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Could AI And Healthcare Chatbots Help Clinicians Communicate With Patients?

Posted on April 25, 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.

AI-driven chatbots are becoming increasingly popular for a number of reasons, including improving technology and a need to automate some routine processes. (I’d also argue that these models are emerging because millennials and Gen Z-ers have spent their lives immersed in online-based social environments, and are far less likely to be afraid of or uncomfortable with such things.)

Given the maturation of the technology, I’m not surprised to see a number of AI-driven chatbots for healthcare emerging.  Some of these merely capture symptoms, such as the diabetes, CHF and mental health monitoring options by Sense.ly.

But other AI-based chatbots attempt to go much further. One emerging company, X2ai, is rolling out a psychology-oriented chatbot offering mental health counseling, Another, UK-based startup Babylon Health, offers a text-only mobile apps which provides medical evaluations and screenings. The app is being pilot-tested with the National Health Service, where early reports say that it’s diagnosing and triaging patients successfully.

One area I haven’t seen explored, though, is using a chatbot to help doctors handle routine communications with patients. Such an app could not only triage patients, as with the NHS example, but also respond to routine email messages.

Scheduling and administration

The reality is that while doctors and nurses are used to screening patients via telephone, they’re afraid of being swamped by tons of electronic patient messages. Many feel that if they agree to respond to patient email messages via a patient portal, they’ll spend too much time doing so. With most already time-starved, it’s not surprising that they’re worried about this.

But a combination of AI and healthcare chatbot technology could reduce their time required to engage patients. In fact, the right solution could address a few medical practice workflow issues at one time.

First, it could triage and route patient concerns to doctors and advanced practice nurses, something that’s done now by unqualified clerks or extremely busy nurses. For example, the patient would be able to tell the chatbot why they wanted to schedule a visit, with the chatbot teasing out some nuances in their situation. Then, the chatbot could kick the information over to the patient’s provider, who could, with a few clicks, forward a request to schedule either an urgent or standard consult.

Perhaps just as important, the AI technology could sit atop messages sent between provider and patient. If the patient message asked a routine question – such as when their test results would be ready – the system could bounce back a templated message stating, for instance, that test results typically take five business days to post on the patient portal. It could also send templated responses to requests for medical records, questions about doctor availability or types of insurance accepted and so on.

Diagnosis and triage

Meanwhile, if the AI concludes that the patient has a health concern to address, it could send back a link to the chatbot, which would ask pertinent questions and send the responses to the treating clinician. At that point, if things look questionable, the doctor might choose to intervene with their own email message or phone call.

Of course, providers will probably be worried about relying on a chatbot for patient triage, especially the legal consequences if the bot misses something important. But over time, if health chatbot pilots like the UK example offer good results, they may eventually be ready to give this approach a shot.

Also, patients may be uncertain about working with a chatbot at first. But if physicians stress that they’re not trying put them off, but rather, to save time so they can take their time when patients need them, I think they’ll be satisfied.

I admit that under ideal circumstances, clinicians would have more time to communicate with patients directly. But the truth is, they simply don’t, and pressuring them to take phone calls or respond to every online message from patients won’t work.

Besides, as providers work to prepare for value-based care, they’ll need not only physician extenders, but physician extender-extenders like chatbots to engage patients and keep track of their needs. So let’s give them a shot.

EMR and EHR Reaches 2000 Posts Published

Posted on April 24, 2017 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.

We’re taking a small break from our regularly scheduled MACRA Monday program to bring you this special announcement. This post is the 2000th blog post on EMR and EHR! Check out the admin view I woke up to this morning:

I’m pretty excited by this achievement since I nearly sold this blog about 8-9 years ago. Plus, this blog was kind of started on a lark to help someone who wanted a place to blog. 21 blog posts later, he got a new job and couldn’t blog anymore, so I continued it without him.

As EMR and EHR has progressed, we’ve worked hard to focus the content of the site on the ambulatory market and have expanded beyond the topics of EMR and EHR into anything that might be useful to an ambulatory organization. I’m happy to say that EMR and EHR is approaching 5 million pageviews.

