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HIT for HIEs

Posted on October 17, 2017 I Written By

The following is a guest blog by Mike O’Neill, CEO at MedicaSoft. This is the third blog in a three-part sponsored blog post series focused on new HIT for integration. Each month, a different MedicaSoft expert will share insights on new and innovative technology and its applications in healthcare.

Health Information Exchanges (HIEs) have been in the news lately, and for good reason. With major hurricanes devastating Texas, Florida, the British Virgin Islands, and Puerto Rico, accessibility of patient health information rapidly became a major concern. Electronic Health Record adoption has led to most patient data being in electronic form, but it hasn’t necessarily made that data available when and where care is delivered. HIEs can help make that data available; during the recent storms two HIEs were able to spring to action to help clinicians provide care for patients. The ability of the Houston and San Antonio-area HIEs (Greater Houston Healthconnect (GHHC) and Healthcare Access San Antonio (HASA) to exchange information allowed patient records to be accessed remotely – which was absolutely critical during this natural disaster.

If you were on the fence about “the cloud,” this is the perfect case study in its effectiveness. More than ever, HIEs are called upon to assist by making health records available during critical care encounters. HIEs need modern technology to best serve their communities in these instances, going beyond basic connectivity and interoperability to deliver tangible value using the wealth of data they collect –

  1. Organize the data into meaningful health records. HIEs often have access to years of raw data. They may need help organizing it into a clinical data repository, matching patients, and providing a health record that is clinically useful. This is one way we assist HIEs in using the data they’ve collected.
  2. Provide valuable alerts & notifications. These are useful, especially in a crisis, to locate patients, but they can also give patients notice on events they need to follow-up on. This is another layer we build onto HIEs’ data foundation.

Health records that are useful go a long way – beyond individual hospitals, and regions and state lines. To be useful, health records must go where the patients go, wherever that may be.

An emerging approach to meet this need is the Strategic Health Information Exchange Collaborative (SHIEC’s) Patient-Centered Data Home (PCDH) concept among HIEs. PCDH helps providers access real-time health information across regional and state lines, wherever the patient is seeking care. Regardless of where the clinical data originates, it becomes part of the patient’s longitudinal patient record – the PCDH – giving patients control of their data.

About Mike O’Neill
Mike is the CEO at MedicaSoft. He came to MedicaSoft from the U.S. Department of Veterans Affairs (VA) where he was a Senior Advisor and member of the founding team of the VA Center for Innovation. Mike serves as the Chairman of the Board of Directors of the Open Source Electronic Health Record Alliance (OSEHRA). Prior to VA, Mike was involved in the commercialization of new products and technology in startups and large companies. He is a die-hard Virginia Tech Hokie.  

About MedicaSoft
MedicaSoft designs, develops, delivers, and maintains EHR, PHR, and UHR software solutions and HISP services for healthcare providers and patients around the world. For more information, visit www.medicasoft.us or connect with us on Twitter @MedicaSoftLLC, Facebook, or LinkedIn.

The Impact of HIEs in Natural Disasters – #HITsm Chat Topic

Posted on September 19, 2017 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’re excited to share the topic and questions for this week’s #HITsm chat happening Friday, 9/22 at Noon ET (9 AM PT). This week’s chat will be hosted by Brian Mack (@BFMack) from @GLHC_HIE on the topic of “The Impact of HIEs in Natural Disasters.”

On August 29th, 2005, Hurricane Katrina, a category 3 storm, made landfall in SE Louisiana. Torrential rain and sustained winds exceeding 110 MPH quickly overwhelmed the protective measures in place, and the subsequent storm surge breached levies and flooded huge swaths of New Orleans and surrounding areas. Mass-devastation across Louisiana and Mississippi contributed to the deaths of nearly 1,500 people, forced tens of thousands more from their homes, and caused an estimated $108 billion in property damage. At that time, only 10% of physicians were actively using electronic medical records, and electronic health information exchange was still was in its infancy. An incalculable number of paper health records were lost forever. The lack of access to patient information during and following the storm significantly hindered medical response efforts, and required years to replace.

