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The Irony Of Healthcare Standards

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Healthcare delivery should be standardized. Medicine is, after all, primarily a science. Providers must diagnose and treat patients. Clinicians must form hypotheses, test hypotheses, and act. As providers obtain new information, they must adjust their thesis and repeat the cycle until patients are treated. Although there is an art to patient interaction, the medical process itself is scientific.

Science is based on repeatable, nullable hypotheses. Diagnostics and treatments are too.

And yet, it’s widely known that healthcare delivery is anything but standardized. Even basic pre-operative checklists vary dramatically across locations. Although some of this variation can be accounted for by physical constraints and capital limits, most of the aberrations can be attributed to management and culture. Checklists and protocols attempt to standardize care, but even the protocols themselves are widely debated within and between organizations.

It’s also widely known that most innovations take the better part of two decades to roll out through the US healthcare system. For an industry that should be at the cutting edge, this is painful to acknowledge.

There’s a famous saying that vendors represent their clients. It should be no surprise that major health IT vendors are slow to innovate and respond. Providers are used to slow changes, and have come to expect that of their vendors. Since providers often cannot absorb change that quickly, vendors become complacent, the pace of innovation slows, and innovations slowly disperse.

In the same light, health IT vendors are equally unstandardized. In fact, health IT vendors are so unstandardized that there’s an entire industry dedicated to trying to standardize data after-the-fact. The lack of standards is pathetic. A few examples:

Claims – Because insurance companies want to reject claims, they have never agreed on a real standard for claims. As such, an entire industry has emerged – clearing houses – to help providers mold claims for each insurance company. In an ideal world, clearing houses would have no reason to exist; all claim submissions, eligibility checks, and EOBs should be driven through standards that everyone adheres to.

HL7 – It’s commonly cited that every HL7 integration is just that: a single HL7 integration. Although HL7 integrations share the same general format, they accommodate such a vast array of variety and choice that every integration must be supported by developers on both sides of the interaction.

As a technologist, the lack of interoperability is insulting. Every computer on this planet – Windows, Mac, iOs, Android, and other flavors of Linux – communicate via the TCP/IP and HTTP protocols. Even Microsoft, Apple, and Google play nicely within enterprises. But because of the horribly skewed incentives within healthcare, none of the vendors want their customers to interact with other vendors, even though cooperation is vital.

Perhaps the most ironic observation is that technology is widely considered to be hyper-competitive. Despite hyper-competition, the tech giants have coalesced around a common set of standards for communication and interoperability. Yet health IT vendors, who operate within a vertical that prides itself on its scientific foundations, fail to communicate at the most basic levels.

March 13, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

High Costs of Health IT, ePrescribing, and HIE — #HITsm Chat Highlights

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The following is our regularly scheduled roundup of tweets from yesterday’s #HITsm chat. You can also check out John’s blog post on yesterdays #HITsm topics.

Topic One: Costs vs benefits. Will high costs always be the #1 barrier cited to #healthIT adoption?

 

Topic Two: Why does ePrescribing have such widespread acceptance while #telehealth adoption is so low?

 

Topic Three: #HIE as a noun or a verb? Does negative press for HIE organization$ hinder health data exchange as a whole?

#HITsm T4: Is #CommonWell just a bully in a fairy godmother costume?

 

Topic Five: Open forum: What #HealthIT topic had your attention this week?

June 29, 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.

Bringing Long Term Care Into HIEs Without An EMR

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HIEs will never achieve their full potential if all players in the healthcare process aren’t included in the network. But without an EMR to connect to the HIE, how can a provider participate?

A new software package developed by Geisinger Health System and the Keystone Beacon Community Program offers a new option allowing nursing homes, home health agencies and other long-term care facilities without EMRs to upload data to HIEs, reports EHR Intelligence.

The package, KeyHIE Transform, extracts data from the Minimum Data Set and Outcome and Assessment Information Set that nursing homes already submit to CMS. It turns that information into a Continuity of Care Document usable by any EMR which is HL7-compatible.

