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ONC’s Interoperability Standards Advisory Twitter Chat Summary

Posted on September 2, 2016 I Written By

The following is a guest blog post by Steve Sisko (@ShimCode and

Yesterday the Office of the National Coordinator for Health Information Technology (ONC) hosted an open chat to discuss their DRAFT 2017 Interoperability Standards Advisory (ISA) artifacts.  The chat was moderated by Steven Posnak, Director, Office of Standards and Technology at Office of the National Coordinator for Health Information and used the #ISAchat hashtag under the @HealthIT_Policy account. The @ONC_HealthIT Twitter account also weighed in.

It was encouraging to see that the ONC hosted a tweetchat to share information and solicit feedback and questions from interested parties. After a little bit of a rough start and clarification of the objectives of the chat, the pace of interactions increased and some good information and ideas were exchanged. In addition, some questions were raised; some of which were answered by Steven Posnak and some of which were not addressed.

What’s This All About?

This post summarizes all of the tweets from the #ISAchat. I’ve organized the tweets as best as I could and I’ve excluded re-tweets and most ‘salutatory’ and ‘thank you’ tweets.

Note: The @hitechanswers  account shared a partial summary of the #ISAchat on 8/31/16 but it included less than half of the tweets shared in this post. So you’re getting the complete scoop here.

