Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and HIPAA for FREE!!

Is FHIR Adoption At A Turning Point, Or Is This Just More Hype?

Posted on October 8, 2018 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.

Over the last few years, healthcare industry players have continued to experiment with the use of HL7 FHIR to solve key interoperability problems.

Perhaps the most recent efforts to do so is the Da Vinci Project, which brings together a group of payers, health IT vendors, and providers dedicated to fostering value-based care with FHIR. The group has begun work on two test cases, one addressing 30-day medication reconciliation and the other coverage requirements discovery.

This wasn’t big news, as it doesn’t seem to be doing anything that new. In fact, few if any of these projects — of which there have been many — have come close to establishing FHIR firmly established as a standard, much less fostering major change in the healthcare industry.

Now, a new analysis by the ONC suggests that we may finally be on the verge of a FHIR breakthrough.

According to ONC’s research, which looked at how health IT developers used FHIR to meet 2015 Edition certification requirements, roughly 32% of the health IT developers certified are using FHIR Release 2, and nearly 51% of health IT developers seem to be using a version of FHIR combined with OAuth 2.0.

While this may not sound very impressive (and at first glance, it didn’t to me), the certified products issued by the top 10 certified health IT developers serve about 82% of hospitals and 64% of clinicians.

Not only that, big tech companies staking out an expanded position in healthcare are leveraging FHIR 2, the ONC notes. For example, Apple is using a FHIR-based client app as part of its healthcare deployment.  Amazon, Alphabet, and Microsoft are working to establish themselves in the healthcare industry as well, and it seems likely that FHIR-based interoperability will come to play a part in their efforts.

In addition, CMS has shown faith in FHIR as well, investing in FHIR through its Blue Button 2.0,  a standards-based API allowing Medicare beneficiaries to connect their claims data to applications, services, and research programs.

That being said, after citing this progress, the agency concedes that FHIR still has a way to go, from standards development implementation, before it becomes the lingua franca of the industry. In other words, ONC’s definition of “turning point” may be a little different than yours or mine. Have I missed something here?

Look, I don’t like being “that guy,” but how encouraging is this really? By my standards at least, FHIR uptake is relatively modest for such a hot idea. For example, compare FHIR adoption of AI technology or blockchain. In some ways, interoperability may be a harder “get” than blockchain or AI in some ways, but one would think it would be further along if it were completely practical. Maybe I’m just a cynic.

Will Personal Health Information Exchanges (PHIE) Lead the Consumer Medical Record Revolution and Bridge the Gap Between PHRs and EHRs? (Part 2 of 2)

Posted on August 5, 2015 I Written By

The following is a guest blog post by Cora Alisuag, RN, MN, MA, CFP, President & CEO, CORAnet Solutions, Inc.
Cora Alisuag, CEO, CORAnet Solutions
Be sure to check out part 1 in this series where we talked about the movement towards an empowered patient who controls their health record.

Lack of Interoperability Continues to Hamper Patient Record Access

However, it has been six years since the HITECH Act passed, yet most Americans seeking medical care are still unable to obtain their full medical records for a variety of reasons. Some hospitals will simply not release them or proprietary EHR system vendors not allowing hospitals, let alone patients, direct access.

This capability also comes at a critical time as enormous obstacles hamper the ability of people to obtain their medical records. This is documented in the ONC’s “2015 Report to Congress on Health Information Blocking” which concludes that it is apparent that some health care providers and health IT developers are knowingly interfering with the exchange of health information in ways that limit its availability and use to improve health and health care.

This situation is only going to worsen as the Centers for Medicaid and Medicare (CMS) is considering a change to the EHR meaningful use rule that requires five percent of patients must view or download or transmit their health data to only one patient; not one percent, one patient.

Blue Button Not Gaining traction

In the meantime, other PHR technology has been introduced, but has not gained popularity including forays from Microsoft and Google. The ONC and other government organizations’ initiative to adopt and use the Blue Button platform for exchanging healthcare data between clinicians equipped with electronic health-record systems and patients with mobile computing devices is stalled, according to a recent survey by the not-for-profit Workgroup for Electronic Data Interchange (WEDI).

