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Globalizing Health Data is Impossible

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I keep hearing people say over and over that we just need to have a standardized set of data and interfaces for healthcare. This is one of the most unrealistic comments I hear and it is said all the time. This will just never happen.

In a recent LinkedIn conversation, Susan Hirst offered this insight on the idea of globalizing data:

I worked in a different industry in the 90′s and they tried to globalize data! They put millions on the table with some of the country’s best…when all pieces, parts were brought together under very strict development criteria nothing talked to each other in the program. It was abandoned because to fix the pcs and parts would have dbled the cost.

Same with EHR and government fingers in the program pie! Every specialty has specific needs and no two physician will practice the exact same….besides, the incentives offered to go thru the pain never overcome the actual cost in hard assets and lost productivity! So we all know the “who” behind the mandates and it is not all just government.

I’ll leave her finally conspiracy theory comment aside, and just focus on the challenge of globalizing healthcare data. Doctors will never let it happen. The most we can hope for is interoperability of data. This is an achievable goal and will happen. Healthcare data is going to be exchanged between providers. In the relatively near future a doctor will have access to a patient’s entire medical record whenever they need it. This will be a sea change in how it works today.

What won’t happen is all of that healthcare information being sent in some sort of standardized way so that the granular data can be sucked into the EHR and presented to the doctor in a standard way. Certainly we’ll be able to do that with some elements of the health record. We do that today with prescriptions, lab results, etc. Although, if you’ve worked on even those interfaces, you will understand why we won’t ever be able to do the same with the entire health record.

Good, Bad, or otherwise, doctors have a lot of autonomy in how they practice medicine and how they document the patient visit. This is unlikely to change and is a major reason why we’ll never have truly globalized health data.

August 6, 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.

Interoperability Needs Action, Not Talk – #HIMSS13 Blog Carnival

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When you talk to people outside of healthcare about the value of healthcare IT, you will often get a response that healthcare IT is fantastic because it makes it so easy for medical data to be shared with who needs the data when they need it. Those of us in healthcare IT know that this is far from the reality of what’s possible with healthcare data today. This is really unfortunate, because the promise of technology in healthcare is to make the movement of data possible. We’re currently missing out on the benefits of this promise.

I don’t know about the rest of you, but I’m sick and tired of hearing the excuses for why healthcare data can’t be shared. We’ve heard them all: privacy, security, data governance, payment model, etc etc etc. Yet we go to the HIMSS Interoperability Showcase and see that the technology to start sharing data is there, but what seems to be missing is the willpower to push the data sharing through despite the challenges and naysayers.

Maybe Farzad is on to something when he called for EHR vendors to do what’s “Moral and Right.” There’s no more moral or right thing someone can do in healthcare than to make healthcare data interoperable. It’s not only EHR vendors that need to do this, but hospital institutions and doctors offices as well.

We need some brave leaders in healthcare IT to step up and start sharing data. No, I don’t want an announcement at HIMSS that a healthcare organization has partnered with a vendor to start sharing data. I don’t want a new organization formed to assist with healthcare data sharing initiatives. I don’t need another book on the challenges of HIE. We don’t need a session on HIEs and data sharing standards. No, we need brave organizations that say that sharing healthcare data is the right thing to do and we’re making it happen.

I’m not suggesting an organization should do anything ruthless or reckless. I’m suggesting that healthcare organization start DOing something as opposed to talking about it. The time for talking is over and the time for DOing is here. Healthcare data interoperability won’t happen until we make this choice to DO instead of TALK.

I’m not even asking for a healthcare organization to start sharing all their healthcare data everywhere. In fact, I think that’s another failed interoperability strategy that we seem to keep trying over and over. If you try to solve all of our healthcare interoperability problems in one major project, you’ll end up doing nothing and solve none of the problems.

Instead a successful interoperability strategy will focus on sharing one meaningful piece of healthcare data while still keeping in mind that this is just the start. Connect the healthcare data end points with that one meaningful piece of data. Once you make that connection, others will start to wonder why that same process can’t be used for other important and valuable pieces of healthcare data. This is exactly the push that healthcare interoperability needs. We need departments and providers jealous of other departments and providers that are sharing their data. The same principle of jealousy can apply across institutions as well.

Yes, this will take a forward looking leader that’s willing to take what many in healthcare would consider a risk. Imagine a hospital CIO whose stuck trying to explain why their hospital is sharing data that will help doctors provide better care to their patients. Imagine a hospital CIO explaining why they’re driving healthcare costs down by lowering the number of duplicate tests that are done because they already have the data they need thanks to interoperable healthcare data. I’d hate for a hospital CEO to have to explain why they’ve reduced hospital readmissions because they shared the hospital data with a patient’s primary care doctor.