Fast forward to Aug. 24th-26th, 2017, when Hurricane Harvey, an even larger (Cat. 4) storm struck Southern Texas, and dumped more than 40 inches of rain on the greater Houston area. While Harvey has been described as “Houston’s Katrina” in terms of its intensity and impact, the story was significantly different for the healthcare delivery system. Two health information exchanges in the region, the Greater Houston Healthconnect (GHHC) and Healthcare Access San Antonio (HASA) worked together to assist both those who stayed through the storm, as well as those who were evacuated. GHHC staff actually shuttled between shelters in the Houston area, overseeing the set-up of HIE portals, to help clinicians provide care for patients. Providers were able to maintain access to patient records, even from remote locations, using laptops and WiFi to access EHR systems in the normal way. As a result, the response to medical needs, and continuity of care for the population impacted by Harvey across Texas was seamlessly maintained at a very high level.

This week’s #HITSM Twitter chat will discuss the opportunities, challenges, and value of community-based Health Information Exchange in connecting the “last mile” of interoperability, particularly in emergency situations.

Some additional reading:

Here are the questions that will serve as the framework for this week’s #HITsm chat:
T1: What lesson(s) should we, as participants in the healthcare ecosystem, take away from events like Hurricanes Katrina & Harvey? #HITsm

T2: What roles do/should stakeholders: government (local, state, federal), HC providers, private sector, citizenry play in assuring adequate preparation for disasters? #HITsm

T3: What responsibilities do health IT infrastructure vendors (EHR), and Health Information Exchange have in supporting successful emergency response? #HITsm

T4: How do community based HIE’s differ from national interoperability efforts and/or vendor based solutions in emergency situations? #HITsm

T5: What examples from your own local communities can you share where community-based health information exchange either made a difference, or COULD have made a difference in responding to a public emergency? #HITsm

Bonus: Aside from the basic task of networking disparate healthcare providers, how could Health Information Exchange contribute to better connected communities? #HITsm

Upcoming #HITsm Chat Schedule
9/29 – Condition Management vs Episodic Care Management
Hosted by Brian Eastwood (@Brian_Eastwood) from @ChilmarkHIT

10/6 – After Death Data Donation – A #hITsm Halloween Horror Chat
Hosted by Regina Holliday (@ReginaHolliday), Founder of #TheWalkingGallery

10/13 – Role of Provider Engagement for Improving Data Accuracy
Hosted by @CAQH

We look forward to learning from the #HITsm community! As always, let us know if you’d like to host a future #HITsm chat or if you know someone you think we should invite to host.

If you’re searching for the latest #HITsm chat, you can always find the latest #HITsm chat and schedule of chats here.

Lab Interfaces and EHR

Posted on June 4, 2014 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.

The following is a great response on LinkedIn by Robert D. Coli, M.D. to my post about Lab Interfaces Being an EHR Standard. I’d love to hear your thoughts about what he says in the comments.

There are now a total 880,000 professionally active U.S. physicians, working in 200,000 mostly small private practices (100K with one or two members and 160,000 with 8 or less). Because of ARRA/HITECH’s carrots and sticks, over 60% of them have now installed ONC-certified EHRs. There are also a total of more than 8,800 hospital-based and over 5,600 independent, community-based clinical labs using LIS products sold by over 200 vendors, many of which are using proprietary LIS-Provider Link (LPL) software and middleware from a least a dozen EHR-LIS system integrators. Creating bidirectional ambulatory and inpatient EHR-LIS interfaces reportedly costs in the range of $10,000 to $50,000 per installation.

