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Diagnosis And Treatment Of “Epic Finger”

Posted on January 20, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The following is a summary of an “academic” paper written by Andrew P. Ross, M.D., an emergency physician practicing in Savannah, GA. In the paper, Dr. Ross vents about the state of physician EMR issues and repetitive EMR clicking (in quite witty fashion!). Rather than try and elaborate on what he’s said so well, I leave you with his thoughts.

At long last, medical science has identified a subtle but dangerous condition which could harm generations of clinicians. A paper appearing in the Annals of Emergency Medicine this month has described and listed treatment options for “Epic finger,” an occupational injury similar to black lung, phossy jaw and miner’s nystagmus.

Article author Andrew Ross, MD, describes Epic finger, otherwise known as “Ross’s finger” or “the furious finger of clerical rage,” as a progressive repetitive use injury. Symptoms of Epic finger can include chronic-appearing tender and raised deformities, which may be followed by crepitus and locking of the finger. The joint may become enlarged and erythematous, resembling “a boa constrictor after it has eaten a small woodland mammal.”

Patients with Epic finger may experience severe psychiatric and comorbid conditions. Physical complications may include the inability to hail a cab with one’s finger extended, play a musical instrument or hold a pen due to intractable pain.  Meanwhile, job performance may suffer due to the inability to conduct standard tests such as the digital rectal exam and percussion of the abdomen, leading in turn to depression, unhappiness and increased physician burnout.

Dr. Ross notes that plain film imaging may show findings consistent with osteoarthritic changes of the joint space, and that blood work may show a mild leukocytosis and increased nonspecific markers of inflammation. Ultimately, however, this elusive yet disabling condition must be identified by the treating professional.

To treat Epic finger, Dr. Ross recommends anti-inflammatory medication, aluminum finger splinting and massage, as well as “an unwavering faith in the decency of humanity.”  But ultimately, to reverse this condition more is called for, including a sabbatical “in some magnificent locale with terrible wi-fi and a manageable patient load.”

Having identified the syndrome, Dr. Ross calls for recognition of this condition in the ICD-10 manual. Such recognition would help clinicians win acceptance of such a sabbatical by employers and obtain health and disability insurance coverage for treatment, he notes. In his view, the code for Epic finger would fit well in between “sucked into jet engine, subsequent encounter,” “burn due to water skis on fire” and “dependence on enabling machines and devices, not elsewhere classified.”

Meanwhile, hospitals can do their part by training patients to recognize when their healthcare providers are suffering from Epic finger. Patients can “provide appropriate and timely warnings to hospital administrators through critical Press Ganey patient satisfaction scorecards.”

Unfortunately, the prognosis for patients with Epic finger can be poor if it remains untreated. However, if the condition is recognized promptly, treated early, and bundled with time spent in actual patient care, the author believes that this condition can be reversed and perhaps even cured.

To accomplish this result, clinicians need to stand up for themselves, he suggests: “We as a profession need to recognize this condition as an occult manifestation of our own professional malaise,” he writes. “We must heal ourselves to heal others.”

A Look At The Role Of EMRs In Personalized Medicine

Posted on January 19, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

NPR recently published an interesting piece on how some researchers are developing ways to leverage day-to-day medical information as a means of personalizing medical care. This is obviously an important approach – whether or not you take the full-on big data approach drug researchers are – and I found the case studies it cited to be quite interesting.

In one instance cited by the article, researchers at Kaiser Permanente have begun pulling together a dashboard, driven by condition types, which both pulls together past data and provides real-life context.

“Patients are always saying, don’t just give me the averages, tell me what happened to others who look like me and made the same treatment decisions I did,” said Dr. Tracy Lieu, head of Kaiser’s research division, who spoke to NPR. “And tell me not only did they live or die, but tell me what their quality of life was about.”

Dr. Lieu and her fellow researchers can search a database on a term like “pancreatic cancer” and pull up data not only from an individual patient, but also broad information on other patients who were diagnosed with the condition. According to NPR, the search function also lets them sort data by cancer type, stage, patient age and treatment options, which helps researchers like Lieu spot trends and compare outcomes.

