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I’ve mentioned a few times about the very interesting CONNECT open source project that was coming out of ONC. In fact, I did a video about CONNECT and NHIN at HIMSS. Turns out the mastermind behind CONNECT is a guy named Vish Sankaran.

Well, I just got news that Vish will be leaving ONC and FHA to pursue other opportunities. This is a real loss for ONC. It will be interesting to watch the progress of CONNECT and the NHIN without Vish at ONC.

The following is the letter that Vish sent out about his departure.

Dear Friends,

Within the next several weeks I will be departing from the Federal Health Architecture program to seek other opportunities.

This was not an easy decision, but it comes at an ideal time for FHA and for me, when FHA is reshaping to fit in with the overarching federal health IT body being formed.

This is also a great time to bring in new leadership to further the great work you’ve already accomplished. And on the personal front, I am exploring exciting new opportunities that will allow me to continue my passion.

My departure has allowed me to look back and review FHA’s legacy – a legacy built through all of our hard work. I joined the Office of the National Coordinator for Health IT shortly after our nation’s leadership issued Presidential Executive Order 13335, which set up the ONC and called for a commitment to build a nationwide electronic health information system.

When agencies were called upon to work together to enable interoperability and improve services to their beneficiaries, the agencies responded! Twenty federal agencies came together to discuss more than challenges – they joined workgroups dedicated to determining common needs, worked together to develop tools and solutions, and most importantly, they shared their experiences in advancing health IT within their own agencies and with their counterparts. We all learned and benefited from this collaboration.

Our achievements have been significant, creating a template for how the public and private sectors could work together to set a new bar for health information exchange and to create an “ecosystem” of buyers and sellers in the marketplace. A great illustration of our collaboration is the CONNECT solution, which has been adopted by both government agencies and the private sector. This open-source platform has evolved into a venue for innovation which continues to this day.

Our efforts have not gone unnoticed. FHA has been on the agenda of more than 150 conferences and meetings dedicated to health IT. Media coverage of the program can be found in a wide range of publications and online media sites. Most gratifying is that our program has received seven awards from organizations recognizing innovation in health IT.

Without your strong and steadfast support, we would not have made the mark that we did. My time here was my first exposure to the inner-workings of the federal government – and more than anything else, I learned that our government is staffed with dedicated and hard working individuals. I wish all Americans would have had the opportunity to share my experience. I now understand that public service is more than a career – it is a calling.

I look forward to continuing to be involved in the national effort to make health and human services a transformative force for our society. I know that I will have the opportunity to see many of you again. Until I do, I trust you know that you have my thanks and appreciation for all you have done during my tenure as FHA Program Director. Let us keep advancing the “openness” in our government activities and work across the public and private sector to reduce cost and improve health and human services to our citizens.

Friends, the “Patient is Waiting”!

Take care,

Vish Sankaran
Program Director
Federal Health Architecture
Office of the National Coordinator for HIT

Today, I attended a forum at HIMSS 10 where I heard a representative from a small state talk about their plans for an HIE. They’ve already introduced some legislation that will allow people in their state to opt out of having their information stored in an HIE. She referred to it as a framework for HIE. Unfortunately, a framework doesn’t deal with issues like how you’d actually allow people to opt out of an HIE. Would you just discard the person’s data that’s sent from their doctor’s EMR? Not to mention, would the patient have the option to opt out at the doctors office or would they have to know they need to go to the government page to opt out?

These items aside, I was even more interested in trying to dive into the funding for an HIE in that state. I asked the representative whether the state would be able to fund a state HIE or if they would need federal money or some sort of private partnership.

Her answer was simple. Basically, her state (which might be different in other states) didn’t have the money to be able to fund an HIE. She thought that the most likely option would be some sort of private partnership which would make an HIE in her state a reality.

The HIMSS representative then talked about how the HITECH act has provided what amounts to seed money for states to be able to establish HIE. Unfortunately, this is just seed money and not a sustainable way to run an HIE. It’s like they’re just throwing some seed money out there and hoping that someone will figure out some creative way to have a sustainable revenue model for an HIE. Without this type of sustainable revenue model, then the HIE will start to disappear the way RHIO have basically disappeared.

Today I started discussions with someone about an RHIO and EMR project in China. I’ve always been fascinated with China. Maybe it’s the mystery of 1.2 billion people for which we know very little. I don’t know, but I’ve always found China intriguing.

Turns out that I’m just as intrigued with China when it comes to healthcare technology as well.

Let’s talk about some of the challenges of an RHIO in the US. Now think about how many of them are solved by having a nationalized healthcare system and how many of those challenges just don’t exist. I’m not saying that China won’t have its own challenges associated with implementing an RHIO, but it seems that they would be more manageable. Espescially if you get the right people on board. Plus, it would likely mean getting less people on board than we have to deal with in the US.

Another question is how China deals with issues like privacy and ownership of healthcare data. I’m sure they have some privacy laws, but they don’t have fears of insurance companies using their healthcare info against them. Also, the government ownd the healthcare data and likely can transfer it as they please between clinics (since they run them all, no?).