In the beginning, I was the main blogger on the site, but I certainly haven’t done this alone. To all those people who contributed to EMR and EHR over the years, I can’t thank you enough:

Anne Zieger – 429 posts
Jennifer Dennard – 143 posts
Andy Oram – 106 posts
Katie Clark – 44 posts
Carl Bergman – 45 posts
Priya Ramachandran – 40 posts
Dr. Jeff – 21 posts
Janae Sharp – 5 posts
Julie Maas – 5 posts
Colin Hung – 1 post
Guest Bloggers – 53 posts
*Note: Many of these people also blog on other Healthcare Scene blogs as well.

The nice thing is, we’re really just getting started. We have a lot more planned for EMR and EHR. One thing we’re working on is doing a number of blog post series on topics that matter to ambulatory practices similar to what we’ve done with MACRA Monday. These series will be deep dives into topics that matter to ambulatory practices.

From these blog post series, we’re also going to generate a list of the various companies in that space similar to what we’ve done with EHR companies in the past. One challenge we see ambulatory practices face is they don’t know all of the companies out there that are creating innovative solutions that can make their practice run more efficiently. Hopefully these new resources will help them cut through all the noise and discover companies they’ve likely never heard of before.

It’s an exciting time in the industry because I think that practices are now ready to move beyond the EHR. Don’t get me wrong, the EHR has had a good run and will continue to be an integral part of every practice. In fact, we still have a lot of work to do to get value out of the EHR. However, we need to explore what else practices need to be successful in this ever-changing healthcare world. We’ll be exploring this question in our next 2000 blog posts.

Thanks to all of you who keep reading and please let us know on our contact us page how we can help you even more.

A New Definition of EHR

Posted on April 19, 2017 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.

That’s a pretty funny play on words by Nicholas DiNubile, MD. Well, it’s funny unless you’re the one that’s become the government tool. Dr. DiNubile also shared this picture with the above definition.

While I think that this picture is an exaggeration of reality for most doctors, what isn’t an exaggeration is administrative overheard a doctor has now is much greater than it was in the past. In most cases, the EHR hasn’t made it any better and what the EHR vendors have had to implement for meaningful use and now mACRA have generally made this worse.

Over the past couple weeks, I’ve had the good luck of spending a lot of time with my colleague Shahid Shah. Something he’s been sharing lately is that “Doing stupid faster isn’t innovation.” We see a lot of this in healthcare. Talking to one healthcare IT vendor he came to the realization that all his company does is stupid faster. It was a shocking thought for him and likely for many that read this.

As you look at your organization and where you want to take it, are you focused on true innovation or are you busy doing stupid faster? If you’re doing the former, keep fighting the good fight. If you’re doing the later, it might be time to take a step back and reconsider your path forward.

Is ICSA Labs Getting Out of the EHR Certification Business?

Posted on April 18, 2017 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 got the following email that was received by ICSA customers:

Dear Valued Customer:

Your organization has received product testing and certification services as a customer of ICSA Labs, a division of MCI Communications Services, Inc., d/b/a Verizon Business Services (“ICSA Labs”).

I am writing to inform you that ICSA Labs will no longer be accepting new engagements for product testing and certification, or renewing expiring Statement(s) of Service. However, please be assured that we will continue to honor any existing, active Statements of Service that we may have with your organization, and to maintain any current certifications for the applicable term.

Thank you for your attention to this matter. If you have any questions, please contact icsalabsinfo@icsalabs.com.

Sincerely,

George Japak
ICSA Labs, Managing Director

Does this mean ICSA is withdrawing as an EHR Certifying body (ATCB)? I asked EHR certification expert, Jim Tate, which EHR certifying bodies remain if ICSA is pulling out and he said that right now Drummond, ICSA, InfoGard, and SLI are authorized to test and only Drummond, ICSA, and InfoGard are authorized to certify. You can find more details on the ONC website.

A part of me isn’t really surprised since the EHR certification business isn’t a great business. There are a limited number of clients and a limited amount of revenue available. Plus, under meaningful use, EHR certification became a commodity. That’s why CCHIT couldn’t survive. Seems like ICSA Labs is heading the same direction as CCHIT.

The bigger question I would ask is should EHR certification continue at all?

MACRA Stats – MACRA Monday

Posted on April 17, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

I love a good stat. I realize that you can make stats tell you whatever you want. However, if you look at them with a critical eye, you can learn something about both the organization producing the stat and the population that the stat represents.

It’s no surprise that I found these MACRA stats shared by David Chou to be of great interest and a perfect MACRA Monday discussion.

