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Understanding Personal Health Data: Not All Bits Are the Same (Part 3 of 4, Government Information)

Posted on September 30, 2015 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.

Previous segments of this article (parts 1 and 2) have explored the special characteristics of various types of data shared on the Internet. This one will look at one more type of data before we turn to the health care field.

Government Information

Governments generate data during their routine activities, often in wild and unstructured ways. They have exploited this data for a long time, as some friends of mine found out a good 35 years ago when they started receiving promotions for wedding registries from local companies. They decided that the only way those companies could know they were getting married is from the town where they obtained their marriage license.

Government data offers many less exploitative uses, however; it forms a whole discipline of its own explored by such groups as the Governance Lab and the Personal Democracy Forum. Governments open data on transportation, bills and regulations, and crime and enforcement, among other things, to promote civic engagement and new businesses.

The value of such data comes from its reliability. Therefore, data that is inconsistently collected, poorly coded, outdated, or inordinately redacted reduces public confidence. Such lapses are all too common, even on the U.S. government’s celebrated data.gov site.

Joel Gurin, president and founder of the Center for Open Data Enterprise, told me that some of the most advanced federal agencies in the open data area — the Departments of Health and Human Services, Energy, Transportation, and Commerce — provide better access to their records on their own sites than on data.gov. The latter is not set up as well for finding data or getting information about its provenance, meaning, and use.

Some government data requires protection because it contains sensitive personal information. Legal battles often arise regarding whether data should be released on elected officials and employees — for instance, on police officers who were arrested for drunk driving — because the privacy rights of the official clash with the public’s right to know. De-identification is not always done properly, or succumbs to later re-identification efforts. And data can be misleading in the cases where analysts and journalists don’t understand the constraints around data collection. In addition, protection is currently decided on a rather arbitrary basis, and varies wildly from jurisdiction to jurisdiction.

For a long-range perspective on government data quality, I talked to Stefaan G. Verhulst, co-founder and Chief Research and Development Officer of the Governance Laboratory at NYU. He said, “The question is whether a government should only share data that is of high value and high quality, or whether we can benefit from a hybrid approach where the market addresses some of the current weaknesses of data. A site such as data.gov represents a long tail: some data may be of value only to a tiny set of people, but they may be willing to invest money in extracting the data from formats and repositories that are less than optimal. And hopefully, weaknesses will be rectified at the source by governments over time.”

Gurin, in his book Open Data Now (which I reviewed), calls for government outreach and partnerships with stakeholders, such as businesses that can capitalize on open data. Such partnerships would help decide what data to release and where to put resources to improve data.

One gets interesting results when asking who owns government data. The obvious answer is that it belongs to the taxpayers who paid for its collection, and by extension (because restricting it to taxpayers is unfeasible) to the public as a whole.

Nonetheless, many foreign countries and local U.S. governments copyright data. Access to such data is prohibitively expensive. Even when information is supposedly in the public domain, obscure data formats make it hard to retrieve online, and government agencies throughout the U.S. often charge exorbitant fees to people who obtain data, even when requests are granted under the Freedom of Information Act. Recent low points include resistance in Massachusetts to reforming the worst public record policies in the country, and the bizarre persecution of open government advocates by Georgia and Oregon. Unfortunately, the idea that government data should be open to all is intuitive, but far from universally accepted.

Now we have looked at four types of data in a series of articles; the next one will bring the focus back to health care.

Understanding Personal Health Data: Not All Bits Are the Same (Part 2 of 4, Personal Data and Media Content)

Posted on September 29, 2015 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 introduced the notion that many types of data on the Internet, including personal health data, come entangled with constraints on how we can store, share, and use it. I’ll examine two more types of data–personal data and media content–in this article, and government information in the next.

