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Key Articles in Health IT from 2017 (Part 1 of 2)

Posted on January 2, 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.

This article provides a retrospective of 2017 in Health It–but a retrospective from an unusual perspective. I will highlight interesting articles I’ve read from the year as pointers to trends we should follow up on in the upcoming years.

Indubitably, 2017 is a unique year due to political events that threw the field of health care into wild uncertainty and speculation, exemplified most recently by the attempts to censor the use of precise and accurate language at the Centers for Disease Control (an act of political interference that could not be disguised even by those who tried to explain it away). Threats to replace the Affordable Care Act (another banned phrase) drove many institutions, which had formerly focused on improving communications or implementing risk sharing health care costs, to fall back into a lower level of Maslow’s hierarchy of needs, obsessing over whether insurance payments would cease and patients would stop coming. News about health IT was also drowned out by more general health topics such as drug pricing, the opiate crisis, and revenue pressures that close hospitals.

Key issues

But let’s start our retrospective on an upbeat note. A brief study summary from January 4 reported lower costs for some surgeries when hospitals participated in a modest bundled payment program sponsored by CMS. This suggests that fee-for-value could be required more widely by payers, even in the absence of sophisticated analytics and care coordination. Because only a small percentage of clinicians choose bold risk-sharing reimbursement models, this news is important.

Next, a note on security. Maybe we should reprioritize clinicians’ defenses against the electronic record breaches we’ve been hearing so much about. An analysis found that the most common reason for an unauthorized release of data was an attack by an insiders (43 percent). This contrasts with 26.8 percent from outside intruders. (The article doesn’t say how many records were compromised by each breach, though–if they had, the importance of outside intruders might have skyrocketed.) In any case, watch your audit logs and don’t trust your employees.

In a bracing and rare moment of candor, President Obama and Vice President Biden (remember them?) sharply criticized current EHRs for lack of interoperability. Other articles during the year showed that the political leaders were on target, as interoperability–an odd health care term for what other industries call “data exchange”–continues to be just as elusive as ever. Only 30% of hospitals were able to exchange data (although the situation has probably improved since the 2015 data used in the study). Advances in interoperability were called “theoretical” and the problem was placed into larger issues of poor communication. The Harvard Business Review weighed in too, chiding doctors for spending so much money on systems that don’t communicate.

The controversy sharpened as fraud charges were brought against a major EHR vendor for gaming the certification for Meaningful Use. A couple months later, strangely, the ONC weakened its certification process and announced it would rely more on the vendors to police themselves.

A long article provided some historical background on the reasons for incompatibility among EHRS.

Patients, as always, are left out of the loop: an ONC report finds improvements but many remaining barriers to attempts by patients to obtain the medical records that are theirs by law. And should the manufacturers of medical devices share the data they collect with patients? One would think it an elementary right of patients, but guidance released this year by the FDA was remarkably timid, pointing out the benefits of sharing but leaving it as merely a recommendation and offering big loopholes.

The continued failure to exchange data–which frustrates all attempts to improve treatments and cut costs–has led to the question: do EHR vendors and clinicians deliberately introduce technical measures for “information blocking”? Many leading health IT experts say no. But a study found that explicit information blocking measures are real.

Failures in interoperability and patient engagement were cited in another paper.

And we can’t leave interoperability without acknowledging the hope provided by FHIR. A paper on the use of FHIR with the older Direct-based interoperability protocols was released.

We’ll make our way through the rest of year and look at some specific technologies in the next part of the article.

EHR Vendor Says Good Bye to Meaningful Use

Posted on December 30, 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.

ComChart Medical Software, LLC president, Hayward K. Zwerling, MD, earlier this month posted a letter on The Health Care Blog saying that the ComChart EMR would no longer be meaningful use certified. Here’s a portion of the letter that describes the reasoning:

ComChart EMR will continued to be certified as a Complete EMR for Stage I Meaningful Use. Unfortunately, we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.

In addition to the Meaningful Use mandates, there continues to be a never ending stream of new mandates such as ICD-10, PQRI, Meaningful Use 2, Meaningful Use 3, SNOMED, ePrescribing, LOINC, Direct Project, health information exchanges etc. As a result of the mountain of mandates, ComChart EMR and the other small EMR companies will have to choose to implement the mandates or use their resources to add “innovative” features to their EMR. Unfortunately, the small EMR companies do not have the resources to do both.

(I suspect this is also true, to some extent, for all EMR companies.)

While the individual people involved in promulgating these EMR mandates (mostly) have the best of intentions, they clearly do not understand what transpires in the exam room, as many of the mandated features confer little or no benefit to either the patient or the healthcare provider.

In addition to a lack of understanding of what is important during the process of providing healthcare, it has also become apparent to me that the Federal and State health information technology agenda is now largely driven by the strongest HIT companies and health institutions; the individual physician is only an afterthought in the entire process.

This choice basically means that anyone interested in meaningful use and EHR incentive money won’t be doing so with ComChart EMR. The regulations say that even someone attesting to meaningful use stage 1 in 2014 has to use a 2014 certified EHR. ComChart won’t be able to meet that requirement.

I knew that this was going to happen with a number of EMR vendors, but ComChart really missed a huge opportunity with this announcement. The most damning part of the letter is when Dr. Zwerling says “we will not be able to meet the Stage 2 (or greater) Meaningful Use certification requirements as these requirements are technically extremely difficult to implement.” I was aghast by this statement. So much so that I had a brief email exchange with Dr. Zwerling to see if he really meant what he said. Was it that they weren’t able to meet the requirements or that they chose not to meet them?

He responded, “Anything can be done, it is just a question of how much resources are going to be thrown at the problem and what is not going to get done return.”

It seems that Dr. Zwerling didn’t consult a PR or marketing person on how to make the most of this decision. Any of them would have told him that this decision could be a huge opportunity to differentiate the ComChart EHR from all the hundreds of certified carrot chasing EHR companies out there.

If Dr. Zwerling had asked me, I’d have told him that he should have said, “ComChart EHR has talked with our hundreds of physician end users about meaningful use and EHR certification and we’ve found that they don’t value any of the meaningful use criteria. Because of doctors desire to not be bogged down by meaningful use requirements, we’ve chosen to listen to our doctors and focus on what makes doctors lives easier. We’ll continue innovating our product to the needs of doctors, but we’ll be letting doctors drive that innovation versus some committee in Washington.”

I could keep going, but you get the idea. ComChart could have told every doctor out there that they were the ULTIMATE PHYSICIAN EHR that cares so much about the physicians who use their EHR that they’re shunning meaningful use because it’s detrimental to the way physicians should be practicing medicine. Making this case would not be hard and the message would resonate with the majority of physicians.

I’m not sure if this strategy would work or not. Government money that’s perceived as “free” is a hard opponent. However, government bureaucracy and headaches are an easy target that everyone understands and hates. In ComChart’s case, saying that they essentially aren’t capable of the complex meaningful use requirements is sending the wrong message. All doctors hear when they read this is that your EMR development team isn’t sophisticated or strong enough to keep up. What a missed opportunity and likely the nail in ComChart’s coffin!

Hopefully this is a warning message to any other EHR vendors who choose to go the route of shunning meaningful use and EHR certification. I’m not sure that shunning MU is a winning strategy for an EHR vendor, but being the physician advocate at least gives them a fighting chance.