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Open Source Software and the Path to EHR Heaven (Part 2 of 2)

Posted on September 20, 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 previous segment of this article explained the challenges faced by health care organizations and suggested two ways they could be solved through free and open source software. We’ll finish the exploration in this segment of the article.

Situational awareness would reduce alert fatigue and catch errors

Difficult EHR interfaces are probably the second most frustrating aspect of being a doctor today: the first prize goes to the EHR’s inability to understand and adapt to the clinician’s workflow and environment. This is why the workplace redounds with beeps and belches from EHRs all day, causing alert fatigue and drowning out truly serious notifications. Stupid EHRs have an even subtler and often overlooked effect: when regulators or administrators require data for quality or public health purposes, the EHR is often “upgraded” with an extra field that the doctor has to fill in manually, instead of doing what computers do best and automatically replicating data that is already in the record. When doctors complain about the time they waste in the EHR, they often blame the regulators or the interface instead of placing their finger on the true culprit, which is the lack of awareness in the EHR.

Open source can ease these problems in several ways. First, the customizability outlined in the first section of this article allows savvy users to adapt it to their situations. Second, the interoperability from the previous section makes it easier to feed in information from other parts of the hospital or patient environment, and to hook in analytics that make sense of that information.

Enhancements from outside sources could be plugged in

The modularity of open source makes it easier to offer open platforms. This could lead to marketplaces for EHR enhancements, a long-time goal of the open SMART standard. Certainly, there would have to be controls for the sake of safety: an administrator, for instance, could limit downloads to carefully vetted software packages.

At best, storage and interface in an EHR would be decoupled in separate modules. Experts at storage could optimize it to improve access time and develop new options, such as new types of filtering. At the same time, developers could suggest new interfaces so that users can have any type of dashboard, alerting system, data entry forms, or other access they want.

Bugs could be fixed expeditiously

Customers of proprietary software remain at the mercy of the vendors. I worked in one computer company that depended on a very subtle feature from our supplier that turned out not to work as advertised. Our niche market, real-time computing, needed that feature to achieve the performance we promised customers, but it turned out that no other company needed it. The supplier admitted the feature was broken but told us point-blank that they had no plans to fix it. Our product failed in the marketplace, for that reason along with others.

Other software users suffer because proprietary vendors shift their market focus or for other reasons–even going out of business.

Free and open source software never ossifies, so long as users want it. Anyone can hire a developer to fix a bug. Furthermore, the company fixing it usually feeds the fix back into the core project because they want it to be propagated to future versions of the software. Thus, the fixes are tested, hardened, and offered to all users.

What free and open source tools are available?

Numerous free and open source EHRs have been developed, and some are in widespread use. Most famously is VistA, the software created at the Department of Veterans Affairs, and used also by the Indian Health Service and other government agencies, has a community chaperone and has been adopted by the country of Jordan. VistA was considered by the Department of Defense as well, but ultimately rejected because the department didn’t want to invest in adding some missing features.

Another free software EHR, OpenMRS, supports health care in Kenya, Haiti, and elsewhere. OpenEMR is also deployed internationally.

What free and open source software has accomplished in these settings is just a hint of what it can do for health care across the board. The problem holding back open source is simple neglect: as VistA’s experience with the DoD showed, institutions are unwilling to support open source, even through they will pay 10 or 100 times as much on substandard proprietary software. Open Health Tools, covered in the article I just linked to, is one of several organizations that shriveled up and disappeared for lack of support. Some organizations gladly hop on for a free ride, using the software without contributing either funds or code. Others just ignore open source software, even though that means their own death: three hospitals have recently declared bankruptcy after installing proprietary EHRs. Although the article focuses on the up-front costs of installing the EHRs, I believe the real fatal blow was the inability of the EHRs to support efficient, streamlined health care services.

We need open source EHRs not just to reduce health care costs, but to transform health. But first, we need a vision of EHR heaven. I hope this article has taken us at least into the clouds.

Open Source Software and the Path to EHR Heaven (Part 1 of 2)

Posted on September 19, 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.

Do you feel your electronic health record (EHR) is heaven or hell? The vast majority of clinicians–and many patients, too, who interact with the EHR through a web portal–see it as the latter. In this article, I’ll describe an EHR heaven and how free and open source software can contribute to it. But first an old joke (which I have adapted slightly).

A salesman for an EHR vendor dies and goes before the Pearly Gates. Saint Peter asks him, “Would you like to go to heaven or hell?”

Surprised, the salesman says, “I didn’t know I had a choice.”

Saint Peter suggests, “How about this. We’ll show you heaven and hell, and then you can decide.”