Maybe implementing interoperability in healthcare isn’t such a brave thing after all. In fact, it’s a brave thing for us not to be sharing data. Why aren’t we holding our healthcare institutions accountable for not sharing data that could save lives, lower costs, and improve healthcare? Why are we ok with non-profit institutions worrying more about profit than the real stakeholders their suppose to be serving? Are we really so far gone that healthcare organizations can’t do something so obvious: sharing healthcare data?

Think of all the other major healthcare initiatives that would benefit from being able to share healthcare data where it’s needed. Meaningful Use, Obamacare (Affordable Care Act if you prefer), Clinical and Business Intelligence, Mobile Health, ACO’s, population health, etc could all benefit from healthcare institutions that embraced interoperable healthcare data.

Who’s going to take the lead and start doing what we all know should be happening? It won’t happen by #HIMSS13, but over cocktails at HIMSS I hope some hospital CIOs, doctor groups, EHR vendors, and other medical providers come together to do what they know is the right thing to do as opposed to just talking about it.

The above blog post is my submission to the #HIMSS13 Blog Carnival.

February 8, 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.

Lawsuits Will Eventually Drive EHR Adoption?

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In the recent #HITsm chat, tireless patient advocate Sherry Reynolds offered this intriguing tweet:


Once EHR’s are the standard of care sadly lawsuits will drive adoption .. “so why didn’t you see the lab results doctor?” #HITsm
@eHealthSherry
Sherry Reynolds

The first question I’d ask based on this tweet is when will EHR become the “standard of care.” I’m sure that some could argue that now based on the $36 billion in EHR incentive money that the government is spending. However, even the most optimistic EHR adoption numbers are at 50% and I’d put it closer to 30% with ambulatory EHR dragging that number down. With that said, what would it take to have EHR as the standard of care that a doctor provider? I’m not a lawyer, but I know a number of healthcare lawyers read this blog. I hope that some of them will chime in with their thoughts.

Sherry’s last comment about not having the lab results points more towards the exchange of healthcare data being the real issue a doctor could face. Not only would this be a potential lawsuit issue for doctors, but at some point enough patients will ask this question as well. I’m sure most doctors aren’t worried since we’re pretty far from that tipping point.

I do think that doctors are quite attune to liability and can be a very big motivating factor for them. I think the same will happen with insecure text messaging in healthcare. The first couple lawsuits against a doctor for sending PHI over text and we’ll see widespread adoption of secure text platforms.

While I can see some of the realities that Sherry tweeted about, a part of me really hates to think that fear of lawsuits would end up being the driving force behind EHR adoption.

August 2, 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.

They Do Listen: Stage 2 Proposal Includes Some Changes to Stage 1 – Meaningful Use Monday

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Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money. Check out Lynn’s previous Meaningful Use Monday posts.

Included in the Proposed Rule for Meaningful Use Stage 2 are several modifications to the requirements for Meaningful Use Stage 1—likely in response to a barrage of comments from providers. 

The MU Stage 1 measure requiring a test of the ability to exchange clinical data would be removed effective 2013. Apparently, the concept of a test created a great deal of confusion. This change, however, should not be interpreted as reduced interest in interoperability. In fact, Stage 2 is all about the sharing of data. The measure would be replaced in Stage 2 by numerous other measures that require the sharing of clinical information—both between providers and with patients. 

The “all 3 vital signs dilemma”, (described in a previous Meaningful Use Monday post), would be resolved by a change to the vital signs measure. Separating height and weight from blood pressure, the revised measure would allow a provider to meet the threshold for recording height and weight, while claiming an exclusion for blood pressure, (or vice-versa). This is good news for specialists like orthopaedists who may routinely document height and weight but who rarely document blood pressure unless it is relevant to a specific patient’s problem. This change would be available as an option in 2013, and formalized in 2014. (The vital signs measure would also increase the minimum age requiring blood pressure documentation from 2-year olds to 3-year olds.) 

Many providers reported a problem in meeting the CPOE measure because of the way the calculation was defined—particularly those providers whose treatment does not frequently include prescribing medication. Now, providers would be able to define the denominator as the number of medications ordered, rather than the “number of unique patients with at least one medication in the patient’s medication list”, (since that list often includes medications downloaded from Surescripts and prescribed by other providers.) There is already a CMS FAQ (#10369) that allows providers to use this alternate definition even in 2012.

The government is listening, so make your voice heard. Use your experience in Meaningful Use Stage 1 to influence Meaningful Use Stage 2. Submit your comments on the Proposed Rule for Stage 2.

April 9, 2012 I Written By

Lynn Scheps is Vice President, Government Affairs at EHR vendor SRSsoft. In this role, Lynn has been a Voice of Physicians and SRSsoft users in Washington during the formulation of the meaningful use criteria. Lynn is currently working to assist SRSsoft users interested in showing meaningful use and receiving the EHR incentive money.

