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Karen DeSalvo Remains as National Coordinator of ONC Along with New Position

Posted on October 31, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

In case you missed it, last week it was announced that Karen DeSalvo had been appointed Assistant Secretary of Health focused on Ebola by HHS Secretary Burwell. In that same announcement Jacob Reider also announced his departure from ONC.

While the news was true that DeSalvo was taking on a new role at HHS as Assistant Secretary of Health, ONC also published a blog post that DeSalvo would stay on as National Coordinator of Health IT as well:

Dr. DeSalvo will serve as Acting ASH while maintaining her leadership of ONC. Importantly, she will continue to work on high level policy issues at ONC, and ONC will follow the policy direction that she has set. She will remain the chair of the Health IT Policy Committee; she will continue to lead on the development and finalization of the Interoperability Roadmap; and she will remain involved in meaningful use policymaking. She will also continue to co-chair the HHS cross-departmental work on delivery system reform.

Lisa Lewis will provide day to day leadership at ONC. Lewis served as Acting Principal Deputy National Coordinator before Dr. DeSalvo joined ONC, so she has had experience with all parts of our work. She will lead our extremely talented and very strong team during Dr. DeSalvo’s deployment to the Office of the Assistant Secretary for Health.

But most importantly, the team that is ONC is far more than one or two leaders. The team of ONC is personified in each and every individual – all part of a steady ship and a strong and important part of HHS’ path toward delivery system reform and overall health improvement.

Seems like an awkward arrangement if you ask me. DeSalvo will be providing high level leadership on policy direction, but Lisa Lewis will handle the day to day leadership. That job description for DeSalvo sounds like something an Assistant Secretary of Health might do and Lisa Lewis’ job sounds like something the National Coordinator would do.

I’m sure there’s more to this story. Maybe moving DeSalvo to Assistant Secretary was a way for ONC to save money and keep DeSalvo on board working on healthcare IT. If ONC’s budget gets cut, then HHS still has a way to pay for DeSalvo. Maybe that’s why Lisa Lewis can’t be promoted to full National Coordinator. Then again, maybe it’s like I mentioned when we first heard the DeSalvo news, DeSalvo is more of a public health person than she is a healthcare IT person.

The fact that DeSalvo is remaining as National Coordinator is interesting. However, I just came back from CHIME (healthcare CIO conference) where DeSalvo was scheduled as one of the plenary session speakers. However, she didn’t show and so the whole session was cancelled. I guess you could make the case that she’s got Ebola to deal with right now, but it also illustrates how health IT will be playing second fiddle for her going forward. Likely says something about the future of ONC.

Connected Health takes the stage at Partners symposium

Posted on October 28, 2014 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://radar.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 Connected Health Symposium is not one of the larger health conferences, but it is one of the most respected. I met a number of leaders in health IT there who praised it for the conference scope and seriousness, and told me they were glad to see me there covering it.

Many issues in health IT and patient empowerment, however, are best learned not from any conference, but from the tussles and tears of everyday life. Let us hope no reader has undergone the personal experience of having her reports dismissed and of being misdiagnosed, as did several speakers at the conference.

But many of us have spent three hours on the phone with an insurer to approve a single medication shipment, or fought in vain to get the medical records that US law requires providers to give us, or watched our doctor fumble with his new EHR for fifteen minutes while trying to stay engaged with us.

It’s encouraging to see the progress of patient engagement at Massachusetts General Hospital, as reported by Gregg Meyer of Partners Healthcare System (the funder behind the Center for Connected Health that put on the symposium). But can small and rural providers struggling with cash flow join the movement?

These institutions would be comfortable using swyMe, a HIPAA-compliant telemedicine system that allows doctors to interview patients over everyday mobile devices and perhaps avoid a trip to the hospital. swyMe can also transmit audio and video from devices that EMTs can connect up to the phone. (Not many devices with the necessary hardware connectors are on the market, though.)

swyMe was one of the “innovators” highlighted in a conference demo. Jeffrey Urdan, COO of the company that makes it, told me later that he felt “low tech” compared to some of the fancy, expensive devices at the demo. But most of the providers in the US, and elsewhere, are more on swyMe’s level than theirs.

Another hurdle to forming connected teams that serve the patient is interoperability. A sign of the distance we have yet to come can be found in iCancerHealth, a service for cancer patients offered by Medocity. A free app is available to individuals, but the main integrated service is offered through providers or pharma companies doing clinical trials. The service includes such conveniences as medication tracking, treatment plans, a diary, audio and video connections to their physician, and even a way to form communities with other patients.