Kaiser has also supplemented the traditional clinical data with the results of a nine-question survey, which patients routinely fill out, looking at their perception of their health and emotional status. As the article notes, the ideal situation would be if patients were comfortable filling out longer surveys on a routine basis, but the information Kaiser already collects offers at least some context on how patients reacted to specific treatments, which might help future patients know what to expect from their care.

Another approach cited in the article has been implemented by Geisinger Health System, which is adding genetic data to EMRs. Geisinger has already compiled 50,000 genetic scans, and has set a current goal of 125,000 scans.

According to Dr. David Ledbetter, Geisinger’s chief scientific officer, the project has implications for current patients. “Even though this is primarily a research project, we’re identifying genomic variants that are actually important to people’s health and healthcare today,” he told the broadcaster.

Geisinger is using a form of genetic testing known as exome sequencing, which currently costs a few thousand dollars per patient. But prices for such tests are falling so quickly that they could hit the $300 level this year, which would make it more likely that patients would be willing to pay for their own tests to research their genetic proclivities, which in turn would help enrich databases like Geisinger’s.

“We think as the cost comes down it will be possible to sequence all of the genes of individual patients, store that information in the electronic medical record, and it will guide and individualize and optimize patient care,” Ledbetter told NPR.

As the story points out, we might be getting ahead of ourselves if we all got analyses of our genetic information, as doctors don’t know how to interpret many of the results. But it’s good to see institutions like these getting prepared, and making use of what information they do have in the mean time.

The Digital Health Biography: There’s A New Record In Town

Posted on January 18, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Few of us would argue that using EMRs is not a soul-sucking ordeal for many clinicians. But is there any alternative in sight? Maybe so, according to Robert Graboyes and Dr. Darcy Nikol Bryan, who are touting a new model they’ve named a “digital health biography.”

In a new article published in Real Clear Health, Graboyes, an economist who writes on technology, and Bryan, an OB/GYN, argue that DHBs will be no less than “an essential component of 21st century healthcare.” They then go on to describe the DHB, which has several intriguing features.

Since y’all know what doctors dislike (hate?) about EMRs, I probably don’t need to list the details the pair shares on why they generate such strong feelings. But as they rightly note, EMRs may take away from patient-physician communication, may be unattractively designed and often disrupt physician workflow.

Not only that, they remind us that third parties like insurance companies and healthcare administrators seem to get far more benefits from EMR content than clinicians do. Over time, data analytics efforts may identify factors that improve care, which eventually benefits clinicians, but on a transactional level it’s hard to dispute that many physicians get nothing but aggravation from their systems.

So what makes the DHB model different? Here’s how the authors lay it out:

* Patients own the DHB and data it contains
* Each patient should have only one DHB
* Patient DHBs should incorporate data from all providers, including PCPs, specialists, nurse practitioners, EDs, pharmacists and therapists
* The DHB should incorporate data from wearable telemetry devices like FitBits, insulin pumps and heart monitors
* The DHB should include data entered by patients, including family history, recollections of childhood illness, fears and feelings
* DHB data entry should use natural language rather than structured queries whenever possible
* The DHB should leverage machine learning to extract and organize output specific to specific providers or the patient
* In the DHB model, input and output software are separated into different categories, with vendors competing for both ends separately on functionality and aesthetics
* Common protocols should minimize the difficulty and cost of shifting from one input or output vendor to the other
* The government should not mandate or subsidize any specific vendors or data requirements
* DHB usage should be voluntary, forcing systems to keep proving their worth or risk being dumpted
* Clinical applications shouldn’t be subservient to reimbursement considerations

To summarize, the DHB model calls for a single, patient-controlled, universal record incorporating all available patient health data, including both provider and patient inputs. It differ significantly from existing EMR models in some ways, particularly if it separated data input from output and cut vendors out of the database business.

As described, this model would eliminate the need for separate institutions to own and maintain their own EMRs, which would of course stand existing health IT structures completely on their head. Instead of dumping information into systems owned by providers, the patient would own and control the DHB, perhaps on a server maintained by an independent intermediary.

Unfortunately, it’s hard to imagine a scenario in which providers would be willing to give up control to this great an extent, even if this model was more effective. Still, the article makes some provocative suggestions which are worth discussing. Do you think this approach is viable?