“Sounds fair,” says the EHR salesman.

First they take him to heaven. People wearing white robes are strumming harps and singing hymns, and it goes on for a long time, till they take him away.

Next they take him to hell. And it’s really cool! People are clinking wine glasses together and chatting about amusing topics around the pool.

When the EHR salesman gets back to the Pearly Gates, he says to Saint Peter, “You know, this sounds really strange, but I choose hell.”

Immediately comes a clap of thunder. The salesman is in a fiery pit being prodded with pitchforks by dreadful demons.

“Wait!” he cries out. “This is not the hell I saw!”

One of the demons answers, “They must have shown you the demo.”

Most hospitals and clinicians are currently in EHR hell–one they have freely chosen, and one paid for partly by government Meaningful Use reimbursements. So we all know what EHR hell look like. What would EHR heaven be? And how does free and open source software enable it? The following sections of this article list the traits I think clinicians would like to see.

Interfaces could be easily replaced and customized

The greatest achievement of the open source movement, in my opinion, has been to strike an ideal balance between “let a hundred flowers bloom” experimentation and choosing the best option to advance the field. A healthy open source project encourages branching, which lets any individual or team with the required expertise change a product to their heart’s content. Users can then try out different versions, and a central committee vets the changes to decide which version is most robust.

Furthermore, modularization on various levels (programming modules, hooks, compile-time options, configuration tools) allows multiple versions to co-exist, each user choosing the options right for their environment. Open source software tends to be modular for several reasons, notably because it is developed by many different individuals and teams who want control over their small parts of the system.

With easy customization, a hospital or clinic can mandate that certain items be highlighted and that safe workflow rules be followed when entering or retrieving data. But the institution can also offer leeway for individual clinicians and patients to arrange a dashboard, color scheme, or other aspect of the environment to their liking.

Many of the enablers for this kind of agile, user-friendly programming are technical. Modularity is built into programming languages, while branching is standard in version control systems. So why can’t proprietary vendors do what open source communities routinely do? A few actually do, but most are constrained in ways that prevent such flexibility, especially in electronic health records:

  • Most vendors are dragging out the lifetime of nearly 40-year old technology, with brittle languages and tools that put insurmountable barriers in the way of agile work styles. They are also stuck with monolithic systems instead of modular ones.
  • The vendors’ business model depends on this monolithic control. To unbundle components, allow mix-and-match installations, and allow third parties to plug in new features would challenge the prices they charge.
  • The vendors are fundamentally unprepared for empowered users. They may vet features with clinically trained consultants and do market research, but handling power over the system to users is not in their DNA.

Data could be exchanged in a standard format without complex transformations

Data sharing is the lifeblood of modern computing; you can’t get much done on a single computer anymore. Data sharing lies behind new technologies ranging from the Internet of Things to real-time ad generation (the reason you’ll see a link to an article about “Fourteen celebrities who passed out drunk in public” when you’re trying to read a serious article about health IT). But it’s so rare in health care–where it’s uniquely known as “interoperability”–that every year, reformers call it the most critical goal for health IT, and the Office of the National Coordinator has repeatedly narrowed its Meaningful Use and related criteria to emphasize interoperability.

Open source software can share data with other systems as a matter of course. Data formats are simple, often text-based, and defined in the code in easy-to-find ways. Open source programmers, freed from the pressures on proprietary developers to reinvent wheels and set themselves apart from competitors, like to copy existing data formats. As a stark example of open source’s advantages, consider the most recent version of the Open Document Format, used by LibreOffice and other office suites. It defines an entire office suite in 104 pages. How big is the standards document for the Microsoft OOXML format, offering roughly equivalent functionality? Currently, 6,755 pages–and many observers say even that is incomplete. In short, open source is consistently the right choice for data exchange.

What would the adoption of open source do to improve health care, given that it would solve the interoperability problem? Records could be stored in the cloud–hopefully under patient control–and released to any facility treating the patient. Research would blossom, and researchers could share data as allowed by patients. Analytical services could be plugged in to produce new insights about disease and treatment from the records of millions of people. Perhaps interoperability could also contribute to solving the notorious patient matching problem–but that’s a complicated issue that I have discussed elsewhere, touching on privacy issues and user control outside the scope of this article.

The next segment of this article will list three more benefits of free and open source software, along with an assessment of its current and future prospects.

Wireless Healthcare IT, Risk Analysis, and Ever-changing Technology: Around Healthcare Scene

Posted on December 16, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and EHR

Why 2013 Will Be A Good Year For EMRS

EMRs don’t always have the best reputation, particularly concerning their ease for implementation. However, there are some things that are looking up in 2013 for the industry. Ann Zieger discusses these, and includes ideas such as vendors being able to offer mobile options, as well as consolidation leading to a more stable vendor market.