Personal Data

The photos, status updates, hotel reviews, and other personal postings we upload daily constitute a huge repository of data, along with a huge market. This section talks about the melange of information that determined seekers can find about us online: usually things we voluntarily offer through Facebook, Instagram, etc., but also things that others say about us and “data exhaust” generated by our purchases and other activity that companies and governments track. When we go online, we tend to present the sides of ourselves we would like others to know about–but we don’t always understand what we’re revealing about our predilections, prejudices, and drives.

A 2012 McKinsey report suggests that social technologies offer anywhere from $900 billion to $1.3 trillion in annual value — and that’s just counting four industries (page 9 of the report).

So our personal data clearly has value. However, there are qualifications to this value. The problem is that no one is tasked with making sure the information is correct. People enter lies and distorted versions of their life events to social networks all the time. Marketers and other data-slurping companies hope that the inaccuracies work themselves out during big-data processing. But that assumes that the truth lies in there somewhere (a dubious proposition) and that sophisticated data mining techniques can eliminate inaccurate outliers.

Ownership is a curious and fascinating question for personal data. Do you “own” the data item indicating that you just purchased a shirt from Everlane? Proponents of vendor relationship management would say yes. These Internet reformers would like consumers to be in charge of the data related to their transactions, and would like companies that want to use such data for marketing or planning to pay customers. Others would argue that Everlane has just as much a right to the data as you do — you are both parties to a transaction.

As I have indicated elsewhere, ownership is a slippery concept, even when you generate it yourself. When I take photos of friends, they often ask me not to post the pictures to Facebook. I respect this, treating them as owners of their digital images. It’s interesting, incidentally, that this question of intrusive photo-taking underlies the seminal work on privacy: the 1890 Harvard Law Review article by Warren and Brandeis.

Currently, ownership is something of a Wild West where anyone who gets your personal data can use it, unless you have explicitly put it under license. So protection — the third trait of Internet data I address throughout this article — is weak and oft trampled on in personal data. I think we all want to protect personal health data from this situation, a theme I’ll return to when we get to that section of the article.

Media Content

Because I work for a publisher — and one particularly prescient in its adaptation to the wired world — I have participated in many discussions of media content. I’m talking here of things that aren’t just thrown on the open Internet, like articles on this Radar blog, but are hidden behind walls that you can enter only after paying, or at least by entering an email address and some personal information such as the size and industry of your company. Your email address is tremendously useful to the company providing the content, whether they use it to shove ads at you, sell information to vendors, or determine what future content to produce.

Is media content valuable? Certainly it is, thanks to the years of expertise and hours of effort invested by those who created and curated it. Note that in the previous section, I cited a McKinsey report. I didn’t spend hours vetting the report or checking McKinsey’s credentials. I relied on their reputation as a key source of information in the tech industry — an example of the value created by trusted content sites.

This confirms the dictum that information on the Internet wants to be expensive, as famously said by Stewart Brand. That’s why many people spend good money to access news sites and online books, and other people go to great efforts to get it for free.

The question of ownership is resolved by copyright law, but in ways that are not entirely compatible with the Internet. For instance, many researchers would often love to share their papers with all who want them, but the publishers usually own the content and place restrictions on such sharing. Luckily, many academic publishers now allow authors to place early pre-publication drafts online for free download. I can locate a free copy of most research articles by entering the title and author names into a search engine.

Indeed, when we talk about “owning” data, we fall into a trap prepared by large corporate interests who depend upon notions of Intellectual Property to maintain their income flows. I am not opposed to the exercise of copyrights, patents, and trademarks, but I worry about the extension of these carefully defined concepts to a larger context where casual references to property and (as a consequence) ownership in are at best unhelpful and at worst meaningless.

Protection is also a controversial topic hre. Many publishers (but definitely not my company, O’Reilly Media) take extraordinary efforts to protect data, notably digital rights management, which I cover in other articles. It’s notable that no laws restrict you from downloading software from the Internet to make a gun, but severe laws punish not just downloading copyrighted content, but offering tools that let people break the digital rights management on that content.