This is great, but iCancerHealth works with data from only one provider. This can be a limitation even for the few months that cancer patients typically use the service, and could certainly be a problem if the service were expanded to a broader range of illnesses. Similarly, there’s no seamless way to share data with patient communities; it has to be re-entered manually. Enhancing the service to encompass multiple providers would probably require wider adoption of electronic health record standards.

As an example of finding a creative solution to devices that lack interoperability, Mobile Diagnostic Services demonstrated an app that could photograph the display panel of a device, interpret the bars on the display to create digital data, and transmit the values to a health record in the cloud. This is a process well-known to computer programmers from thirty years ago as “screen scraping,” now relevant to the health industry.

One of the strengths of the Connected Health Symposium was the platform it gave to patients and doctors to express their frustrations with the old way of delivering care and the slow pace of change. The testimony could come from entrepreneur Robin Farmanfarmaian, who lost three organs unnecessarily to misdiagnosis, or Sarah Krüg, president of the Society for Participatory Medicine, whose parents died from diseases that might have been caught if the doctors had paid attention to their reported symptoms.

Or the testimony could come from Greg LaGana and Barry Levy, MDs who write and perform in a musical review called Damaged Care that skewers everything about doctors behavior as well as the legal and financial environment in which they have to operate.

Anna MCollister-Slipp, co-founder of Galileo Analytics and a sufferer from type 1 diabetes, regaled us with the dozens of vital sign measurements, treatments, and other details she has to manage on her own manually. She still get lab reports only because her doctor sends them via email (using a private account, so that HIPAA zealots don’t discipline him–the rights and wishes of the patient are supposed to be paramount). Like other conference attendees, though, she reported progress in tools and patient-oriented culture.

Less was heard at the symposium from other sectors of the medical field, but we did hear from Michael of Aetna, Jonathan Bush of athenahealth, and Beverley Bryant of England’s National Health Service. The panel on which Bryant spoke proved to be discouraging. Many of us in the US like to think that other developed nations with their universal health care systems have solved the coordination and interoperability messes that the US is in. But the panelists expressed many familiar frustrations.

I plan to return to the Connected Health Symposium next year, and I’m sure each year will bring a bit of progress toward better communication among staff, better use of patient data, and better integration of tools. The mood at the show was largely positive. But a little probing turned up barriers in the way of the healthcare system we all want.

#MGMA14 Twitter Roundup

Posted on October 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 spending the past couple days at the MGMA Annual conference in Las Vegas. It’s been interesting to talk to many of the leaders in healthcare. There seems to be a lot of confusion and uncertainty in the air. In fact, that seems to be the case at all the healthcare conferences I’m attending lately. While the industry is going through a turbulent period, it’s still been interesting to see the ongoing evolution that’s happening.

The Twitter stream has been a little disappointing to me. I’d like to see more attendees tweeting content. The vendors are extremely active. However, I found a few tweets which highlight a few of the topics being discussed.


I’m always amazed with how many people want their EHR to be connected. If it being connected was so valued by end users, then why hasn’t it happened? There’s still a misalignment of incentives that needs to be solved.


Lots of these ideas floating around. Everyone agrees that the move to some sort of quality based reimbursement is coming. We’re going to see a lot more discussions like the one above. Unfortunately, right now it’s a lot of speculation.


I wasn’t able to make this session, but it certainly brings up some interesting questions. We’ve written a number of times before about the value of a practice with and without an EHR. This certainly seems to call into question whether a practice without EHR is worth saving. This is going to become a really interesting topic as more doctors who’ve never used EHR in their practice decide to retire.

Meaningful Use #HITsm Twitter Chat

Posted on October 17, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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 had the honor today to host the #HITsm Twitter chat. For those not familiar with the #HITsm chat, you just join every Friday at Noon ET and watch the tweets that are sent using the #HITsm hashtag. There are usually 4-5 questions that are discussed over the hour chat. Since I was the host, I created the questions this week. I chose to focus the chat on the latest happenings with meaningful use. The transcript of the chat is found here.

I just took a look at the stats for the chat on Symplur and saw that the chat had 68 participants that sent out 474 tweets which had 3,196,079 impressions. You have to be a little careful looking at impressions since that’s potential impressions, but it’s still interesting to consider the possible reach of a chat.