WEDI questioned 274 providers, health plans, HIT vendors and claims clearinghouses in the Second Annual Survey of Industry Awareness of Blue Button, conducted late in 2014. Only eight percent of respondents noted that their organizations actually used Blue Button, down from 15% of survey respondents in 2013.

PHRs Largely Unpopular

PHRs joined the lexicon of medical terminology several years ago as a convenience way for consumers to have copies of their medical records. It was largely born out of EHR’s lack of interoperability and access. However, as far back as 2009, a Health Affairs article detailed the major factors behind the slow adoption of PHRs. The article reviewed some of the reasons and includes cost, access, interoperability, security concerns, and data ownership.

Because health records which include clinical data, laboratory results and medical images do not flow freely among multiple organizations due to lack on EHR interoperability, PHRs do not automatically receive data. This means that the data must often be entered manually by consumers—a time-consuming and error-prone process. For most consumers, this lack of safe and reliable automation makes it problematic to maintain a PHR, and a PHR that is not up-to-date likely will not be used. Unlike PHIEs, the API-EHR connectivity connection is the missing link in PHRs.

However, the authors of the Health Affairs article offered a challenge. They described a gap between today’s personal health records (PHRs) and what patients say they want and need from this electronic tool for managing their health information. They noted that until that gap is bridged, it is unlikely that PHRs would be widely adopted, but noted that in the future; when these concerns are addressed, and health data is portable and understandable in content and format, PHRs will likely prove to be invaluable.

“While we all agree that lack of interoperability continues to stymie patient health record access and PHRs might not be the ultimate solution, but if a PHIE can bridge the gap by accessing EHR data through an open API while offering the security and convenience of a PHR. I believe PHIEs offer a solution that should satisfy the spontaneity of millennials’ and more frequent use of middle-aged and elderly users,” says Tiffany Casper, RNC, CNM, MSN and President of EMR Consultants which helps medical organizations transition to EMR systems.

About Cora Alisuag
Cora Alisuag is the CEO of CORAnet Solutions, Inc., a health information technology company. She is the inventor of CORAnet technology, the software engine that drives CORAnet’s Personal Health Information Exchange (PHIE), allowing patients’ mobile device access to their complete medical records. She is also an MN, MA, CFP and healthcare industry speaker and serial medical entrepreneur.

A Treatment Plan for Technology in Health Care

Posted on May 16, 2014 I Written By

The following is a guest blog post by Andy Oram, writer and editor at O’Reilly Media.

The kind of health care reform that brings better care at a reasonable cost will consist of many, tightly interlocking strands. Each of us—everyday consumers and patients, health care providers, payers and public health officials, technology developers, policy makers, and clinical researchers—can do specific things to push health care forward, and many of these involve computer technology.

During a stint in the mental health field, I would meet regularly with a team of professionals from different disciplines (and with the patient) to work out a treatment plan. This article similarly lays out some tasks each of us in his or her respective fields can carry out. Like the meetings I attended many years ago, this is a collaborative approach where my suggestions are meant to elicit constructive responses and push-back.

Naturally, a treatment plan must start with a firm diagnosis and an assessment of the patient’s strengths and weaknesses. For health information technology, I try to provide that assessment in my report, The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. Refer to it for background as we jump into action and assign tasks to each stakeholder.


  • Measure the vital signs that are important to your health, and extract them from the silos of devices or vendor web sites into your personal health record. The Blue Button Initiative promotes open standards that increasingly bring within your reach the records that others hold about you.
  • This process is important because physicians will need your statistics to carry out effective diagnoses and planning—for instance, to know whether you need to make an office visit and even to check into the hospital. Collecting this data also means the clinical staff can review it before a visit and not waste your whole 15 minutes asking you about your condition.
  • Casual readers may see this advice as simply an appeal to join the Quantified Self movement, but it is much, much more. Vital signs give you leverage that can drive change throughout the health care system. First, it creates a pressing need for the doctors’ electronic medical records to open up and accept patient-generated data. It can also lead to discussions about who owns your data—it should be you—and who gets to use it for research or other purposes. The ripple effects can render the entire health care industry more responsive and intelligent in handling patients—and also more respectful of their right to control the flow of their data.