Topic 1: Tell us about the ISA (Interoperability Standards Advisory)
Account Tweet Time
@gratefull080504 Question: What is the objective of #ISAchat?   12:04:35
@onc_healthit To spread the word and help people better understand what the ISA is about 12:05:00
@gratefull080504 Question: What are today’s objectives, please? 12:08:43
@onc_healthit Our objective is to educate interested parties. Answer questions & hear from the creators 12:11:02
@johnklimek “What’s this I hear about interoperability?” 12:12:00
@cperezmha What is #PPDX? What is #HIE? What is interoperability? What is interface? #providers need to know the differences. Most do not. 12:14:41
@techguy Who is the target audience for these documents? 12:44:06
@healthit_policy HITdevs, CIOs, start-ups, fed/state gov’t prog admins. Those that have a need to align standards 4 use #ISAchat 12:46:18
@ahier No one should have to use proprietary standards to connect to public data #ISAchat 12:46:19
@shimcode Reference Materials on ISA
Ok then, here’s the “2016 Interoperability Standards Advisory”
@shimcode And here’s “Draft 2017 Interoperability Standards Advisory” 12:07:38
@stephenkonya #ICYMI Here’s the link to the @ONC_HealthIT 2017 DRAFT Interoperability Standards Advisory (ISA): 12:10:57
@techguy Question: Do you have a good summary blog post that summarizes what’s available in the ISA? 12:52:15
@onc_healthit We do! Authored by @HealthIT_Policy and Chris Muir – both of whom are in the room for #ISAchat 12:53:15
@healthit_policy Good? – The ISA can help folks better understand what standards are being implemented & at what level 12:06:29
@healthit_policy Getting more detailed compared to prior versions due largely to HITSC & public comments 12:29:48
@healthit_policy More work this fall on our side to make that come to fruition. In future, we’re aiming for a “standards wikipedia” approach 12:33:03
@survivorshipit It would be particularly helpful to include cited full documents to facilitate patient, consumer participation 12:40:22
@davisjamie77 Seeing lots of references to plans to “explore inclusion” of certain data. Will progress updates be provided? 12:50:00
@healthit_policy 1/ Our next milestone will be release of final 2017 ISA in Dec. That will rep’snt full transition to web 12:51:15
@healthit_policy 2/ after that future ISA will be updated more regularly & hopefully with stakeholder involved curation 12:52:21
@bjrstn Topic:  How does the ISA link to the Interoperability Roadmap? 12:51:38
@cnsicorp How will #ISA impact Nationwide Interoperability Roadmap & already established priorities? 12:10:49
@healthit_policy ISA was 1st major deliverable concurrent w/ Roadmap. Will continue to b strong/underlying support to work 12:13:49
@healthit_policy ISA is 1 part of tech & policy section of Roadmap. Helps add transparency & provides common landscape 12:53:55
@healthit_policy Exciting thing for me is the initiated transition from PDF to a web-based/interactive experience w/ ISA 12:30:51
@onc_healthit Web-based version of the ISA can be found here: We welcome comments! 12:32:04
@techguy Little <HSML> From a Participant on the Ease of Consuming ISA Artifacts
So easy to consume!
@healthit_policy If I knew you better I’d sense some sarcasm :) that said, working on better nav approaches too 12:43:36
@techguy You know me well. It’s kind of like the challenge of EHRs. You can only make it so usable given the reqs. 12:45:36
@shimcode I think John forgot to enclose his tweet with <HSML> tags (Hyper Sarcasm Markup Language) 12:46:48
@ahier Don ‘t Use My Toothbrush!
OH (Overheard) at conference “Standards are like toothbrushes, everyone has one and no one wants to use yours”
Topic 2: What makes this ISA different than the previous drafts you have issued?
Account Tweet Time
@cnsicorp #Interoperability for rural communities priority 12:32:40
@healthit_policy Rural, underserved, LTPAC and other pieces of the interoperability puzzle all important #ISAchat 12:35:33
@cnsicorp “more efficient, closer to real-time updates and comments…, hyperlinks to projects…” 12:47:15
@shimcode Question: So you’re not providing any guidance on the implementation of interoperability standards? Hmm… 12:21:10
@gratefull080504 Question: Are implementation pilots planned? 12:22:51
@healthit_policy ISA reflects what’s out there, being used & worked on. Pointer to other resources, especially into future #ISAchat 12:24:10
@ahier The future is here it’s just not evenly distributed (yet) #ISAchat 12:25:15
@healthit_policy Yes, we put out 2 FOAs for High Impact Pilots & Standards Exploration Awards 12:25:56
@healthit_policy HHS Announces $1.5 Million in Funding Opportunities to Advance Common Health Data Standards. Info here:
Topic 3: If you had to pick one of your favorite parts of the ISA, what would it be?
Account Tweet Time
@shimcode The “Responses to Comments Requiring Additional Consideration” section. Helps me understand ONC’s thinking. 12:45:32
@healthit_policy Our aim is to help convey forward trajectory for ISA, as we shift to web, will be easier/efficient engagement 12:47:47
@healthit_policy Depends on sections. Some, like #FHIR, @LOINC, SNOMED-CT are pointed to a bunch. 12:49:15
@gratefull080504 Question: What can patients do to support the objectives of #ISAchat ? 12:07:02
@gratefull080504 Question: Isn’t #ISAChat for patients? Don’t set low expectations for patients 12:10:44
@gratefull080504 I am a patient + I suffer the consequences of lack of #interoperability 12:12:26
@healthit_policy Certainly want that perspective, would love thoughts on how to get more feedback from patients on ISA 12:12:35
@gratefull080504 What about patients? 12:13:03
@gratefull080504 First step is to ensure they have been invited. I am happy to help you after this chat 12:13:57
@survivorshipit Think partly to do w/cascade of knowledge–>as pts know more about tech, better able to advocate 12:15:21
@healthit_policy Open door, numerous oppty for comment, and representation on advisory committees. #MoreTheMerrier 12:15:52