The Marvels of Technology Missing in Health IT

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I’m currently on the long flight from Las Vegas to New York City. The early flight time and long flight remind me why I prefer to just stay in Las Vegas with the occasional west coast trip, but I digress. In order to not lose an entire day of work on the airplane, I spent far too much for the overpriced internet service on my flight. As I’m traveling at 30,000 feet, it’s amazing to me that I’m connected nearly as good as when I’m sitting at home. Sure, in flight internet has been around for quite a while, but it still amazes me. What will amaze me even more is when the internet is free on every flight. Maybe pharma ads could pay for this too.

While experiencing this amazing connectivity, I can’t help but think of how poor so much of the connectivity in healthcare is. That’s right. We can find a way to offer internet connectivity at 30,000 feet in an aircraft moving hundreds of miles per hour and yet we can’t get connectivity to rural hospitals and other healthcare locations?

Plus, even speaking more broadly, I can access all of my normal services from an airplane, but for some reason I have no way to connect all of my healthcare data together.

Those in the industry realize the problems. The challenge of connecting all of our healthcare data from the various EHR (or maybe in this case EMR is appropriate) data silos is an academic exercise that’s easily accomplished. Hit any of the interoperability showcases at HIMSS or other healthcare IT events and you’ll see EHR software vendors communicating with each other and sharing data. Why then can’t we make this a reality?

The challenges are still the same they’ve been for a long time now: funding and politics.

I still cringe to think of the missed opportunity that ARRA and the HITECH Act could have provided in this regard. Instead of incentivizing use of an EMR, they should have and could have incentivized interoperability of healthcare data. The great part is that you’re not going to start exchanging data in healthcare without an EHR so you’d be getting more EHR software adopted and interoperability. Water under a bridge now I guess, but it keeps eating at me.

My biggest hope now is that a grass roots movement will form that will drive what we should be doing anyway. Everyone knows and understands the benefits to healthcare and the patient of exchanging healthcare data. It’s easy to make the case for how patient care improves and how duplicate costs are avoided. We need more people that are willing to hop on board interoperability of healthcare data cause it’s the right thing to do. Sure, we need to do it in a smart and reasonable way, but the ROI of healthcare data exchange goes well beyond dollars and cents. This ROI can’t be put on a spreadsheet, but instead will help us all sleep better at night.

Are there any movements like this out there? I can’t say I’ve seen any, but I’d love to see one. Then, we’d have a real beacon community that’s set on a hill because it earned and deserved the recognition as opposed to beacon communities paid for by tax payers.

Side Note: I’ll be in NYC this week at the Digital Health Conference and at the mHealth Summit in DC next week. I’m already planning to meet a number of my readers at these events, but I’d love to meet more.

November 30, 2011 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.

The Pains of Healthcare Data Interoperability Described First Hand

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I was hit by this comment made by Ciro on a LinkedIn group that I’m apart of (You can find the HealthcareScene.com blog network on LinkedIn if you want to join).

My patients are discharged from hospitals and are seen in different offices. I have no clue what changes have been made when I open the patient’s record in my emr. We have to call to have notes faxed to us all the time. Then we scan the documents into the emr and attach it to the patient record as a tif file. If a patient has a reaction to a medication and is seen at urgent care facility, I will not know about it unless the patient tells me. There is no integrity in my emr data since changes are made all the time. Our hospital recently spent millions on a emr that does not integrate with any outpatient emr. Where is the data exchanger and who deploys it? What button is clicked to make this happen!

My practice is currently changing its emr. We are paying big bucks for partial data migration. All the assurances we had about data portability when we purchased our original emr were exaggerated to make a sale.

Industry should have standards. In construction there are 2×4 ‘s , not 2×3.5 ‘s. Government should not impinge on privacy and free trade but they absolutely have a key role in creating standards that ensure safety and promote growth in industry.

I have 3 takeaways from Ciro’s comments.

1. The Pain of NO Healthcare Data Exchange – I can’t remember ever reading a first hand account that so aptly described the pains a doctor faces in trying to care for a patient and not being able to get the data they need to care for the patient properly. We need more stories like this that describe the pains of getting data exchanged in healthcare. Doctors need to recognize these pains and broadcast it far and wide. Otherwise, we’re not going to see any real significant movement. Patients can join in the chorus as well.

2. Healthcare Data Exchange Is Still Far Away – “Our hospital recently spent millions on a emr that does not integrate with any outpatient emr.” Doesn’t that comment just sting you to the core? If it doesn’t you’re probably the one that collected the million dollar checks from the hospital. I’m not sure what to say about the CIO that purchased a system that wouldn’t integrate with other EHR software.

3. Govenment’s Missed Opportunity – The last paragraph of Ciro’s comments talks about how the US government should have helped create a standard for data exchange. I still believe the EHR incentive money should be spent on establishing this standard and rewarding use of the standard. It’s probably too late now.

Keep the stories of terrible experiences exchanging healthcare data coming. I love to learn from first hand experiences. So, send them over and I’ll be sure to get your stories out and heard. Examples of great electronic healthcare data exchange would be welcome too. Few things motivate and gets things accomplished as much as pain and jealousy.

August 12, 2011 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.