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Modeling Health Data Architecture After DNS

Posted on September 12, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I was absolutely intrigued by the idea of structuring the healthcare data architecture after DNS. As a techguy, I’m quite familiar with the structure of DNS and it has a lot of advantages (Check out the Wikipedia for DNS if you’re not familiar with it).

There are a lot of really great advantages to a system like DNS. How beautiful would it be for your data to be sent to your home base versus our current system which requires the patient to go out and try and collect the data from all of their health care providers. Plus, the data they get from each provider is never in the same format (unless you consider paper a format).

One challenge with the idea of structuring the healthcare data architecture like DNS is getting everyone a DNS entry. How do you handle the use case where a patient doesn’t have a “home” on the internet for their healthcare data? Will the first provider that you see, sign you up for a home on the internet? What if you forget your previous healthcare data home and the next provider provides you a new home. I guess the solution is to have really amazing merging and transfer tools between the various healthcare data homes.

I imagine that some people involved in Direct Project might suggest that a direct address could serve as the “home” for a patient’s health data. While Direct has mostly been focused on doctors sharing patient data with other doctors and healthcare providers, patients can have a direct address as well. Could that direct address by your home on the internet?

This will certainly take some more thought and consideration, but I’m fascinated by the distributed DNS system. I think we healthcare data interoperability can learn something from how DNS works.

Value of Data, EMR Jobs, and EMR vs EHR

Posted on July 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.


I agree with Wen that the EMR and claims data needs to be cleaned up. I think it gives the wrong message to say it’s not meaningful though. Once it’s cleaned up, it has a lot of value.


How many of you have applied for a job because you saw it posted on Twitter? I’m really interested in this since I do a lot of health IT job posts on Twitter. We see quite a bit of traffic from Twitter to our healthcare IT job board, but I haven’t added a good way to track who signs up and applies for jobs. That’s next.


I love how academic Practice Fusion tries to make the discussion. I thought I made the discussion of EMR vs EHR much simpler.

IMS IPO and Health Data Privacy

Posted on January 7, 2014 I Written By

The following is a guest post by Dr. Deborah Peel, Founder of Patient Privacy Rights. There is no bigger advocate of patient privacy in the world than Dr. Peel. I’ll be interested to hear people comments and reactions to Dr. Peel’s guest post below. I look forward to an engaging conversation on the subject.

Clearly the way to understand the massive hidden flows of health data are in SEC filings.

For years, people working in the healthcare and HIT industries and government have claimed PPR was “fear-mongering”, even while they ignored/denied the evidence I presented in hundreds of talks about dozens of companies that sell health data (see slides up on our website)

But IMS SEC filings are formal, legal documents and IMS states that it buys “proprietary data sourced from over 100,000 data suppliers covering over 780,000 data feeds globally”. It buys and aggregates sensitive “prescription” records, “electronic medical records”, “claims data”, and more to create “comprehensive”, “longitudinal” health records on “400 million” patients.

* All purchases and subsequent sales of personal health records are hidden from patients. Patients are not asked for informed consent or given meaningful notice.
* IMS Health Holdings sells health data to “5,000 clients”, including the US Government.

These statements show the GREAT need for a comprehensive health data map—–and that it will include potentially a billion places that Americans’ sensitive health data flows.

In what universe is our health data “private and secure”?

Physician Focus, Data as King, and Real Time EHR Data

Posted on December 1, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.


I’m a little torn on this tweet. While I agree that there is too much administrative overhead in healthcare that distracts from patients and lifelong learning, I also think that things like EMR could contribute to both. A well implemented EMR software can help doctors focus on patients and help the doctor learn. This is certainly not the way most doctors look at EMR. Is this an EMR image problem or EMR software that’s not living up to its potential?


Of course, you have to take this tweet with a grain of salt since it comes from our very own Big Data Geek, Mandi Bishop. However, it’s an interesting topic of discussion. How important is the EMR data in healthcare today?


This tweet is related to the healthcare data tweet above. We all know that the EHR data isn’t perfect. Although, it’s worth noting that the paper chart wasn’t perfect either. However, I was more interested in the idea of real-time EHR data. I don’t think we’re there yet, but I’m interested to see how we could get there.