@gratefull080504 I am currently on @ONC_HealthIT Consumer Advisory Task Force Happy to contribute further 12:17:08
@healthit_policy 1 / The ISA is technical in nature, & we haven’t gotten any comments on ISA before from patient groups 12:08:54
@healthit_policy 2/ but as we look to pt generated health data & other examples of bi-directional interop, we’d like to represent those uses in ISA 12:09:51
@resultant TYVM all! Trying to learn all i can about #interoperability & why we’re not making progress patients expect 13:09:22
@shimcode Question: Are use cases being developed in parallel with the Interoperability Standards? 12:13:28
@shimcode Value of standards don’t lie in level of adoption of std as a whole, but rather in implementation for a particular use case. 12:16:33
@healthit_policy We are trying to represent broader uses at this point in the “interoperability need” framing in ISA 12:18:58
@healthit_policy 2/ would be great into the future to have more detailed use case -> interop standards in the ISA with details 12:19:49
@healthit_policy Indeed, royal we will learn a lot from “doing” 12:20:40
@shimcode IHE Profiles provide a common language to discuss integration needs of healthcare sites and… Info here: 12:29:12
@techguy I’d love to see them take 1 section (say allergies) and translate where we’d see the standards in the wild. 12:59:04
@techguy Or some example use cases where people want to implement a standard and how to use ISA to guide it. 13:00:38
@healthit_policy Check out links now in ISA to the Interop Proving Ground – projects using #ISAchat standards. Info here: 13:02:54
@healthit_policy Thx for feedback, agree on need to translate from ISA to people seeing standards implemented in real life 13:01:08
@healthit_policy Commenting on ISA Artifacts
We want to make the #ISA more accessible, available, and update-able to be more current compared to 1x/yr publication
@cperezmha #interoperability lowers cost and shows better outcomes changing the culture of healthcare to be tech savvy is key 12:35:10
@healthit_policy One new feature we want to add to web ISA is citation ability to help document what’s happ’n with standards 12:37:12
@shimcode A “discussion forum” mechanism where individual aspects can be discussed & rated would be good. 12:39:53
@healthit_policy Good feedback. We’re looking at that kind of approach as an option. ISA will hopefully prompt debate 12:40:50
@shimcode Having to scroll through all those PDF’s and then open them 1 by 1 only to have to scroll some more is VERY inefficient. 12:41:25
@shimcode Well, I wouldn’t look/think too long about it. Adding that capability is ‘cheap’ & can make it way easier on all. 12:43:48
@shimcode Question: What Can Be Learned About Interoperability from the Private Sector?
Maybe @ONC_HealthIT can get input from Apple’s latest #healthIT purchase/Gliimpse? What do they know of interoperability?
@healthit_policy > interest from big tech cos and more mainstream awareness is good + more innovation Apple iOS has CCDA sprt 12:22:59
@drewivan Testing & Tools
I haven’t had time to count, but does anyone know approximately how many different standards are included in the document?
@healthit_policy Don’t know stat off had, but we do identify and provide links for test tools as available. 12:56:31
@drewivan And what percentage of them have test tools available? 12:54:38
@shimcode According to the 2017 ISA stds just released, a tiny fraction of them have test tools. See here: 12:58:02
@shimcode I take back “tiny faction” comment on test tools. I count 92 don’t have test tools, 46 do. No assessment of tool quality though. 13:08:31
@healthit_policy Testing def an area for pub-private improvement, would love to see # increase, with freely available too 12:59:10
@techguy A topic near and dear to @interopguy’s heart! 12:59:54
@resultant Perhaps we could replace a couple days of HIMSS one year with #interoperability testing? #OutsideBox 13:02:30
Walk on Topic: Promotion of ISA (Thank you @cperezmha)
What can HIE clinics do to help other non-users get on board? Is there a certain resource we should point them too to implement?
Account Tweet Time
@davisjamie77 Liking the idea of an interactive resource library. How will you promote it to grow use? 12:35:57
@healthit_policy A tweetchat of course! ;) Also web ISA now linking to projects in the Interoperability Proving Ground 12:39:04
@davisjamie77 Lol! Of course! Just seeing if RECs, HIEs, other #HIT programs might help promote. 12:40:44
@healthit_policy Exactly… opportunities to use existing relationships and comm channels ONC has to spread the word 12:41:28
@stephenkonya Question: How can we better align public vs private #healthcare delivery systems through #interoperability standards? 12:42:23
Miscellaneous Feedback from Participants
Account Tweet Time
@ahier Restful APIs & using JSON and other modern technologies 12:54:03
@waynekubick Wayne Kubick joining from #HL7 anxious to hear how #FHIR and #CCDA can help further advance #interoperability. 12:11:30
@resultant We all do! The great fail of #MU was that we spent $38B and did not get #interoperability 12:14:21
@waynekubick SMART on #FHIR can help patients access and gain insights from their own health data — and share it with care providers. 12:17:44
@resultant I think throwing money at it is the only solution… IMHO providers are not going to move to do it on their own… 12:20:44
@shimcode @Search_E_O your automatic RT’s of the #ISAChat tweets are just clouding up the stream. Why? smh 12:08:30
Do you see #blockchain making it into future ISA
@healthit_policy Phew… toughy. lots of potential directions for it. Going to segue my response into T2 12:28:58
@hitpol #blockchain for healthcare! ➡ @ONC_HealthIT blockchain challenge. Info here: 12:31:33
@healthit_policy That’s All Folks!
Thank you everyone for joining our #ISAchat! Don’t forget to leave comments.
PDF version