There were some really interesting tweets during the chat, so here are the questions and a few (ok, more than a few since I got carried away) of my favorite tweets: Read more..

Will EHR Vendors Become Service and Consulting Companies?

Posted on October 14, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

This is the topic of a really interesting LinkedIn discussion: Will EHR Vendors Become Service and Consulting Companies?

I think this is a really great question and one that’s worthy of serious consideration. I think we’ve seen this happen time and time again in the IT industry. Some of the best examples are IBM, HP, and Dell. As their IT hardware and software becomes a “commodity” then they leverage their relationships and domain expertise to change into a service and consulting company. Usually this also involves them spending their extra cash to acquire the leading consulting company (or companies) in the industry as well.

In some ways we’re already seeing this happen. Epic announced a consulting division of their company in order to retain their senior staff. Cerner’s always made a good chunk of their money from consulting services.

Of course, thanks to meaningful use incentive money and some still massive upgrade costs, EHR vendors haven’t needed to shift their business model to a service and consulting model yet. There’s still plenty of money to be made just selling the software, training, etc.

What will also be interesting to watch is whether the large service and consulting companies like Accenture, IBM, HP, Dell, etc. will eat up the market share so that the EHR companies don’t have as much of an opportunity to grow a service and consulting business. No doubt it will be a big dog fight. Not to mention many of the current EHR consulting companies (although, you could see many of these getting acquired by the EHR vendors).

I guess my short answer to this question is: In the short term, we’re not likely to see a massive shift towards services and consulting, but long term it’s very likely to happen. What are your thoughts?

Open Standards Advance in Health Care Through the Appeal of FHIR and SMART

Posted on October 13, 2014 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://radar.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 poor state of interoperability between EHRs–target of fulminations and curses from health care activists over the years–is starting to grind its way forward. Dr. Kenneth Mandl, a leader of the SMART Platform and professor at the Boston Children’s Hospital Informatics Program, found that out when his team, including lead architect Josh Mandel, went to HIMSS this year to support Cerner’s implementation of his standard, and discovered three other vendors running it.

That’s the beauty of open source and standards. Put them out there and anyone can use them without a by-your-leave. Standards can diffuse in ways the original developers never anticipated.

A bit of background. The SMART platform, which I covered a few years ago, was developed by Mandl’s team at Harvard Medical School and Children’s Hospital to solve the festering problem of inaccessibility in EHRs and other health care software. SMART fulfilled the long-time vision of open source advocates to provide a common platform for every vendor that chose to support it, and that would allow third-party developers to create useful applications.

Without a standard, third-party developers were in limbo. They had to write special code to support each EHR they want to run on. Worse still, they may have to ask the EHR vendor for permission to connect. This has been stunting the market for apps expanding the use of patient data by clinicians as well as the patients themselves.

SMART’s prospects have been energized by the creation of a modern interoperability resource called FHIR. It breaks with the traditional health care standards by being lean, extendible in controllable ways, and in tune with modern development standards such as REST and JSON.

It helps that SMART was supported by funds from the ONC, and that FHIR was adopted by the leading health care standards group, HL7. HL7’s backing of FHIR in particular lent these standards authority among the vendor and health care provider community. Now the chocolate and peanut butter favored by health IT advocates have come together in the SMART on FHIR project, which I wrote about earlier this year.

Mandl explains that SMART allows innovators to get access to the point of care. As more organizations and products adopt the SMART on FHIR, API, a SMART app written once will run anywhere.

Vendors have been coming to FHIR meetings and expressing approval in the abstract for these standards. But it was still a pleasant surprise for Mandl to hear of SMART implementations demo’d at HIMSS by Intermountain, Hewlett-Packard, and Harris as well as Cerner.

The SMART project has just released guidlines for health care providers who want to issue RFPs soliciting vendors for SMART implementations. This will help ensure that providers get what they ask and pay for: an API that reliably runs any app written for SMART.

It’s wise to be cautious and very specific when soliciting products based on standards. The notion of “openness” is often misunderstood and taken to places it wasn’t meant to go. In health care, one major vendor can trumpet its “openness” while picking and choosing which vendors to allow use of its API, and charging money for every document transferred.