Further segments of this article will continue to explore Internet information and its meaning for the health care field.

Understanding Personal Health Data: Not All Bits Are the Same (Part 1 of 4)

Posted on September 28, 2015 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.

When people run out of new things to say in the field of health IT, they utter the canard, “Why can’t exchanging patient data be as easy as downloading a file on the Internet?” For a long time, I was equally smitten by the notion of seamless exchange, which underlies the goals of accountable care, patient-centered medical homes, big data research, and the Precision Medicine Initiative so dear to the White House. Then I began to notice that patient information differs in deep ways from arbitrary data on the Internet.

Personal health data isn’t alone in having special characteristics that make handling it fraught with dangers and complications. In this article, I’ll look at several other types of online data laden with complexity — money, personal data, media content, and government information — and draw some conclusions for how we might handle health data.

Money

I am not an early adopter by habit, even though I work in high tech. When someone announces, “Now you can pay your bills using your phone!” it sounds to me like “Now you can mow your lawn using your violin!” Certain things just don’t go together naturally. Money is not like other bits; you can’t copy it the way people casually share their photos or email messages.

Of course I endorse the idea of online payment systems. They have transformed the economies of rural communities in underdeveloped parts of the world like sub-Saharan Africa. They can be useful in the U.S. for people who can’t get credit cards or even checking accounts.

Perhaps that’s why there are at least 235 (as of the time of publication) online payment systems. But money isn’t a casual commodity. It requires coordination and control. Even the ballyhooed Bitcoin system needs checks and balances. Famously described as decentralized because many uncoordinated systems create the coins and individuals store their own, Bitcoin-like systems are actually heavily centralized around the blockchain they hold in common.

Furthermore, most people don’t feel safe storing large quantities of bitcoins on personal servers, so they end up using centralized exchanges, which in turn suffer serious security breaches, as happened to Mt. Gox and Bitstamp.

So let’s look at some special aspects of money as data.

First, money has value. Ultimately — as we have seen in the crisis of the Euro and the narrowly averted default by Greece — money’s value comes from guarantees by banks, including countries’ central banks. Money’s value is increased by the importance placed on it by the people that want to steal it from us or cheat us out of it.

Second, money has an owner. In fact, I can’t imagine money without an owner. It would be like gold bullion buried on a desert island, contributing nothing to the world economy. So, the Internet culture of sharing has no meaning for money.

Third, money must be protected. Most of us — who can — use credit cards, because they are backed by complex systems for detecting theft and fraud run by multinational corporations who can indemnify us and handle our mishaps. If we store our money outside the banking system, we lack these protections.

These three traits — value, ownership, and protection — will turn up again in each of the types of Internet content I’ll look at in upcoming installments of this article. Does a review of money on the Internet help us assess health data? Comparisons are shaky, because they are very different. But because health data is so sensitive, we might learn a lot about its protection by paying attention to how money is handled.

Using Healthcare Analytics to Achieve Strong Financial Performance

Posted on September 25, 2015 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.

Everyone is talking about analytics, but I’ve been looking for the solutions that take analytics and package it nicely. This is what I hoped for when I found this whitepaper called How Healthcare Providers Can Leverage Advanced Analytics to Achieve Strong Financial Performance. This is a goal that I think most of us in healthcare IT would like to achieve. We want healthcare providers to be able to leverage analytics to improve their business.

However, this illustration from the whitepaper shows exactly why we’re not seeing the results we want from our healthcare analytics efforts:
Advanced Analytics Impact on Healthcare

That’s a complex beast if I’ve ever seen one. Most providers I talk to want the results that this chart espouses, but they want it just to happen. They want all the back end processing of data to happen inside a black box and they just want to feed in data like they’ve always done and have the results spit out to them in a format they can use.

This is the challenge of the next century of healthcare IT. EHR is just the first step in the process of getting data. Now we have the hard work of turning that data into something more useful than the paper chart provided.