About Steve Sisko
Steve Sisko has over 20 years of experience in the healthcare industry and is a consultant focused on healthcare data, technology and services – mainly for health plans, payers and risk-bearing providers. Steve is known as @ShimCode on Twitter and runs a blog at You can learn more about Steve at his LinkedIn page and he can be contacted at

ONC Announces Winners Of FHIR App Challenge

Posted on August 3, 2016 I Written By

Anne Zieger 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 ONC has announced the first wave of winners of two app challenges, both of which called for competitors to use FHIR standards and open APIs.

As I’ve noted previously, I’m skeptical that market forces can solve our industry’s broad interoperability problems, even if they’re supported and channeled by a neutral intermediary like ONC. But there’s little doubt that FHIR has the potential to provide some of the benefits of interoperability, as we’ll see below.

Winners of Phase 1 of the agency’s Consumer Health Data Aggregator Challenge, each of whom will receive a $15,000 award, included the following:

  • Green Circle Health’s platform is designed to provide a comprehensive family health dashboard covering the Common Clinical Data Set, using FHIR to transfer patient information. This app will also integrate patient-generated health data from connected devices such as wearables and sensors.
  • The Prevvy Family Health Assistant by HealthCentrix offers tools for managing a family’s health and wellness, as well as targeted data exchange. Prevvy uses both FHIR and Direct messaging with EMRs certified for Meaningful Use Stage 2.
  • Medyear’s mobile app uses FHIR to merge patient records from multiple sources, making them accessible through a single interface. It displays real-time EMR updates via a social media-style feed, as well as functions intended to make it simple to message or call clinicians.
  • The Locket app by MetroStar Systems pulls patient data from different EMRs together onto a single mobile device. Other Locket capabilities include paper-free check in and appointment scheduling and reminders.

ONC also announced winners of the Provider User Experience Challenge, each of whom will also get a $15,000 award. This part of the contest was dedicated to promoting the use of FHIR as well, but participants were asked to show how they could enhance providers’ EMR experience, specifically by making clinical workflows more intuitive, specific to clinical specialty and actionable, by making data accessible to apps through APIs. Winners include the following:

  • The Herald platform by Herald Health uses FHIR to highlight patient information most needed by clinicians. By integrating FHIT, Herald will offer alerts based on real-time EMR data.
  • PHRASE (Population Health Risk Assessment Support Engine) Health is creating a clinical decision support platform designed to better manage emerging illnesses, integrating more external data sources into the process of identifying at-risk patients and enabling the two-way exchange of information between providers and public health entities.
  • A partnership between the University of Utah Health Care, Intermountain Healthcare and Duke Health System is providing clinical decision support for timely diagnosis and management of newborn bilirubin according to evidence-based practice. The partners will integrate the app across each member’s EMR.
  • WellSheet has created a web application using machine learning and natural language processing to prioritize important information during a patient visit. Its algorithm simplifies workflows incorporating multiple data sources, including those enabled by FHIR. It then presents information in a single screen.