The owners of every lab business and physician practice would love to see the day that open source interoperability standards (for both data transport and content exchange) usher in the era of “commoditized connectivity” (what Dr. Doug Fridsma describes as “the arrows between the boxes”) between physician EHRs (which are used to order the tests) and LISs (which process the patient specimens and make the test results available to the ordering physician, and more recently with the new CLIA regulations, directly to patients). Currently however, there are no marketplace financial incentives for EHR and LIS vendor businesses to replace their millions of expensive customized interfaces (an innovation that sustains their business model) with the lower cost, more efficient and convenient commodity interfaces (an innovation that would disrupt their business model).

The potentially very good news (for labs, private practice physicians and vendors who are adapting to the constructive disruption of HIE 1.0) is that with the emergence of over 600 ACOs and thousands of PCMHs, tangible value-driven, risk-based incentives, a low profile, open source triad of EHR to Lab LIS interoperability standards are moving from pilot projects to production/deployment versions..

Since January 2011, right on the successful launch of the Direct Project Protocol pilots, over 3,000 individuals and organizations, including some of the biggest vertically integrated EHR/PHR, LIS, and HIE platform vendors in the U.S., have been busily creating an extensive portfolio of open source standards specifically aimed at overcoming many of the major barriers to health IT connectivity and seamless interoperability. You can find a good chronology of these efforts in the link to the archive of S&I Framework newsletters here.

The S&IFramework’s Lab Results Interface (LRI), Lab Orders Interface (LOI) and electronic Directory of Services (eDOS) Initiatives have been underway since January 2011. Notwithstanding the potential major impact on the global health IT systems interoperability markets and its vendors, the LRI+LOI+eDOS Initiatives have received little media coverage and exposure outside of some health IT media channels.

Over the next 3-5 years, if they are demanded and widely adopted and used by the knowledgeable customers of EHR and LIS vendors, the HL7-ballotted, normative versions of these three components of an open source interface solution can significantly reduce the costs of creating and maintaining millions of customized EHR-LIS interfaces and enable more efficient, less costly and more accurate ordering and reporting of the results of all 5,000+ available clinical lab tests to physicians and their patients.

If that actually occurs, the vendors of EHR, PHR and HIE platform products will ultimately have to consider reinventing their venerable business models by embracing disruptive IT innovations that enhance the value of the applications “inside their boxes” and can allow them to compete successfully on the basis of the price and quality of their products.

Healthcare Risks, Privacy Risks, and Blowing Up MU

Posted on May 18, 2014 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.


All of healthcare has risks. The key is getting a good grasp of all the risks. Are we doing that really well in healthcare IT and EHR?


I repeatedly find that most people are happy to give up some privacy risk for the potential for better health. This increases even more when someone is seriously sick. Privacy becomes even less important to them.


I always love to see tweets from someone I’ve never met or heard of tweeting out my articles. Tim did a good job summarizing my post about blowing up meaningful use. The post has gotten some good traction and a great discussion. I’m sure that they won’t take my exact approach, but I hope that it will help push ONC to move MU in a direction of extreme simplification.

The Nurse Will See You Now

Posted on May 13, 2014 I Written By

Kyle is CoFounder and CEO of Pristine, a VC backed company based in Austin, TX that builds software for Google Glass for healthcare, life sciences, and industrial environments. Pristine has over 30 healthcare customers. Kyle blogs regularly about business, entrepreneurship, technology, and healthcare at kylesamani.com.

The Atlantic just wrote a piece highlighting the growing trend of non-physicians (commonly referred to as midlevels) providing healthcare. The reason is simple: supply and demand–more precisely, a fixed supply.

For any location where a patient demands healthcare services, there is only a binary result: either there is a qualified healthcare professional available to deliver care, or not. This slide (from Pristine’s investor presentation) illustrates this:

Screenshot 2014-05-04 21.01.17

The supply and demand problem is further compounded by an archaic regulatory system. The path toward becoming a physician, at least in the US, is so arduous that the decision to pursue becoming an MD must be made by age 18 or 19. Even if a huge cohort of 18 year olds suddenly decided they wanted to be physicians, the artificially capped supply of available residency slots each year stimies traditional supply and demand economics.