The slipperiness of the “open” concept is not limited to health IT. For years, Microsoft promulgated an “open source” initiative while keeping to the old proprietary practices of exerting patent rights and restricting who had access to code. Currently they have made great progress and are a major contributor to Linux and other projects, including tools used with their HealthVault PHR.

Google, too, although a major supporter of open source projects, plays games with its Android platform. The code is nominally under an open license–and is being exploited by numerous embedded systems developers that way–but is developed in anything but an open manner at Google, and is hedged by so many requirements that it’s hard to release a product with the Android moniker unless one partners closely with Google.

After talking to Mandl, I had a phone interview with Stan Huff, Chief Informatics Officer for Intermountain. Huff is an expert in interoperability and active in HL7. About a year ago he led an effort at Intermountain to improve interoperability. The motivation was not some ethereal vision of openness but the realization that Intermountain couldn’t do everything it needed to be competitive on its own–it would have to seek out the contributions of outsiders.

When Intermountain partnered with Cerner, senior management had by that time received a good education in the value of a standard API. Cerner was also committed to it, luckily, and the two companies collaborated on FHIR and SMART. Cerner’s task was to wrap their services in a FHIR-compliant API and to make sure to use standard technology, such as in codes for lab data.

Intermountain also participated in launching a not-for-profit corporation, the Healthcare Services Platform Consortium, that promotes SMART-on-FHIR and other standards. A lot of vendors have joined up, and Huff encourages other vendors to give up their fears that standardization is a catheter siphoning away business and to try the consortium out.

Intermountain currently is offering several applications that run in web browsers (and therefore should be widely usable on different platforms). Although currently in the prototype stage, the applications should be available later this year. Besides an application developed by Intermountain to monitor hemolytic disease among neonates and suggest paths for doctors to take, they support several demonstration apps produced by the SMART project, including a growth chart app, a blood pressure management app, and a cardiovascular app.

Huff reports that apps are easy to build on SMART. In at least one case, it took just two weeks for the coding.

Attendees at HIMSS were very excited about Intermountain’s support for SMART. The health care providers want more flexible and innovative software with good user interfaces, and see SMART providing that. Many vendors look to replicate what Intermountain has done (although some hold back). Understanding that progress is possible can empower doctors and advocates to call for more.

Is EHR on Life Support? Short Answer…No

Posted on October 10, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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, David Swink sent me a link to an article from the Washington Examiner and this quote from the article:

“A revolt is brewing among doctors and hospital administrators over electronic medical records systems mandated by one of President Obama’s early health care reforms.”

“The American Medical Association called for a “design overhaul” of the entire electronic health records system in September because, said AMA president-elect Steven Stack, electronic records “fail to support efficient and effective clinical work.”

It seems like there have been a wave of articles similar to this coming out in the national media. For some reason the national media only likes to report on things when “the sky is falling.” It’s kind of a ridiculous report though.

What’s not ridiculous is that many doctors are dissatisfied with their EHR software. That is something that is real and many are extremely frustrated with it and many of the EHR regulations that require a lot of extra work by them. Does that mean that we’re going to see an EHR “design overhaul” or that the doctors are going to revolt against EHRs and stop using them?

My answer (as the headline alludes) is that it’s not going to happen. Certainly we’re going to see some EHR switching over the next few years. In fact, we might see a lot of EHR switching. However, we’re not going to see a mass of people revolting against EHR and going back to paper. That would be a true revolt and it’s just not going to happen. Like it or not, EHR is the go forward technology that will be used by healthcare to document healthcare.

Meaningful use on the other hand is a different story. I do think that meaningful use is on life support. If the congress can somehow get the Flex-IT Act to pass, then we can take meaningful use off life support, but I’m still not planning to discharge MU from the hospital. The program has some serious health issues.

On a more optimistic note, I’m really excited to see what doctors and hospitals start doing with the data stored in EHR. Is it everything we want it to be? No, but I believe we’re still going to see a lot of good come from EHR software now that EHR’s are implemented and we’ve largely got MU behind us.

Ebola Lapse in Dallas Offers Few Lessons, Except About Our Over-reliance on Technology

Posted on October 8, 2014 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://radar.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.

Of all the EHR problems encountered daily across the country, the only one to hit the major news outlets was a non-story about a missed Ebola diagnosis in Dallas, Texas. Before being retracted, the hospital’s claim of an Epic failure launched a slew of commentary in the health IT field. These swirled through my head last night as I tried to find a lesson in the incident.

