Time again for our weekend EHR Twitter round up. Let the fun begin.

@ahier – Brian Ahier
#EHR’s need encryption says @HealthPrivacy to Senate panel bitly.com/rTnx6s

Is there an EHR software that doesn’t use encryption? Is there a doctor’s office that’s paying for an EHR that doesn’t use encryption? Certainly not all EHR encryption implementations are created equal. In fact, I wish that things like encrypting data were part of an EHR certification. Why? Cause that’s something you can actually certify in a meaningful manner.

@drmikesevilla – Mike Sevilla, MD
RT @SeattleMamaDoc Computers all down in the exam rooms today. One major limitation of an EMR/EHR (dependence on a computer)

Definitely is one challenge with an EMR/EHR. I wonder how many patients were seen without the chart, because it couldn’t be found quickly. There are always pros and cons to IT. It does highlight the need to have a well thought out plan for how you’re going to care for patients when your EHR is down.

@iWatch – iWatch News
State health exchanges might not be sustainable after $548M in stimulus money runs out: bit.ly/t9QfSl #HIE #EHR

Wait, so changing the name of them from RHIO to HIE didn’t solve any of the problems with these exchanges? Oh yes, I forgot to mention the extra $548 million to help solve the problems. I think this best illustrates that money isn’t the issue or at least there are more issues with HIE than just the money.

Yes, I still have quite a bit of HIMSS content that I haven’t had a chance to post. Luckily most of the information is really timeless and so it doesn’t matter when it’s posted. One of those was some of the information I got at the public policy forum at HIMSS. Here’s some quick hits from it:

Dr. Rhonda Medows from Georgia said, “Could extend benefits to Long Term care based on capital improvement benefits.” I wonder if she’ll still do this if it’s true that there will be some money for long term care in the current healthcare reform. At least Georgia was looking at some creative ways to get some money for healthcare IT in under served areas.

State representative Rosenthall from NH-Representative said that 40-50 percent of doctors in NH have some access to EMR. She also said that 900 out of 4500 have ePrescribing (20 percent).

Probably the most interesting thing Representative Rosenthall said was in response to my question about how NH (a small state) would fund a state HIE. She quickly and frankly responded that their state must do a private partnership since the state won’t have the money in their small tax base to be able to fund the HIE. I’m guessing that many states will be in this same position.

Finally, I think it was one of the HIMSS public policy people (sorry I don’t remember which one) made an interesting comment about the government’s approach to funding the state HIE efforts. They described that the “seed funding” for HIE that’s been given to states is almost like a hope that they’ll figure out some sustainable creative revenue model and not just disappear the way RHIO have.

I remember the hype that surrounded even the term RHIO about 4 years ago and no one speaks of them anymore. It’s a really serious question to ask if HIE’s are going to find that “creative revenue model” that has alluded health information exchange in the past. I’d love to hear from people about what the most promising HIE revenue models are right now.

Everyone seems to love talking about RHIO, HIE and all of the other various initiatives happening around sharing patient health information amongst doctors. This weekend, I want to open it up to you the readers to get an idea of what type of participation you’ve had in an RHIO, HIE or other clinical data exchange.

Are you participating in one now? Do you like it? Do you hate it? In fact, what do you like and what do you hate? Do you use an EMR to interface with the exchange? What’s the interface like? How much work is it to manage the interface?

I’d also be interested in hearing about people who are working through the process now. Where are you at in the process? What’s holding you up from making this happen?

Let’s help educate each other on what’s happening with something that I think we can all universally agree is important and INCREDIBLY challenging.

I’ll admit to not being the most expert person on HIE, RHIO, NHIN, and all of the other acronyms associated what really is just creating systems and structures for sharing healthcare data between various doctors and systems. However, I do have some knowledge in the area since I believe all of these things will be important for those using an EMR. So, I was surprised when I’d never heard of HHS’ health connect software.

Here’s a short bit from Government Health IT of the government’s connect software’s latest update:

The Health & Human Services Department (HHS) has updated the government’s Connect software to improve information security and enterprise services for organizations that want to use it to exchange health data, said its senior architect.

Connect is federally developed software that lets agencies and healthcare organizations share health data by using the protocols, agreements and core services that make up the nationwide health information network (NHIN).

HHS is trying to develop improvements in the Connect gateway quickly so it can serve as an early model of the NHIN, executives said yesterday.