Nursing, on the other hand, has a more varied cohort in terms of age of entry. Many nurses don’t enter the profession until well into their late 20s or 30s. The same is true of physician assistants. This has resulted in a more liquid supply of non-physician practitioners, and these non-physician practitioners are available to respond to the influx of new patients resulting from the ACA, and to the growing number of retiring baby boomer population.

Given the fixed supply of physicians, there are two fundamental ways to solve the supply and demand problem: make physicians more efficient, or substitute physicians with others who can do an equally good job for a given patient’s needs.

The realities of practitioner supply suggest that nurses and other non-physician practitioners will deliver an increasingly large percentage of healthcare services. Physicians will be relegated to the “high end” per Clayton Christensen’s disruption theory. That could manifest itself in a future in which midlevels deliver primary care and triage more acute conditions to “higher end” specialist physicians.

The greatest challenge in the triage-centric model led by midlevels is the (historically quite poor) communication among healthcare providers. We will need a robust technological infrastructure to support the seamless transfer of patient data among providers. Additionally, we’ll need more capable communication tools to empower providers to connect with one another and with patients regardless of location.

Telemedicine seems to be taking hold to power a future in which location is irrelevant. Interoperability is improving within health enterprises, though there are some signs that community health information exchanges (HIEs) are not doing as well as many had hoped.

At some point down the line, we’ll likely look back and wonder why location mattered so much. It shouldn’t, and because of telemedicine, and liquid data connectivity, it won’t.

Population Health Management (PHM) – The New Health IT Buzzword

Posted on May 6, 2014 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.

For some reason in healthcare IT we like to go through a series of buzzwords. They rotate through the years, but usually have a very similar meaning. The best example is EMR and EHR. You could nuance a difference between the two terms, but in practice they both are used interchangeably and we all know what it means.

With this in mind, I was intrigued by an excerpt from Cora Sharma’s post on Financial Analytics Bleeding into Population Health Management:

It appears that “population health management” (PHM) just has a better ring to it than “accountable care” or “HMO 2.0”. Increasingly, PHM is becoming an umbrella term for all of the operational and analytical HIT tools needed for the transition to value-based reimbursement (VBR), including EHR, HIE, Analytics, Care Management, revenue cycle management (RCM), Supply Chain, Cost Accounting, … .

On the other hand, HIT vendors continue to define PHM according to their core competencies: claims-based analytics vendors see PHM in terms of risk management; care management vendors are assuming that PHM is their next re-branded marketing term; clinical enterprise data warehouse (EDW) and business intelligence (BI) vendors argue that a single source of truth is needed for PHM; HIE and EHR vendors talk about PHM in the same breath as care coordination, leakage alerts and clinical quality measures (CQM); and so on.

Cora is right. Population Health Management does seem to be the latest buzzword and for some reason feels better to people than accountable care. I guess it makes sense. People don’t want to be held accountable for anything. However, they love to help a population be healthy.

Coming out of 30+ meetings with vendors at HIMSS this year I was asking myself a similar question. What’s the difference between an HIE, healthcare analytics, business intelligence, data warehouses (EDW) and even many of the financial RCM products? I see them all coming together into one platform. I guess it will be called population health management.

To Cora’s broader point in the post, there is a real coming together that’s happening between clinical and financial data in healthcare. All I can think is that it’s about time. The division of the data never really made sense to me. The data should be one and available to whatever system needs the data. ACOs are going to drive this to become a reality.

Is the SHIN-NY “Public Utility” HIE Funding a Model for Other HIE?

Posted on April 25, 2014 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.

I first started working with the New York eHealth Collaborative (NYeC) many years ago when they first organized the Digital Health Conference many years ago. Hopefully they’ll have me back again this year since I’ve really enjoyed our ongoing partnership. Plus, it’s a great way for me to get a deeper look into the New York Health IT landscape.