The facts seem to be as follows. A 42-year-old man named Thomas Eric Duncan arrived from Liberia and checked in to the emergency room at Texas Health Presbyterian Hospital Dallas complaining of symptoms consistent with an Ebola diagnosis. He told the admitting nurse he had come from Liberia, and the nurse entered the data into the Epic EHR.

The purpose of recording the patient’s travel history, however, seemed to be simply to determine the need for immunizations, so the EHR kept it within a nurse’s section of the data (which the hospital called a “workflow”) and did not display it to the doctor. The doctor sent Duncan home, where he came into contact with about 100 people who were potentially infected. His symptoms worsened and he returned to the hospital two days later, where he was finally diagnosed correctly and admitted.

Late night musing #1: If Texas Health Presbyterian Hospital Dallas can’t diagnose a case of Ebola, why do they think they can treat one? The hospital has won numerous awards, including one for patient safety–I guess you’re safe once you’re admitted.

Meanwhile, the city of Dallas waited several extra days to clean up infected sheets and other belongings from the Duncan home. In Africa, such detritis are recognized as a major source of new Ebola infections.

Late night musing #2: Does this reflect the competence of public health officials in this country? Maybe we should turn the job over to the Secret Service.

It’s really a shame that the national press jumped on the hospital’s announcement that the EHR was the source of the problem. Commenters criticized the hospital right away, asking why the nurse didn’t simply tell the doctor, and why the doctor didn’t ask on his own.

Finally, the hospital backed off from blaming Epic, thus making the hospital look even stupider and more guilty than it already appeared. Nevertheless, EHRs at some hospitals may be designed to flag warning signals.

Clearly, there are many layers to this health care failure. I don’t blame the nurse, or even the doctor. ERs are always busy, and the nurse might never have known who would see the patient or even be in the ER when the doctor finally saw him.

But I do find a small lesson in the brief appearance of the EHR as a pivotal character in the story. The nurse thought he or she was doing their job just by entering the data into the EHR, and the doctor thought he was doing his job by reading it. The EHR had loomed as a magical solution to health care workflow–in the minds of hospital administrators, if not the ER staff.

Maybe if the nurse knew that the travel history was for the purpose of immunizations, he or she would not have relied on the EHR to use that information for diagnosis. Besides showing the need for training, some of my colleagues suggest that this problem calls for FDA regulation of EHR interfaces. They also suggest that systems use good user interface design to highlight important information (which would require a definition of what’s “important”) or at least allow searches for critical elements of the record.

Late night musing #3: Behind this also lies the mindlessness of much data collected by EHRs. I’m sure the nurse knew whether the unfortunate Mr. Duncan was a smoker and whether he suffered from depression, because regulations require these things to be recorded. Travel history became just another one of these automatic requirements to be tossed into the EHR and forgotten.

My story also concerns the musings of other health IT commentators, who suggested that EHRs be better integrated into “workflows”–as if every clinician follows a mechanical path of treatment and the EHR can figure out what it is.

Another thoughtful posting calls for integrating infectious diseaess into clinical decision support. But as my colleague Sandra Raup (R.D., J.D., M.P.H.) points out, CDS depends on a long history of clinical data collection. One can’t instantly add a new disease.

It might have been useful for some international health organization to realize, when the Ebola outbreak began to spread, that it would eventually break out of central Africa, and then to provide an app to hospitals around the world for checking symptoms and travel history. There is certainly a creative role for health IT to play.

I think the messiness of the Texas Health Presbyterian Hospital Dallas story shows why EHR failures, numerous as they are, don’t get reported in the press. There are just too many complicating factors. The EHR is partly configured by the clinic’s staff, who thereby become responsible for some of its decisions. The EHR failure usually comes when the staff is under stress, when they have communication problems, when the patient’s condition is rare. Ascribing blame becomes a tangled mess; one must start designing systems with multiple, redundant points to catch failures that can fall through the cracks.

So one level, this is just another sad story of humanity’s tendency to trust too much in its technology, a story that ranges from the flight of Icarus to the sail of the Titanic and the failure of the Fukushima Daiichi nuclear power plant. On other, it’s a familiar story of a systemic problem leading to what’s sometimes called a “normal failure.” Not much new to learn, but lots of work to do. Clinicians have to evaluate EHRs and know how the data is used, a more open system in all directions.

Should Healthcare Institutes Perform “Rip-and-Replace” to Achieve Interoperability? Less Disruption, Please!