Wireless Healthcare IT Could Hold the Key to Preventable Readmissions

CardioMEMS developed a heart-failure monitoring system, the first of its kind. The company understands the need from back-end data and has a lot of potential for the future. Technology like this may be the key to preventing hospital  readmissions.

Hospital EMR

Hospitals Stepping Up Security Risk Analysis, While Practices Lag

EMRs pose a large risk for criminal hackers to come in. However, according to a HIMSS survey, around 90 percent of hospitals are now conducting annual risk analysis. Unfortunately, practices only came in at about 65 percent. An even more surprising fact was that 22 percent of survey responders reported having a security breach next year. While there have been a lot of strides made toward stepping up security risk analysis, there is still a ways to go.

Meaningful Health IT News

Technology Changes Faster Than You Think

In 2005, smart phones weren’t mainstream in the health industry. This post also includes other interesting facts about mHealth only seven years ago, and it goes to show just how fast technology is changing. It raises the question, where will we be seven years from now? An interesting infographic from 2005 is also shown in this post as well.

Smart Phone Healthcare

The Patient’s Guide Reveals How iPhone Dominates Mobile Health Research

A recent study done by the Patient’s Guide researched the use of medical devices. During this study, they discovered how the iPhone is by far the most popular device being used. This post includes an infographic from The Patient’s Guide that displays other findings from the study.

Doctors Increasingly Texting, But HIPAA Protection Lacking

Posted on November 2, 2012 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.

A new study of physicians working at pediatric hospitals has concluded what we might have assumed anyway — that they prefer the use of SMS texting via mobile phone to pagers. What’s worrisome, however, is that little if any of this communication seems to be going on in a HIPAA-secure manner.

The study, by the University of Kansas School of Medicine at Wichita, asked 106 doctors at pediatric hospitals what avenues they prefer for “brief communication” while at work. Of this group, 27 percent chose texting as their favorite method, 23 percent preferred hospital-issued pagers and 21 percent face to face conversation, according to a report in mHealthWatch.

What’s interesting is that text-friendly or not, 57 percent of doctors said they sent or got work-related text messages.  And 12 percent of pediatricians reported sending more than 10 messages per shift.

With all that texting going on,  you’d figure hospitals would have a policy in place to ensure HIPAA requirements were met. But in reality, few doctors said that their hospital had such a policy in place.

That’s particularly concerning considering that 41 percent of respondents said they received work-related text messages on a personal phone, and only 18 percent on a hospital-assigned phone. I think it’s fair to say that this arrangement is rife with opportunities for HIPAA no-nos.

It’s not that the health IT vendor world isn’t aware that this is a problem; I know my colleague John has covered technology for secure texting between medical professionals and he’s also an advisor to secure text messaging company docBeat. However, not much is going to happen until hospitals get worried enough to identify this as a serious issue and they realize that secure text message can be just as easy as regular text along with additional benefits.

In the mean time, doctors will continue texting away — some getting 50-100 messages a day, according to one researcher — in an uncertain environment.  Seems to me this is a recipe for HIPAA disaster.

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

Posted on October 20, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: When can we seriously say the data being captured and stored in EHRs is leading to new opportunities for patient care?

Topic Two: Do hospitals prioritize complete data capture for max reimbursement or for an aid for clinicians in patient care?

#HITsm T3: Does electronic data entry really take more time than paper notes? What can improve speed?

 

#HITsm T4: Interoperability. What can be done to increase awareness of the CCD and CDA standards designated for data exchange?

Wireless Health Data Collection Innovations Getting Hot

Posted on September 25, 2012 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.

This week, psfk.com and pharma partner Boehringer Mannheim published a list of the week’s top innovations in healthcare. All were interesting, but I was particularly intrigued by a couple which continue to stretch the boundaries of wireless medicine.

One innovation example comes from a German research team, which has developed a tiny chip (a two-millimeter device much shorter than an eyelash) which can sample blood sugar levels by testing tears or sweat. The chip is equipped to transmit the results wirelessly to providers, as well as sending patients alerts to their wireless phone.  Even cooler, the chip can be powered wirelessly through radio frequency, keeping it charged for weeks or even months.

Another entirely cool innovation comes from U.S. high school student Catherine Wong, who has invented an ECG made of off the shelf electronic components which can broadcast results wirelessly.  The device, which could make ECGs available to to the two billion-plus people without access to healthcare, picks up heart signals, then transmits them via cellphone to a healthcare provider.  The cellphone connects to the ECG using Bluetooth, and heart rhythms display on  a smartphone screen thanks to a Java app.