E-Patient Update:  The Virtues, And Failings, Of Doctor-Patient Email

Posted on January 10, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Lately, I’ve been thinking about my experiences with emailing my providers. I’m certainly grateful that this channel is now available, as I’ve used it to manage some important health problems. That being said, there’s also some new challenges to address when reaching out to your clinician.

Some of the important benefits I’ve gotten from emailing my doctors include:

  • Cutting out middlemen: If I want to communicate with my PCP outside of a medical visit, I have to call, wait on hold for the receptionist to answer, then wait for a nurse to find out what I want, who might get back to me if she can track down the doctor. Email communication bypasses the whole bureaucracy, which I love.
  • Quick solutions: If a doctor is at all wired, she may be able to shoot quick responses to basic questions (“Do I need to schedule a follow-up?”) far more quickly than if I’m at the end of a voice-message queue. Of course, the more email she has the longer it may take to respond, but responding to my email is still quicker than a phone conversation in most cases.
  • Messaging during off hours: If I want to communicate with a doctor, but the issue isn’t critical, I can write to them anytime I’d like – even while I’m eating a 3AM snack! I don’t have to wait until office hours, when I’m likely to be juggling other workaday issue and forget to reach out.

But there are also disadvantages to emailing my doctors, and they’re significant:

  • Problems with communication: A few times, I’ve been in situations where emailing doctors created confusion rather than clarifying things. For example, one specialist sent me an email suggesting an appointment slot, and though I never confirmed, he still considered the slot booked (and charged me for missing it)! That was a relatively petty problem, but if there was a similar level of misunderstanding about a clinical matter it could have been much worse.
  • Unclear expectations: If you call a medical practice’s service overnight for help with a serious problem, you can be pretty sure the on-call doc will call back. But when you email a doctor, it’s not clear what you can expect. There’s no formal rule – or even best practices guidelines, as far as I know – governing how quickly doctors should answer emails, what issues they’re willing to tackle via this medium or how they should handle email responses when they’re on vacation or ill (ask a colleague or nurse to monitor their inbox?)
  • Lack of context: In most cases, the email messages I’ve gotten from doctors resemble text messages rather than letters. Sometimes that’s enough, but in other cases I wish I could get more context on, say, why they’re recommending a med or suggesting I get screened at an emergency department.

Without a doubt, being able to email doctors is a good thing. However, I think it will work better for both sides if doctors have tools that help them manage multichannel conversations with patients.

Specifically, I believe doctors need access to a secure messaging portal, one which offers not only a unified inbox but also tools for prioritizing messages, perhaps using AI to identify urgent issues, and automates routine tasks. Ideally, it would identify patients by their name or email address, and pop up a patient status summary for those with urgent concerns — and yes, this would probably require EMR integration, but why not? (Feel free to write me at anne@ziegerhealthcare.com if something like this already exists!)

The last thing we need is for patient emails to become one more cause of physician burnout. So let’s give doctors the tools they need to manage the messaging process effectively and stay connected with patients who need them most. In fact, what if we made the messaging so effective that it saved them time over a voicemail message?

E-Patient Update: All I Want For 2017

Posted on January 6, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Over the past year, I’ve done a lot of kvetching about the ways in which I think my e-relationships with doctors and hospitals have fallen short. I don’t regret doing so, but I think it’s just as important to focus on the future. So without further ado, here’s a list of ways in which providers could improve their digital interactions with me and my fellow patients during the coming year:

  • Have consistent policies and operations: Over time, I’ve found that many providers don’t seem to keep track of what they say about e-services such as portals and telemedicine visits. Others do little to let you know whether, say, doctors respond to email and how long it may take for them to do so. All of this creates patient confusion. This year, please be consistent in what you do and how you do it.
  • Create channels for patient feedback: As you may recall, I recently trashed a practice that didn’t respond to patient complaints about a broken appointment-making function on its site, and noted that all could have been avoided if patient objections had gotten routed to practice administrators sooner. Let’s make sure this doesn’t happen anymore. This year, make sure your patients don’t face this kind of frustration; create formal channels for patient technical feedback and have a process for escalating their concerns quickly.
  • Give us more access: While patients do have access to some data from their medical records, most of the time we still have to jump through onerous hoops if we need a complete record. Given that it’s all digital these days, this is very hard for us to understand, so fix this process. (And by the way, don’t pile on $2.50 per page charges when you produce a digitally-produced patient record; not only is it insulting and predatory, if that fee doesn’t reflect the costs of sharing the record it may be illegal in many states.)
  • Give us more control: Particularly when, like me, you have more than one chronic condition to manage, it gets very tiring to deal with the policies of multiple institutions when you want the big picture. We want more control of our records!  We’ll be much happier (and possibly healthier) if we have ways to compile complete record sets of our own.
  • Take us seriously: The following is not just an e-patient concern, but it still applies. Too often, when I raised a concern (“Why do you say I don’t have an appointment when I made one online?”) I’ve gotten a blank stare or defensive posturing. This year, providers, please take our digital problems as seriously as other any problems we face in interacting with you. We do!