The stat that stands out to me is the 51% of physicians who reported that they weren’t getting paid on a performance basis or that their compensation had a very small performance based piece to it. For those of us following the cutting edge of what’s happening in the world of healthcare, it’s sometimes important to remember that while the shift to value based reimbursement is happening, it still has a long ways to go.

I found David Chou’s tweet with these stats interesting when he said “Most physicians prefer the old model of payment vs MACRA.” I would look at these stats a bit differently than David.

I would suggest that these stats say that doctors prefer reimbursement models they understand and ones that pay them well. This is proven out in the stat that 71% of physicians surveyed would participate in value-based payment models if offered financial incentives to do so. It’s not really a shocking insight that doctors are happy to shift models if there are financial incentives to do so.

The challenge is that most doctors don’t think that a value based reimbursement model is going to pay them more for the work they do. They’re probably right. This explains why nearly 8 in 10 physicians surveyed prefer fee-for-service or salary for their compensation. If a new model came along that would pay them more than their current fee for service model, then they’d happily switch models.

Sometimes we make things too complicated. Physicians just want to be paid well for the work they do. Sounds like all of us no? The concern for most physicians is that these models are unlikely to pay them more. In fact, it’s quite possible they’ll pay them less or at least pay them the same for more work.

I haven’t seen any plan or projections to pay doctors more. In fact, the rhetoric in society is that we pay too much for healthcare (which is true). As a society, we all agree that we should be paying less for healthcare. However, as a healthcare provider or healthcare organization the idea of paying less for healthcare translates to getting paid less. Who’s going to take the hit when it comes to getting paid less? Providers? Hospitals? Pharma? Med device companies? Health IT Companies?

Could value based reimbursement models theoretically cost less and pay all of these stakeholders the same amount of money because patients were healthier? Works great in theory, but looking at the past history of these programs tells another story. So, it’s no wonder that most doctors would happily stay in the fee-for-service reimbursement world they know vs moving to value based reimbursement models.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Provider-Backed Health Data Interoperability Organization Launches

Posted on April 12, 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.

In 1988, some members of the cable television industry got together to form CableLabs, a non-proft innovation center and R&D lab. Since then, the non-profit has been a driving force in bringing cable operators together, developing technologies and specifications for services as well as offering testing and certification facilities.

Among its accomplishments is the development of DOCSIS (Data-over-Cable Service Interface Specification), a standard used worldwide to provide Internet access via a cable modem. If your cable modem is DOCSIS compliant, it can be used on any modern cable network.

If you’re thinking this approach might work well in healthcare, you’re not the only one. In fact, a group of powerful healthcare providers as just launched a health data sharing-focused organization with a similar approach.

The Center for Medical Interoperability, which will be housed in a 16,000-square-foot location in Nashville, is a membership-based organization offering a testing and certification lab for devices and systems. The organization has been in the works since 2011, when the Gary and Mary West Health Institute began looking at standards-based approaches to medical device interoperability.

The Center brings together a group of top US healthcare systems – including HCA Healthcare, Vanderbilt University and Community Health Systems — to tackle interoperability issues collaboratively.  Taken together, the board of directors represent more than 50 percent of the healthcare industry’s purchasing power, said Kerry McDermott, vice president of public policy and communications for the Center.

According to Health Data Management, the group will initially focus on acute care setting within a hospital, such as the ICU. In the ICU, patients are “surrounded by dozens of medical devices – each of which knows something valuable about the patient  — but we don’t have a streamlined way to aggregate all that data and make it useful for clinicians,” said McDermott, who spoke with HDM.

Broadly speaking, the Center’s goal is to let providers share health information as seamlessly as ATMs pass banking data across their network. To achieve that goal, its leaders hope to serve as a force for collaboration and consensus between healthcare organizations.

The project’s initial $10M in funding, which came from the Gary and Mary West Foundation, will be used to develop, test and certify devices and software. The goal will be to develop vendor-neutral approaches that support health data sharing between and within health systems. Other goals include supporting real-time one-to-many communications, plug-and-play device and system integration and the use of standards, HDM reports.

It will also host a lab known as the Transformation Learning Center, which will help clinicians explore the impact of emerging technologies. Clinicians will develop use cases for new technologies there, as well as capturing clinical requirements for their projects. They’ll also participate in evaluating new technologies on their safety, usefulness, and ability to satisfy patients and care teams.

As part of its efforts, the Center is taking a close look at the FHIR API.  Still, while FHIR has great potential, it’s not mature yet, McDermott told the magazine.

