private HIE quite seriously. I’m not sure if this is driven by ACOs, by hospital consolidation, or some other force, but the move to implement a private HIE is happening in many health systems.

For a lot of reasons this makes sense. There is a business reason to create a private HIE and you own all the endpoints, so it’s easier to create consensus.

As I look across the landscape, I think these private HIEs could be what makes the nationwide HIE possible. Once a whole series of large private HIEs are in place, then it’s much easier to just connect the private HIEs than it is to try and connect each of the individual healthcare organizations.

Watch for the major hospital CIOs to meet at events like CHIME or HIMSS and discuss connecting their private HIEs. It will create some unlikely relationships, but it could be our greatest hope for a nationwide HIE.

June 14, 2013 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.

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

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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!

March 2, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

HIE as Avenue for New Patient Acquisition

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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.

November 23, 2012 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.

HIE Waste

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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.

October 30, 2012 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.

Enterprise HIE vs Public HIE

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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.

September 28, 2012 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.

HIEs And Health Data Ownership

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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.

August 16, 2012 I Written By

Katherine Rourke 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.

Where is the Value in Health IT?

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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.

August 10, 2012 I Written By

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 and Google Plus. Healthcare Scene can be found on Google+ as well.