As I look at this list, I think it’s interesting that I have no temptation to suggest one technology or another (though as your faithful scribe I’ve seen many intriguing options). The truth is, I’d submit, that most providers should get their social and operational ducks in a row before they roll out sophisticated patient engagement platforms or roll out major telehealth initiatives. Just make sure everything works, and everybody cares, and you’ll be off to a better start.

The Value Of Pairing Machine Learning With EMRs

Posted on January 5, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

According to Leonard D’Avolio, the healthcare industry has tools at its disposal, known variously as AI, big data, machine learning, data mining and cognitive computing, which can turn the EMR into a platform which supports next-gen value-based care.

Until we drop the fuzzy rhetoric around these tools – which have offered superior predictive performance for two decades, he notes – it’s unlikely we’ll generate full value from using them. But if we take a hard, cold look at the strengths and weaknesses of such approaches, we’ll get further, says D’Avolio, who wrote on this topic recently for The Health Care Blog.

D’Avolio, a PhD who serves as assistant professor at Harvard Medical School, is also CEO and co-founder of AI vendor Cyft, and clearly has a dog in this fight. Still, my instinct is that his points on the pros and cons of machine learning/AI/whatever are reasonable and add to the discussion of EMRs’ future.

According to D’Avolio, some of the benefits of machine learning technologies include:

  • The ability to consider many more data points than traditional risk scoring or rules-based models
  • The fact that machine learning-related approaches don’t require that data be properly formatted or standardized (a big deal given how varied such data inflows are these days)
  • The fact that if you combine machine learning with natural language processing, you can mine free text created by clinicians or case managers to predict which patients may need attention

On the flip side, he notes, this family of technologies comes with a major limitation as well. To date, he points out, such platforms have only been accessible to experts, as interfaces are typically designed for use by specially trained data scientists. As a result, the results of machine learning processes have traditionally been delivered as recommendations, rather than datasets or modules which can be shared around an organization.

While D’Avolio doesn’t say this himself, my guess is that the new world he heralds – in which machine learning, natural language processing and other cutting-edge technologies are common – won’t be arriving for quite some time.

Of course, for healthcare organizations with enough resources, the future is now, and cases like the predictive analytics efforts going on within Paris public hospitals and Geisinger Health System make the point nicely. Clearly, there’s much to be gained in performing advanced, liquidly-flowing analyses of EMR data and related resources. (Geisinger has already seen multiple benefits from its investments, though its data analytics rollout is relatively new.)

On the other hand, independent medical practices, smaller and rural hospitals and ancillary providers may not see much direct impact from these projects for quite a while. So while D’Avolio’s enthusiasm for marrying EMRs and machine learning makes sense, the game is just getting started.

Patients Frustrated By Lack Of Health Data Access

Posted on January 3, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new survey by Surescripts has concluded that patients are unhappy with their access to their healthcare data, and that they’d like to see the way in which their data is stored and shared change substantially.  Due to Surescripts’ focus on medication information management, many of the questions focus on meds, but the responses clearly reflect broader trends in health data sharing.

According to the 2016 Connected Care and the Patient Experience report, which drew on a survey of 1,000 Americans, most patients believe that their medical information should be stored electronically and shared in one central location. This, of course, flies in the face of current industry interoperability models, which largely focus on uniting countless distributed information sources.

Ninety-eight percent of respondents said that they felt that someone should have complete access to their medical records, though they don’t seem to have specified whom they’d prefer to play this role. They’re so concerned about having a complete medical record that 58% have attempted to compile their own medical history, Surescripts found.