As readers know, the idea of broadcasting test results to remote providers via wireless devices is not a new one. The idea is so hot, in fact, that the FCC is holding a public meeting on September 24 to discuss how to accelerate the adoption of such approaches. (The event will be live streamed at http://www.itif.org/events/recommendations-mhealth-task-force at 2PM Eastern Standard Time.)

After watching projects like these germinate for a number of years, I’m thrilled to see more innovation arising in this sector of the mHealth space. Inventors, keep it coming!

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

Posted on September 22, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Every week, HL7 Standards, hosts a #HITsm Tweet Chat and poses four questions “on current topics that are influencing healthcare technology, health IT, and the use of social media in healthcare.” It’s always a great discussion and also a great chance to meet a wide variety of people that are passionate about healthcare IT.

In case you missed it, or are curious about what went on this week, we’ve put together the list of topics with some of the best responses for each topic. There were some interesting topics this week, as well as some great responses. If you have any opinions on any of these topics, feel free to continue the discussion in the comments. This chats take place every Friday at 11AM CST. You’ll find members of Healthcare Scene regularly participating in the chat under some of the following Twitter accounts: @techguy@ehrandhit@hospitalEHR, and @smyrnagirl.

Topic One: Politics #EHR reimbursement will likely reach $20 billion. Why is this big govt initiative exempt from critics?

Topic Two: Health data security: What does health data security look like and how is it different than financial data security?

Topic Three: Clash of the #Health IT Titans: What is most beneficial patients, #HIEs or #ACOs? 

Topic Four: Innovation in #healthIT: What are some examples of innovative groups/ideas that may disrupt the current system? 

The Immortal Life of Healthcare IT, Secure Texting Scam, and iPhone Heart Rate — Around Health Care Scene

Posted on September 9, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR and EHR

The Immortal Life of Healthcare IT

Patient engagement has evolved in many ways in the past century. While patients used to rely on doctors for any information regarding health care, it’s now common for patients to “diagnose” themselves, before even stepping foot into a doctor’s office. “The Immortal Life” by Henrietta Lacks, and the authors thoughts, are compared and contrasted to life nowadays.

Interview with Verizon Wireless’ Arthur Lane

A leader for mobile health solution development for Verizon’s Connected Health, Arthur Lane, was interviewed over at EMR and EHR this past week. He focuses his work on developing solutions that help with Verizon’s wireless, cloud, and security. The interview focuses on Health IT and mHealth, and what is in the works at Verizon. He discussed the benefits of mHealth, and what is to come in the future.

Hospital EMR and EHR
What Won’t Happen in #HIT By September 2013

There’s a lot going on with Health Care IT, and it seems as if we’re always hearing about the latest and greatest innovation. However, despite the leaps and bounds that are being made, we can’t expect everything in the EMR industry to be perfect by next year. Anne Zeigler talks about things that won’t be happening in #HIT over the next year, including lack of major growth in remote monitoring and no high penetration HIE.

Meaningful Healthcare It News With Neil Versel

Sampling of opinions on meaningful use Stage 2

The meaningful use Stage 2 final rules have caused quite a bit of discussion across the web since they were announced. Some good, some bad. Neil Versel compiled some of the opinions and thoughts he has discovered over the past few weeks, and created this post with some of them.

Wired EMR and EHR Doctor

The Secure Texting Scam

Medical practices may be getting offers from companies that offer “secure texting,” that won’t violated HIPAA standards. However, how secure can texting be? Dr. Michael Koriwchak talks about the “secure texting scam,” and talks about the reasons why secure texting can fail. Don’t get caught in this trap, and end up paying a large amount for a product that might not deliver what you think.

Smart Phone Health Care

Detect Heart Rate With iPhone Camera – #HITsm Chat Discovery

Finding out your heart rate is now easier than ever — simply by using the camera on your iPhone. This new way to detect heart rate requires no special equipment, beyond an iPhone 4. The app tracks the information and allows the user to view changes over time, among other features.

MU Stage 2, ICD-10 Delay, Epic-Related Safety Errors, and Mobile EMRs – Around HealthCare Scene

Posted on August 26, 2012 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

EMR Thoughts

Meaningful Use Stage 2 Final Rule Published

The long awaited MU Stage 2 final rule was published last week by CMS. No one will be required to follow the requirements until 2014, when the program is set to begin. The Stage 2 final rule is 672 pages long. The press release concerning MU Stage 2 mentions interesting facts, such as 3,300 hospitals have participated thus far.