Health care providers:

  • Get involved in the design of the technologies you used. Demand to be on the design team, not just consultants on the sidelines, and demand that the software be easy to customize in deep ways that respond to your ways of doing things.
  • This endeavor goes beyond ease of use and even beyond the prevention of errors related to confusing interfaces. It determines the types of data collected, when you can input and change the data, and whether it can empower the patients to choose life-enhancing behaviors. Therefore, advocate for data that patients can also use and understand, because they are responsible for their own behavior. Finally, insist that electronic record systems maintain public databases that can log the errors you find, as recommended in a recent  government report.

Payers and public health officials:

  • Collect and release data to support clinical and cost-containment analyses by providers, payers, and consumers, working with them to ensure the data’s value, accuracy, and usability.  To open its secrets to modern analytical tools, data needs to be consistent, formatted in programmer-friendly ways, and timed to be delivered to the public promptly and regularly.
  • What will be the payback for the investment in shared data sets? Treatment depends on clinical research, but it is well understood now that double-blind clinical studies can’t solve every problem: they are usually short-timed and their subjects are often unrepresentative of realistic populations, so they are often overturned in the field. Therefore, studies need to augmented by longitudinal, large-scale analytics (“big data” solutions) that can turn up trends hidden by the idiosyncrasies of double-blind studies. And your data is lifeblood of large-scale analytics.

Technology developers:

  • Work on free and open source software solutions instead of competing with all your fellow developers to reinvent the programming wheels. Extending the Fast Health Interoperable Resources (FHIR) standard with fields focusing on patient-generated data would be one good step. Open source software does not prevent you from making money from your investment in a variety of ways, including web solutions (Software as a Service). In fact, combining efforts in free software solutions will give you more and better software, because you can exploit the contributions of everyone who is part of the development community. Free, open software also eliminates the current tussles over standards, because data formats will be transparent and therefore easy to produce and consume.
  • The freedom to change and redistribute software will ultimately improve clinical settings as they can adapt the software to their needs, an especially important value to carry software to diverse regions of the world.

Policy makers:

  • Require the collection and exchange of data about patients, providers, and public health (with the consent of the patient) to become an automatic part of the workflow within institutions, between institutions, and between provider and patient. The Meaningful Use guidelines make a start toward interoperability, but the certifications and showcases are not enough to ensure that it’s clean and structured consistently, or that the formats permit viable comparisons.
  • Breaking down the silos between the providers’ data sets will also break down the silos of their thinking and allow better interventions in patients’ medical conditions. It will also welcome the addition of patient-generated data and observations of daily living, a rich source of information that will flesh out lab tests and other data from clinical visits.

Clinical researchers:

  • Develop trials to validate that the new wave of low-cost applications and devices are accurate, safe, and effective. Traditional double-blind clinical trials are usually too expensive and slow to fit the budgets and schedules of modern technology development, so seek out sleeker, cleverer types of tests to provide the necessary validation.
  • Your efforts will be much more than a leg up for companies making medical devices and software The validation of apps and devices will enable doctors to confidently prescribe their use and insurers to pay for them. They will, in turn, lead to a flood of new, patient-generated generated data that will significantly fine-tune treatment—especially when interoperability allows providers to collaborate—and will combine with open data sets to generate new treatments.

This treatment plans focuses on technology because it is a great facilitator, providing the tools and environment for effective treatments and reduced costs. The plan will not in any way diminish the other, less technologically focused stakeholder tasks. Public health officials still have to clean up poisonous environments, battle against obesity and tobacco use, and reduce disparities in gender, race, and environment. Doctors still need to learn compassionate care. Payers should move resolutely to fee-for-value reimbursement—although with a recognition that the data needed to properly stratify patients is sometimes scant—and expand their guidelines to include innovative treatment approaches such as telehealth and games. Clinical researchers still need to uncover whatever factors in the genes and other “omics” differentiate between patients in order to hone in on effective individualized treatments. Everyone with health problems should join support networks.