Part of the reason they’re eager to see someone have full access to their health records is that it would make their care more efficient. For example, 93% said they felt doctors would save time if their patients’ medication history was in one location.

They’re also sick of retelling stories that could be found easily in a complete medical record, which is not too surprising given that they spend an average of 8 minutes on paperwork plus 8 minutes verbally sharing their medical history per doctor’s visit. To put this in perspective, 54% said that that renewing a driver’s license takes less work, 37% said opening a bank account was easier, and 32% said applying for a marriage license was simpler.

The respondents seemed very aware that improved data access would protect them, as well. Nine out of ten patients felt that their doctor would be less likely to prescribe the wrong medication if they had a more complete set of information. In fact, 90% of respondents said that they felt their lives could be endangered if their doctors don’t have access to their complete medication history.

Meanwhile, patients also seem more willing than ever to share their medical history. Researchers found that 77% will share physical information, 69% will share insurance information and 51% mental health information. I don’t have a comparable set of numbers to back this up, but my guess is that these are much higher levels than we’ve seen in the past.

On a separate note, the study noted that 52% of patients expect doctors to offer remote visits, and 36% believe that most doctor’s appointments will be remote in the next 10 years. Clearly, patients are demanding not just data access, but convenience.

E-Patient Update:  When Your Tech Fails, Own It!

Posted on December 30, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I am reasonably comfortable with my primary care practice which, though not exactly chi-chi – no latte machine in the lobby! — does a reasonably good job with the basics of scheduling, payment, referrals and the like.  And I also like that my PCP is part of a multispecialty group linked together by an athenahealth EMR and portal, which makes it easier to coordinate my care.

But recently, I’ve run into some technical problems with the practice portal, repeatedly and inconveniently. And rather than take action, apologize or even acknowledge the problem on an executive level, the group appears to be doing nothing whatsoever to address the issue.

The issue I’m having is that while the portal is supposed to let you schedule appointments online, my last two didn’t show up in the group’s live schedule. This may not sound like a big deal, but it is. One of the appointments was to see a neurologist for help with blinding migraines, and trying to attend the non-existent meeting was a nightmare.

Because I needed my neurologist, I scraped myself out of bed, put on an eye mask to avoid extra light exposure – migraine makes you terribly light-sensitive – and had my husband guide me to the car. But when I walked into the lobby (peeking out from under the mask to avoid crashing into things) I was told that they had nothing for me on the schedule.

Almost crying at this point, and with migraine-induced tears streaming down my cheeks, I begged them to squeeze me in, but they refused. To add insult to injury, they all but told me that it must have been my fault that the appointment booking didn’t take. There was no “I’m sorry this happened” whatsoever, nor any suggestion that their technology might be glitchy. If I hadn’t been so sick I might have gotten into a screaming match with the supercilious receptionist, but given my condition I just slinked away and went back to bed.

I’ve since learned, from a much nicer clerk at the affiliated primary care practice, that the group has been getting scores of calls from similarly aggrieved patients whose time had been wasted – and health needs unmet. “Tell the doctor, so she can tell the practice management committee,” she told me. “This is happening all the time.”

Of course, because I write about health IT, I realize that practice leaders may be struggling with issues that defy an easy fix, but I’m still disappointed with their failure to respond publicly. There are many steps they could have taken, including:

* Putting a warning on their practice website, and (if possible) the portal that the scheduling function has issues and to double-check that their appointment registered
* Disabling the scheduling function entirely until they’re reasonably certain it works
* Putting a sign in on the practice’s front desk alerting patients about the problem
* Updating the practice’s “hold” message with an advisory

And that’s just what came to mind immediately. They could do postcards, email messages, letters, robocalls…I don’t care if they drive around town with a guy who shouts the message into a megaphone. I just want expect them to take responsibility and treat my time and health with respect. Sure, tech will go south, but if it does, own it! There’s no excuse for ignoring problems like these.

Healthcare Trade Groups Join To Evaluate mHealth Apps

Posted on December 29, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A group of leading healthcare organizations, including HIMSS, the American Medical Association, the American Heart Association and DHX Group, have come together to evaluate mHealth apps. The new organization, which calls itself Xcertia, says members came together to foster knowledge about clinical content, usability, privacy, security and evidence of efficacy for such apps.