A Tool For Evaluating E-Health Applications

Posted on April 11, 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.

In recent years, developers have released a staggering number of mobile health applications, with nearly 150,000 available as of 2015. And the demand for such apps is rising, with the mHealth services market projected to reach $26 billion globally this year, according to analyst firm Research 2 Guidance.

Unfortunately, given the sheer volume of apps available, it’s tricky to separate the good from the bad. We haven’t even agreed on common standards by which to evaluate such apps, and neither regulatory agencies nor professional associations have taken a firm position on the subject.

For example, while we have seen groups like the American Medical Association endorse the use of mobile health applications, their acceptance came with several caveats. While the organization conceded that such apps might be OK, it noted that such approval applies only if the industry develops an evidence base demonstrating that the apps are accurate, effective, safe and secure. And other than broad practice guidelines, the trade group didn’t get into the details of how its members could evaluate app quality.

However, at least one researcher has made an attempt at developing standards which identify the best e-Health software apps and computer programs. Assistant professor Amit Baumel, PhD, of the Feinstein Institute for Medical Research, has recently led a team that created a tool to evaluate the quality and therapeutic potential of such applications.

To do his research, a write-up of which was published in the Journal of Medical Internet Research, Baumel developed an app-rating tool named Enlight. Rather than using automated analytics, Enlight was designed as a manual scale to be filled out by trained raters.

To create the foundation for Enlight, researchers reviewed existing literature to decide which criteria were relevant to determine app quality. The team identified a total of 476 criteria from 99 sources to build the tool. Later, the researchers tested Enlight on 42 mobile apps and 42 web-based programs targeting modifiable behaviors related to medical illness or mental health.

Once tested, researchers rolled out the tool. Enlight asked participants to score 11 different aspects of app quality, including usability, visual design, therapeutic persuasiveness and privacy. When they evaluated the responses, they found that Enlighten raters reached substantially similar results when rating a given app. They also found that all of the eHealth apps rated “fair” or above received the same range of scores for user engagement and content – which suggests that consumer app users have more consistent expectations than we might have expected.

That being said, Baumel’s team noted that even if raters like the content and found the design to be engaging, that didn’t necessarily mean that the app would change people’s behaviors. The researchers concluded that patients need not only a persuasive app design, but also qualities that support a therapeutic alliance.

In the future, the research team plans to research which aspects of app quality do a better job at predicting user behaviors. They’re also testing the feasibility of rolling out an Enlight-based recommendation system for clinicians and end users. If they do succeed, they’ll be addressing a real need. We can’t continue to integrate patient-generated app data until we can sort great apps from useless, inaccurate products.

A Quick Look at MACRA in the Twittersphere – MACRA Mondays

Posted on April 10, 2017 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.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

MACRA is still an extremely hot topic and so there’s a lot of discussion about it happening on Twitter and other social media platforms. For today’s MACRA Monday I thought I’d highlight a number of tweets about MACRA that might help you in your efforts.


This was one of the main reasons that doctors didn’t want to participate in meaningful use. Seems like it’s carrying over into MACRA. Is there reason to be concerned?


I thought this was an interesting way to breakdown the two parts of MACRA: APMs and MIPS. I’d just add that APMs require the new entities to report as well. You can’t get away from reporting in either of them.


Leavitt Partners has a deep perspective on what’s happening with healthcare. In the link they assert that MACRA may have a bigger direct impact on physicians and the delivery system than ACA (Obamacare). They could very well be right.


I wouldn’t have guessed this is a radiology society’s top priority. It matters to them, but it seems like they’d have bigger fish to fry.


Numbers like this are disturbing. Does it really take that much to be prepared for MACRA? Or do doctors just not understand MACRA and so they answered that they’re not ready? Maybe I was wrong about how many will just take the penalties. Although, it’s still early and I think most will be able to avoid penalties thanks to Pick Your Pace.

Any great tweets or insights you’ve seen about MACRA lately? If so, share them in the comments.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

E-Patient Update: Doctors Need To Lead Tech Charge

Posted on April 7, 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.

Doctors, like any other group of people, vary in how comfortable they are with technology. Despite the fact that their job is more technology-focused than ever before, many clinicians use tech tools because they must.

