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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 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 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.

The Irony Of Healthcare Standards

Posted on 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

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.

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

Posted on 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.

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?

Bringing Long Term Care Into HIEs Without An EMR

Posted on 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.

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.

The Next Generation of Doctors – #HITsm Chat Highlights

Posted on 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.

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.

 

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

Posted on 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.

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?

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

Posted on 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.

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?

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

Posted on 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.

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? 

 

 

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

Posted on 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.

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? 

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

Posted on 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.

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?