Progress depends on reformers building relationships with the players named in this article and determining how the interests of each player can be bent to meeting the goals of reform. For instance, take one of the dilemmas mentioned in this article: that devices and software apps are underutilized because they are unvalidated. The players we need to involve are:

Payers: They have an interest in bringing down the out-of-control costs of chronic illnesses that are making their plans unaffordable. This motivates them to encourage the use of medical devices and apps for day-in, day-out patient engagement and monitoring. But they want only devices and apps whose effectiveness has been validated.

Technology developers: They have an interest in getting their devices and apps validated so that they can be integrated into medical care and funded by payers, but double-blind clinical trials are too expensive and time-consuming for this purpose.

Clinical researchers: They have an interest in finding new funding, because traditional sources such as NIH and pharma companies are cutting back.

Consumers/patients/citizens: They urgently want to overcome chronic health conditions—but with solutions that are rock-bottom simple and low-cost. The consumer devices and free or low-cost apps can be this solution if they’re validated and covered by insurance.

The solution may therefore involve persuading payers to fund clinical researchers to develop new validation methods, perhaps by running modern “big data” statistical methods over data provided by payers and others. These methods, when shown to be good enough, can lead to quicker approvals for devices and apps and ultimately to realizing the promise of patient tracking.

Technology remains a key part of the mix. As stakeholders come to understand how technology can help them meet their goals, they can assess the status of the technologies and demand improvements that realize the mission of improved health care.

You might be an #HITNerd If…

Posted on March 30, 2014 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.

You might be an #HITNerd If…

you know that blue button is not a funny ICD-10 code.

Find all our #HITNerd references on: EMR and EHR & EMR and HIPAA.

NEW: Check out the #HITNerd store to purchase an #HITNerd t-shirt of cell phone case.

Note: Much like Jeff Foxworthy is a redneck. I’m well aware that I’m an #HITNerd.

Unlocking The Power of Data Science In Healthcare

Posted on January 29, 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

Vinod Khosla, Founder of Sun Microsystems and Khosla Ventures, recently stated that “in the next 10 years, data science and software will do more for medicine than all of the biological sciences together.”

The rise of population health and healthcare analytics companies aligns with Khosla’s claim. There are hordes of companies implementing healthcare analytics and helping providers identify at-risk populations to engage in proactive care. Despite their efforts, most of the analytics companies have been struggling to help providers actually improve outcomes.


Because data science in and of itself is meaningless. Effective data science can only provide insights. The challenge is in acting on insights provided by data. This is a widely acknowledged problem that every data science / analytics company faces; this problem has been particularly difficult in healthcare where a backwards culture and incentive structure have skewed the system towards complacency and volume rather than proactive care and value.

In healthcare, the actionability and effectiveness of data science hinge on communication between providers and patients, and on patients’ ability to act on those insights. There are a few methods of provider-to-patient communication and actionability:

At the point of care (in person or virtual visit) – providers have been educating patients at the point of care since the dawn of the profession. With advanced data analytics, providers can give more accurate, more customized education during the encounter. But the problem is that patients must act on that information at home when the doctor isn’t looking over the patient’s shoulder. Patients consistently fail to do what providers have asked them to do. The problem here is that the patient education and actionability based on education are intermediated by time and (lack of) context. Patients simply forget or are unwilling to do what their providers ask them to do in order to better care for themselves. Patients aren’t being educated in the right context. Point of care education won’t encourage patients from smoking the next cigarette, taking their meds on time, or skipping cheesecake at the office party.

Patient portals – the federal government has mandated that providers enable patients to engage with providers via patient portals. The basic premise of this mandate is that with access to their own health information, patients will take better care of themselves. Patient portals have some potential to empower patients to learn about their conditions at home and investigate conditions in more depth, but they don’t solve the context problem. Patient portals won’t do anything to help patients order a salad instead of a hamburger.