The whitepaper does suggest these three steps we need to take to get value from our analytics efforts:
1. Data capture, storage, and access
2. Big data and analytics
3. Cognitive computing

If you read the whitepaper they talk more about all three of these things. However, it’s very clear that most organizations are still at step 1 with only a few starting to dabble in step 2. Some might see this as frustrating or depressing. I see it as exciting since it means that the best uses of healthcare IT are still to come. However, we’re going to need these solutions to be packaged in a really easy to use package. Otherwise no one will adopt them.

Is ICD-10 the Next y2k?

Posted on September 24, 2015 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’ve started to see more and more people comparing ICD-10 to y2k. I think it’s going to be a great comparison for most organizations. Given the lead time for ICD-10, I believe that ICD-10 is going to be a non-event for most of them. Sure, there will be some hiccups along the way, but nothing major to report.

What’s certain to me is that October 1, 2015 will be a total non-event. I know hospitals are already planning their ICD-10 go live parties, but I don’t think there’s going to be much to talk about. Any problems or issues they have with ICD-10 probably won’t be apparent right away. I think that any major issues with ICD-10 won’t come to light until months after ICD-10 is implemented.

Wait for the stories to come out 2-3 months after ICD-10 is implemented. Then, we’ll start hearing about insurance companies that weren’t ready to process ICD-10 claims or had issues with the way they were processing it. Months later we’ll hear about healthcare organizations that aren’t getting paid and are facing cash flow issues. ICD-10’s impact isn’t going to be over on day one like it was for y2k. It’s a very different issue in that regard.

The other reason I don’t think we’ll hear much about ICD-10 issues is that healthcare organizations that run into issues aren’t going to broadcast that fact. Are we really going to hear healthcare organizations chiming in that they botched their ICD-10 implementation, thought it was going to be delayed again, and weren’t ready? I don’t think so. Any problems with ICD-10 are going to be kept private. At least until an organization isn’t getting paid and goes out of business.

I’m sure we’ll have a wave of ICD-10 implementation articles hit on October 1, 2015. My guess is that none of them will be worth reading since there won’t be anything to say. Wait until Thanksgiving and we’ll start to see the real stories about the challenges of the ICD-10 implementation start to hit the wires.

ComChart EHR Stops Selling Its EHR

Posted on September 23, 2015 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.

Almost 2 years ago, one EHR vendor decided to not go after meaningful use stage 2. At the time I wrote about how that EHR vendor should have used that decision as an extraordinary marketing opportunity for their EHR. They could argue that they were focused on the doctor’s needs and not on government regulation. It was the perfect marketing opportunity which I believe they botched.

That EHR vendor was ComChart EHR. Botched marketing opportunity or not, the ComChart website has been updated to inform ComChart users that the ComChart EHR was no longer available for sale to the public. A letter then follows which outlines that the President of ComChart, Hayward Zwerling, M.D., will continue to use the ComChart EHR in his practice until he retires and will provide updates he does for his practice to others who already have the software. ComChart also has a read-only license option for those doctor who choose to leave ComChart, but still want access to their old records. This method of shutting down an EHR stands in stark contrast to other EHR shutdowns that no doubt left doctors high and dry.

At the end of the letter, Dr. Zwerling argues that more technology is not going to solve healthcare’s cost and quality problems. I agree completely. It’s not about more technology. Technology in and of itself doesn’t solve anything. It’s a tool in the toolbox. It’s certainly not the solution to all of healthcare’s ills.

Here’s the full letter from the ComChart website:

Dear ComChart Users;

I want to thank you for your years of support and encouragement. Some of you have been using ComChart EMR for more than 15 years. You have provided me with the encouragement, ideas and support which I needed to create the best EMR for the small medical practice. I am not bragging; ComChart EMR has literally had the highest KLAS rating from 2006 – 2012. In the 2012 ranking, ComChart EMR again had the highest overall score (92.9) and the highest Product Quality Rating (8.4) in the Ambulatory 1-10 Provider category.