As I see it, the two contests don’t necessarily need to be run on separate tracks. After all, providers need aggregate data and consumers need prioritized, easy-to-navigate platforms. But either way, this effort seems to have been productive. I’m eager to see the winners of the next phase.

ONC Offers Two Interoperability Measures

Posted on July 14, 2016 I Written By

Anne Zieger 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.

For a while now, it’s been unclear how federal regulators would measure whether the U.S. healthcare system was moving toward the “widespread interoperability” MACRA requires. But the wait is over, and after reviewing a bunch of comments, ONC has come through with some proposals that seem fairly reasonable at first glance.

According to a new blog entry from ONC, the agency has gotten almost 100 comments on how to address interoperability. These recommendations, the agency concluded, fell into four broad categories:

  • Don’t create any significant new reporting burdens for providers
  • Broaden the scope of interoperability measurements to include providers and individuals that are not eligible for Medicare and Medicaid EHR incentives
  • Create measures that examine usage and usefulness of exchanged information, as well as the impact on health outcomes, in addition to measuring the exchange itself
  • Recognize that given the complexity of measuring interoperability, it will take multiple data sources, and that more discussions will be necessary to create an effective model for such measurements

In response, ONC has come up with two core measures which address not only the comments, but also its own analysis and MACRA’s specific definitions of “widespread interoperability.”

  • Measure #1: Proportion of healthcare providers electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received outside sources.
  • Measure #2: Proportion of healthcare providers who report using information electronically received through outside providers and sources for clinical decision-making.

To measure these activities, ONC expects to be able to draw on existing national surveys of hospitals and office-based physicians. These include the American Hospital Association’s AHA Information Technology Supplement Survey and the CDC National Center for Health Statistics’ annual National Electronic Health Record Survey of office-based physicians.

The reasons ONC would like to use these data sources include that they are not limited to Medicare and Medicaid EHR incentive program participants, and that both surveys have relatively high response rates.

I don’t know about you, but I was afraid things would be much worse. Measuring interoperability is quite difficult, given that just about everyone in the healthcare industry seems to have a slightly different take on what true interoperability actually is.

For example, there’s a fairly big gulf between those who feel interoperability only happens when all data flows from provider to provider, and those who feel that sharing a well-defined subset (such as that found in the Continuity of Care Document) would do the trick just fine. There is no way to address both of these models at the same time, much less the thousand shades of gray between the two extremes.

While its measures may not provide the final word on the subject, ONC has done a good job with the problem it was given, creating a model which is likely to be palatable to most of the parties involved. And that’s pretty unusual in the contentious world of health data interoperability. I hope the rollout goes equally well.

ONC Kicks Off Blockchain Whitepaper Contest

Posted on July 11, 2016 I Written By

Anne Zieger 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.

Hold onto your hats, folks. The ONC has taken an official interest in blockchain technology, a move which suggests that it’s becoming a more mainstream technology in healthcare.

As you may know, blockchain is the backbone for the somewhat shadowy world of bitcoin, a “cryptocurrency” whose users can’t be traced. (For some of you, your first introduction to cryptocurrency may have been when a Hollywood, CA hospitals was forced to pay off ransomware demands with $17K in bitcoins.)

But despite its use by criminals, blockchain still has great potential for creating breakthroughs for legitimate businesses, notably banking and healthcare. Look at dispassionately, a blockchain is just a distributed database, one which maintains a continuously growing list with data records hardened against tampering and revision.