Messaging and notifications – this is the least explored, least understood, and in my opinion, the most potent communication channel to impact patient behavior. Automated notifications on iOS and Android can be presented contextually provided the device has contextual data to present notifications. Context is king. We live in the age of context. As devices learn more about their owners, devices can present contextual information to help change behavior. If your smartphone (or Google Glass, Jawbone, iWatch, etc) knows that you’re about to smoke a cigarette, it can automatically connect you with your husband/wife so that they can yell at you. If your device knows that you’re out at a steakhouse for dinner with business guests, it can remind you to order grilled chicken instead of a fried steak. The number of opportunities are endless.

To provide a better sense of the power of context, let’s examine Google and Facebook ads. Facebook ads are anything but contextual. When I’m scrolling through my news feed, I don’t care about the latest Hobbit movie, some new workout shake, or Dell’s newest laptop. I logged into Facebook to check out what my friends are up to, not to learn about the Hobbit or a laptop.

But when I Google “flight from Austin to New York January 18th” there’s a huge probability that I’m already committed to spending several hundred dollars to fly to New York, get a hotel, and spend money in NYC. With that search, only relevant advertisers – airlines, taxis, hotels, and local NYC attractions – will bid for my attention; I’m not going to see an ad for The Hobbit when searching for for a trip to NY.

This sense of context is reflected in Facebook and Google’s click through rates (CTR). 1-3% of all Google searches result in the user clicking on an ad. Between .01-.3% of FaceBook ads are clicked on. Google is measurably 10-100x more effective than Facebook. That’s the power of context.

There’s nothing wrong with emailing patients PDFs and interactive digital education tools after an encounter; there’s nothing wrong with patient portals and BlueButton. All of these communication channels fall short in that they don’t take advantage of real-time two way contextual communications. All of these channels are intrinsically one-way and lack context.

Books were the the first few-to-many communication channel. Then newspapers and magazines. Then radios. Then movies and TV. The defining characteristic of the Internet is that it is the first to enable two-way, many-to-many communications. The federal government’s healthcare communication model is fundamentally based on 20th century communication strategies. The power of data science will drive meaningful changes in patient behavior only when communication strategies leverage 21st century communication models.

Daylight Savings Time EMR Impact, Blue Button, and 4000 clicks/shift

Posted on November 3, 2013 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.

Fall daylight savings is always a pain. Systems don’t like having something happen an hour later, but at the same time as something that happened an hour previous.

I’d love to hear what other people think of Blue Button. Do you think it’s great?

This stat really stood out to me. 4000 clicks/shift. That’s interesting to consider. Although, I wonder how many clicks I do every day of my job as well. I’ve always talked about how the number of clicks doesn’t matter as much as which clicks they are and how the software responds when you click. See my EMR to Piano Player analogy for more on that view.

Health IT Tweet Roundup – Neil Versel Edition

Posted on July 21, 2013 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.

As you know, each weekend I like to do a roundup of interesting tweets and add a bit of commentary. This time I thought it would be fun to grab some tweets from just one person, Neil Versel. Neil has been doing a number of really great posts on his blog Meaningful Health IT News lately (Full Disclosure: Neil’s blog is part of the Healthcare Scene blog network). The following tweets highlight some of Neil’s recent blog posts.

I agree that Blue Button Plus is a great step forward for Blue Button. This post is particularly interesting because Neil didn’t see the promise of Blue Button before the changes were made and it was called plus.

This is a great discussion on the meaningful use requirements and Blue Button’s role in them. Join in if you have some knowledge on the area about what your EHR is doing.

Neil’s right about people who don’t cover healthcare regularly not understanding many of the true dynamics at play. I do find it interesting that Neil is such a fan of clinical decision support. I still think it’s in such an infant state. I can’t wait for much more advanced clinical decision support.

Cerner Supports Blue Button +

Posted on July 5, 2013 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.