Visualization of Healthcare Data, DocGraph, and Open Source — #HITsm Chat Highlights

Posted on February 9, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: How can we leverage referral and collaboration information in #HealthIT software? What is DocGraph good for?

Topic Two: Generally, what are the best examples of data visualization of healthcare data that you have seen or heard of?

Topic Three: What other open doctor data should we merge with DocGraph? #HealthIT

Topic Four: What open data or open source software do you use regularly as a #HIT professional? #HealthIT

Topic Five: What open data or open source software do you wish existed? #HealthIT

Is Healthcare Big Data Biased?

Posted on November 30, 2012 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.

Have you ever wondered whether YOUR healthcare data is included in the “big data” everyone’s talking about? After all, healthcare big data analytics are going to change the world; shouldn’t those changes be representative of the population they will impact?

To answer that question, we have to identify the sources of the healthcare big data being used to effect change, and consider the likelihood that your data may have been captured and consumed by one of the reporting organizations. So let’s start with the “capture” part of that equation.

Have you received some type of healthcare service this year? That includes, but is not limited to: hospital visit, physical therapy, doctor visit, chiropractor visit, urgent care visit, e-visit or phone consultation, health risk assessment or health fair.

Have you purchased or requested any regulated healthcare product this year, such as prescription drugs?

Do you have private health insurance?

Are you enrolled in Medicare or Medicaid?

If yes to any of the above, and the last question, in particular, YES, your data is included in the “big data” analytics currently shaping policy. It is likely that each billable product and service is attached to your Electronic Health Record, available for review and reporting by each involved party from your PCP (Primary Care Provider) to your friendly insurance call center agent. Your individual collection of data points are aggregated into a larger population, and sliced and diced to provide insights into groundbreaking research efforts. Congratulations! But does that inclusion mean that the conclusions driven by healthcare big data are representative?

By nature, the relevance of data-driven insights increases in proportion to the size of the population – and data points – included. But what if the outliers for the general population are the norm for your data set? Are your conclusions skewed?

What if you represent a population segment that is recognized as underserved? Consider the following, from the first Health Disparities and Inequalities Report, prepared in 2011 by the CDC (Centers for Disease Control): “Increasingly, the research, policy, and public health practice literature report substantial disparities in life expectancy, morbidity, risk factors, and quality of life, as well as persistence of these disparities among segments of the population…defined by race/ethnicity, sex, education, income, geographic location, and disability status.”

If your access to healthcare is limited by any of the factors indicated above, your data may not be captured unless/until there is an acute episode which requires medical intervention. In the report, the CDC acknowledges the challenge of capturing national data to support health initiatives for these populations; it is widely accepted as a barrier to healthcare equality that must be overcome.

What if you’re healthy? I’ll use myself as an example. I don’t go to the doctor unless it’s urgent, and I haven’t visited my PCP in over a year. I’ve injured my shoulder and my back over the past year, both of which required MRI and CAT scans to diagnose severity; however, I do not follow any medically supervised treatment plan for rehabilitation. I don’t take any routine prescription medication. I’m an exercise enthusiast who works out intensely 5-6 days/week, and I sleep 8-9 hours a night. Yes, I do sleep that much. And no, me putting all this information into a blog does not constitute the data being captured for use in healthcare big data analytics. Because I haven’t needed to go to my PCP lately, don’t take routine prescription medication, and am not of age for Medicare or income level for Medicaid, the only current healthcare data available for analysis for me is orthopedic in nature and revolves around imaging data, not traditional clinical measures. Someone like me who had NOT experienced an acute care episode would have no current data available for consumption and reporting as part of a larger population.

Could it be that much, if not most, healthcare big data cited for research purposes is comprised primarily of a triangle of outlier population segments: 1) oldest, 2) poorest, and 3) sickest?

Perhaps. So, when reading on the advances in healthcare big data analytics, ask yourself whether that “big data” means “YOUR data”.

PS – For those of you curious about defining “big data” in healthcare, read Dr. Graham Hughes blog post for SAS, “How Big Is Big Data In Healthcare?”, detailing the nuances of the term as it relates to data size, complexity, and usage. Also, I’d like to thank the good folks at Vanderbilt University for compiling a fairly comprehensive list of healthcare data resources; it has been highly educational. Finally, if you’d like to read the complete CDC report, you can find it here.

