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The Bases of Competition in Healthcare – Open vs Closed

Posted on December 15, 2011 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.

I’m sure that many of you have read the always insightful and intriguing Vince Kuraitis and his e-CareManagement blog. If you haven’t you should start doing so now. I just recently came across his post called “Getting an Epic Opinion Off My Chest” about the proprietary solutions and walled gardens that have and are being created in healthcare.

He starts off really strong with the following points:

What are acceptable bases of competition in health care?

My sense is that the distinctions here are not well understood and often go undiscussed, so I’ll quickly get to the point:

It’s OK for care providers to compete on the bases of quality, price, patient satisfaction, and many other factors

It’s NOT OK for care providers to compete on the basis of controlling or limiting access to patient health information. It’s just not right.

He later goes on to assert that in many industries the idea of creating proprietary, non-interoperable technology is an acceptable means of competitive differentiation, but Health Care is different.

Certainly there are people’s lives involved in this and so it’s a different animal all together. If I can’t transfer my music from one MP3 to another it might be unfortunate, but having a loved one die because the right healthcare information was stuck in a closed system is a much more serious issue and one that should require careful consideration.

Outside the ethical reasons to support the benefits of access to patient information, I think there’s a great business case for doing so as well.

One example of the business case I outlined in my post about EMR data liberation. That’s a subtly different situation than what Vince described, but I believe you can make the business case for the benefits of an open system.

For those familiar with SalesForce.com, they could have easily been a few hundred million dollar company on the back of their CRM software. They could have then expanded into other related business verticals as they built off a closed garden. Instead, they opened up their system to allow a lot of other companies to build on their Force platform. As a platform, they’re a multi-billion dollar company.

Why healthcare IT vendors can’t see the value of open is a bit beyond me? I guess some might argue that the GE and Microsoft announcement was a step towards this type of open environment. Based on the analysis I’ve read, I think this is part of their vision for what they’re trying to create.

Whether Microsoft and GE will be able to execute on the vision of the platform is still not clear. However, what I believe is clear is that directionally this is where the market will eventually go. There will be a healthcare platform that does a great job connecting heterogeneous systems.

So, yes, I think that morally the right thing to do is to open your system, but I also think it makes great business sense to do so as well. The closed garden strategy might work well in the short term, but long term open always seems to find a way to win in a much bigger way.

The Marvels of Technology Missing in Health IT

Posted on November 30, 2011 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.

I’m currently on the long flight from Las Vegas to New York City. The early flight time and long flight remind me why I prefer to just stay in Las Vegas with the occasional west coast trip, but I digress. In order to not lose an entire day of work on the airplane, I spent far too much for the overpriced internet service on my flight. As I’m traveling at 30,000 feet, it’s amazing to me that I’m connected nearly as good as when I’m sitting at home. Sure, in flight internet has been around for quite a while, but it still amazes me. What will amaze me even more is when the internet is free on every flight. Maybe pharma ads could pay for this too.

While experiencing this amazing connectivity, I can’t help but think of how poor so much of the connectivity in healthcare is. That’s right. We can find a way to offer internet connectivity at 30,000 feet in an aircraft moving hundreds of miles per hour and yet we can’t get connectivity to rural hospitals and other healthcare locations?

Plus, even speaking more broadly, I can access all of my normal services from an airplane, but for some reason I have no way to connect all of my healthcare data together.

Those in the industry realize the problems. The challenge of connecting all of our healthcare data from the various EHR (or maybe in this case EMR is appropriate) data silos is an academic exercise that’s easily accomplished. Hit any of the interoperability showcases at HIMSS or other healthcare IT events and you’ll see EHR software vendors communicating with each other and sharing data. Why then can’t we make this a reality?

The challenges are still the same they’ve been for a long time now: funding and politics.

I still cringe to think of the missed opportunity that ARRA and the HITECH Act could have provided in this regard. Instead of incentivizing use of an EMR, they should have and could have incentivized interoperability of healthcare data. The great part is that you’re not going to start exchanging data in healthcare without an EHR so you’d be getting more EHR software adopted and interoperability. Water under a bridge now I guess, but it keeps eating at me.

My biggest hope now is that a grass roots movement will form that will drive what we should be doing anyway. Everyone knows and understands the benefits to healthcare and the patient of exchanging healthcare data. It’s easy to make the case for how patient care improves and how duplicate costs are avoided. We need more people that are willing to hop on board interoperability of healthcare data cause it’s the right thing to do. Sure, we need to do it in a smart and reasonable way, but the ROI of healthcare data exchange goes well beyond dollars and cents. This ROI can’t be put on a spreadsheet, but instead will help us all sleep better at night.

Are there any movements like this out there? I can’t say I’ve seen any, but I’d love to see one. Then, we’d have a real beacon community that’s set on a hill because it earned and deserved the recognition as opposed to beacon communities paid for by tax payers.

Side Note: I’ll be in NYC this week at the Digital Health Conference and at the mHealth Summit in DC next week. I’m already planning to meet a number of my readers at these events, but I’d love to meet more.

Is MUMPS the Major Healthcare Interoperability Problem?

Posted on November 11, 2011 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.