This approach provides a bridge to a wide range of data which currently gets left behind by most HIEs. And as EHR Intelligence rightly notes, with telehealth and remote monitoring becoming more popular ways of managing senior  health, as well as assisted living, it will be increasingly important for other providers to have access to all of the seniors’ data via the HIE.

Geisinger’s KeyHIE has already run several  pilot programs using t his technology in long-term care facilities and home health agencies. It expects to launch the technology to the market in April of this year.

As is often the case, Geisinger seems to be ahead of the market with a solution that makes great sense.  After all, finding a way to integrate new data into an HIE — especially one that draws on existing data — is likely to add significant value to that HIE.  I’m eager to see whether this technology actually works as simply as it sounds.

March 13, 2013 I Written By

Katherine Rourke is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

The Next Generation of Doctors – #HITsm Chat Highlights

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The theme for today’s chat was “The Next Generation of Doctors.” When I read this, I wasn’t sure what to expect. It definitely sounded like an interesting topic, and it proved to be one. Here are the questions that were asked, and some of my favorite responses:

Topic One: Who are the emerging leaders you admire for their ideas in shaping the future of medicine? Why? Share resources!

 

 

 

Topic Two: Do you think new ways of learning will attract different types of personalities to the field of medicine?

 

 

Topic Three: How can the next generation of doctors learn from patients who are active through social media?

 

 

 

Topic Four: What does the next generation of doctors think of Quantified Self? How will the role of hte docotr change because of #OS?

 

Topic Five: What is your big idea or dream for the future of medicine.

 

January 27, 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.

EMR Vendors, Patient Privacy, and Election Day — #HITsm Chat Highlights

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Topic One: When EMR vendors leave the marketplace or discontinue a product, how can usability be sustained?

Topic Two: How do we protect patient privacy with payer-based HIEs?

 

Topic Three: How can we draw attention to patient safety in the U.S. prison system?

Topic Four: Are we over the election and back to business as usual with healthcare?

November 17, 2012 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.

Data Capture, Electronic Data, and Interoperability — #HITsm Chat Highlights

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Topic One: When can we seriously say the data being captured and stored in EHRs is leading to new opportunities for patient care?

Topic Two: Do hospitals prioritize complete data capture for max reimbursement or for an aid for clinicians in patient care?

#HITsm T3: Does electronic data entry really take more time than paper notes? What can improve speed?

 

#HITsm T4: Interoperability. What can be done to increase awareness of the CCD and CDA standards designated for data exchange?

October 20, 2012 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.

Patient Portal, HIE Policy, and Portable Technologies — #HITsm Chat Highlights

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Topic One: How would you make a business case to leaders of an organization for a basic patient portal? 

 

 

 

Topic Two: What should an HIE policy regarding information sharing consent include? Can other technologies help? 

 

 

 

Topic Three: Why are portable technologies being adopted at a quicker rate than other health IT?

 

 

 

Topic Four: Free for All: What other health IT news/issues have interested you most this past week? 

 

 

October 6, 2012 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.

EHR Reimbursement, Health Data Security, and Innovation – #HITsm Chat Highlights

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Every week, HL7 Standards, hosts a #HITsm Tweet Chat and poses four questions “on current topics that are influencing healthcare technology, health IT, and the use of social media in healthcare.” It’s always a great discussion and also a great chance to meet a wide variety of people that are passionate about healthcare IT.

In case you missed it, or are curious about what went on this week, we’ve put together the list of topics with some of the best responses for each topic. There were some interesting topics this week, as well as some great responses. If you have any opinions on any of these topics, feel free to continue the discussion in the comments. This chats take place every Friday at 11AM CST. You’ll find members of Healthcare Scene regularly participating in the chat under some of the following Twitter accounts: @techguy@ehrandhit@hospitalEHR, and @smyrnagirl.

Topic One: Politics #EHR reimbursement will likely reach $20 billion. Why is this big govt initiative exempt from critics?