It’s hardly surprising that that healthcare groups would want to take a stand on the issue of health app quality. According to a study published late last year by the IMS Institute for Healthcare Informatics, there are at least 165,000 mHealth apps available on the iTunes and Android stores.

But what percentage of those apps are worth using? Nobody really knows. It’s hard to tell after casual use which apps are useful and which don’t live up to their hype, which protect patient privacy and which leave data open to prying eyes, and particularly, which offer some form of clinical benefit and which just waste people’s time. And without a set of formal standards by which to judge, it’s very hard to compare one with the other in a meaningful way.

This uncertainty is holding back mHealth adoption by doctors. According to a recent survey by the AMA, physicians are interested in using apps and related tools – in fact, 85% told researches that digital health solutions can have a positive impact on patient care – they’re also reluctant to “prescribe” apps until they understand them better. (There’s also a group of doctors I’ve encountered who say that until mobile apps are FDA-approved, they won’t take them seriously, but that may be another story.)

In late November, attendees at a recent AMA meeting moved the mHealth puck up the ice a little bit, adopting a set of proposed set best principles for mobile health design. The criteria they adopted for mobile apps and devices included that they should follow evidence-based practice guidelines, support data portability and interoperability, and have a clinical evidence base to support their use. But these guidelines are hardly specific enough to help doctors decide which apps to adopt.

So far, all Xcertia is willing to say about its plans is that it plans to develop a framework of principles that will “positively impact the trajectory of the mobile health app industry.” The guidelines should help both consumers and clinicians choose mHealth apps, the group reports.

Let’s hope those guidelines are less ho-hum than those coming out of the AMA meeting – after all, it certainly would be good if developers and providers had concrete standards upon which they could base their app efforts.

Rival Interoperability Groups Connect To Share Health Data

Posted on December 27, 2016 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Two formerly competitive health data interoperability groups have agreed to work together to share data with each others’ members. CommonWell Health Alliance, which made waves when it included Cerner but not Epic in its membership, has agreed to share data with Carequality, of which Epic is a part. (Of course, Epic said that it chose not to participate in the former group, but let’s not get off track with inside baseball here!)

Anyway, CommonWell was founded in early 2013 by a group of six health IT vendors (Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth.) Carequality, for its part, launched in January of this year, with Epic, eClinicalWorks, NextGen Healthcare and Surescripts on board.

Under the terms of the deal, the two will shake hands and play nicely together. The effort will seemingly be assisted by The Sequoia Project, the nonprofit parent under which Carequality operates.

The Sequoia Project brings plenty of experience to the table, as it operates eHealth Exchange, a national health information network. Its members include the AMA, Kaiser Permanente, CVS’s Minute Clinic, Walgreens and Surescripts, while CommonWell is largely vendor-focused.

As things stand, CommonWell runs a health data sharing network allowing for cross-vendor nationwide data exchange. Its services include patient ID management, record location and query/retrieve broker services which enable providers to locate multiple records for patient using a single query.

Carequality, for its part, offers a framework which supports interoperability between health data sharing network and service providers. Its members include payer networks, vendor networks, ACOs, personal health record and consumer services.

Going forward, CommonWell will allow its subscribers to share health information through directed queries with any Carequality participant.  Meanwhile, Carequality will create a version of the CommonWell record locator service and make it available to any of its providers.

Once the record-sharing agreement is fully implemented, it should have wide ranging effects. According to The Sequoia Project, CommonWell and Carequality participants cut across more than 90% of the acute EHR market, and nearly 60% of the ambulatory EHR market. Over 15,000 hospitals clinics and other healthcare providers are actively using the Carequality framework or CommonWell network.

But as with any interoperability project, the devil will be in the details. While cross-group cooperation sounds good, my guess is that it will take quite a while for both groups to roll out production versions of their new data sharing technologies.

It’s hard for me to imagine any scenario in which the two won’t engage in some internecine sniping over how to get this done. After all, people have a psychological investment in their chosen interoperability approach – so I’d be astonished if the two teams don’t have, let’s say, heated discussions over how to resolve their technical differences. After all, it’s human factors like these which always seem to slow other worthy efforts.

Still, on the whole I’d say that if it works, this deal is good for health IT. More cooperation is definitely better than less.