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Healthcare Data Standards Tweetstorm from Arien Malec

Posted on May 20, 2016 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.

If you don’t follow Arien Malec on Twitter, you should. He’s got strong opinions and an inside perspective on the real challenges associated with healthcare data interoperability.

As proof, check out the following Healthcare Standards tweetstorm he posted (removed from the tweet for easy reading):

1/ Reminder: #MU & CEHRT include standards for terminology, content, security & transport. Covers eRx, lab, Transitions of Care.

2/ If you think we “don’t have interop” b/c no standards name, wrong.

3/ Standards could be ineffective, may be wrong, may not be implemented in practice, or other elts. missing

4/ But these are *different* problems from “gov’t didn’t name standards” & fixes are different too.

5/ e.g., “providers don’t want 60p CCDA documents” – data should be structured & incorporated.

6/ #actually both (structured data w/terminology & incorporate) are required by MU/certification.

7/ “but they don’t work” — OK, why? & what’s the fix?

8/ “Government should have invested in making the standards better”

9/ #actually did. NLM invested in terminology. @ONC_HealthIT invested in CCDA & LRU projects w/ @HL7, etc.

10/ “government shouldn’t have named standards unless they were known to work” — would have led to 0 named

11/ None of this is to say we don’t have silos, impediments to #interoperability, etc.

12/ but you can’t fix the problem unless you understand it first.

13/ & “gov’t didn’t name standards” isn’t the problem.

14/ So describe the problems, let’s work on fixing them, & abandon magical thinking & 🦄. The End.

Here was my immediate response to the tweetstorm:

I agree with much of what Arien says about their being standards and the government named the standards. That isn’t the reason that exchange of health information isn’t happening. As he says in his 3rd tweet above, the standards might not be effective, they may be implemented poorly, the standards might be missing elements, etc etc etc. However, you can’t say there wasn’t a standard and that the government didn’t choose a standard.

Can we just all be honest with ourselves and admit that many people in healthcare don’t want health data to be shared? If they did, we’d have solved this problem.

The good news is that there are some signs that this is changing. However, changing someone from not wanting to share data is a hard thing and usually happens in steps. You don’t just over night have a company or individual change their culture to one of open data sharing.

FHIR Optimism – Is It Misplaced?

Posted on July 9, 2015 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.

We’ve all seen the optimism around FHIR. I even wrote the cheeky post titled FHIR is on Fire. I think that observation is still accurate. If you mention the word FHIR, then people start listening. I saw a number of sessions at HIMSS on FHIR and there was a lot of interest. I actually think that many people were (and are) still trying to figure out how FHIR is different from all the previous HL7 versions, but there was a definite interest in learning about it.

Admittedly, I’m still working to understand FHIR as well. However, in all the learning I’ve done, FHIR feels like more of the same. Certainly it’s a step forward from previous HL7 iterations. I think that it has much more robust capabilities. There is a lot to like about FHIR and I don’t want to thwart people’s efforts to bring it to light.

As I’ve thought about this more though, I don’t think FHIR is the coming of interoperability. Here’s what I asked in today’s #KareoChat:

I think most would agree that the reason we don’t have healthcare data interoperability yet has almost nothing to do with the technology. It has everything to do with political and economic reasons why healthcare organizations didn’t (and many still don’t) want to share data. I’m quite sure that if there was a political and financial reason to share data it would happen very quickly.

Assuming you agree with this premise, why then do we think that a new tech standard (FHIR in this case) will change those dynamics? Will FHIR be so plug and play obvious that healthcare executives will start being embarrassed for not sharing data when it’s so easy? My past experience with healthcare standards say that won’t be the case. FHIR will be a technical improvement over what we have today, but still will require a lot of effort.

I’d love to be proven wrong on this. Do you have a different view? I’d love to learn in the comments.