Unfortunately, my experience with the recent ComChart EMR upgrade has convinced me that I should stop selling ComChart EMR as more than half of the offices have had upgrade problems.

I believe the technology underlying ComChart EMR has gotten too complicated for smaller offices and the “upgrade” process is too slow for larger offices. In addition, I am not in complete control of the IT situation, I am reliant on Filemaker, Inc and the plugin makers and other HIT vendors and the faxing program companies as well as OS updates – all of these vendors create problems that I have to “solve” and which are beyond my ability to control.

I intend to continue using ComChart EMR in my office until I retire, or I am forced by external factors to give up ComChart EMR. I believe I have another decade in practice. I will continue to develop ComChart EMR for my practice and make these upgrades available to you should you choose to continue to use ComChart EMR. I will continue to support your practices as I have done to date.

If you decide you are not going to continue using ComChart EMR, I would recommend that you purchase a “read-only license”. That will allow you to continue to access your records, read your records, print out the records, for as long as you need them. The read-only license comes with no technical support. Because of this, you need to be careful about changing operating systems on the computer that is running your read-only version of ComChart EMR.

As some of you know, I’ve blogged about health information technology in the past. Although I am a firm believer that health information technology helps me run a more efficient practice, there is a scarcity of data demonstrating that health information technology improves the quality of health or reduces the cost of healthcare at the societal level. Despite this lack of data, the Federal Government has felt it appropriate to apply financial penalties to physicians who do not use the health information technology software specified by the Federal Government and in the manner mandated by the Federal Government. To a large extend, this problem has occurred because the large EMR/EHR vendors now have undue influence over the Federal Government’s HIT initiative.

I have periodically blogged on the topic of evidence-based medicine as it applies to health information technology. Unfortunately, my comments have fallen on deaf ears.

Personally I am convinced that the solution to the healthcare cost and quality problem does not lie in the application of more/better health information technology. While the data would suggest that health information technology can have a marginal impact on the quality of care, and maybe even on the cost of care, it is not THE solution to a health care cost/quality problem. Politicians should stop listening to the IT geeks and the larger EMR vendors and begin to look at the published data about the efficacy of Certfied EMRs/EHR and Meaningful Use and start listening to the practicing physicians. Believing that more health information technology will solve the healthcare problem will only delay the process of finding a real solution to a very large problem.

I wish my users all the best, and I really appreciate the support you have given me over the years. If you have any questions, feel free to call me on my cell phone or email me, anytime, as you have done in the past.

Hayward Zwerling, M.D.
President ComChart Medical Software

Improving Diagnosis in Healthcare

Posted on September 22, 2015 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.

Rasu Shrestha, MD, MBA has been really sharing amazing information lately on Twitter. If you don’t follow him, you should do so now. Today, he shared this great image (below) together with a link to what he called a landmark paper from IOM called “Improving Diagnosis in Health Care“.
Improving Diagnosis in Health Care
*Click on the image to see it in full size

The paper also had this great video with it which tells some of the stories behind the paper:

FDA Adds Patient Engagement Advisory Committee

Posted on September 21, 2015 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.

Today on the FDA blog they announced the first ever Patient Engagement Advisory Committee. I’m sure that patient advocates all over the US are celebrating this addition. I love this acknowledgement on the blog post announcement:

Although it may seem odd in retrospect, the development of new technologies intended to improve patients’ lives has largely relied upon expert opinions rather than asking patients and families directly what they consider most important.

But that’s changing.

This is a great first step for the FDA to have more involvement from the patient. It can be easy as a researcher to ignore the patient voice when looking at the data for a drug or medical device. Hopefully this new committee will provide a more well rounded view of the impact their choices have on the lives of patients.