Accountable Care Organizations and SCOTUS

Posted on June 19, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

The Supreme Court ruling on SCOTUS is likely to come sometime this month. There are all sorts of opinions out there about what’s going to happen to the ruling, but a recent tweet caused me to stop and think about the real impact of SCOTUS. The tweet (which sadly I can’t find again) said something about the Supreme Court’s ruling on Obamacare and SCOTUS really doesn’t matter to healthcare since the change in care model has already been started.

I take one slight exception to this comment. I agree that the ACO (Accountable Care Organization) movement and all that it embodies is already upon us and won’t be affected by the Supreme Court’s decision on SCOTUS. However, I think the SCOTUS legal decision does matter and will still have an impact on healthcare. Not to mention the politics related to the decision. Although, I’ll leave both of those topics for a different blog.

I do think it’s worth exploring ACOs and why SCOTUS or NO-SCOTUS, ACOs are here to stay in healthcare.

Dave Chase recently said in a Forbes article that “More than 80% of the newly formed ACOs are driven solely by private sector efforts.

I believe that Dave Chase got these numbers from an ACO Watch article about a Leavitt Partners study on ACO growth and dispersion. It’s a powerful number to consider that despite all the efforts by government to move to accountable care organizations that only 20% of the newly formed ACOs came from the government. What a healthy thing and a great illustration of why SCOTUS won’t impact ACOs in any major way.

Dave Chase in the above linked article adds this additional quote from Philip Betbeze:

As Philip Betbeze stated, “In their day-to-day-lives, it [the SCOTUS decision] largely won’t affect the 180-degree shift they’re making in reimbursement philosophy. For most systems, those changes are taking place largely at the behest of commercial plans and local employers.” The fee-for-value train has left the station. Woe is the health system that hasn’t made aggressive moves to reinvent themselves.

We’re still early in the reimbursement philosophy switch, but the winds of change are upon us. Personally I’m excited to see how health systems reinvent themselves. I think this reinvention will be around these key pillars:

*Communication – ACO’s will drive better communication. This will include patient to doctor, doctor to doctor, and even patient to patient. The beauty is that in an ACO, the goal will be for the patient not to come to the office instead of the de facto, come to the office answer most practices give today.

*Data – Practices better be preparing for the tsunami of healthcare data on the horizon. How an ACO takes that data and uses it to improve patient care is going to be key.

If you look at these pillars of an ACO, are they even possible to deal with without technology?

State of Utah Medicaid Breach Affects 800,000

Posted on April 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

The reports and details around the State of Utah Medicaid Breach are starting to come out. An article in the Salt Lake Tribune gave the following numbers:

* 280,000 social security numbers were expose to hackers
* 500,000 less sensitive information like names and birth dates was exposed

This is interesting since the initial data breach number was at 24,000 Utahns on public health insurance were at risk. 800,000 is quite a few more people. The Tribune article says it touches 1 in every 6 Utahns. Compared with other breaches, that’s huge.

I know people love to read reports about healthcare data breaches (see one of my most popular posts on HIPAA Privacy Violations and HIPAA Lawsuits). It’s kind of like the rubber neckers on the freeway when there’s an accident. We have to turn our head to see what happened.

Here’s another part of the article linked above that provides more details.

So far, there have been no reports of people using the information to obtain fraudulent credit cards and loans.

But due to the breach’s scope and potential for harm, the FBI is now investigating.

“Computer intrusions are one of our top priorities,” said Greg Bretzing, assistant special agent in charge of the FBI’s Salt Lake City office. He declined to comment on the investigation or confirm the suspicions of state technology officials who traced the hacker, or hackers, to Eastern Europe.

Unfortunately, we’re really short on details of what actually happened. Not all hacks are created equal. In many cases, a computer gets hacked by a bot with no thought of what information is actually on the server. These bots just scan the internet for vulnerabilities and go through any doors that people left open. Often it’s just about the conquest and not about the information on the actual machine. Unless they give us more details, it will be hard to really know if this was intentional or coincidental.

Although, in this breach, a whole lot of social security numbers are at risk and their is a market for those since our whole financial life revolves around that number. I’ve had a number of Twitter conversations about the market for breached healthcare data. I’m still not convinced there is much of a market for it. I could imagine a scenario where a HUGE amount of aggregate healthcare data has some real value and could be sold to someone. I just don’t see the same value of an individual health record like there is with an individual social security number. Although, I’ll never underestimate the creativity of humans.