Topic Two: Health data security: What does health data security look like and how is it different than financial data security?

Topic Three: Clash of the #Health IT Titans: What is most beneficial patients, #HIEs or #ACOs? 

Topic Four: Innovation in #healthIT: What are some examples of innovative groups/ideas that may disrupt the current system? 

September 22, 2012 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.

Vendor Collaboration, Communicating Interoperability, and Healthcare Politics – #HITsm Chat Highlights

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Every week, HL7 Standards, hosts a #HITsm Tweet Chat and poses four questions “on current topics that are influencing healthcare technology, health IT, and the use of social media in healthcare.” It’s always a great discussion and also a great chance to meet a wide variety of people that are passionate about healthcare IT.

In case you missed it, or are curious about what went on this week, we’ve put together the list of topics with some of the best responses for each topic. There were some interesting topics this week, as well as some great responses. If you have any opinions on any of these topics, feel free to continue the discussion in the comments. This chats take place every Friday at 11AM CST. You’ll find members of Healthcare Scene regularly participating in the chat under some of the following Twitter accounts: @techguy@ehrandhit@hospitalEHR, and @smyrnagirl.

Topic One: Will vendors begin to collaborate more now that HL7 is making their standards free to non-members? 

 

 

 

Topic Two: How can #healthIT professionals “simplify the message” to better communicate interoperability

 

 

 

 

Topic Three: Why are #healthIT initiatives missing from the current political discourse? 

 

 

 

Topic Four: Health IT Free for all: What news or info has most interested you the past week?

 

September 8, 2012 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.

ICD-10 Benefits – Where are they?

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One of the interesting topics of discussion at HIMSS was around the delay of ICD-10. However, I have yet to find an answer to what I think is probably the most important question around ICD-10. I posted the question and some other thoughts related to the question on the EHR Guy’s passionate post about ICD-10. Here’s my question and comments:

“What are the true benefits to using ICD-10?”

I’ve read story after story about ICD-10 (including this post) and so far I’ve only seen people giving general lip service to the basic idea that more specifically quantified data will somehow have a benefit to the healthcare system. Darren in the comment above says, “The fact that ICD-10 helps so many electronic and quality initiatives right now, or as pointed out above, are, in fact, required to achieve them”

What are the electronic and quality initiatives to which he speaks? What are the true benefits that we’ll get if we go to ICD-10? I haven’t seen enough of these examples.

We could also look at this same question another way. The rest of the world has been using ICD-10 for a lot longer than us. What have been the benefits that the rest of the world has seen from their use of ICD-10 that we haven’t seen in the US since we’re still on ICD-9?

I’m not trying to say that there aren’t benefits. I’m just saying if there are, then why aren’t we hearing more stories with concrete examples of the benefits? If there are, I’d love to see them and make them more widely known.

The EHR Guy offered this reply:

What you are asking for is reasonable and fair.

I will post, in a future blog, examples of why migrating to ICD-10 has beneficial clinical quality outcomes other than the intended reimbursement aspect of it which has been the main purpose of implementing it here in the United States.

But in essence a deep specificity would eliminate the erroneous coding accompanied by bulk documentation to justify the claim to be reimbursed.

Achieving semantic interoperability with erroneous coding is impossible. I’ve been in aggregation projects where abstracting information from HL7 messages was futile because no one in the healthcare organization seemed to understand what was contained in them.

This will be a very lively topic for months to come. I look forward to your participation in the discussions.

I look forward to the EHR Guy offering some more concrete examples in future blog posts. Although, I think this question deserves much more attention. I’ll admit to not being an expert on ICD-10. I know enough to be dangerous. So, I’d love to hear some of the real life benefits that ICD-10 has provided other countries and/or the benefits the US will get from ICD-10 implementation.

If we don’t have more stories and example of these benefits, then instead the stories related to the cost and inconvenience of ICD-10 (which are easy to find) will dominate the conversation. If that’s the case, then we can be sure that ICD-10 will be delayed.

March 8, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.