Here’s the outline of ways the FDA thinks this patient committee can help the FDA:

  • to help identify the most important benefits and risks of a technology from a patient’s perspective;
  • to assess the relative importance to patients of different attributes of benefit and risk, and clarify how patients think about the tradeoffs of these benefits and risks for a given technology; and
  • to help understand how patient preferences vary across a population.

I’m excited to see how this works out for the FDA. Although, is it just me or does one patient committee feel like a bad strategy for engaging patients? How can one patient committee understand the impact of hundreds of drugs and medical devices. It almost seems like every drug or medical device needs its own patient committee to be able to provide quality feedback for that drug or medical device. Maybe you could narrow it a bit more to specific disease types or something.

I realize there’s a massive scaling problem when you start talking about one patient committee for every drug or medical device. I’d suggest that the company submitting the drug or medical device could provide the patient committee, but that would be fraught with conflict of interest. Even if the FDA opened up a virtually committee online you can imagine how the various companies would game that system by “encouraging” patients to submit comments to that virtual online committee.

Maybe the best solution would be to work with the healthcare organizations themselves and get them to encourage patient feedback on the various drugs and medical devices that are being approved. I’m sure there are ways that can be gamed as well. The key for me is making sure that a broader patient voice is heard. One committee is a great step forward, but that’s putting a lot of power into a few people’s hands and they may not have the time or understanding needed to provide quality feedback across the wide variety of drugs and medical devices that are being approved by the FDA.

What Does ICD-10 Ready Software Really Mean?

Posted on September 18, 2015 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’ve been having a number of conversations with people about the coming switch over to ICD-10. Invariably those conversations lead to a discussion around how EHR vendors have implemented ICD-10. I can pretty much promise you that every EHR vendor still in business has some way to support ICD-10. However, just because they can support entry of an ICD-10 code doesn’t mean they’re providing the EHR user a good tool to discover the correct ICD-10 code.

This discussion was highlighted really well in these two tweets:


And Joe’s response:

I’ve only seen one EHR vendor who had an amazing ICD-10 coding tool. It basically did all the coding for you as part of the documentation. I’ll be interested to see how well that tool plays out in a real life environment, but their approach is unique and beautiful. I’ve seen some others that do a decent job. I’ve seen others that still apply the standard search box methodology that’s been used for ICD-9. Good luck to those people.

However, this tweet from Erin Head made me cringe even more:

I’ll be interested to see how doctors still on paper react to the change to ICD-10. It’s coming! Are you ready? Is your EHR ready or do they just say they’re ready? We’ll know soon.

DeSalvo Says We Need Common Interoperability Standards – I Think There’s More To It

Posted on September 17, 2015 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 came across an article on FierceHealthIT which has a really fascinating quote from Karen DeSalvo, National Coordinator for Health IT. Here it is:

“What seems that it would have been helpful is if we had agreed as an ecosystem–the government, the private sector–that we would have a set of common standards that would allow us to have more seamless sharing of basic health information,” she said. “We’re moving toward that with the industry, but I think what that’s created is a complexity and aggregation of data … In hindsight, maybe some more standardization, or a lot more,” was necessary.

Is lack of a standard what’s keeping healthcare from being interoeprable?

I personally don’t think that’s the biggest problem. Sure a standard would help, but even with the best standards in the world if organizations see data sharing as contrary to their best interest then no standard will overcome that view. It’s been said many times that we have an issue of desire and will to share data. It’s not a technical problem. Sure, a standard would be helpful once there is a will to share data, but if organizations wanted to share data they’d figure out the standard.

Later in the article, CommonWell Executive Director Jitin Asnaani said “Standards are not standards because we say they are; standards are standards because everybody uses them.

This is the problem. People don’t want to share health data and so no standard is being used. I still wish they’d blow up meaningful use and use the rest of the money to incentivize organizations to start sharing. People went bat crazy implementing an EHR as they chased government money. I’d love to see healthcare organizations go bat crazy becoming interoperable as they chased the rest of the government meaningful use money.