ICD-10 Delay Finalized with New Unique Plan Identifier

In an announcement that was kind of lost in the midst of the meaningful use stage 2 final rule, the ICD-10 delay is official. As someone said on Twitter, you now have two years to get ready for ICD-10. You better get started now. The announcement of a Health Plan Identifier (HPID) is also very big news.

EMR and EHR

Nurses Raise Alarm Over Epic-Related Safety Errors

With any EMR, there is an adjustment period. However, there was an error recently at a prison clinic in California that could have been deadly that was related to the implementing of an Epic installation. Nurses have raised many concerns about the system, and have likely not been adequately trained. Is the issue with Epic because of the system, or because of inadequate training?

We Know What’s Right, but It’s Hard
Being healthy and overcoming illnesses takes works. And obviously, most of us know that if we don’t put in that effort, there will be negative consequences. Unfortunately, many people don’t put in that effort. Luckily, with the advent of being able to monitor health from home with smart phone apps and other gadgets, it is easier to do what we know is right. Is mHealth applications the answer to the question of how do we motivate ourselves to do what we know we should?

Happy EMR Doctor

Can We Talk? Challenges of SaaS Type EMR User Interfaces

SaaS EMR User Interfaces have a variety of challenges. The latest issue is ensuring that all the individual software work together in a way that doesn’t interrupt a practice’s workflow. This week, Dr. Michael West talks about how, when one component gets updated, it often causes others to work less efficiently. His office recently experienced this, and described the frustrating experience.

Smart Phone Health Care

Detecting Parkinson’s with a Phone Call

About 5 percent of adults over the age of 80 has Parkinson’s Disease. A new technology is being developed that supposedly can detect Parkinson’s Disease. And not only can it detect it, but with 98.6 percent overall accuracy. This raises the question, what can a smart phone not do? This is just the beginning of disease detection and treatment with smart phones. What’s next?

Five Health Communities Every Patient Should Use

It’s easier than ever to have a health problem. Okay, not really, but it’s easier to find support. There are many great communities online dedicated to helping patient’s find information about just about every health topic out there. Some offer free advice from medical professionals, and others implement social media. Here are five of the best communities everyone should join.

Hospital EMR and EHR

Survey: Virtually All Docs Want Mobile EMRs

9 out of 10 doctors want to be able to access their EMR on a mobile device, according to a recent study. It makes sense, since so many doctors are using iPads and smart phones nowadays. Luckily for these doctors, companies like Vitera and eClinicalWorks are working on mobile solutions for this. Hopefully these solutions will include things like reviewing and updating patient charts, and ordering prescriptions, which ranked among the top functions doctors are hoping a mobile EMR would include.

HIEs And Health Data Ownership

Posted on August 16, 2012 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.

Without a doubt, patient consent for release of medical data is going to be an immense headache for HIEs. Though they’re poised to extend their tentacles into hospitals and practices across the U.S., we’re still far from sure how we’re going to keep the walls firm between what data patients have released and what they haven’t.

As Forbes contributor Doug Pollack notes, it’s still not clear whether you can limit access to say, just the psychiatric notes in your chart while releasing the rest of the content.  Even if you can, setting such minute permissions within each e-chart is an IT nightmare.

That being said, there’s a bigger problem afoot, one which Pollack dismisses but I do not. My question is this:  who owns the data that travels across an HIE?  While IANALADWTB (I am not a lawyer and don’t wish to be), my research suggests that an already fuzzy issue is just going to get fuzzier.

While it may be beyond dispute that a patient owns the right to access their health data and control who gets to see it, who owns the patient data if an HIE breaks up?  The hospitals involved?  The doctor?  The patient?  Do they engage in a country-fair rope pull to see who wrestles down ownership?

And that’s only the tip of the iceberg. Consider that networking giants like Verizon Enterprise Solutions are planting their humungous stake in the HIE arena, and things only get more complicated.

Verizon just signed a deal under which it will manage the HIE infrastructure for Pennsylvania-based managed care giant Highmark, one which embraces more than a dozen hospitals.  If the HIE contract were to go sour, would Verizon just turn over its data backups to the hospitals, Highmark and affiliated physicians without a fight?   Or would it be to its legal advantage to stall, stall, stall while patients waited and hospitals fumed?

Regardless of how the law evolves on the matter, there are going to reasons for spats when partners representing different interests come together on an HIE.  I’m betting data control will lead to some of the biggest ones.

Things may go smoothly in the new era of HIEs, but if they don’t, the whole darned “sharing” thing could come crashing to the ground.  And hospitals that try to stand up to deep-pockets giants like Verizon and Highmark may live to regret it.