“The intent of the plan is that Connect will be a reference implementation of NHIN and provide a mechanism for organizations that are building gateways to have the ability to test against it and to provide for feedback to the NHIN specification group,” said Les Westberg, Connect technical lead in the Federal Health Architecture program and an executive with Agilex.

Is there anyone that knows more about this program that can give us a review of what’s going on. I’d love to hear about how far it’s come, the challenges its overcome and the challenges it still faces.

In fact, if you are someone working on one of the acronyms listed at the top that are trying to provide the all to elusive healthcare data interoperability I’d love to learn more about what’s going on in the comments or through a guest post if you have a lot to say.

If you’ve been reading my blog, then you know that I’ve started a pretty interesting and complicated discussion about EHR and EMR sharing of patient data. I first posted an example of sharing data with an EHR and then followed it up with some challenges associated with sharing of EHR data.

In my interoperability challenges post, Bjorn from Health Xcel posted a lengthy comment discussing some challenges of data sharing and made the case for RHIO (Regional Health Information Organizations) and HIE (Health Information Exchanges) as a means for sharing patient data between hospitals and doctors offices.

His comment was so well done that I’m copying it below for more people to see and read it. I don’t personally agree with everything that was said. I also think he didn’t address the funding challenges of RHIO and the policy problems. Maybe Bjorn will return with some comments on how those might work. Enjoy Bjorn’s take on RHIO and HIE (emphasis added):

I think Google Health and MS HealthVault will be good awareness catalysts for the quiet e-health revolution that is taking place. However, I do not think the defining change we need lies with their business model. A patient-centric model sounds good but we’d be assuming that everyone has an account with one of these systems and that they know how to use them. How will the data about a patient that is stored in a hospital be reconciled with Google Health? Which of course leads to interoperability concerns.

Web 2.0 does not lend itself to creating a reliable e-health solution either as service A is dependent on service B and if service B is down, service A won’t function and has no power to fix it by their own volition.

I think so far the industry, aka hospitals, has been trying to solve the problem by adding a patient interface to large hospital systems so patients can see their records. It’s also a step in the right direction but again it is not the golden calf we are looking for.

So what is the ideal system of the future?
A patient should be able to enter any hospital in the world, conscious or unconscious, and the hospital should have all the information they need about the patient to administer correct treatment and to notify the right people.

How do we do this?
I am a believer in the HIE / RHIO model. In the [not too distant] future, hospitals should concern themselves with healing people and not how to spend their IT budget. Hospitals, insurance agencies, smaller providers and patients will all be connected to an RHIO (Region Health Information Organization) where they will have a wealth of services; either to enter sensitive data or to discover data about one patient or the entire population. RHIOs will be connected to a larger e-health backbone consisting of HIEs that are the great data aggregators of the world. RHIOs would be responsible for conforming to regional regulations. This model is similar to how we connect to the Internet today. We don’t jack directly into one of the main Internet hubs of the world but go through an ISP that can provide us with an email address, a web page AND connect us to the rest of the world.

HIEs and RHIOs run on a software platform where health IT vendors can deploy their software applications. Some required components:

- User discovery
o Any one node on the system should be able to query the other nodes to find a user and her data
- Portable user
o This goes with the first bullet point in that a user should be able to log in to the system anywhere in the world and even though the user does not have an account with the RHIO she is directly interfacing with, RHIO should know how to authenticate her correctly
- Interoperability / Standards / Data aggregation and discovery
o The key to any successful e-health venture. Services need to be able to talk to each other. It shouldn’t matter whether the services reside within the same application or in different parts of the world. I believe the semantic web (web 3.0) will be a key facilitator of making this possible.
- Federated security
o If we take the previous examples of Google Health and MS HealthVault, they would all have to have their own security scheme and user authentication and access control. Multiply that by a dozen and suddenly a lot of money is being spent on recreating the wheel over and over. We need a unified system for this.
- Updates
o All applications should reside server side and users should have thin-client access only. When the applications are being updated, it should happen across the board overnight. If something goes wrong, there should be a way to undo the upgrade without hospitals or anyone else having to do anything.
- Data sharing
o The patient-centric network will definitely happen as users become more educated. But hospitals still need to be able to have access to patient data even though they have not been granted access, in case of emergency.

Ok, this suddenly got really long ;-) There is a lot of work to do for everyone in order to get true e-health solutions to work. The biggest obstacles aren’t technical but political and also the willingness to adopt a new way of interfacing with your health.

Cheers
bjorn