While NYeC organizes this conference, has an accelerator, and is (is this a was yet?) even a REC, the core of everything they do is around their HIE called the SHIN-NY. Unlike some states who don’t have any HIE or RHIO, New York has 10 regional health information exchanges (formerly and for some people still called RHIOs). The SHIN-NY is the platform which connects all of the state’s RHIOs into one connected health network. Plus, I know they’re working on some other more general initiatives that share and get data from organizations outside of New York as well.

While the SHIN-NY has been worked on and sending data for a number of years, the news just came out that Governor Cuomo included $55 million in state funding for the SHIN-NY HIE. This is a unique funding model and it makes me wonder how many other states will follow their lead. Plus, you have to juxtapose this funding with my own state of Nevada’s decision to stop funding the state HIE that was supported with a lot of federal government funds as well.

In my HIE experience, I’ve found that every state is unique in how they fund and grow their HIE. Much of it often has to do with the cultural norms of the state. For example, New York is use to high state taxes that support a number of government programs. Nevada on the other hand is use to no state tax and government funding largely coming from the hospital and gaming sectors. Plus, this doesn’t even take into account the local healthcare bureaucracies and idiosyncrasies that exist.

What do you think of this type of HIE funding model? Do you wish your state would do something similar? Will we see other states follow New York’s example?

I’m excited to see how NY, NYeC and the SHIN-NY do with this HIE funding. Knowing many of the leaders in that organization, I think they’re going to be a great success and have a real impact for good on healthcare in NY.

#HIMSS14 Day 1 – Interoperability, HIE and Social Media

Posted on February 24, 2014 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.

Well, this is technically my second or third day, but this is the first official day of HIMSS. It’s a mad house like you can imagine and the vendor hall is as big as you’d expect. You need about 3 weeks to go through it. I actually decided to do a walking meeting with someone and we basically walked the whole exhibit floor twice. Luckily, the conversation was good and we dove into some interesting topics. I also told them about my future mobile strategy for Healthcare Scene. She liked it. Hopefully I can roll it out in the next few months.

My day happened to start off with a lot of discussion on interoperability and HIE with MAeHC and then Orion Health. I think it’s really interesting to see the progress we’ve made when it comes to interoperability and HIE, but I also found it interesting that Micky Tripathi from MAeHC still described healthcare interoperability as being in its infancy. I largely agree with him and it’s really too bad. Although, it was also interesting to compare that to Orion Health talking about how they’ve proven that HIE can work. Plus, they also noted something I’ve written multiple times: Private HIEs are growing faster than the Public HIEs.

I’m still really torn on the business model for interoperability and HIEs. I don’t see a clear model in most situations. I even saw one tweet yesterday that talked about taxing on a per patient basis to pay for the HIE. I heard that in NY they’re actually literally working on a tax to fund it. However, I really think that calling it a per patient tax is a really bad way to describe the funding. I’ll certainly be covering more of my interoperability and HIE discussions in the future. Watch for those blog posts in the coming weeks.

I also did a lot of social media talk today. Together with Shahid Shah and Cari McLean we had a discussion about Social Media and Influence. It was great to see so many friendly faces in the audience. I feel lucky every chance I get to hear Shahid talk. He’s really good at reframing things in interesting ways. Plus, Cari has a unique perspective to offer from her perch on top of the HIMSS Social Media tower. I previously noted that social media has just become an integral part of HIMSS. What’s interesting is that most of the companies at HIMSS haven’t created it as an integral part of their company. Many are still learning, but it’s great to see them learn. I hope many will attend the Health IT Marketing and PR Conference where we dive in a lot deeper on these topics.

As I said to someone today, social media can provide value to every company, but not every company should do social media. Some companies aren’t ready to commit to doing social media the right way. Other companies aren’t ready to be that open and transparent. Social media is just one tool in the kit. Although, it’s a really powerful one if used properly. I’ve also been touched by the power of social media to help individuals. Social media has connected me to people that would have no doubt been back at their rooms or in the corner of the event wondering why they were there, but instead they’re out having a good time and connecting with other interesting people.