The State of Utah Medicaid is offering the standard 1 year identity theft service to those affected. Seems like identity theft services might be the business of the future since every breach turns to them to cover what happened. They haven’t offered any healthcare data identity theft services since I’ve never seen such a service. Is that service not available because it’s not really a problem? I know healthcare identity theft is an issue, but I don’t think those issues stem from breaches. I’d be interested if someone has information that says otherwise.

I’ll also add my regular disclaimer. this healthcare data breach has NOTHING to do with an EHR breach. I’m sure we’ll have a major breach of EHR data at some point in the future, but as of now insurance data and lost devices seems to dominate the healthcare breaches that I’ve seen.

The Disappearing EMR, Patient Built EMR, EMR Competes with Paper, and Healthcare and Data

Posted on March 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

You should know the drill by now. Each weekend, I go through and list some of the interesting, insightful, entertaining, news-worthy or otherwise notable tweets that I find covering my favorite topics of EMR, EHR and healthcare IT.

I have a feeling a few of these tweets will drive some interesting discussion around EHR. I hope they do since I do enjoy a nice discussion.

First up is a tweet that’s pretty profound to consider when we think about EMR:


I think the EMR has disappeared for a number of clinicians, but not enough. Maybe this supports my comment in a previous post that we hear a lot of stories of failed EMR implementations, but we don’t hear the stories of as many successful EMR implementations. Is that because those EMR that are so successful basically disappear. Reminds me of life where you start to take for granted something that at first was such a game changer.


My first gut reaction to this tweet was the need to link my really old post, “Develop Your Own EMR, Are You Crazy?” Although, this seems like a little bit different situation. I do wonder how many people developing EHR software end up seeing doctors who use that same software. I wonder if they’d have different priorities and/or if they’d take different approaches if their healthcare was the only motivator behind the EHR software they developed.


This one’s a little self congratulatory I admit, but I always love to see people tweeting my posts. Plus, I love to see how they frame what I’ve written. I prefer to look at that post as a look at ways that EHR can still improve, not as an ode to paper or even worse an excuse for doctors to still use paper. If you liked that post, look forward to another post this week in the “Healthcare Spoiled” series.


This is very true. We’re not ready to handle all the healthcare data that’s being produced today, let alone the tsunami of healthcare data that will come. I’m not too concerned though. It means there’s a tremendous opportunity on the horizon for an entrepreneur to do something amazing.

eCollaboration at HIMSS12, MU Stage 2, Healthcare Social Media, Tablets and Accessible Patient Data

Posted on February 5, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

I’m sure many of you are recovering from the Super Bowl right now. I got exactly what I wanted from the Super Bowl: a great game. I didn’t care too much either way, but I am glad that I predicted the Giants to be the winners. Too bad I’m not a betting man. Although, I guess that’s the trick with betting….but I digress.

Time for my regular weekend round up of interesting things happening in the healthcare IT and EMR twittersphere. We’ve got some really interesting tweets this week. Here we go.


When I created and posted my list of HIMSS 12 sessions, they hadn’t created the agenda for the eCollaboration Forum at HIMSS and so I couldn’t add any sessions. However, the eCollaboration Forum at HIMSS 12 agenda is up now, so check it out. I know there are a number of sessions I’m going to add from the forum. I also love that they have the online option linked in this tweet for those not attending HIMSS 2012.


This is really important news. I think a lot of us are REALLY interested to see the final meaningful use stage 2 details. Good find by Neil Versel.


I’m sure we’re going to continue seeing the trend of more and more doctors gleaning value from engaging in social media. At a minimum doctors are going to start finding more and more new patients using social media including things like physician blogging. A well done practice website and social media effort is going to be really valuable for the doctor of the future.


Yes, blogging will also help hospitals in a number of ways too. Social media can benefit hospitals, doctors, practices, etc.


I was fascinated by this tweet. First because I wonder what changes will make tablets more than just great for content consumption. Second, the idea of PCs being more intellectually flexible.


I know there are reasons why financial data is more portable and accessible than healthcare data, but it still irks me that we haven’t overcome those reasons…yet!