Right now, the most common use the blockchain is to serve as a public ledger of bitcoin transactions. But the concept is bubbling up in the healthcare world, with some even suggesting that blockchain should be used to tackle health data security problems.

And now, the ONC has shown interest in this technology, soliciting white papers that offer thoughtful take on how blockchain can help meet important healthcare industry objectives.

The whitepaper, which may not be no longer than 10 pages, must be submitted by July 29. (Want to participate, but don’t have time to write the paper yourself? Click here.Papers must discuss the cryptography and underlying fundamentals of blockchain technology, explain how the use of blockchain can meet industry interoperability needs, patient centered outcomes research, precision medicine and other healthcare delivery needs, as well as offering recommendations for blockchain’s implementation.

The ONC will choose eight winning papers from among the submissions. Winning authors will have an opportunity to present the paper at a Blockchain & Healthcare Workshop held at NIST headquarters in Gaithersburg, MD on September 26th and 27th.

In hosting this contest, ONC is lending blockchain approaches in healthcare a level of credibility they might not have had in the past. But there’s already a lot of discussion going on about blockchain applications for health IT.

So what are people talking about where blockchain IT is concerned? In one LinkedIn piece, consultant Peter Nichol argues that blockchain can address concerns around scalability and privacy electronic medical records. He also suggests that blockchain technology can provide patients with more sophisticated privacy control of their personal health information, for example, providers can enhance health data security by letting patients combine their own blockchain signature with a hospital’s signature.

But obviously, ONC leaders think there’s a lot more that can be done here. And I’m pretty confident that they’re right. While I’m no security or cryptocurrency expert, I know that when a technology has been kicked around for several years, and used for a sensitive function like financial exchange without racking up any major failures, it’s got to be pretty solid. I’m eager to see what people come up with!

The Real HIPAA Blog Series on Health IT Buzz

Posted on April 8, 2016 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’re not familiar with the Health IT Buzz blog, it’s the Health IT blog that’s done by ONC (Office of the National Coordinator). I always love to see the government organizations blogging. No doubt they’re careful about what they post on their blog, but it still provides some great insights into ONC’s perspective on health IT and where they might take future regulations and government rules.

A great example of this is the Real HIPAA series of blog posts that they posted back in February. Yes, I realize I’m behind, but I’ll blame it on HIMSS.

Here’s an overview of the series:

It’s a common misconception that the Health Insurance Portability and Accountability Act (HIPAA) makes it difficult, if not impossible, to move electronic health data when and where it is needed for patient care and health. This blog series and accompanying fact sheets aim to correct this misunderstanding so that health information is available when and where it is needed.

The blog series dives into the weeds a bit and so it won’t likely be read by the average doctor or nurse. However, it’s a great resource for HIPAA privacy officers, CIOs, CSOs, and others interested in healthcare interoperability. I can already see these blog posts being past around management teams as they discuss what data they’re allowed to share, with whom, and when.

What’s clear in the series is that ONC wants to communicate that HIPAA is meant to enable health data sharing and not discourage it. We all know people who have used HIPAA to stop sharing. We’ll see if we start seeing more people use it as a reason to share it with the right people at the right time and the right place.

Workflow Redesign Is Crucial to Adopting a New Health IT System – Breakaway Thinking

Posted on January 20, 2016 I Written By

The following is a guest blog post by Todd Stansfield, Instructional Writer from The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Todd Stansfield
Workflow analysis and redesign have long been touted as essential to health IT adoption. Most organizations recognize the importance of modifying current workflows to capitalize on efficiencies created by a new application and identify areas where the system must be customized to support existing workflows. Despite this recognition, there remains room for improvement. In fact, last month the Office of the National Coordinator (ONC) identified the impact of new IT systems on clinical workflows as one of the biggest barriers to interoperability (ouch).

A successful redesign includes both an analysis of current workflows and desired future workflows.