There you go. I talked about a number of other things today, but I’ll cover that over the weeks and months ahead. For now I’m calling my day today HIMSS HIE, Interoperability and Social Media day.

Be sure to also check out my #HIMSS14 Twitter Roundup and my post on Hospital EMR and EHR about the real cause of hospital readmissions. I think the later post will be a post I reference over and over as people continue to talk about solutions that reduce hospital readmissions.

Health Insurance Exchange Q&A with John Kelly from Edifecs

Posted on September 27, 2013 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.

The following is an interview about Health Insurance Exchanges with John Kelly, Principal Business Advisor, Edifecs.
John Kelly
1. Where are we at with Health Insurance Exchanges (HIX)? What are the timelines for their implementation?

The Patient Protection and Affordable Care Act (ACA) mandates creation of a retail market for health insurance, where individuals can shop, compare and buy healthcare coverage much the same way as they would a car. The goal is to provide greater access to healthcare coverage and eventually lower costs. While the ACA initiated the health insurance exchanges (HIXs) as the first step in creating a new retail market for healthcare, it specifically did not stipulate the Federal and State exchanges as the stated goal of the legislation. The stated goal was to reform the way Americans purchased their healthcare. Before the October 1st deadline has even arrived, the HIX model is already evolving beyond the federally funded exchanges. Private exchanges are already up and running and private websites (eHealth Insurance, et al.) have begun to integrate with public infrastructure. Much of the country has focused on the open enrollment date, but the real challenges come afterward, as the industry deals with the operational realities of participating on HIXs over the long term.

The public exchanges are due to launch next week, and open enrollment runs through March 31, 2014. Starting January 1, 2014 all health plans purchased through the insurance exchanges will go into effect, meaning those who bought their health insurance on an exchange will be covered.

2. This is implemented on a state-by-state basis, right? Are all 50 states ready?

There are numerous exchanges. Each state had the option to establish its own state-operated HIX or participate in the Federally Facilitated Marketplace (FFM). Thirty-three states chose the FFM, 15 states plus the District of Columbia are running their own marketplaces, and two states are partnering with the federal government to run their exchange.

In addition to the state-run marketplaces, another major component is the Data Services Hub, which is a tool developed by The Centers for Medicare & Medicaid Services (CMS) to interact with all 51 exchanges, verify applicant information and determine eligibility for enrollment in select health plans and subsidy programs.

Some states are more prepared than others, having made investments in customer service hotlines, technology testing, and consumer education campaigns. Generally, these states made early decisions to participate, so their implementations are more mature, though I doubt any would say they are all set to go. As enrollment gets underway, all of the exchanges will engage in constant improvements (much like any large technology project) to iron out bugs and improve functionality. For the states that didn’t make those investments, it will be a more difficult process.

3. What do health insurance exchanges mean for the health plans? What’s their reaction to the health insurance exchanges?

HIXs are creating a disruptive force for insurers and purchasers, a force that will change the way they conduct business. For insurers, it will change everything from attracting consumers to their end-to-end administrative processes (member enrollment, system integration, payment transactions, etc.).

It hasn’t been easy, particularly because of the compressed timeline between the federal government releasing detailed guidelines and the go-live date of October 1, 2013. Insurers are trying to balance caution with the prospect of 30 million enrollees and $200 billion in revenue within the next decade.

Many health insurers have realized they already participate in Medicare and Medicaid, a form of retail healthcare purchasing, so why not exploit the opportunity of these new exchanges? The reward potential is compelling, especially for regional plans that can now compete with national plans for employers who may choose to migrate to “defined contribution” plans. This is likely to be the largest open enrollment period in history nationwide. While it is not an ideal situation to increase enrollment under such a tight timeline, many realize the potential opportunities and are committed to making it work.

