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Key Articles in Health IT from 2017 (Part 2 of 2)

Posted on January 4, 2018 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The first part of this article set a general context for health IT in 2017 and started through the year with a review of interesting articles and studies. We’ll finish the review here.

A thoughtful article suggests a positive approach toward health care quality. The author stresses the value of organic change, although using data for accountability has value too.

An article extolling digital payments actually said more about the out-of-control complexity of the US reimbursement system. It may or not be coincidental that her article appeared one day after the CommonWell Health Alliance announced an API whose main purpose seems to be to facilitate payment and other data exchanges related to law and regulation.

A survey by KLAS asked health care providers what they want in connected apps. Most apps currently just display data from a health record.

A controlled study revived the concept of Health Information Exchanges as stand-alone institutions, examining the effects of emergency departments using one HIE in New York State.

In contrast to many leaders in the new Administration, Dr. Donald Rucker received positive comments upon acceding to the position of National Coordinator. More alarm was raised about the appointment of Scott Gottlieb as head of the FDA, but a later assessment gave him high marks for his first few months.

Before Dr. Gottlieb got there, the FDA was already loosening up. The 21st Century Cures Act instructed it to keep its hands off many health-related digital technologies. After kneecapping consumer access to genetic testing and then allowing it back into the ring in 2015, the FDA advanced consumer genetics another step this year with approval for 23andMe tests about risks for seven diseases. A close look at another DNA site’s privacy policy, meanwhile, warns that their use of data exploits loopholes in the laws and could end up hurting consumers. Another critique of the Genetic Information Nondiscrimination Act has been written by Dr. Deborah Peel of Patient Privacy Rights.

Little noticed was a bill authorizing the FDA to be more flexible in its regulation of digital apps. Shortly after, the FDA announced its principles for approving digital apps, stressing good software development practices over clinical trials.

No improvement has been seen in the regard clinicians have for electronic records. Subjective reports condemned the notorious number of clicks required. A study showed they spend as much time on computer work as they do seeing patients. Another study found the ratio to be even worse. Shoving the job onto scribes may introduce inaccuracies.

The time spent might actually pay off if the resulting data could generate new treatments, increase personalized care, and lower costs. But the analytics that are critical to these advances have stumbled in health care institutions, in large part because of the perennial barrier of interoperability. But analytics are showing scattered successes, being used to:

Deloitte published a guide to implementing health care analytics. And finally, a clarion signal that analytics in health care has arrived: WIRED covers it.

A government cybersecurity report warns that health technology will likely soon contribute to the stream of breaches in health care.

Dr. Joseph Kvedar identified fruitful areas for applying digital technology to clinical research.

The Government Accountability Office, terror of many US bureaucracies, cam out with a report criticizing the sloppiness of quality measures at the VA.

A report by leaders of the SMART platform listed barriers to interoperability and the use of analytics to change health care.

To improve the lower outcomes seen by marginalized communities, the NIH is recruiting people from those populations to trust the government with their health data. A policy analyst calls on digital health companies to diversify their staff as well. Google’s parent company, Alphabet, is also getting into the act.

Specific technologies

Digital apps are part of most modern health efforts, of course. A few articles focused on the apps themselves. One study found that digital apps can improve depression. Another found that an app can improve ADHD.

Lots of intriguing devices are being developed:

Remote monitoring and telehealth have also been in the news.

Natural language processing and voice interfaces are becoming a critical part of spreading health care:

Facial recognition is another potentially useful technology. It can replace passwords or devices to enable quick access to medical records.

Virtual reality and augmented reality seem to have some limited applications to health care. They are useful foremost in education, but also for pain management, physical therapy, and relaxation.

A number of articles hold out the tantalizing promise that interoperability headaches can be cured through blockchain, the newest hot application of cryptography. But one analysis warned that blockchain will be difficult and expensive to adopt.

3D printing can be used to produce models for training purposes as well as surgical tools and implants customized to the patient.

A number of other interesting companies in digital health can be found in a Fortune article.

We’ll end the year with a news item similar to one that began the article: serious good news about the ability of Accountable Care Organizations (ACOs) to save money. I would also like to mention three major articles of my own:

I hope this review of the year’s articles and studies in health IT has helped you recall key advances or challenges, and perhaps flagged some valuable topics for you to follow. 2018 will continue to be a year of adjustment to new reimbursement realities touched off by the tax bill, so health IT may once again languish somewhat.

DirectTrust, CHIME Deal Not All It’s Cracked Up To Be

Posted on September 7, 2017 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.