Jeremy Bikman from KATALUS Advisors wrote this interesting comment on a LinkedIn discussion I was participating in:

Perhaps there is a place for MUMPS but only if healthcare continues to thumb its nose at the prevailing technology trends. It’s hard for me to envision healthcare to continue to embrace a technology that doesn’t like to play nicely with other non-MUMPS systems. If there were real advantages to it you would see a fair number of high tech firms utilizing it (Facebook, salesforce.com, Twitter, Spotify, etc).

If your goal is to have an enterprise system with a database that has some scale to it and certainly has good speed, and you don’t really care about interoperability with other systems, then MUMPS is certainly a good viable option. But IMO, the days of healthcare IT being insular, and moving out of phase with the rest of the tech world, are numbered.

I found this comment incredibly interesting. Mostly because I’ve never personally believed that the fact that many of the larger healthcare IT and EMR systems are built on MUMPS was any part of the reason why healthcare entities aren’t interoperable. I’m a tech guy by background, but I’ve never worked on a MUMPS software system myself so I don’t have first hand knowledge of MUMPS in particular. However, it seems wrong to “blame” MUMPS on the lack of healthcare data interoperability.

I guess the way I look at it is that no matter which database back end you have, you’re always going to need some front end interface to take care of the transport of the healthcare data to another system. Is this any harder with MUMPS than another SQL or even NOSQL database? From my experience it shouldn’t matter. I’d love to hear if there are reasons why it is harder.

I also don’t want to give the impression that Jeremy is trying to say that MUMPS is the only reason that healthcare IT has been so insular and closed. I’m pretty sure he agrees with me that a lot of other factors that have stopped healthcare from sharing data. I just don’t believe that MUMPS is one of those reasons.

Of course, the question of whether MUMPS should continue in healthcare is a different question. In fact, I wrote about MUMPS in healthcare IT and EMR here.

What are your thoughts? Is MUMPS the problem with healthcare interoperability? What are the other reasons stopping healthcare interoperability?

Update: Jeremy Bikman provided the following clarifying comment in the comments of this post:
Good points John. I really should have clarified. MUMPS is not really the issue (although I still stand by my assertion that if it was such a superior technology you’d see it all over Silicon Valley, RTP, etc). The main issue is really with the walled garden (w/ razor wire and machine guns along the top) approach of the major EMR/HIS vendors that have it as their foundation.

The more control you exert over your clients and the harder you make it to connect with other systems, the more money you can make…at least in the short-term.

John’s thought: I still look forward to the discussion around MUMPS and interoperability and healthcare interoperability in general.

No @ Sign for Healthcare

Posted on September 15, 2010 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.

I recently heard Arien Malec from ONC summarize the biggest challenge of Healthcare Information Exchange (HIE) in one simple phrase:

There’s no @ sign for healthcare

It’s a really basic idea, but sadly cuts straight to one of the core reasons HIE isn’t happening. We don’t have a great way to authenticate, verify and address health information to another provider.

Twitter has created this interesting concept of using @ to specify people. For example, you can find me @techguy and @ehrandhit. It’s amazing how quickly Twitter has created a whole new set of addresses where we can communicate with other people. Certainly it’s not designed for healthcare, but it’s amazing that they could create this whole new address system for people and organizations. And trust me when I say that Twitter is a great communication and collaboration mechanism.

One of the main reasons the fax machine is so successful in healthcare is that each clinic has a unique identifier, their fax phone number. I’ll be writing more about the fax machine in the future, but HIE needs to solve the problem of a verifiable address that’s unique to each healthcare provider if we want to move beyond the fax machine.

It seems like the people behind NHIN are trying to address this challenge, but they still have a ways to go. Does anyone else know of other ways people are trying to address the missing @ sign in healthcare?

HHS Connect Program For Healthcare Data Interoperability

Posted on October 11, 2009 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.

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

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

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

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

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

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

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

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

Simple Plan for Meaningful EHR Use

Posted on July 24, 2009 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.

Yes, I’m still on my kick of asking the question of why we’re making the definition of meaningful use so complicated. Certainly I could make an ambitious goal of every doctor having to document everything granularly and electronically and share everything with everyone so we give the best care possible to patients. The reality is that if you do that, then no one will care about meaningful use and the EHR stimulus money will go unspent.

Certainly the above is a bit of an exaggeration, but I can’t help but ask myself if the definition of “meaningful use” isn’t so ambitious that the above will be the net result (at least for small practices) of the current definition of meaningful use.

It’s a little bit wrong for me to say it’s too complex, but not offer a plan. Here’s a real simple idea that should accomplish nearly as much as the meaningful use matrix presented by the HIT policy committee. It has 2 main areas of focus:

Data Interoperability – Establish a standard (since there isn’t a really good and widely adopted one now) including the privacy requirements that should be part of healthcare data interoperability. Then, require that EMR users show you that they can share the data from their clinics with other clinics according to that standard.

Reporting – Require that doctors be able to report data to HHS. Focus on receiving data that will improve the management of Medicare (since that’s what they should be doing with all this data anyway) and also data that will improve public health. HHS should be required to have plans on how it will use this data to accomplish each of these goals. Otherwise, why report it?

Why keep it so simple? Because you have to keep it so that you can actually measure that it’s being done. If you can’t measure it, then why have it as a requirement?

Plus, try to satisfy the above requirements without some form of EMR. It’s nearly impossible. If we truly want to increase EMR adoption, then ONC better be very careful about setting the bar so high when it doesn’t need to be.