Key stakeholders – direct and indirect – should take part in analyzing existing workflows. An objective third party should also be present to ask the right questions and facilitate the discussion. This team can collaborate to model important workflows, ideally in visual form to stimulate thorough analysis. To ensure an efficient and productive meeting, you should model workflows that are the most common, result in productivity losses, have both upstream and downstream consequences and involve multiple parties. The National Learning Consortium recommends focusing only on what occurs 80 percent of the time.

Once you document current workflows, you can set your sights on the future. Workflow redesign meetings are the next step; you need them to build a roadmap of activities leading up to a go-live event and beyond – from building the application to engaging and educating end users. Individuals from the original workflow analysis sessions should be included, and they should be joined by representatives from your health IT vendor (who can define the system’s capabilities) and members of your leadership team (who can answer questions and provide support).

After the initial go-live, you need to periodically perform workflow analysis and continue adjusting the roadmap to address changes to the application and processes.

Why should you spend all the time and effort to analyze and redesign workflows? Three reasons:

  1. It makes your organization proactive in your upcoming implementation and road to adoption. You’ll anticipate and avoid problems that will otherwise become bigger headaches.
  2. It’s the perfect opportunity to request customizations to adapt your application to desired workflows.
  3. It gives your staff a chance to mentally and emotionally prepare for a change to their daily habits, increasing buy-in and decreasing resistance to the switch.

Thorough and disciplined workflow redesign is an important step to adopting a new health IT application, but of course it’s not the only one. You’ll still need leadership to engage end users in the project, education that teaches learners how to use the new application to perform their workflow, performance metrics to evaluate adoption, and continual reinforcement of adoption initiatives as the application and workflows change over time.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Insightful Tweets from Farzad Mostashari’s Session at #MGMA15

Posted on October 13, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today, Farzad Mostashari took the stage at the MGMA Annual Conference. As a man that I respect and someone that has deep connections and insights into what’s happening in Washington and how that plays out in actual practice (thanks to his ACO company), I was interested in the insights he’d share.

Here’s a quick Twitter roundup of some of the insights he shared:

The ONC Health IT Complaint Form That Has No Teeth

Posted on September 14, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Neil Versel over on MedCityNews just reported that the ONC Healthcare IT Complain form that was announced on Friday is not working. If you go and visit the health IT complaint form, it just says “You are not authorized to access this page.”

While it’s quite ironic that the complaint form is down, I’m pretty sure it’s a simple fix. I’ve seen that error before on many websites and I’m guessing the ONC/HHS web people just need to make the form go live and then the page will load properly with the form.

I was discussing the irony of the form being down with Neil Versel on Facebook and I told him that I was more interested in what ONC is going to do with the complaints than whether the form was working or not. If ONC isn’t going to do anything with the complaints they receive, then the form might as well be down. Submitting a healthcare IT complaint to an organization that can do nothing about it might be a little cathartic, but not very much. In fact, over time it just leads to more anger that people have complained and nothing’s been done.

I asked Neil, “Do they [ONC] have any power to do anything?” He answered, “No. The HIT Safety Center they are working on is basically toothless.”

That’s been my impression as well. ONC would love to do something about it, but they don’t have many levers they can pull. The worst they could do is terminate an EHR’s certification, but they’ve been doing that already.

Neil and I did discuss that maybe all of the data they receive from their healthcare IT complaint form could be used to make a case for why they need more options available for them to punish bad actors in healthcare IT. As it is it seems the only thing they can offer healthcare IT complainers is some empathy. Of course, they can’t do that until they get their form working. Where’s the form I can fill out to let ONC know that their complaint form isn’t working?

Flow – A Spoken Word HIE Piece by Ross Martin

Posted on August 27, 2015 I Written By

John Lynn is the Founder of the 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 and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Want to see brilliance in action? Check out this spoken word piece about HIEs by Ross Martin.