Perhaps the biggest change for plans is that they will have to learn to compete for members and customers, rather than employer groups and brokers. The shift away from competing for members began in the early 1990’s with “sole source” health plan marketing. Plans will need to re-learn some old skills. Plans will need to compete much more consciously on value as opposed to just cost. This was the primary and clear intent of the ACA.

4. What do the health insurance exchanges mean for an employer?

Up until recently, the consensus in the industry was that most employers would stick with the conventional employer-sponsored benefits system, rather than switch to a defined contribution plan. But as this recent Wall Street Journal article explains, many employers are now moving toward providing employees a sum of money to go buy their own coverage. This trend indicates that many companies are looking at HIXs as a way to control the increase in their healthcare benefit costs, while perhaps more importantly, providing their employees with greater choice. This is a huge sea change. While employers have known they need to continue offering healthcare coverage to attract the most talented workforce, they have been struggling with the spiraling costs. Many now see HIXs as an ideal solution.

5. What do the health insurance exchanges mean for patients?

These exchanges are part of a greater trend toward patients playing a larger, more active role in their own healthcare. For selecting a healthcare plan, HIXs are shifting decision-making from employers to their employees; in essence returning healthcare to a direct-to-consumer sales model that will redefine consumer expectations, customer service and healthcare consumer marketing. The overall success of this shift will be based upon the ability of consumers to be better purchasers. There is certainly more risk and effort involved, but the upside is a significant increase in choice and a strong incentive for the plans to compete aggressively on value for dollar.

6. What broader goals do you see the health insurance exchanges bringing to healthcare?

As I mentioned above, one mandate in the ACA is to establish a retail marketplace for healthcare as a means to improving access to healthcare and inevitably lowering costs. HIXs are the current manifestation of that goal, and it’s a positive disruption in the market. As we’ve seen with other such market force change, we may be able to predict the disruption, but we can only guess at the form it will take after the first wave of innovation and market reaction.

7. What are the biggest challenges for health insurance exchanges?

There are a lot of moving pieces, and as with any large technology project, there are always going to be bugs to be fixed and improvements to be made. There is no reason to believe each state’s marketplace won’t go live on October 1 or soon after; however, many won’t be perfect. This launch is similar to the “soft launch” of a retail store opening, and it may take a few months to get everything working. It will probably take a couple of open enrollment cycles to achieve a steady state. The long-term challenge is the same as any insurance product; will the actuarial base support the financial health of the system over time? As this is a market rooted in Federal Law, similar to the experience seen in the Commonwealth of Massachusetts Connector (“Romney Care”), I suspect the system will demonstrate remarkable inertia and will roll slowly toward equilibrium.

These Exchanges have no choice but to continuously improve. By March 2014, I expect the industry will be thinking, “It could have been a lot worse, but we made it,” and they’ll be moving forward to make the next open enrollment much smoother.

A Biometrically Controlled Healthcare System

Posted on September 6, 2013 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.

I recently had a nice conversation with Brian Dubin, VP at CERTIFY, where we discussed biometrics in healthcare. Brian got me interested when he described CERTIFY as a biometrics based “big data” company. When I first started this blog, I fell completely in love with all the various biometric options. Check out one of my first posts on Facial Recognition back in April 2006. Shortly after that I even made this EMR and biometrics contribution to a healthcare IT wiki as part of a “blogposium”. [Excuse my moment of nostalgia]

While CERTIFY works with all of the major biometric fingerprints: Finger, Palm, Iris, Facial, Voice, and Signature, I was even more intrigued by a discussion we had around a healthcare system that was biometrically controlled (my word not CERTIFY’s). I realize that the word “controlled” might have negative connotations surrounding it, but I think it is fascinating to consider all of the ways that your biometric identity could be incorporated into healthcare.

Here are some examples I’m considering (some are a reality today and others will be in the future):
Arrive at the office – Imagine that when you arrive at the hospital or medical practice and a video camera grabs your image and the front desk already knows who you are and can say, “Hi John, glad to have you hear today.” Yes, this freaks out some people, but many of the front desk people remember the faces of the patients. Now they can know your name and check you in much quicker.