Plus, unlike the US there is tremendous advantage for them to not do duplicate tests. The US is the opposite. This makes a nice case for creating a solid infrastructure for exchanging data in an RHIO to lower costs.

Lots more to think about. If you know more about healthcare and/or EMR/RHIO in China I’d love to hear more about it. Plus, I’m interested in connecting with healthcare professionals I China as well.

I’ll admit beforehand that I’m a member of the Fred Trotter fan club. He’s a little bit psycho when it comes to open source licensing and the like, but that’s probably why I love him so much. When he truly believes in something he’s fully engaged in that cause.

So, of course I am completely interested in Fred Trotter’s blog post about CONNECT where he said the following:

The right conversation starts with this: we can assume that CONNECT -will- unify the health information transfer in the US. It will serve as the basis for the core NHIN and regional networks will have the option of implementing it. That means that CONNECT sets the bar for health exchange. Software must be as good as CONNECT to be considered for a local Health Information Exchange, otherwise, why not use CONNECT?

I think this is the second time that I’ve heard the name of the project CONNECT like this. I think that’s a sign that I better do some more looking into this project.

Government Health IT ran an interesting article talking about the Department of Defense (DoD) and Veterans Affairs deadline for interoperability of electronic health records. Here’s a short section of the article:

For Navy Capt. Michael Weiner, acting deputy program officer of the Defense Health Information Management System, the two departments have met the relevant interoperability criteria, which were set by the Interagency Clinical Informatics Board, he said.

These included making DoD inpatient discharge notes available to the VA; increasing the number of electronic gateways deployed between the two systems; enhancing the sharing of social history; creating the ability to view scanned documents between systems; and making available DoD periodic health assessments and separation physicals to the VA.

“These were the agreed upon metrics and measures of success and we have achieved them all,” Weiner, told Government Health IT.

However, Rear Adm. Gregory Timberlake, the now retired head of the IPO, committed earlier this year to the complete and computable interoperability of six categories of data by September 30. Not all of these are now shareable in computable form, Weiner acknowledged.

Those six classes of data–for prescriptions, laboratory results, radiology results, and physician, nursing, and therapist notes–were to augment the exchange of drug interaction and allergy information for shared DoD/VA patients previously available. Lab results and radiology results are still not shareable in computable format, according to Weiner.

Of course, we should applaud those who are working on interoperability of EHR software. However, this is a small example of the complexity that’s involved in trying to make healthcare data interoperable. If two organizations that are so closely tied as the DoD and VA are having a challenge sharing their EHR records, imagine what it’s going to be like in the private sector.

This is an interesting press release about connecting 7,000 physicians and 13 hospitals EHR systems together. Although, the most glaring part is the $400 million it will take to make it happen. Here’s the press release:

“The North Shore-LIJ Health System announced today it is subsidizing up to 85 percent of the cost of implementing and operating an Electronic Health Records (EHR) system in the offices of its more than 7,000 affiliated physicians in New York City and Long Island — part of a $400 million investment to strengthen the quality of care throughout the region by automating inpatient and outpatient records in all medical settings, including 13 hospitals. In implementing the largest EHR program in the New York metropolitan area and one of the largest in the nation, North Shore-LIJ will provide physicians with individual subsidies of up to $40,000 over five years.”

Michael J. Dowling, president and chief executive officer (CEO) of the North Shore-LIJ Health System said “We’re not going to measure our return-on-investment (ROI) in terms of dollars and cents; our ROI will be based on our ability to improve patient outcomes.”

“Glen Tullman, CEO of Allscripts, noted that providing physicians with real-time care guidelines via the EHR increases the probability of achieving fundamental improvements in the quality of patient care.”

John Bosco, North Shore-LIJ’s chief information officer said “the Allscripts’ EHR will connect to a separate inpatient clinical information system from Eclipsys Corporation that North Shore-LIJ is deploying at its hospitals and other facilities.”

We keep hearing about the Big National Data Bank for Healthcare Information. The thought is that you need a big data bank so everyone’s health information is available anywhere/anytime. This type of personal health information repository has many problems. First it is complex and expensive to set up and maintain. Second there are very significant and well-founded privacy concerns. And finally, this large, complex electronic structure may not be needed … it might even be counterproductive!

Is there another way to transport patient health data from one platform to another (so it can go from one EMR to another), so that healthcare providers, anywhere/anytime can provide fully informed care for individual patients which would be less expensive and higher in quality?

I think the answer is YES!

There are standard data exchange platforms currently being used which can help us all share “meaningful” personal health information. They are called the Continuity of Care Record (CCR), CCD and HL7. For more information on these platforms, I suggest you read Brian Klepper’s blog post. This blog gave me great insight into this connectivity issue.

In addition to obviating the need for a big data bank, these data exchange platforms make it possible for small, innovative EMR companies to compete and survive in the “EMR Jungle”. By allowing for diversity and encouraging innovation, we will end up with better EMR software. In addition, physicians will be able to pick EMRs that suit their practice style and can make them more efficient, productive and better doctors. I think we need a patchwork quilt of unique EMRs that are all well connected rather than a few big standard lemming EMRs that are totally connected by “big brother” or “big business”.

What are your thoughts on this topic?