Posted on October 7, 2014 I Written By

The following is a guest blog post by Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Dr Voltz
A KLAS Research Report on the EMR buying trends of 277 hospitals with at least 200 beds has identified that almost half will be making a new EMR purchase by 2016.  Of the providers considering a change, 34 percent have already selected a vendor and another 44 percent are strongly leaning toward a specific vendor. Driving factors include concerns over outdated technology and health system consolidation.

But is the technology really outdated and health system consolidation necessary, or is the real issue lack of interoperability?  And if you are a hospital looking for a new EMR, let’s not forget the history of technology before we jump to conclusions that the greatest market share means the best of breed.

When we look at EMR adoption over the past number of years, we need to be careful with the data we use. Implementations, and now rip and replace switching to other venders, has been the only choice offices, clinics, hospitals and health systems had to address the issues with interoperability.

Most of current deployed EMRs are designed as a one-size-fits-all, leading to the situation where today out-of-the-box functionalities fit none of the care providers’ requirements. Besides that, EMR vendors have been designed with proprietary data where patient medical sharing (or exchange) becomes the biggest roadblock for patient care continuum. The reason for the rip-and-replace approach by some hospitals is to reach interoperability between inpatient and outpatient data with a single integrated and consolidated database approach.

A 50 percent turnover of EMRs is an incredibly high numbers of hospitals and clinics who have either replaced or are looking to replace their current EHR’s. Being that the majority of the initial implementations were supported by the HITECH act, one would think the government would raise issue with vendors to address this high turnover of EHR’s. There seems to be a general misperception that if our current systems do not meet the demands and needs of providers, administrators, and financial arms of a healthcare delivery system, ripping out the system and implementing a new one will solve the issues.

What is the True Total Cost of Ownership of an EMR?

Healthcare management must look beyond the actual cost paid to an EHR vendor as the only cost but they must look into the total cost, much beyond the normal Total Cost of Ownership (TCO). TCO only includes the initial license cost, maintenance cost, IT support cost, but in healthcare, there is another cost – it is the disruption of the care providers’ workflow. That disruption is directly correlated to healthcare system revenue and patient care outcomes.

Stop this disruption and let’s look for another solution where we integrate disparate systems since many of them are built upon databases that can address the needs of health. The cost to providers in time to learn a new system, the migration and loss of patient data that has been collected in the current systems, the capital expense of system software, the hardware, trainers, IT personnel, etc. all add to the burden, something that is currently being looked at as a necessary expense.

Interoperability Saves Resources

This need not be the case when platforms exist to connect systems and improve access for providers. Having a consistent display of data allows for more efficient and effective management of patients and when coupled with a robust collaborative platform, we close many of the open loopholes that exist in medicine today, even with EHR’s.

2.0 EMR connectors like Zoeticx and others have taken the medical information bus, middleware platform, to solve the challenges that current EHR’s have not.  This connection of systems and uniform display of information that physicians depend on for the management of patients is crucial if hospitals want their new EMRs to succeed. In addition, a middleware platform allows for patients to access their medical information between EMR’s in a single institution or across institutions, a major issue for Meaningful Use.

Fragmentation Prevents Some EMRs From Connecting With Their Own Software

Large EMR vendors’ lack of healthcare interoperability only reflects on how they compete against each other. Patient medical data and its proprietary structure is the tool for such competition where the outcome would not be necessarily beneficial for the hospital, medical professionals or patients. There are plenty of examples where healthcare facilities with EHRs even from the same vendor fail to interoperate with each other.

Such symptoms have little to do with the EMRs that have the same data structure, but about the fragmentation being put in place over the years of customization. We believe that the reason for this is to address fragmentation of the software product. Fragmentation is a case where deployments from the same software products have gone through significant amounts of customization, leading to its divergence from the product baseline.

To believe that ripping the whole infrastructure – inpatient and outpatient–as the method to reach interoperability would only cause a lot of disruption, yet the outcome would be very questionable down the road. Appreciating the backlash of calling the implementation of EMR’s a beta-release, we have much data to use in looking for the next solution to HIT.

As with much of medicine, we are constantly looking for the best way to take care of our patients. Like it or not, EMR’s have become a medical device and we need to start to evaluate them as we would any device used to manage health and disease. As we move forward, there will be an expansion in the openness of patient data, and in my prediction, a migration away from a single EHR solution to all of the requirements of healthcare, and into a system of interconnected applications and databases.