Cerner has announced plans to support and participate in the Blue Button + initiative, marking a small step towards freer sharing of patient health information by its clients.

Blue Button +, launched as the Automate Blue Button Plus Initiative, is the next generation version of the Blue Button technology for consumer download of health information. This next gen Blue Button is intended to provide a blueprint for better-structured and secure transmission of personal health data.

What this announcement means in practical terms, according to an entry in Cerner’s blog, is that the EMR giant will make it possible for its Cerner Direct clients to securely zap information to any personal health record participating in Blue Button +.  Cerner Direct users will also be able to send automated reminders to people managing specific health conditions or who need age/gender-specific check-ups, plus send out summaries of care and instructions following a health visit.

Cerner Direct, as readers probably guessed, uses standards drawn from the Direct Project, a set of standards and documentation allowing providers to push data from one point to another. Cerner has obtained accreditation from the Direct Trusted Agent Accreditation Program offered by DirectTrust and the Electronic Healthcare Network Accreditation Commission.

And why is Cerner taking this step? “The primary goal we have for our clients is to help create a trusted, reliable group of participants with which to securely exchange health care information using Direct protocols over the open internet, helping them reduce their liabilities by creating an efficient, secure method of communication based on best practices,” writes Andy Heeren of Cerner.

This sounds like a reasonable move toward greater data interoperability, if not an earthshaking one. It will be interesting to see where Cerner takes this.

Farzad Mostashari Tweets #HDPalooza

Posted on June 4, 2013 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.

Health data geeks from across the US have descended on Washington DC this week for what’s called Health Datapalooza. It’s a sort of Mecca for healthcare data sharing where health data geeks virtually hold hands and sing koombaya as they circle around blue buttons and hard drives full of granular health data. As someone who believes that health data liberacion is the right direction for healthcare, this is a great event and this year it seems to have really hit its stride.

One of the biggest advocates of using healthcare data for good is ONC’s own Farzad Mostashari. Never someone afraid to tweet or Retweet health data related topics, Farzad’s twitter account has been incredibly active during Health Datapalooza. So, I thought I’d use it to illustrate some of the messages Farzad found important enough to share from the event. Plus, I’ll throw in my commentary after each tweet as appropriate. (Note: when the tweet is from someone else it’s because Farzad retweeted it.)

If you want to stop reading here you could, because it’s the core of Farzad’s message. Although, if you want to go into depth on the topic, keep reading. At least Farzad has made clear that he’s going to use whatever methods he has available to make patients’ health data available.

I’ve said this a few times recently as well. I have an extreme belief in the creativity and drive of entrepreneurs. We just need more of them to be able to do their work in healthcare.

Amen! The challenge is getting this message to consumers. If you tell them that their data will be kept private, but will be shared where appropriate to provide better care, every patient wants this to happen. In fact, most already assume this is what’s happening.

Healthcare problems are still a HUGE challenge. We don’t need any more barriers than we already have to overcome.

I wish the $36 billion in EHR incentive money would have been spent on standardization. We’d have had better results. I’m still not sure how we’re going to get to future payment models. Govt could play a role in it.

Speaking of changing payment models. Seems like government doesn’t know how to get their either. A fundamental delivery system transformation could be translated as impossible.

The ladies will love Farzad in his bowtie. I love people who aren’t afraid of trying what seems impossible. Who in health IT is doing that today? I guess looking at the last tweet CMS and ONC are trying.

I’m not sure if we should be proud or sad at the 8% number. Granted, it’s a lot of people that have to learn about it. Although, since many don’t care about their health data, 8% is pretty good.

I’ll be interested to see this number post-meaningful use stage 2. Doctors will be really encouraging their patients to get their health data so they can meet MU stage 2.

This isn’t actually from Health Datapalooza, but Farzad did just retweet it. I haven’t dug into Obama’s plan to deal with patent trolls, but I’m really glad more of a spotlight is being put on this challenging problem. In the case of software, I’m really against patents because as the tweet says they do stifle innovation. It’s ironic because they’re suppose to encourage innovation, but it’s just not the reality of how they’re being used.