Recently, CHIME and DirectTrust announced a deal that sounded pretty huge on the surface. In a joint press release announcing the agreement, the two organizations said they had agreed to work together “to promote the universal deployment of the Direct Trust framework and health information exchange network as the common electronic interface for health information exchange across the U.S.”

Their plans include making the Direct exchange network available anywhere they can, including hospitals, medical practices, pharmacies, labs, long-term care facilities, payers, insurers and health departments, and to top it off, on applications. If things go the way they planned, you’ll hardly be able to kick a health IT rock without finding Direct under it.

As I noted earlier this year, DirectTrust is on something of a roll. In May, it noted that the number of health information service providers who engaged in Direct exchanges grew to almost 95,000 during the first quarter of this year. That’s a 63% increase versus the same period in 2016. The group also reported that the number of trusted Direct addresses which could share PHI grew 21%, to 1.4 million, and that there were 35.6 million Direct exchange transactions during the quarter, up 76% over the same period last year.

Sounds good. But let’s not judge this in a vacuum. For example, on the same day DirectTrust released its first quarter results, the Sequoia Project kicked out a press release touting its performance. In the release, Sequoia noted that its Carequality initiative was under full steam, with more than 19,000 clinics, 800 hospitals and 250,000 providers using the Carequality Interoperability Framework to share health data.

In considering the impact of Carequality, let’s not forget that late last year it connected with rival interoperability group CommonWell Health Alliance. I don’t know if you can say that interoperability effort can corner a market– the organizations using the rival health data sharing networks probably overlap substantially—but it’s certainly an interesting development. While the two organizations were both allied with a leading EMR vendor (CommonWell with Cerner and Carequality with Epic), the agreement has effectively brought the muscle of the two EMR giants together.

I guess it’s fair to say that the Carequality alliance and DirectTrust may own interoperabililty for now, rivaled only by the stronger regional HIEs.  That’s pretty impressive, I admit. Also, it’s interesting to see an accepted health IT organization like CHIME throw its weight behind Direct. I wouldn’t have expected CHIME to dive in here.

That being said, when you get down to it, none of the groups’ capacity for sharing health data is as great as it sounds. For example, if Epic’s Care Everywhere exchange only transmits C-CDA records, you have to ask yourself if Carequality is working at a higher level. If not, we’re in “meh” territory.

Bottom line, it seems clear that these organizations are winning the battle for interoperability mindshare. Both seem to have made a fair amount of progress. But between you and me in the lamppost, let’s not get excited just yet.

Direct, Sequoia Interoperability Projects Continue To Grow

Posted on May 15, 2017 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.

While its fate may still be uncertain – as with any interoperability approach in this day and age – the Direct exchange network seems to be growing at least. At the same time, it looks like the Sequoia Project’s interoperability efforts, including the Carequality Interoperability Framework and its eHealthExchange Network, are also expanding rapidly.

According to a new announcement from DirectTrust, the number of health information service providers who engaged in Direct exchanges increased 63 percent during the first quarter of 2017, to almost 95,000, over the same period in 2016.  And, to put this growth in perspective, there were just 5,627 providers involved in Q1 of 2014.

Meanwhile, the number of trusted Direct addresses which could share PHI grew 21 percent, to 1.4 million, as compared with the same quarter of 2016. Again, for perspective, consider that there were only 182,279 such addresses available three years ago.

In addition, the Trust noted, there were 35.6 million Direct exchange transactions during the quarter, up 76 percent over the same period last year. It expects to see transaction levels hit 140 million by the end of this year.

Also, six organizations joined DirectTrust during the first quarter of 2017, including Sutter Health, the Health Record Banking Alliance, Timmaron Group, Moxe Health, Uticorp and Anne Arundel Medical Center. This brings the total number of members to 124.

Of course, DirectTrust isn’t the only interoperability group throwing numbers around. In fact, Seqouia recently issued a statement touting its growth numbers as well (on the same day as the Direct announcement, natch).

On that day, the Project announced that the Carequality Interoperability Framework had been implemented by more than 19,000 clinics, 800 hospitals and 250,000 providers.

It also noted that its eHealth Exchange Network, a healthcare data sharing network, had grown 35 percent over the past year, connecting participants in 65 percent of all US hospitals, 46 regional and state HIEs, 50,000 medical groups, more than 3,400 dialysis centers and 8,300 pharmacies. This links together more than 109, million patients, Sequoia reported.