Once again, we have learned that massively engineered systems do not evolve into complex adaptive systems to respond to changing environmental pressures. Simple, interrelated and interdependent applications are more fluid and readily adaptable to the constantly changing healthcare environment. Currently, the only buffer for the stresses and changes to the healthcare system are the patients and the providers who depend on these systems to manage healthcare.

About Dr. Donald Voltz
By Dr. Donald Voltz, MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.  A board-certified anesthesiologist, researcher, medical educator, and entrepreneur. With more than 15 years of experience in healthcare, Dr. Voltz has been involved with many facets of medicine. He has performed basic science and clinical research and has experience in the translation of ideas into viable medical systems and devices.

Health IT Thought Leadership

Posted on October 3, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 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.

One of the big trends I see happening in the Health IT world is that every company wants to be a thought leader in the industry. It’s a powerful thing to provide thought leadership to your potential customers. It can also be an extremely challenging thing for an organization to sell that type of investment to their executive leadership team.

With that in mind, we’ve been working on some really compelling thought leadership marketing packages for health IT companies. It’s literally a fully integrated marketing package which integrates with our existing readership, email marketing, social media mentions (Twitter, LinkedIn, Facebook, Google Plus, etc), and ongoing traffic from search engines and related posts. Plus, you can use that thought leadership content in your own marketing efforts.

You can see some of the companies who’ve been sponsoring content on our network of Healthcare IT blogs. Barry Haitoff from Medical Management Corporation of America has been doing a series of posts focused on ways ambulatory practices can improve revenue. The Breakaway Group has sponsored a series of posts called Breakaway Thinking which focuses on ways to really improve what we’re doing in healthcare and break away from the competition. Vishal Gandhi from ClinicSpectrum has done an amazing job with the Cost Effective Healthcare Workflow Series. I love the way Vishal merges both technology and people into the optimal workflow.

I love the win win that these sponsored series provide. They allow us to keep the lights on here at Healthcare Scene, while still meeting our primary goal of providing value to the readers. We’d love for you to Contact Us if you’re interested in sponsoring your own series of blog posts.

Along with the sponsored series, we’re also extremely grateful for the various advertisers that have supported the site as well. Here are a few of the advertisers that have renewed their ad recently. Take a look at them and see if one of them could help you in your job.

Ambir (Advertiser since 1/2010) – I appreciate Ambir since they’ve been a sponsor for so long. I have one of their scanners on my desk and it’s worked great for me. Plus, they’re working on some really interesting workflow iPad applications that are really exciting too. Check them out to see what they’re working on.

Digital Health Conference (Advertiser since 7/2011) – This is the 4th year the Digital Health Conference, organized by NYeC, has advertised with us to promote there event in November. I’ll be at the event (see my full Fall HIT Conference schedule), so let me know if you plan to attend. Plus, you can get 20% off your registration if you use the discount code: HCS. Hopefully I’ll get to see many of you readers at the event.

Cerner (Advertiser since 9/2011) – Another great long term supporter of the site. Cerner Ambulatory EHR really needs no introduction. If you’re looking for an EHR, check them out. Their iPad application still had the coolest EHR iPad application feature I’ve seen: one swipe prescription refill.

gMed (Advertiser since 8/2013) – I had a really great chance this summer to get to know gMed on a much deeper level when they invited me to give the Keynote on the future of EHR at their EHR user conference. They certainly do make a compelling case for their Gastro specific EHR software. There are things they do because they’re specialty specific that you’ll really never see from a general EHR vendor.

Modernizing Medicine (Advertiser since 1/2014) – This is another specialty specific EHR vendor that takes a really unique approach to how you document a visit. If they are in your specialty (Dermatology, Ophthalmology, Orthopedics, Plastic Surgery, Otolaryngology, Gastroenterology, Urology, Rheumatology, Cosmetics), be sure to get a demo and see what makes them unique. I’ve also been invited to speak at their EHR user conference in November.

Finally thanks to the 3.6 million times this website’s been loaded by a reader and the 2166 people who subscribed to EMR and EHR and read the almost daily emails. To those who haven’t yet subscribed, here’s a link to subscribe to all the Healthcare Scene blogs you find interesting. It’s really hard to believe that we’re well over 5 years and 1,344 blog posts into this journey and in some ways it feels like we’re just getting started.