Here’s the background Ross Martin shares about the piece:

On Monday, August 17th, 2015 I begin a new chapter as Program Director for the new Integrated Care Network initiative at CRISP, Maryland’s health information exchange. We will be providing data to healthcare providers to enhance their care coordination efforts and providing additional care coordination tools to some of those providers who don’t already have these capabilities in place.

To mark the transition, I decided to make a video of this spoken word piece I wrote in 2012 (originally entitled “A Man among Millions”) for my last day consulting for the Office of the National Coordinator for Health IT while I was working at Deloitte Consulting. This piece explains why I am so passionate about making health information exchange work for all of us.

I am grateful for the opportunity to make a difference with an amazing team of collaborators and look forward to providing updates on our progress over the coming months and years.


Great Meaningful Use and Eligible Providers Chat

Posted on April 29, 2015 I Written By

John Lynn is the Founder of the 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 and 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 received an email from a regular reader, Dr. Mike, who owns a single specialty ortho group. In the email Dr. Mike talks about the challenges that Eligible Providers (EPs) are facing with meaningful use stage 2. He describes the story as falling on “deaf ears” at CMS and ONC. He also offered these stats on meaningful use to illustrate his case that meaningful use is a failure:

Only 38,472 have attested to Stage 2, My guess is that only about half actually did Stage 2 as there was the Stage 1 reprieve. Even so, that is only 18% of EPs have successfully attested which is an complete failure of MU.

Then, he asked me an important question:

Someone ask CMS and ONC the tough questions please…Now what are they going to do?

In response to him, I told him that I’d been talking about the challenge that meaningful use is for doctors for quite a while. However, I also told him that most hospitals are participating in meaningful use, so “we’ll see how that plays out.” What I meant is that in the meaningful use program we now have one group (EPs) that are not doing so well with meaningful use and their hospital counterparts that are relying on the millions in EHR incentive money (not to mention avoiding the penalties).

Then I answered his important question, “I can tell you what ONC and CMS are going to do. Spin It!”

Of course, Dr. Mike is great at engaging in conversation so he offered this reply:

1. Elizabeth Myers and the rest of CMS and ONC really did try to spin every bad number and “we cannot assess the numbers yet” was a constant theme.
2. I totally agree they will continue to try to spin the numbers or ignore them as long as possible. I’m not sure why they cannot face the truth about MU.
3. The 36K that did MU 2 are the cream of the crop. I would even argue that the other 82% are the cream also as they were the early adopters and gung ho about MU. The fact that 82% of the over achieving EPs have skipped out on MU 2 is a travesty. There is NO chance ONC and CMS is going to pull in the lagging EPs.
4. If you don’t know already, I own a single specialty Ortho group and we skipped MU completely after we saw the MU 2 rules. Proposed MU 3 just help us box it up and bury it.

I have no idea why ONC and CMS cannot let go of the program, let EHR vendors actually work with EPs for all the thing we are missing from our IT (usability, safety, security, efficiency). Right now we cannot do anything to customize our workflow or improve our experience as it will potentially decertify the EHR for MU. MU sucks all the air out of the room. EHRs right now are a billing and click box for MU system with a marginal clinical system slapped on…

Its about time ONC lets the market do its thing, instead of this constant objective, measures, menu, core, numerators, denominators, attesting, auditing disaster they created.

Once EPs leave the program, they are not coming back. So this should be a big deal for ONC and CMS.

I haven’t gone in and fact checked his numbers (I’d love to hear if you have different numbers), but the emotion in his comments is something I’ve heard from many providers. In fact, I’ve heard it from many EHR vendors. They’re tired of coding their EHR software to the test and the government regulations as well. They want to do more innovative things, but the government regulations are stifling their ability to do it. Resources only go so far.

I think we’re in the early days of provider discontent with meaningful use. However, it’s starting to boil. I’ll be interested to see what happens when it boils over. I’m predicting that will happen once many of these doctors start seeing the penalties hit their pocketbooks.