So what does all of this mean? At the moment, it’s still hard to tell:

  • While Direct and Sequoia are expanding pretty quickly, there’s few phenomena to which we can compare their growth.
  • Carequality and CommonWell agreed late last year to share data across each others’ networks, so comparing their transaction levels to other entities would probably be deceiving.
  • Though the groups’ lists of participating providers may be accurate, many of those providers could be participating in other efforts and therefore be counted multiple times.
  • We still aren’t sure what metrics really matter when it comes to measuring interoperability success. Is it the number of transactions initiated by a provider? The number of data flows received? The number of docs and facilities who do both and/or incorporate the data into their EMR?

As I see it, the real work going forward will be for industry leaders to decide what kind of performance stats actually equate to interoperability success. Otherwise, we may not just be missing health sharing bullseyes, we may be firing at different targets.

Will the CommonWell Health Alliance Change Interoperability? — #HITsm Discussion

Posted on March 9, 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.

Today’s #HITsm Chat was a little bit different than usual. Instead of the typical four or five questions, because of the #HITsm HIMSS chat on Tuesday there was only one question:

Will the CommonWell Health Alliance change interoperability?

The CommonWell Health Alliance launched a website, and this is their mission:

The CommonWell Health Alliance will be designed to be an independent not-for-profit trade association organization open to all health information technology vendors devoted to the simple vision that a patient’s data should be available to patients and providers regardless of where care occurs. Additionally, provider access to this data must be built-in to EHR technologies at a reasonable cost for use by a broad range of healthcare providers and the patients they serve.

Overall, the response to this during the #HITsm chat was positive. The chat started out with OchoTex, who said:

— Chad Johnson (@OchoTex) March 8, 2013

T1: Sure it will! Probably mostly in terms of creating awareness that cooperation needs to occur, and will need to happen soon. #HITsm

Hi all. IMO the missing ingredient in achieving interop is network effects; Commonwell brings critical mass to reach tipping pt. #HITsm

— Vince Kuraitis (@VinceKuraitis) March 8, 2013

I think what happens within the next 3 months will determine if CommonWell is real or just a HIMSS PR opp. #HITsm

CommonWell Health Alliance – The Healthcare Interoperability Enabler?

Posted on March 4, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com 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 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 biggest news that will likely come out of HIMSS was the big announcement that was made about the newly formed CommonWell Health Alliance. They’ve also rolled out a website for the new organization.

This was originally billed as a Cerner and McKesson announcement and would be a unique announcement from both the CEO of Cerner and McKesson. Of course, the news of what would be announced was leaked well before the press briefing, so we basically already knew that these two EHR companies were working on interoperability.

In what seemed like some final, last minute deals for some of the companies, 5 different software products were represented on stage at the press event announcement for CommonWell Health Alliance. The press event was quite entertaining as each of the various CEOs took some friendly jabs at each other.

Of course, Jonathan Bush stole the show (which is guaranteed to happen if he’s on stage). I think it was Neal Patterson who called Jonathan Bush the most articulate CEO in healthcare and possibly in any industry. Jonathan does definitely have a way with words.

One of Jonathan’s best quote was in response to a question of whether the CommonWell Health Alliance would just be open to any health IT software system, or whether it was just creating another closed garden. Jonathan replied that “even a vendor of epic proportions” would be welcome in the organization. Don Fluckinger from Search Health IT News, decided to ask directly if Judy from Epic had been asked about the alliance and what she said. They adeptly avoided answering the question specifically and instead said that they’d talked to a lot of EHR vendors and were happy to talk to any and all.

Although, this is still the core question that has yet to be answered by the CommonWell Health Alliance. Will it just be another closed garden (albeit with a few more vendors inside the closed garden)? From what I could gather from the press conference, their intent is to make it available to anyone and everyone. This would even include vendors that don’t do EHR. I think their intent is good.

What I’m not so sure about is whether they’ll put up artificial barriers to entry that stop an innovative startup company from participating. This is what was done with EHR certification when it was started. The price was so high that it made no sense for a small EHR vendor to participate. They could have certified as well, but the cost to become certified was so high that it created an artificial barrier to participation for many EHR vendors. Will similar barriers be put up in the CommonWell Health Alliance? Time will tell.

With this said, I think it is a step forward. The direction of working to share data is the right one. I hope the details don’t ruin the intent and direction they’re heading. Plus, the website even says they’re going to do a pretty lengthy pilot period to implement the interoperability. Let’s hope that pilot period doesn’t keep getting extended and extended.

Finally, I loved when Jonathan Bush explained that there were plenty of other points of competition that he was glad that creating a closed garden won’t be one of them. I hope that vision is really achieved. If so, then it will be a real healthcare interoperability enabler. Although, artificially shutting out innovative healthcare IT companies would make it a healthcare interoperability killer.