Interoperability: The High Jump and The Long Jump with ONC’s Doug Fridsma

Posted on March 5, 2013 I Written By

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

I’ll admit, I was incredibly nervous about interviewing Dr. Doug Fridsma, the Chief Science Officer for the Office of the National Coordinator and the face of both the Standards and Interoperability (S&I) Framework and the Federal Health Architecture initiative. Not only do I consider him a key luminary, but his overarching responsibility for the future of interoperability and standards-based programs is incredibly alluring. I swoon over those who have the power and desire to effect meaningful, positive change on a grand scale. I wasn’t disappointed.

Doug explained his philosophy towards fulfilling the promise of interoperability with a sports metaphor: the high jump and the long jump.

“I don’t like high jumps,” he said. “High jumps, if you knock down the bar, you’re done and you get no points. Long jumps, you get points for each increment. The high jump for interoperability is ubiquitous data liquidity. The long jump is Meaningful Use.”

The S&I Framework project is tracking progress towards standardization and standards adoption across 5 areas of Meaningful Use and interoperability:

  1. Meaning – shared vocabularies across continuum of care
  2. Structure of messages shared across continuum of care
  3. Transport of messages
  4. Security of transport and messages
  5. Services for accessing messages

All of these categories are exemplified in the flagship project for Meaningful Use and interoperability: the Automate Blue Button Initiative, affectionately known as ABBI. For those not familiar with ABBI, do an experiment: ask your primary care provider whether you can visit a patient portal and download your medical records by clicking the “Blue Button.” If your PCP can provide you the website link to request the download, you should be able to receive your entire medical record (from that provider) in a vaguely huma-readable format (Excel, Word, PDF, etc.). The medical and clinical jargon may not make a lot of sense; however, it’s certainly an incremental hop in the long jump towards interoperability and standards adoption. The standard vocabularies, structure, transport mechanism, security protocol, and web-enabled access are foundational building blocks which enable the Blue Button program’s adoption.

Doug’s goal with the ABBI program was three-fold: get it OUT there, have providers and patients start USING it, and structure it so that it can be repeatable and scalable. Patient engagement advocates across the Twittersphere applaud the sentiment that we, patients, should have ownership of our health data, and many recognize the ONC’s efforts as instrumental in turning the tide for patient access. Several notable bloggers have covered the ABBI project in detail, analyzing its value to healthcare IT development professionals, providers, and patients, including:
Keith Boone @motorcycle_guy – the ABBI Pitch, with a quick overview of the goals for the program, and humorous insight into providers’ qualms about adoption

Greg Meyer @greg_meyer – Scalable Trust and Trust Bundles, with developer-focused details on the structure and transport categories of interoperability

For the next incremental long jump beyond ABBI and Meaningful Use Stage 2, Doug Fridsma and the ONC have several new initiatives tackling the atomic-level data governance and quality of clinical information. In order to communicate between disparate EHR systems, across multiple facilities and potentially multiple payers, it isn’t just the structure of the container and transport of the message that must be consistent: it’s the individual data elements, themselves, which comprise the meat of the message that must be standardized.

The ONC recently announced the Structured Data Capture Initiative with the goal of creating a technical infrastructure to support “structurally sound” standard data elements with support for “unique semantics”, to capture EHR and supplemental clinical data for use across the continuum of care. This effort officially kicked off the week of HIMSS 2013; its progress will be instrumental in broadening the effectiveness of interoperability and Meaningful Use.

So, as I walk the Interoperability Showcase at HIMSS13, watch the use case demonstrations, and ask the participants the tough questions like, “How are you incorporating the use case development you’re exhibiting here into consideration for your next product full release,” I’ll be taking note of those organizations that seem focused on the next incremental jump towards patient-centric, data-driven healthcare systems. And I’ll be wondering what Doug Fridsma and the ONC will do to get to the next incremental jump on the way to the nirvana of ubiquitous data liquidity.

…I’ll also be kicking myself for not taking the opportunity to get a fan photo with Doug while I had the chance.