Positive patient identification – If you don’t like the video camera identification of a patient, you can also do positive identification of the patient using biometrics in a less big brother’s watching you way. When they sit down at the desk to check in, the patient can use a biometric device to identify themselves. Technology like the one I talk about in my post Retina Scanning vs. Iris Recongition are what can be used for this approach.

Voice recognition for a call center – Imagine when you call into a call center they used voice recognition to identify you. This could be used to access your information more quickly. Although, it could also be used to make sure that whoever the person in the call center pulled up matches the voice on the phone. This could solve them pulling up the wrong “John Smith.”

Single sign on – If your biometric identity is stored in the cloud, then that should make that identity available on any system. Plus, I’ve always been fond of single sign on with Facial recognition. The camera is always watching if you’re there or not and so if you open a new application it can immediately authenticate you since it’s constantly authenticating your biometric identity.

I’m really intrigued by the idea of using biometric identities across multiple systems. I’ve heard many hospital CIOs talk about the hundreds of IT systems they have to support. I’ve also heard doctors and nurses complain about the number of logins and passwords they have to remember. Could biometrics be the solution to this problem? Could a biometric identity be shared between systems or would each system need to do more of the traditional single sign on integration?

Unattended computer – Related to the single sign on, facial recognition can also identify when you’re no longer at a computer. If you leave the computer it can automatically lock the computer to ensure that the health data is kept private. You have to balance how quickly the device locks, but this can be great for security.

Location access – A lot of places already do this with fingerprint or palm scans to access private areas. Plus, this prevents the sharing of keys. You can’t really share your fingerprint very well.

Signatures – There’s certainly an art and identity in someone’s signature. However, why don’t we incorporate even more biometrics into someone’s signature? The combination of a signature plus some other biometric identity would be even more powerful. Plus, when I sign to pick up a prescription, if the pharmacy knew my fingerprint, they could indeed verify that I was the right patient.

HIE identification – I don’t know anyone that’s doing this, but I wonder if instead of trying to make a unique patient identifier, using social security numbers, or some other convoluted method of identity management, could we just use someone’s biometric identity? If we aren’t there today, I think we’ll get there eventually. I’m sure there could be mismatches when it comes to matching two biometric identities that were captured by two separate systems. However, we have plenty of mismatches using ssn, name, birthdate, etc. Maybe the real answer is a combination of biometrics and name, birthdate, etc.

A Biometric Healthcare Experience
Those are some general examples. Now let’s imagine a patient visit where they walk into the hospital and are immediately recognized as a patient seeing Dr. Jones for a surgery. The front desk knows who you and has you sign any forms using your biometrics and then directs you to room 315. When you arrive at room 315 you gain access to the room using your biometric identity. The nurse arrives to prep you for surgery and knows she’s working on the right patient because of your biometric identity.

The nurse signs into the EMR using facial recognition and that biometric identity is captured so the EMR knows exactly who is entering the data into the system. The lab arrives and attached your biometric identity to the blood draws and the results will automatically be sent to the EHR matching on your biometrics.

Your doctor writes a prescription for you which gets sent to the pharmacy. The pharmacy knows that he is indeed a doctor based on the biometric identity of the doctor. Once you go to pickup the prescription they verify your biometric identity to ensure you’re in fact the right patient for that prescription. You later go to your family doctor who’s received all of the information and reports from your surgery which were easily matched to you thanks to your biometric identity.

I could keep going, but I think you get the idea. I’m sure there are major holes in the above example, but I think it’s interesting to consider what a biometrically controlled healthcare experience would look like. Plus, to take a line from Google’s Founder, maybe I’m still thinking too small. It’s possible that biometrics will be able to do so much more. It’s not going to happen tomorrow or all at once, but I’m certain that biometrics will play a big part in the future of healthcare.

I’d love to hear your thoughts on this. Are we on the path to a biometric controlled healthcare system?