As a result, they aren’t great role models when it comes to encouraging patients to engage with portals, try mobile apps or even pay their healthcare bills online. I too am frustrated when doctors can’t answer basic tech questions, despite my high comfort level with technology. I like to think that we’re on the same page, and I feel sort of alienated when my doctors don’t seem to care about the digital health advantage.

This needs to change. Given the extent to which technology permeates care delivery, physicians must become better at explaining how basic tech tools work, why they’re used and how they benefit patients.

Below, I’ve listed three tools which I consider to be critical to current medical practices, based on both my patient experiences and my ongoing research on health IT tools. To me, knowing something about each of them is unavoidable if doctors want to keep up with trends and improve patient care.

The top three tools I see as central to serving patients effectively are:

  • Patient portals: This is arguably the most important technical option doctors can share with patients. To get the most value out of portals, every doctor – especially in primary care – should be able to explain to patients why accessing their data can improve their health and lives.
  • Connected health: For a while, connected health/remote monitoring solutions were a high-end, expensive way to track patient health. But today, these options are everywhere and accessible virtually anyone. (My husband bought a connected glucose monitor for $10 a few weeks ago!) If nothing else, clinicians should be able to explain to patients how such devices can help tame chronic diseases and prevent hospitalizations.
  • Mobile apps: While few apps, if any, are universally trusted by doctors, there’s still plenty of them which can help patients log, measure and monitor important data, such as medication compliance or blood pressure levels. While they don’t need to understand how mobile apps work, they should know something of why patients can benefit from using them.

Of course, this list is brief, but it’s a decent place to start. After all, I’m not suggesting that physicians need to get a master’s in health IT to serve patients adequately; I’m just recommending that they study up and prepare to guide their patients in using helpful tools.

Ultimately, it’s not as important that clinicians use or even have a deep understanding of digital health tools, health bands, smartwatches, sensor-laden clothing or virtual reality. They don’t have to understand cybersecurity or know how to reboot a server. They just have to know how to help patients navigate the healthcare world as it is.

By this point, in fact, I’d argue that it’s irresponsible to avoid learning about technologies that can help patients manage their health. Bear in mind that even if they don’t act like it, even confident, experienced patients like me truly admire our doctors and take what they say seriously. So if I am enthusiastic about using tech tools to manage my health, but my doctor’s eyes glaze over when I talk about them, even I feel a bit discouraged. So why not learn enough to encourage me on my journey?

Two Worth Reading

Posted on April 6, 2017 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com, a free service for matching users and EHRs. For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manger doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst.

HIT is a relatively small world that generates no end of notices, promotions and commentaries. You can usually skim them, pick out what’s new or different and move on. Recently, I’ve run into two articles that deserve a slow, savored reading: Politico’s Arthur Allen’s History of VistA, the VA’s homegrown EHR and Julia Adler-Milstein’s take on interoperability’s hard times.

VistA: An Old Soldier That May Just Fade Away – Maybe

The VA’s EHR is not only older than just about any other EHR, it’s older than just about any app you’ve used in the last ten years. It started when Jimmy Carter was in his first presidential year. It was a world of mainframes running TSO and 3270 terminals. Punch cards still abounded and dialup modems were rare. Even then, there were doctors and programmers who wanted to move vet’s hard copy files into a more usable, shareable form.

Arthur Allen has recounted their efforts, often clandestine, in tracking VistA’s history. It’s not only a history of one EHR and how it has fallen in and out of favor, but it’s also a history of how personal computing has grown, evolved and changed. Still a user favorite, it looks like its accumulated problems, often political as much as technical, may mean it will finally meet its end – or maybe not. In any event, Allen has written an effective, well researched piece of technological history.

Adler-Milstein: Interoperability’s Not for the Faint of Heart

Adler-Milstein, a University of Michigan Associate Professor of Health Management and Policy has two things going for her. She knows her stuff and she writes in a clear, direct prose. It’s a powerful and sadly rare combination.

In this case, she probes the seemingly simple issue of HIE interoperability or the lack thereof. She first looks at the history of EHR adoption, noting that MU1 took a pass on I/O. This was a critical error, because it:

[A]llowed EHR systems to be designed and adopted in ways that did not take HIE into account, and there were no market forces to fill the void.

When stage two with HIE came along, it meant retrofitting thousands of systems. We’ve been playing catch up, if at all, ever since.

Her major point is simple. It’s in everyone’s interest to find ways of making I/O work and that means abandoning fault finding and figuring out what can work.